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146
ACQ
Volume 11, Number 3 2009
ACQ
uiring knowledge in speech, language and hearing
Discussion
Mental health clinicians within this multidisciplinary team who
completed the pre questionnaires indicated a lack of
confidence in their ability to work with children who have
communication difficulties. This is significant as the literature
indicates that communication disorders are the most
common developmental outcome of child abuse and neglect
(Lynch & Roberts, 1982). Prior to collaboration with speech
pathology, the majority of the mental health clinicians found it
challenging to identify children who were having
communication difficulties. They also indicated a lack of
confidence in their ability to adapt therapy and adjust their
style of interaction to meet the communication needs of
these children. In addition, 75% of the clinicians had difficulty
understanding the co-morbid nature between
communication difficulties and mental health problems.
After the clinicians had worked with the speech
pathologists for over six months there was a shift towards
the clinicians feeling more confident in their ability to identify,
adapt and adjust intervention to meet their clients’ needs.
Speech pathology appeared to have the greatest impact
on the clinicians’ confidence in their ability to manage
children with communication difficulties (see table 1).
There was only a slight shift towards the clinicians feeling
they had a more thorough understanding of the reciprocal
relationship between communication and mental health.
This indicates that further education needs to be provided
to these clinicians about the bio-psycho-social impact of
communication difficulties.
While half of the clinicians agreed and the other half
disagreed that the time speech pathologists were able
to devote to the team was adequate, there was 100%
consensus by the mental health clinicians that some
children would have better outcomes if they received direct
intervention from the speech pathologists. It is suggested,
therefore, that the multidisciplinary complex trauma
treatment team should include a speech pathologist allowing
for provision of the full range of vital services including
consultation liaison, assessment, intervention, and education.
There are some obvious limitations to the study. First, the
results from the questionnaire may have been influenced by
a lack of anonymity. The study was also limited by the small
number of participants due to the number of staff in the
complex trauma treatment team. The study did not control
for some of the mental health clinicians previously working
with speech pathologists. Furthermore, this study only
evaluated the perceptions of the clinicians’ knowledge and
confidence, not their actual ability.
How can speech pathology
contribute?
Ongoing complex trauma negatively modifies the developing
brain. However, therapeutic experiences can change the
brain and result in positive outcomes. The benefit of
intervention depends on the nature, timing, pattern, and
duration of therapy (Perry, 2006). Kinniburg et al. (2005)
advocated for health practitioners to adopt a flexible model
of intervention embedded in a developmental and social
context. Cook, Spinazzola, Ford and Lanktree (2005)
suggested treatment of complex trauma should address six
central goals:
1. safety
2. self-regulation
3. self-reflective information processing
4. traumatic experiences integration
This questionnaire consisted of the same 5 questions,
as well as an additional 5 questions, which asked the
participant to rate their knowledge, skills and attitude
towards speech pathology on a five point scale. The post
questionnaire also included 2 open ended questions
asking for suggestions for service improvement and
specific examples of how the clinicians’ practice had
changed.
Results
Table 1 provides an overview of the pre- and post-
questionnaire results.
The comments the clinicians provided in response to
the two open-ended questions contained in the post
questionnaire are displayed in Box 1.
Box 1. Participant feedback following speech
pathology collaboration
Question 1:
Could anything be changed to improve the way in which
services are provided?
Increased SLP time?
SLP position (i.e., a full time speech pathology position within the
complex trauma treatment team)
Need assistance communicating SLP needs of child.
It would be a great improvement if a speech language therapy service
could be provided rather than just assessment.
Would benefit from having SLP provide therapy as well as
assessment/consultation as they have a strong background in mental
health.
I think it would be helpful for clients to receive intervention
from CYMHS speech pathologist in addition to assessment and
consultation. It would assist in the provision of a more holistic service
to the client group.
I think that the SLP team provide a flexible service to (team). Direct
intervention would be ideal although this is not logistically possibly. I
like the idea of a mandatory screening tool for all clients
Question 2:
Please state any specific areas in which your practice
has changed since collaborating with the speech and language
therapists.
More aware of the child’s SLP needs.
More sensitive to speech & language disorders, think about it more &
identify problems with more skill.
I have greater understanding of different levels of speech and
language problems but could do with a greater education regarding
modifying practise/style of communication & make suggestions (to
carers) for intervention in daily lives for kids.
[...] it was the first time that I had sat down with the SLP team and
found out about the service that they offer. It has made me more
aware of the service and how to work collaboratively with them.
It has been helpful to have the insider knowledge of the speech
therapists particularly in the assessment process. As I have become
more informed and aware of what to look for in relation to speech and
language problems.
I understand more about SLP role for example they can specialise
in speech impairments, literacy and emotion/social use of speech.
I assess for speech difficulties in my practise more and take it into
account into my interventions.