ACQ Vol 12 No 3 2010

time- and resource-stretched services, one of the strengths of these articles is the concrete examples they provide on how communication access can be broken down into manageable chunks. The second article in particular provides a structured approach to enable service providers to reflect upon their service, evaluate, and make changes to communication access. For individuals with aphasia and other communication disabilities, the importance of communication access cannot be underestimated. Alan Hewitt (staff member with aphasia at Connect, and co-author of these two articles) describes its significance succinctly: “If it’s not clear I can’t take part. Nor can lots of others who have aphasia. Communication access is the way in to real involvement ... not just involvement around the edges” (Pound et al., 2007, p. 33). Speech pathologists who read these two articles will find it difficult to resist the inspiration to take a second look at how communicatively accessible their own services are, to initiate processes to make changes (however small), and to begin spreading the word on communication access to others. Well worth a read! This article provides the reader with an insight into the meaning of access for people with neurogenic communication disorders in relation to the Environmental and Personal Factors of the World Health Organization’s International Classification of Functioning Disability and Health (ICF; WHO, 2001). It also highlights the complexities associated with the issues of access both within the clinical and research fields. The author begins the article by providing definitions of access and the Environmental and Personal Factors of the ICF. This is followed by a comprehensive discussion of the issues related to research surrounding environmental factors and access. Key points highlighted by the author are that research has tended to focus on the barriers to access rather than the facilitators and that there are few tools available to reliably measure environmental factors. Despite this, the author describes the rehabilitation framework The Life Participation Approach to Aphasia (LPAA) and the work by Connect – The Communication Disability Network as examples of where some progress has been made. The author also challenges the profession by considering whether clinicians are potential barriers and/or facilitators to access and suggests that clinicians need to reflect on their role in promoting access for people with communication disorders. The role of personal factors in supporting a client’s access is also explored. For example, the author describes the role of the speech pathologist in promoting the client’s self-advocacy and highlights a number of key personal factors such as personality traits and past experiences that should be considered when facilitating access. A variety of scenarios are provided to highlight the intricacy of such considerations. For instance, one example illustrates the potential adjustments that could be made to intervention as a result of considering an individual’s copying style and response to communication disability. Access for persons with neurogenic communication disorders Threats, T. (2007). Access for persons with neurogenic communication disorders: Influences of personal and environmental factors of the ICF. Aphasiology , 21 (1), 67–80. Brooke Grohn

Working with clients to improve their access through addressing environmental and personal factors may seem daunting. This article, however, is a good point to begin such reflection. Hospital access for families of injured children: A multi-ethnic perspective Arlidge, B., Abel, S., Asiasiga, L., Milne, S.L., Crengle, S. & Ameratunga, S.N. (2009). Experiences of whanau/families when injured children are admitted to hospital: A multi-ethnic qualitative study from Aotearoa/New Zealand. Ethnicity & Health , 14 (2), 169–183. Clare McCann This highly relevant and informative qualitative study forms part of a larger multi-ethnic investigation of the perceptions of injured children, their families and healthcare providers, in order to understand the impact of injury and the barriers and facilitators to recovery following injury. This paper focuses on the experiences of families when a child is admitted to a hospital following an unintentional injury. The authors are well regarded for their research into health inequalities for Maori and Pacific peoples so it is no surprise that they begin this article by outlining the relative overrepresentation of these minority groups in the healthcare systems as a consequence of colonisation and lower socioeconomic status. They go on to challenge the conventional methodology of research on Maori and Pacific peoples rather than for and by Maori and Pacific peoples. One is reminded of the concept of “user involvement” now being promoted in the aphasia literature and so eloquently presented by Carole Pound at the Speech Pathology Australia conference in Melbourne in May 2010. After discussing their findings, the authors conclude with their recommendations for improving health services and policy. Twenty-three families representing Maori, Pacific and Pakeha (New Zealand European) were interviewed. Culturally appropriate practices were employed for the qualitative interviews including the option for families to be interviewed in their own language. The flexible, narrative approach to the interviews allowed families to tell the story of their child’s injury and the stages of care and recovery (within hospital and at home). The data were analysed and coded into main themes. Despite many families praising the dedication of staff and expressing their satisfaction with overall care, four main themes revealed their concerns with the health services provided. The themes were 1) inadequate communication and information, 2) difficulty negotiating the hospital environment, 3) stress of conflicting demands and 4) issues relating to ethnicity and cultural miscommunication. Each of these themes was discussed in detail and supported by illustrative quotes from the participants. These findings highlight important implications for the delivery of healthcare services. While relatively few speech pathologists work in an acute paediatric hospital setting, the culturally appropriate methodology of this study and the finding of the four themes must surely resonate for us all. In particular we are challenged to reflect on our intercultural communication with clients and their families, the appropriateness of the information (written and verbal) that we provide to them, and the support we give them in dealing with the competing demands of living with a communication impairment and coping with everyday life (work, other children, family expectations).

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing