JCPSLP Vol 17 No 1 2015_lores

Diversity in practice

Time for change Results of a national survey of SLP practice in CALD aphasia rehabilitation Sonia Pang, Zaneta Mok and Miranda Rose

This study investigated aphasia rehabilitation practices for culturally and linguistically diverse (CALD) populations via a national survey of speech-language pathologists (SLPs) in Australia. It also investigated the perceived levels of knowledge, skills, education, confidence, and satisfaction of these SLPs when working with CALD populations. Respondents (n = 73) reported having limited knowledge, skills, education, confidence, and satisfaction levels when it came to providing aphasia assessment and intervention for CALD populations. Reported challenges and areas for improvement included the limited availability of CALD assessment and intervention materials, and the limitations in clinical guidelines and information about assessment and intervention procedures. Such issues were reported over a decade ago, yet our findings suggest limited improvement. Increased attention from universities, SLP departments, and peak bodies is urgently required – and suggested by SLPs themselves – if the quality of service provision for CALD populations in aphasia rehabilitation is to improve, and disparities between CALD and non-CALD services are to be addressed. Introduction As of 2011, 17% of people in Australia aged 65 and over preferred to speak a language other than English (LOTE) at home and 26% were born overseas (Australian Bureau of Statistics, 2012). These statistics are likely to be reflected in the caseloads of speech-language pathologists (SLPs) such as in aphasia rehabilitation. Aphasia occurs in 30% of people with first-ever strokes (Engelter et al., 2006). In 2012, 50,000 Australians experienced a stroke and over 420,000 people were already living with stroke (Deloitte Access Economics, 2012). SLPs are reminded to monitor the quality of their services to culturally and linguistically

diverse (CALD) populations through the Speech Pathology Association of Australia (2009) position paper Working in a Culturally and Linguistically Diverse Society . In Australia, much of the university curriculum and research literature surrounding speech-language pathology is tailored for monolingual English-speaking clients (The Speech Pathology Association of Australia, 2009). This has been identified as a challenge in scholarly discussions on aphasia management for CALD populations (Kiran & Goral, 2012; Lorenzen & Murray, 2008; Rose, Ferguson, Power, Togher & Worrall, 2014). It has been suggested that SLPs are required to make clinical decisions for CALD clients with little support from the research literature and evidence-based assessment and intervention materials (Lorenzen & Murray, 2009; Roberts, 1998). The lack of cultural and language concordance may translate into health care disparities, as recently identified in post-stroke speech-language pathology services (Mok, Rose, & Pang, 2013). However, little has been heard from the actual voices of SLPs in Australia with regards to their own experiences and practices. A comprehensive evaluation of our services to CALD populations must include an investigation of the current state of practice and also the state of knowledge, skills, and resources available for such practice, as reported by clinicians themselves. Surveys by Roger, Code and Sheard (2000) and Al-amawi (2012) have examined aphasia assessment practices with CALD populations within Australia. Both studies found that SLPs were requesting the development of more appropriate assessment tools, and were reporting a lack of knowledge, skills, and experience for working with clients from CALD backgrounds. In an investigation into aphasia rehabilitation practices of SLPs in Australia, Rose et al. (2014) found over half of respondents rated their knowledge of, and confidence with, therapy approaches and techniques for CALD clients as less than adequate. Elsewhere, similar findings have been reported by Centeno (2009) who surveyed SLPs working in adult neurorehabilitation in New York state, USA. Specifically, respondents identified several important conceptual and clinical areas which they felt to be important in entry-level course training and continuing professional development, such as the understanding of aphasia in bilingual speakers and strategies for assessing and testing bilingual speakers. Reported clinical practices of SLPs working with CALD populations

KEYWORDS APHASIA CALD

CURRENT PRACTICE REHABILITATION SURVEY THIS ARTICLE HAS BEEN PEER- REVIEWED

Sonia Pang (top), Zaneta Mok (centre) and Miranda Rose

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JCPSLP Volume 17, Number 1 2015

Journal of Clinical Practice in Speech-Language Pathology