ACQ_Vol_11_no_3_2009

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

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. 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. Box 1. Participant feedback following speech pathology collaboration

3. self-reflective information processing 4. traumatic experiences integration

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing