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Clinical recommendations As the preceding review indicates, delivering speech pathology services to individuals with aphasia who are bilingual or from CALD backgrounds is currently, and will remain for the foreseeable future, a challenging area of practice for the speech pathology profession in Australia. Some recommendations for clinical practice that may assist with the management of this caseload are outlined below. These recommendations are based on the available research literature and the first author’s clinical and research experience with this caseload. • Use clear and consistent terminology to refer to clients from culturally and linguistically diverse backgrounds to facilitate effective service delivery. • Obtain an accurate and comprehensive language history and current language profile to assist with appropriate diagnosis and goal setting with the bilingual/CALD individual with aphasia (Lorenzen & Murray, 2008; Roberts, 2008). • Obtain initial assessment data in both or multiple languages wherever possible to obtain an accurate indication of the relative strengths and weaknesses in and across languages, to assist with accurate diagnosis, and to provide a baseline for treatment (Lorenzen & Murray, 2008). • Beware of directly translating/interpreting English aphasia assessments into other languages as this may not account for cross-linguistic and cross-cultural differences. Appropriate tools for assessment of bilingual aphasia should be culturally adapted and linguistically equivalent (Paradis, 2004). • Where formal assessment in the other language(s) is not possible, identify a set of informal language assessment tasks that may assist with diagnosis of aphasia and obtain interpreter assistance in administering these (e.g., tasks that assess fluency, comprehension and repetition may assist with differential diagnosis of the type of aphasia). Other recommendations include the collection and analysis of language samples (Lorenzen & Murray, 2008), including narrative outputs (Kiran & Roberts, 2012 ), and verbal fluency tasks (Kiran & Roberts, 2012). • Employ practices that will facilitate working with interpreters (see Kambanaros & van Steenbrugge, 2004; Roger & Code, 2011), for example, pre-session briefings to explain the aim, purpose and format of the assessment; education of inexperienced interpreters about typical responses from people with aphasia; and the importance of error information for assessment and diagnosis. • Be familiar with relevant bilingual language processing models and use these to facilitate understanding of aphasia presentation in a bilingual person. • Pool informal clinical resources for working with CALD populations (that may have been developed by various clinicians over time) in a central location that can be accessed by SLPs nationally. • Identify and use relevant existing internet resources, for example, Cue Cards in Community Languages (http://www.easternhealth.org.au/services/language- and-transcultural-services/cue-cards/cue-cards-in- community-languages); The Internet Picture Dictionary (http://www.pdictionary.com/); Life as a Bilingual (http:// www.psychologytoday.com/blog/life-bilingual). • If therapy can be conducted only in English within the clinical setting, try to use family members or other volunteers to implement language tasks in the other language(s) at home (see for example, Boles, 2000). • Provide appropriate education and training for speech pathology students related to management of bilingual/

bicultural clients (Cheng, Battle, Murdoch, & Martin, 2001) and professional development for practising SLPs in relation to assessment and management of bilingual and CALD individuals (e.g., Kritikos, 2003). • Advocate for the resources needed to provide appropriate and equitable services to this population, for example, additional time; more interpreters and adequate access to their services; bilingual SLPs from various cultural backgrounds who could act as consultants to the SLP clinical community (e.g., see Hersh, Armstrong, Panak, et al., 2014; Jodache et al., 2014a). • Finally, it is evident that there is a pressing need for more research relating to speech pathology management of clients with aphasia who are bilingual or from a CALD background. As Rose and colleagues (2014, p. 10) noted in relation to CALD clients with aphasia, “such a large discrepancy between case-load imperatives and clinician preparedness/capacity needs urgent attention”. Conclusion This article outlined some of the key contextual issues and challenges for SLPs working in an Australian context with individuals who are bilingual or from a CALD background. The unique linguistic environment in Australia and lack of research in relation to management of aphasia in bilingual/ CALD individuals was discussed, along with some key areas for consideration in delivering a speech pathology service to this population. Areas for further research have also been highlighted. Finally, recommendations for clinical practice with individuals with aphasia who are bilingual or from a CALD background have been provided to assist SLPs currently working with this population. References Abutalebi, J., & Green, D. W. (2007). Bilingual language production: The neurocognition of language representation and control. Journal of Neurolinguistics , 20 , 242–275. doi:10.1016/j.jneuroling.2006.10.003 Ansaldo, A. I., Marcotte, K., Scherer, L., & Raboyeau, G. (2008). Language therapy and bilingual aphasia: Clinical implications of psycholinguistic and neuroimaging research. Journal of Neurolinguistics , 21 (6), 539–557. doi:10.1016/j. jneuroling.2008.02.001 Ansaldo, A. I., & Saidi, L. G. (2010). Model-driven intervention in bilingual aphasia: Evidence from a case of pathological language mixing. Aphasiology , 24 (2), 309–324. doi:10.1080/02687030902958423 Armstrong, E., Hersh, D., Hayward, C., Fraser, J., & Brown, M. (2012). Living with aphasia: Three Indigenous Australian stories. International Journal of Speech- Language Pathology , 14 (3), 271–280. doi:10.3109/175495 07.2011.663790 Australian Bureau of Statistics (ABS). (2009). Cultural and linguistic diversity. Perspectives on education and training: Social inclusion, 2009 . Retrieved 27 Oct. 2014 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/ Latestproducts/4250.0.55.001Main%20Features62009?op endocument&tabname=Summary&prodno=4250.0.55.001 &issue=2009&num=&view= Australian Bureau of Statistics (ABS). (2010). National Aboriginal and Torres Strait Islander social survey, 2008 . Retrieved 10 Oct. 2014 from http://www.abs.gov.au/ AUSSTATS/abs@.nsf/Latestproducts/4714.0Main%20Feat ures52008?opendocument&tabname=Summary&prodno= 4714.0&issue=2008&num=&view Australian Bureau of Statistics (ABS). (2011a). Cultural diversity in Australia. Reflecting a nation: Stories from

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JCPSLP Volume 17, Number 1 2015

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