JCPSLP Vol 17 No 1 2015_lores

highlighted that entry level education may not provide enough support for SLPs, “although sometimes I am not sure extra stuff at uni would have made a large difference, I would still encounter issues at a service level as well”. Another respondent also suggested, “Increased hands-on exposure to working with interpreters and working with CALD clients as component of SP degree studies”. Apart from the materials identified above, respondents were keen for specific improvements such as those already found in alternative and augmentative communication devices, an updated Bilingual Aphasia Test (McGill, 2014), and electronically based resources (online databases and i-pad applications). Many respondents called for increased continuing PD and education for SLPs and students in the following areas: • the effect of bilingualism on language • assessment and intervention strategies • working with interpreters • the impact of aphasia on LOTEs • communication strategies with CALD clients. Knowledge resource materials, specifically, clear protocols and guidelines for assessment were also requested. Speech Pathology Association of Australia, workplace departments, and SLPs combined with interpreters were identified as possible developers of such materials. One respondent suggested an “awareness drive by the Speech Pathology Association of Australia and joining together with cultural communities to advocate for action”. Confidence and satisfaction Thirty-one per cent of respondents reported feeling very unconfident to somewhat unconfident when conducting aphasia assessment, and 34% when conducting aphasia therapy. Eleven per cent reported feeling very unconfident to somewhat unconfident with their ability to effectively communicate in their clients’ LOTE, 38% with their ability to improve language processing, 30% with their ability to improve client performance in everyday functioning, and 28% with their ability to improve their clients’ quality of life. Only 11% reported feeling either very or somewhat unconfident in their ability to establish a positive therapeutic relationship with the client and their family. Sixty-five per cent reported feeling either very unsatisfied or somewhat unsatisfied with the availability of time to plan, prepare and provide services to CALD clients and 89.1% reported feeling very unsatisfied or somewhat unsatisfied with the materials available for assessment and intervention. Discussion This paper extends the small but growing body of research in this area, offering an opportunity for SLPs to voice the populations. This paper offers an insight into the state of knowledge, skills, and resources available to our profession and the perceived adequacy of our university education training programs. Additionally, information about how confident and how satisfied Australian SLPs are with the services they provide to CALD clients with aphasia is provided. It appears little improvement has been made since Roger, Code, and Sheard (2000) carried out a survey of practices over a decade ago. In our study, over half of the respondents reported having less than adequate levels of knowledge of aphasia in relation to non-English languages. In terms of assessment challenges encountered and their suggestions for improvements in aphasia rehabilitation for CALD

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Client preference

Family member

Most intact language

Interpreter availability

Frequency of use pre-morbidly

Very rarely Rarely

Sometimes Frequently

Very frequently

knowledge and skills, a lack of assessment and intervention material, and also concerns with the quality of the services provided were major challenges. They reported having limited access to, and availability of, culturally appropriate assessment materials and resources, specific LOTE materials for aphasia-specific consumer education and information. Additionally, a number of respondents reported having limited knowledge and skills in appropriate processes for assessment and intervention, linguistic structures of LOTEs (e.g. morphology, syntax), speaking client LOTEs, and education of the concept of aphasia, and rehabilitation to CALD clients. Respondents also commented on the limited amount of research about aphasia management for CALD clients. Many respondents commented on specific concerns about the delivery of their services. With regards to assessment, these were: • limited opportunity for informal observations • problems with transferring use of English assessments to LOTEs • subjective measurements • difficulties assessing higher level language and literacy tasks • difficulties determining a diagnosis, in relation to whether the SLPs were able to confirm whether a perceived error was due to aphasia or ESL, differentiating between different LOTE and dialects, and determining pre- aphasia communication levels. Challenges in intervention included: • difficulty choosing/accessing appropriate topics/materials Figure 5. Frequency which different factors impact on language selection for assessment and intervention • ongoing concerns for support and carry-over post discharge • difficulty educating clients about the value of speech- language pathology. Additionally, difficulties with building client rapport, the clients’ lack of uptake of health care services, and a fear of behaving in a disrespectful manner in terms of clients’ religion and culture were also reported. When asked to list changes they felt would be most beneficial, the availability of culturally and linguistically appropriate assessment and intervention materials and addressing the knowledge and skill base of the profession were again identified as major themes in the participants’ responses. Respondents suggested addressing entry level SLP education – specifically, in providing linguistics studies and increased lecturer support. One respondent • difficulty accessing group therapy for LOTE • difficulty determining the target language

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JCPSLP Volume 17, Number 1 2015

Journal of Clinical Practice in Speech-Language Pathology