JCPSLP Vol 19 No 1 March 2017

Communication and connection: Valuing Aboriginal and Torres Strait Islander perspectives

Aboriginal families’ experiences of attending speech-language pathology

services Laura Graham and Nicole Byrne

Speech-language pathologists may be uncertain about how to work with Aboriginal families. However, Aboriginal children are at increased risk of communication impairment, due to a range of risk factors. The aim of this pilot study was to identify factors that assisted Aboriginal families to attend and engage with paediatric speech-language pathology (SLP) services and to gain feedback from caregivers on ways to improve caregivers of Aboriginal children attending a mainstream (i.e., not Aboriginal-specific) SLP service. The participants’ responses related to three themes: the client and caregiver, the health service, and the community and Aboriginal culture. Possible solutions for improving services were provided by the caregivers, which included providing information to families about what to expect from therapy, services being flexible with appointments, and displaying Aboriginal artwork. The need for further rigorous research in the area is highlighted. M any speech-language pathologists are reportedly uncertain of how to work with Aboriginal families (Cahir, 2011). However, it is critical to improve practice, particularly as Aboriginal children in Australia experience poorer health and well-being than non-Aboriginal children (ARACY, 2013), including a higher risk for communication impairment. Factors impacting on communication include higher rates of otitis media (Couzos, Metcalf & Murray, 2001), low literacy rates (Pink & Allbon, 2008), and increased likelihood of being in foster care (Nathanson & Tzioumi, 2007). Webb (2012) identified that modifications to traditional service delivery (e.g., allowing time to develop relationships with Aboriginal families before commencing therapy, conducting services within the Aboriginal community) are required for therapy to be effective with Aboriginal families in paediatric speech- language pathology (SLP) services. To date, no Australian the cultural-appropriateness of these services. Semi-structured telephone interviews were conducted with ten

studies have investigated Aboriginal families’ experiences with paediatric SLP services. There is currently a large gap in information available on how to support Aboriginal families to access paediatric SLP services and this pilot study aimed to gain an initial insight into factors that may affect attendance and engagement with SLP services. Several factors affecting attendance and engagement with other health services have already been identified in the literature, particularly, access, relationships and the presence of Aboriginal staff. Access to health care services by Aboriginal families It has been reported that a reduced number of Aboriginal families access mainstream (i.e., not Aboriginal-specific) childhood health care services, including early childhood services (Ou, Chen, Garrett, & Hillman, 2011), disability services (DiGiacomo et al., 2013), and occupational therapy services (Nelson & Allison, 2004). Reduced access to speech pathology services has been linked to lack of awareness of what the service provided (Nelson & Allison, 2004; DiGiacomo et al., 2013), and beliefs around the causes of communication impairment. For example, Berndt (1982) reported that traditional Aboriginal beliefs attributed hearing problems to a ghost kidnapping the child and attributed speech problems to a softening of the tongue. Access to both services and transport has been identified as an issue for Aboriginal families in both rural and urban areas (Eades et al., 2010; NACCHO, 2001). Services offered within environments not requiring travel (e.g., school-based occupational therapy service) were rated highly by parents (Nelson & Allison, 2004). Relationships and communication Relationships have been identified as especially important to Aboriginal people, including the relationships between Aboriginal people and health care workers. Having a positive relationship has been described as “pivotal” to successful outcomes for working with Aboriginal people (Nelson & Allison, 2007). The relationship should be built on appropriate communication (DiGiacomo et al., 2013) and can often take time to build and develop (Nelson & Allison, 2007). A SLP study with non-Aboriginal families found a good relationship was an important predictor of satisfaction with SLP services, while a poor relationship may be implicated in disengagement from services (McAllister et al., 2011).

KEYWORDS ABORIGINAL ATTENDANCE ENGAGEMENT INDIGENOUS SPEECH- LANGUAGE PATHOLOGY

THIS ARTICL HAS BEE PEER REVIEWE

Laura Graham (top) and Nicole Byrne

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JCPSLP Volume 19, Number 1 2017

www.speechpathologyaustralia.org.au