JCPSLP Vol 21 No 1 2019

The role of speech-language pathologists in the justice system

What’s the evidence? Speech-language pathology intervention with young people in custody Mary Woodward, Emina McLean, Nathaniel Swain and Pamela Snow

Clinical scenario Josie has recently started in the role of a speech-language pathologist (SLP) in a large youth detention centre, working with young men aged 16–21 years on control orders or long- term remand, many of whom are from Aboriginal and Torres Strait Islander backgrounds. Initially, she focused on building relationships with colleagues (including teachers, youth officers, and psychologists) through learning about their respective ways of working with the young people, delivering in-service professional development about speech-language pathology services, and raising her colleagues’ awareness of the prevalence and impact of communication difficulties in young people in custody. She also conducted communication assessments with some of the young people on admission to the detention centre, and, consistent with published research (Anderson, Hawes, & Snow, 2017; Snow & Powell, 2011; Snow, Woodward, Mathis, & Powell, 2015), confirmed that despite appearing to “talk the talk”, the majority of the young people had significant oral and written language difficulties on formal assessment, with many meeting criteria for a diagnosis of developmental language disorder (DLD) (Bishop, Snowling, Thompson, & Greenhalgh and the CATALISE-2 consortium, 2017). Josie is planning to provide input within a modified Response to Intervention framework (Snow, Sanger, Caire, Eadie, & Dinslage, 2015) and as such has proposed that she will work with some of the young people, individually and/or in small groups, to develop their oral and written language skills. However, some of the youth justice staff have questioned whether this is worthwhile, concerned that it is “too late” to help them. Some health and education staff have also argued that the young people’s time should be focused only on developing work-related skills and gaining certificates, as they can be difficult to motivate to work towards other goals. While Josie recognises the importance of gaining qualifications, her clinical experience is that adolescents and young adults can make gains with respect to language and communication skills, and that improving these skills can have far-reaching impacts on a young person’s health, education, and job prospects. However, Josie is aware that experience from her own clinical practice is just one aspect of evidence-based practice, and she must also consider clients’ choices and the best available evidence from objective research (Dollaghan, 2007). Response Josie has read some recent studies concerning the question of effectiveness of SLP interventions for young

people in youth justice (Gregory & Bryan, 2011; Snow & Woodward, 2016), but knows more research is needed to address important clinical questions about intervention effectiveness and feasibility in this unique environment. She is aware that she will need to draw on published research on SLP with adolescents in other contexts in order to present evidence to her colleagues, and to the young people, when she is proposing intervention. She considers the following question: are language interventions effective for adolescents? Search strategy Given the literature is limited for this clinical population, Josie conducted a search regarding language interventions with adolescents more broadly, as young offenders move between custody and community settings. She searched six databases (CINAHL, Cochrane Library, Google Scholar, MEDLINE, SpeechBITE and Web of Science) to conduct a review of the literature. Four separate searches were conducted via each database. The terms for each search were: 1. language AND intervention* AND adolescen* 2. language AND intervention* AND adolescen* AND speech 3. language AND speech therapy AND adolescen* 4. vocabulary AND intervention* AND adolescen* After reading the title and/or abstract for each search result to determine relevance, Josie created a shortlist of 33 publications. She then read all of these, and discarded 21 articles as they were not assessment/intervention studies, although they were applicable to clinical practice. Discarded papers included review articles, expert opinion pieces, case discussions, tutorials, proposed frameworks and/or intervention models, and clinical practice guidelines. The 12 publications she retained comprised one meta- analysis, two systematic reviews and nine intervention studies, some of which were randomised controlled trials (RCTs). This selection of publications was retained in order to represent the highest-ranked evidence, that is Level I and Level II evidence, as determined by the National Health and Medical Research Council (2009) guidelines, as well as lower-ranking evidence (Levels III and IV) where necessary. Review articles as well as original research publications were included to highlight the breadth and depth of the research conducted to date. Search results Josie’s findings are summarised in Table 1.

THIS ARTICLE HAS BEEN PEER- REVIEWED

(From top to bottom) Mary Woodward,

Emina McLean, Nathaniel Swain and Pamela Snow

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JCPSLP Volume 21, Number 1 2019

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