JCPSLP Vol 21 No 1 2019

student, according to their identified needs. Josie noted that the interventions were carried out within the usual school setting, rather than in a clinic, which was relevant to her as she would be conducting therapy sessions within the detention centre rather than withdrawing the young people into an external clinic. The study recruited 72 of the 75 students attending the specialist school for children with DLD, with an adequate description of the sample, including age, language status, gender, ASD status, and likely educational year level. Josie was mindful that as it was British study, there were cultural and linguistic differences between the research sample and the young people with whom she would be working. Data were collected on each student’s performance before and after one school term’s intervention period. The selected variables of receptive and expressive language (and some written language) skills were appropriate to address the aims, and students’ progress on the intervention goals was measured using individually designed tasks (e.g., percentage correct on an expressive vocabulary task). While the lack of standardised assessment tools (with established validity and reliability) to measure progress could be considered a limitation of the study, Josie thought this reflected her own intended practice. She was aware that there may not be standardised assessments currently available to measure her clients’ progress, particularly when therapy goals focus on an individual’s functional communication needs and ability to participate in educational, vocational and social situations. The variability in the intervention goals, outcomes, and intervention length also meant it was difficult to determine whether specific aspects of the interventions had stronger or weaker effects, but again Josie felt this was reflective of real-life clinical practice, particularly when the young people’s length of detention is often uncertain. A strength of the study is that some of the pre- assessments, and all of the post-assessments, were carried out by a clinician who was “blind” to the intervention targets of the participants; however, Josie was aware that as a sole practitioner, she would be the one completing both the assessments and intervention. Ebbels et al. (2017) clearly described their use of descriptive and inferential statistics to determine that the targeted language outcomes improved significantly more than the control outcomes ( d = 1.06). Their results indicated that the SLP interventions appeared effective, regardless of language area targeted, receptive language impairment status, ASD status, or educational year level. Josie did not consider that they overstated or overgeneralised their results, and she judged the results as consistent with the limited previous research available. Josie noted that the study did not have a pre-published protocol, so any changes made to the research plan after the study commenced could not be identified, and while there were control measures taken pre- and post- intervention (on unrelated language skills, or untrained items), the design did not have a control. A limitation to the study design, therefore, was the lack of random selection and the absence of a control group, both of which would have guarded against the impact of extraneous factors on variables of interest. Implications for practice Josie recognised that young people in the youth justice system are young people first, and “young offenders” second, and that their communication needs must be considered in the same way that SLPs consider the needs of any other clinical population. She was able to gather substantial evidence that language interventions can be effective for adolescents, and therefore felt confident in asserting to

colleagues that it was not “too late” for the young people in the detention centre to improve their communication skills. Josie used the information she had gathered both during in-service presentations to other youth justice staff members when raising awareness of communication difficulties and explaining the role of speech pathology with this population, and when speaking more informally with colleagues about the purpose and rationale of her proposed interventions. Josie noticed that staff members were then more supportive of her work and encouraged the young people to attend and engage in the interventions offered. In the case of young people in custody, it is common to see high prevalence of neurodisability and comorbidity with externalising and internalising mental health problems (Snow & Powell, 2011). These should be taken into account by SLPs, with consideration given to their comorbidities when interpreting assessment results and formulating treatment goals according to the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) model. However, the common complexities of the young people’s presentation should not be viewed as insurmountable barriers to the same kinds of evidence-informed clinical reasoning and service delivery that are advocated for and applied with other populations in other settings. Youth justice settings (custodial and community) are “new frontiers” in speech-language pathology scope of practice, so clinicians in these settings need to invest time into in- service education of health, justice, and welfare colleagues about their scope of practice with this population, and to build the capacity of other professionals to more effectively manage the communication difficulties of the young people in their care. Recent research in Australia (Snow, Bagley, & White, 2017) and the UK (Bryan & Gregory, 2013) indicates that such efforts are well-received by colleagues in the custodial setting and promote the likelihood of appropriate referrals and professional engagement. In developing speech-language pathology settings such as youth justice, where the needs of a complex population must be met, we need to prioritise both evidence-based practice, and crucially also practice-based evidence , as has been applied in related fields, such as the provision of psychological therapies (Barkham & Mellor-Clark, 2013). The communication needs of this population are significant and pervasive, and building the evidence-base for speech- language pathology services will require a flexible balancing of the need for rigour against the inherent constraints of a complex, unpredictable setting. Conclusion Speech-language pathology as a profession needs to set the agenda for how it will go about establishing an evidence-base that supports practice in justice settings, convinces colleagues, policy-makers, service managers, and budget holders of its value. This will hopefully lead not just to improved clinical practice of speech-language pathologists, but also to increased access to speech- language pathology services for those young people (and adults) with communication difficulties who are involved in the justice system, resulting in more speech-language pathology positions within a supportive career structure and subsequently more positive outcomes for the young people concerned. Speech-language pathologists working in the justice field will require an ability to utilise existing youth justice speech-language pathology evidence and adapt evidence from related populations, as has been shown here. References Anderson, S. A. S., Hawes, D. J., & Snow, P. C. (2016). Language impairments among youth offenders: A

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JCPSLP Volume 21, Number 1 2019

Journal of Clinical Practice in Speech-Language Pathology