JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Measurement and evaluation in practice

A rural clinical placement Children’s outcomes Barbara Dodd, Johanna Castles, Melissa Aar, Vanessa Hally, Jane McKimmie, Naomi Mitchell, Stuart Tibbetts, Michelle Wong and Meg Keage

Clinical education in rural and remote settings Internationally, fewer health professionals, per capita, work in regional areas than in cities, due to workforce recruitment and retention difficulties (Department of Health, 2008). While RRCPs have encouraged graduates to seek work in rural practice (Playford, Larson, & Wheatland, 2006), research has focused on medical, rather than allied health professions (AHP) students. Spiers and Harris (2015) identified barriers for AHP students in accessing RRCPs: financial disincentive (e.g., lost earnings, travel costs/ accommodation), fewer learning resources, and lack of peer and family support. Most significant was undersupply of RRCPs. Rural AHPs’ limited capacity to supervise students reflects inadequate funding and difficulty organising collaborations across some state health and education departments. Speech pathology RRCPs One multidisciplinary RRCP in Broken Hill supervised 22 SLP students in 2008-2009 in local primary schools (Jones et al., 2011) as teachers and parents had concerns about the effect of untreated communication impairment on educational attainment. An innovative clinical education model was developed (Jones et al., 2011). Pairs of students led clinics in schools, supervised by local health department SLPs. Recruitment and placement management were administered by universities in Broken Hill and Sydney. Outcomes included fewer referrals to local SLP services and positive stakeholder feedback. Clinical educators in Broken Hill reported that RRCPs challenged students. “Hands-off” supervision led to students demonstrating rapid growth in clinical decision- making skills. Jones, McAllister and Lyle (2015a, p. 66) investigated the effect of RRCPs on perceptions of work readiness and future employability. Qualitative analyses indicated that from “being observational or highly directed learners” students became “semi-autonomous healthcare providers”, indicating the potential for students to deliver effective individual therapy. The context required students to establish intra- professional team working, student teams communicating information about “current activity and future service provision, creating connectivity and continuity of services” (Jones, McAllister et al., 2015b, p. 10). Despite limited prior experience working in professional teams, students focused on service provision, not just their own student experience. The context also provided the opportunity to

Evaluations of speech-language pathology (SLP) students’ learning in rural and remote clinical placements are positive, but treatment outcomes for children have not previously been explored. Eight students provided 4 weeks of intensive intervention in preschools and primary schools, individually or in bi-weekly groups. Caseload characteristics, clinical goals, intervention strategies and outcomes are described using data from student reports, follow-up assessment and school feedback. Referral rates reflected age and socioeconomic disadvantage. Students treated 79% of referrals. Eleven per cent had previously received therapy, mostly for a different aspect of communication. Teaching staff and children’s reassessment reports indicated positive outcomes, with 83% of children not needing ongoing SLP support. Students provided a valuable service contribution for children with communication difficulties. The findings have implications for provision of SLP clinical placements that benefit both children and students. C linical education placements contribute to SLP graduates’ competence to make clinical decisions, manage caseloads and develop skilled assessment, evidence-based treatment and interdisciplinary collaboration. As SLP graduate numbers grow, however, the number of potential clinical supervisors dwindles, primarily due to changes in workplaces employing SLPs (Speech Pathology Australia, 2018; Vogel, 2013). This shortfall affects graduates’ work readiness. Although beneficial, alternative placements like simulated learning environments (Hill, Davidson, & Theodoros, 2010) and “in house” university clinics are expensive and provide limited case management experience compared to intensive remote or rural clinical placements (RRCPs), (Jones et al., 2011). While previous research has primarily focused on the value of RRCPs for students’ work readiness, this paper evaluates outcomes for children treated by SLP students on an RRCP.

KEYWORDS CLINICAL EDUCATION CLINICAL

THIS ARTICLE HAS BEEN PEER- REVIEWED OUTCOMES PAEDIATRIC COMMUNICATION DISORDER

Barbara Dodd (top), Johanna Castles (centre) and Melissa Aar

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology