JCPSLP Vol 21 No 2 2019 DIGITAL Edition

assist family members with communication difficulties, as well as inform SLP practice regarding community values, norms, protocols, and existing facilitatory practices. Specific recommendations for working with children and families Lewis et al. (2017) have proposed a “yarning” methodology as more culturally appropriate for Aboriginal children than standardised testing. Lewis’s Gumerri Assessment moves away from a deficit-based question–answer format to a more conversational, strength-based interaction between clinician and child. The use of universal processing models and frameworks for development (e.g., Stackhouse & Wells, 1997; Locke, 1997) can also provide structure for observation, as can dynamic and criterion referenced probes. Other innovative practices include using qualitative/ ethnographic data collection methods (Lewis et al., 2017). These practices use a lens of viewing the linguistic performance of the child as representative of dialectal and sociocultural diversity speech and language impairment. Using language-/dialect-specific frameworks to analyse language samples (Malcolm, 2018, Pascoe 2018) ensures that normative benchmarks reflect the linguistic and sociocultural environment of the child. Establishing speech community-specific normative data (Lowell & Maypilama, 2018) allows us to develop normative benchmarks where multiple languages exist within a speech community and concepts of deficit vs difference need to be established. Use of a strength-based collaborative approach is most in line with concepts of family-centred primary and cultural security, where projects are developed in response to community concern and are constructed through collaboration (Amery, Wunungmurra, & Gumbala, 2018). Further general principles of practice are outlined in table 1. Specific recommendations for working with adults Piloting of the first speech-language pathology assessment tool designed with and for Aboriginal people with communication disorders, the Aboriginal Communication Assessment After Brain Injury (ACAABI) (Armstrong, Ciccone et al., 2017) has been completed, with the tool to be made available in 2019. The ACAABI consists of an “impairment” section as well as client/family rating scales in which both wording and content have been developed with Aboriginal community members. It has also been translated into one Aboriginal language (Nyangumarta) in order to explore potential translation feasibility. For an overview of culturally appropriate tools related to cognition that may be also useful for SLPs, see overviews by Armstrong, Ciccone, et al. (2017), Dingwall and Cairney (2010) and Dingwall, Lindeman, and Cairney (2014). The Kimberley Indigenous Cognitive Assessment (LoGiudice et al., 2006) is also of particular relevance. Clinical yarning techniques (Lin, Green, & Bessarab, 2016) are also very relevant to SLP assessment and treatment, encompassing elements of cultural security as well as discourse assessment opportunity. Preliminary results on application of such techniques in adult communication therapy suggest that Aboriginal clients appreciate a “yarning” style of therapy, adhering to a therapy protocol of twice/week therapy over an 8-week period. The therapy involved two-way dialogue, story- telling, client-centred communication and careful listening around issues and events that were important to the

Aboriginal health liaison officers should be consulted to provide guidance as appropriate, and interpreters involved if needed. The source of referral is also important. Referrals from family and community are a clear indication that the person’s communication is divergent from that expected in their speech community. Referral from outside the person’s speech community can mean the appropriate target for intervention is the perception of others in the person’s environment. Ensuring congruence with community practices Clinical processes should require a greater emphasis being placed on assessment and intervention that is tailored to the child’s/adult’s linguistic experience and is congruent with cultural language socialisation practices in their community rather than assessment and treatment goal choices being offered from a largely predetermined framework (Ball & Lewis, 2011). Assessment techniques such as those already available (described above in the paediatric area) and those emerging (described below in the adult area) offer ways towards enacting this general principle. As also noted above, the notions of “goal-setting” and “client-centred practice” are largely western concepts and may not align with Aboriginal views of health. It is important to note that Aboriginal clients may not have the same goals as clinicians. For example, the family/client may have little contact with unfamiliar people and communication with familiar people/their kinship group may be functional. Goal- setting often occurs with the patient’s next of kin; however, when working with an Aboriginal patient, a more inclusive approach may well encompass a wider kinship network. Working with extended family One way of ensuring the above principle is adhered to is working with extended family and acknowledging extended kinship systems in the whole clinical process. Outcome measures are often also important for clinical reporting and service delivery purposes and choices of appropriate measures should can incorporate wider family involvement. While such measures may not inherently be compatible with an Aboriginal worldview, sensitive application of the measures (i.e., open discussion with family and community members where possible, and acknowledgment of potentially differing perspectives, values and linguistic strengths) may yield at least perceptions and ensuing goals that align better to the client’s and family’s aspirations than many current practices that see limited uptake of services – with many Aboriginal clients “voting with their feet” as in other areas of health care (Katzenellenbogen et al., 2013). Investing in community-based capacity building instead of individualised service delivery There has been increasing emphasis recently on the importance of a public health approach to communication disorders, particularly in relation to peoples who are considered “underserved”, “at-risk” and/or “hard to reach” (by health service providers) (Wylie, McAllister, Davidson, Marshall, & Law, 2014). While some caution should be applied to the use of these descriptors in line with the above discussion, the idea of working with a focus on community rather than the individual could be applied within the Australian Aboriginal context. SLPs working with communities (importantly in a two-way manner) may well increase community knowledge of SLP and strategies to

53

JCPSLP Volume 21, Number 2 2019

www.speechpathologyaustralia.org.au