JCPSLP Vol 23, Issue 1 2021

may have been set up and in the level of supervision to SLP students provided across different offerings. Further, the current study only recruited clients with mild to mild-moderate dysphagia to reduce the level of support that the SLP students required. However, in actuality, this excluded a large proportion of the community caseload who had more moderate or moderate-severe dysphagia. Hence, the value of the DAT model for students and clients and students with more sever dysphagia is not known. Service costs were not reviewed or analysed for this study. While the DAT group resulted in more clients being reviewed within a short period compared with the traditional community service model of 1:1 face to face assessment and intervention, the time taken for group coordination needed to be considered to establish if this model is more cost effective compared with the standard traditional model. It would be beneficial to investigate this further in future. Dysphagia outcomes also were not reviewed or evaluated in the study. Future studies may assist in identifying whether attending regular or repetitive dysphagia reviews via group-based student-led clinics result in reduced aspiration-related illness presentations; reduced number of hospital admissions relating to dysphagia; and/ or aspiration-related illness and overall morbidity of clients. Finally, as a study investigating the feasibility of the DAT group intervention model, a simple pre–post treatment design was appropriate. However, the comparative effectiveness of the DAT group model against traditional models or introducing control groups becomes an important next step towards establishing the effectiveness of this model, and its value, for clients and students. Clinical implications The present study suggested that a group-based student- led DAT service model may allow increased access of SLP services for clients presenting with chronic mild or mild- moderate dysphagia in comparison to traditional service models. Furthermore, client satisfaction for this model appeared comparable to traditional individual service models. In addition, this novel service-delivery model created a new opportunity for increased clinical placement access to assist students in developing key competencies required for the area of dysphagia. In operationalising the DAT group model of care, some important considerations have emerged. Coordination and planning of these groups took considerable time. Coordination involved pre-planning with university clinical placement coordinators, making contact and providing students with appropriate pre-readings to ensure readiness for the group, as well as contacting clients and coordinating their appointment. It would be beneficial to consider seeking administrative support to assist in the coordination of this group to minimise clinical interruptions to the supervising clinician. Client availability needs consideration when planning a dysphagia group, as the structured group time may limit availability for some clients. An appropriately sized fit-for- purpose space is also vital for the successful running of the DAT group. In addition, costs for food and fluids needs to be considered including potentially exploring funding options for overheads (i.e., food/fluids/feeding utensils) via sponsorship or other fundraising. Lastly, appropriately skilled SLP staffing are required to facilitate this group. SLPs with a minimum 3–4 years’ clinical experience and clinical education experience are recommended to allow for the successful running of the

group-based student-led intervention. It may be challenging for a new graduate or clinician with limited clinical education experience to supervise and oversee multiple dysphagia assessments occurring simultaneously. Conclusion With the ageing population and associated increasing demands on the health care system, alternative service delivery models for assessment and management of dysphagia in the community need to be further explored. Additionally, clinical placements are becoming increasingly difficult to source for SLP students; therefore, new student-led service initiatives are an imperative. The DAT group-based student-led intervention for the management of chronic dysphagia in the community setting was found to improve student confidence and knowledge and reduce anxiety in the area of dysphagia management while maintaining high client satisfaction. Further research would be beneficial to explore cost effectiveness and clinical outcomes of this novel service-delivery model in comparison to traditional individual models of care. Acknowledgements This work was supported by Allied Health Research Clinical Backfill Funding through Gold Coast Health. The authors report no declarations of interest for this research. References Speech Pathology Australia. (2011, 2017). Competency- based occupational standards for speech pathologists . Speech Pathology Australia. Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis, G. (2005). Treatment of chronic stuttering: outcomes from a student training clinic. International Journal of Language and Communication Disorders , 40 (4), 455–466. https://doi. org/10.1080/03093640500088161 Bostick, G., Hall, M., & Miciak, M. (2014). Novel clinical learning from a student-led clinic. The Clinical Teacher , 11 (7), 512–515. https://doi.org/10.1111/tct.12214 Bridle, R., Cream, A., West, D., Majteles, L., & Burnell, D. (2013). The effectiveness of a group therapy programme for dysarthria in clients with Parkinson’s disease: Maintaining evidence based practice across models of service delivery [Conference Poster Abstract]. Movement Disorders , 28 (S1), S280. https://doi.org/https://doi.org/10.1002/mds.25609 Briggs, L., & Fronek, P. (2019). Student experiences and perceptions of participation in student-led health clinics: A systematic review. Journal of Social Work Education , 1–22. https://doi.org/10.1080/10437797.2019.1656575 Cardell, E., & Hill, A. (2013). Student-delivered intensive smooth speech programs for adolescents and adults who stutter: A preliminary exploration of student confidence, anxiety, and interest. Journal of Clinical Practice in Speech Language Pathology , 15 , 54–59. Chan, J. B., Carter, S., & McAllister, L. L. (1994). Sources of anxiety related to clinical education in undergraduate speech-language pathology students. Australian Journal of Human Communication Disorders , 22 (1), 57–73. https:// doi.org/10.3109/asl2.1994.22.issue-1.04 Drozdz, D., Mancopes, R., Silva, A. M., & Reppold, C. (2014). Analysis of the level of dysphagia, anxiety, and nutritional status before and after speech therapy in patients with stroke. International Archives of Otorhinolaryngology , 18 (2), 172–177. https://doi.org/10.1055/s-0033-1364169 Edwards, A., Theodoros, D., & Davidson, B. (2018). Group therapy for maintenance of speech in Parkinson’s

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JCPSLP Volume 23, Number 1 2021

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