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Table 2. Challenges and strategies regarding the child Challenges Strategies Child may have had a previous SP referral, but poor

Child is not to be disadvantaged based on previous failures to attend service under differing

attendance or follow-up while in the care of their

circumstances

parents may have led to their discharge

Hunter New England Local Health District Clinical Priority Tool is applied to all referrals; children in OOHC typically have multiple risk factors placing them at a higher priority (HNELHD, 2012) Work with OOHC health case manager to provide assistance regarding active follow up HNELHD play therapist provided a training workshop to SP team regarding the importance of play, play stages and skills and relationships between play, interaction and communication

Child may not have had previous access to toys/ books/age-appropriate items, impacting upon

development of play skills

Speech pathologists work with childcare providers

Child may have difficulties with trust, building

Initial appointment is an opportunity to gain trust and build rapport with the foster carer (FC)

relationships and rapport

and the child, rather than a formal SP assessment

Education provided to SP team (e.g., attachment, managing complex behaviours) Detailed discussions occur with FC about the child’s communication skills, including child’s length of time with that foster family, the problems they were experiencing in speech/ language when they entered into their care, any changes they have noticed (i.e.,

Child’s speech and language ability on initial placement may be not representative of abilities once they have settled into their foster family and are in a stimulating

environment

improvements) since coming into care

Monitoring the child’s communication development may be the most appropriate intervention.

Child may not respond well to new environments

Visits may be conducted in familiar environments (e.g., preschool)

and people

Families are encouraged to bring some of the child’s familiar toys/ books to the appointment

Where possible child maintains the same speech pathologist through intake, screening, assessment and intervention

Provide a calm environment, introducing one activity at a time

Table 3. Challenges and strategies for the foster carer (FC) Challenges Strategies FC does not typically have information on child’s:

Speech pathologist accesses information from centralised medical systems

• prenatal history (e.g., alcohol exposure) • developmental milestones

Consent from caseworker or non-government organisation (NGO) representative as “parent of the child” to engage with other health/education professionals

• related early developmental factors (e.g., feeding problems) • family history of speech and learning disorders • medical history (e.g., ear infections) • maltreatment FC may not be privy to information regarding the maltreatment of, and the potential impact on, the child FC may not have had links to early intervention or support

Presume child likely has recognised risk factors

Phone call follow-up with caseworker to discuss maltreatment, to ensure accuracy

and appropriateness of sharing this information

Referral to relevant service (e.g., Early Childhood Information Team) to assist families

services (e.g., carer support, playgroups) FC may be unaware of length of placement

to access services

Ongoing liaison with caseworkers FC may have difficulties working with child who has concurrent Liaison with OOHC SP coordinator regarding referral to appropriate services to access behavioural issues, i.e., separation anxiety, trauma, aggression other allied health/multidisciplinary teams

Table 4. Challenges and strategies for the caseworker Challenges Strategies Caseworkers are increasingly situated in NGOs

Educate speech pathologists on caseworkers’ roles

The clinical pathway identifies when there is a need to contact caseworker Incidental education of the caseworkers surrounding specific clients

Caseworkers may have varying exposure or knowledge

regarding speech pathology

Provision of generic information on identification of speech/language delays and referral mechanisms (Lyddiard, 2012b)

Caseworkers’ contact with FC may vary

Ensure contact details of caseworkers are current

Provide regular feedback on intervention (e.g., through the development of family services/support plans)

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JCPSLP Volume 15, Number 3 2013

Journal of Clinical Practice in Speech-Language Pathology