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Table 5. Challenges and strategies for the speech pathologist Challenges Strategies During the intervention the speech pathologist may become

Managers have ensured support mechanisms (e.g., information on employee

privy to information that is outside their comfort zone, especially for inexperienced staff Imbalance of caseload numbers of children in OOHC based on

counselling services, confidential debriefing) are in place

Support is offered to speech pathologists at sites with large numbers of OOHC

different sites’ geographical locations

children on their caseload

Ensure even distribution of cohort across SP staff

Child protection training may be confronting and distressing for staff. SP service does not operate within a multidisciplinary service model which has implications for cross-referral, multidisciplinary goal-setting and of the speech pathologist potentially being asked questions related to other professions (e.g., psychology)

Staff are prepared regarding the content of child protection training

Developed links with relevant multidisciplinary services and discuss appropriate

streamlining of referrals, goal setting

The speech pathologist Speech pathologists are increasingly required to provide intervention to children in OOHC. The issues arising with these children are typically complex given the nature of their family situation, history and severity and complexity of their speech/language delays (Allen & Oliver,1982; Culp et al., 1991; Eigsti & Cicchetti, 2004; Hwa-Froelich, 2012). Speech pathologists have varied levels of self-confidence and experience working with vulnerable groups, including OOHC. For new staff, working with children in OOHC may be an unfamiliar caseload. This has been addressed by the service through establishment of a designated SP OOHC coordinator position. This position provides staff with a key contact for support, mentoring, clinical supervision, orientation of new staff to the challenges of working with this caseload, provision of education related to working with maltreated children, and supports staff regarding the content of child protection training. This service implemented a number of strategies to engage and upskill all SP staff in this area (see Table 5). The speech pathology service Children with speech and language delays are at greater risk of abuse, neglect or trauma (Westby, 2007). Fox, Almas, Degnan, Nelson and Zeanah (2011) suggested it may be more challenging to care for children with a mild language delay than for children without a language delay, and their limited language abilities may make interactions with them unsuccessful and unrewarding, thus raising a greater exposure to maltreatment. Sullivan and Knutson (2000) reported that parental expectations may be unrealistic and are influenced by heightened levels of stress. As a result, in some cases it may be difficult to ascertain whether the language delay or the maltreatment occurred first. The Kaleidoscope SP OOHC coordinator maintains a centralised database of all children in OOHC referred across seven service sites and tracks the child’s journey through SP services, including ensuring follow-up (e.g., if child fails to attend) occurs. In endeavouring to ensure consistency of SP services across the seven sites, a number of strategies have been implemented (see Table 6). Conclusion and future directions The steady increase in referrals to this service over the past two years suggests that the number of referrals of children in OOHC as a result of maltreatment will likely see continued growth. The speech pathologists identified a number of unique challenges that were common to children who were in OOHC, suggesting they are a discrete and

vulnerable group. The key themes in relation to linking in with internal and external partners to support families (COAG, 2009) ensure children in OOHC maintain links with services, despite placement/caseworker changes. It is acknowledged that this discussion paper provides an overview of the strategies that have been implemented in a single SP service and thus may not be transferable to all SP services. The challenges identified herein are the most common ones for this service, and other services may face different challenges and/or have differing solutions for working with these clients. The strategies identified in this paper as successful are based on anecdotal reports and stakeholder feedback; the authors note there are future opportunities to conduct a formal evaluation of these strategies. It is also acknowledged that the identification of challenges and strategies to overcome them is not complete. There are many opportunities for the service to continue to develop and improve the intervention provided to children in OOHC. For the current service the ongoing work with this vulnerable group includes: • increasing the speech pathology staff’s understanding of the impact of different types of maltreatment on predicting speech/language delays (Culp et al.,1991) (to support appropriate diagnostic/prognostic planning and management); staff will continue to be provided with education from a multidisciplinary perspective, guidance as to professional development opportunities in this field and current relevant research; • improved mechanisms to support speech pathologists such as providing ongoing clinical support and education, and maintaining OOHC as a regular agenda item in service meetings; • linking in to other multidisciplinary services for this client group (Hwa-Froelich, 2012); • ensuring intervention is based on current evidence- based practice principles; • the development of standardised assessment protocols in order to develop a thorough picture of the types of communication disorders these children present with and to tailor intervention to meet their needs. The authors have highlighted that speech pathology caseloads are seeing an increase in the number of children in OOHC as a result of maltreatment, and there needs to be discourse within the speech pathology profession regarding this vulnerable group. It is hoped that this paper will raise awareness of the needs of this client group and encourage similar services to document their challenges and strategies

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JCPSLP Volume 15, Number 3 2013

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