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Table 6. Challenges and strategies for the speech pathology service Challenges Strategies Children in OOHC need to be considered separately as a vulnerable group and this challenged the beliefs of some clinicians for these children as a vulnerable group Speech pathologists have different knowledge and experience

NSW Health, Kaleidoscope children services and SP team’s commitment to care

Education of the SP team regarding the social, emotional, physical and

regarding working with children who have suffered maltreatment Consistency in the way in which SP services are provided across

behavioural implications of maltreatment

SP team developed and implemented OOHC clinical pathways to ensure

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coordinated and supported access to services

Timely exchange of information between SP service and

Developed links between SP service and key services within HNELHD, including OOHC clinics, child protection, and HNELHD health case managers

stakeholders

FC may change if child was in short-term or emergency care At referral or at the first appointment, the speech pathologist ensures they have the correct contact details of the current FC and caseworker HNELHD identification of the need for priority services to children in HNELHD district-wide clinical priority tool for paediatric community speech OOHC, due to their high-risk situation and potential inability to pathology services acknowledges this as a discrete group and provides additional access/complete services weighting for prioritisation Ensure speech pathologists are aware of referral for child in OOHC Centralised intake sends an email alert to the SP team leader, which is forwarded to the SP OOHC coordinator and entered onto database Higher representation of Aboriginal children in OOHC HNELHD encourages identification of Aboriginality and has a commitment to reducing health disadvantage (NSW Ministry of Health, 2012)

Information on the number of Aboriginal clients helps support the identification of the need for culturally appropriate resources

Cultural awareness training available to all staff

Culturally appropriate resources are being purchased

Staff education provided regarding HNELHD commitment to reducing Aboriginal disadvantage, and communicating effectively with Aboriginal clients

Liaise with available internal and external Aboriginal staff in local area in the provision of services HNELHD clinical supervision policy requires monthly supervision which may

Consistency and clinical support for less experienced clinicians or those with specific interest in working with vulnerable groups incorporate case management, review and discussion of children in OOHC Child may not be ready for intervention when service identifies it is Flexibility to provide therapy when family situation is conducive to intervention – their turn (i.e., child’s name at top of waiting list) FC may hold off therapy while other services are provided (e.g., psychology); child is not disadvantaged if not accessing services at that time

Clients are put on hold and offered next available therapy appointment when they are ready to access services Implemented a referral transfer system that back dates referral from entry to previous SP service; enables transfer at an equivalent level and eliminates multiple

Many children in OOHC have been living in other geographical locations (outside of the referral area) and may have either been

on a speech pathology waiting list or accessing services elsewhere waits for service Child may not fit into typical service parameters for session caps

Increased flexibility in number of appointments available and cognizant that greater time may be required to build trust and rapport

for comparison. Increased knowledge sharing across speech pathology and other disciplines will benefit all key stakeholders, but in particular maltreated children, through improved service delivery, tailored to their individual needs and circumstances. Acknowledgements The authors wish to thank the community-based services speech pathology team and the HNELHD OOHC Health services. The authors are happy to discuss service delivery with interested speech pathologists. References Allen, R., & Oliver, J. (1982). The effect of child maltreatment on language development. Child Abuse and Neglect , 6 (3), 299–305. Australian Institute of Health and Welfare (AIHW). (2012). Child protection Australia 2010–11 . Child Welfare series no. 53. Cat. no. CWS 41. Canberra: Author.

Castle, J., Groothues, C., Bredenkamp, D., Beckett, C., O’Connor, T., Rutter, M., & the ERA study Team. (1999). Effects of qualities of early institutional care on cognitive attainment. American Journal of Orthopsychiatry , 69 (4), 424–437 Child Family Community Australia (CFCA). (2012). What is child abuse and neglect? Retrieved from www.aifs.gov. au/cfca/pubs/factsheets/a142091/index.html Cooperrider, D., & Whitney, D., (2005). Appreciative Inquiry: A positive revolution in change . San Francisco, CA: Berrett-Koehler Publishers. Council of Australian Governments (COAG). (2009). Protecting children is everyone’s business: National Framework for Protecting Australia’s Children 2009–2020 . Retrieved from http://www.fahcsia.gov.au/sites/default/files/ documents/child_protection_framework.pdf Couzos, S., Metcalf, S., & Murray, R. (2001). Systematic review of exisiting evidence and primary care guidelines

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JCPSLP Volume 15, Number 3 2013

Journal of Clinical Practice in Speech-Language Pathology