“Many wasted months”: Stakeholders’ perspectives about waiting for speech-language pathology services

The following manuscript has just been accepted for publication:
McGill, N., Crowe, K., & McLeod, S. (2020, in press March). “Many wasted months”: Stakeholders’ perspectives about waiting for speech-language pathology services. International Journal of Speech-Language Pathology.

Congratulations to Nicole McGill as this forms part of her PhD.

Here is the abstract:

Purpose: High demand for speech-language pathology services is reflected in long waiting lists. Waiting can be active or passive and has implications for stakeholders, including consumers, professionals, and organisations. The present study explored experiences and perspectives regarding waiting for speech-language pathology services through analysis of stakeholders’ written submissions to an Australian Government Senate Inquiry.
Method: Written submissions (n = 337) were screened for terms related to waiting (n = 133). Included submissions were written by organisations (36.8%), speech-language pathologists (29.3%), and parents of children with communication and/or swallowing difficulties (27.8%).
Result: Inductive thematic analysis identified three themes. (1) Duration. Consistently described as long. (2) Consequences. Consumers’ consequences included: burden on physical health, finances, time, emotional wellbeing, and relationships, reduced continuity of care, and increased intervention needs. Professional consequences included: stress and burnout impacting job satisfaction, and reduced effectiveness. Societal consequences included: social and ethical burden, and a drain on health and legal systems. (3) Actions. Consumers advocated and sought alternatives (e.g. threats to harm their child, relocation to a capital city), professionals implemented service delivery and policy actions, and organisations lacked effective system-wide strategies.
Conclusion: Existing services did not appear to meet stakeholders’ needs. Action is needed to improve speech-language pathology waiting lists and access to services, and minimise possible consequences for stakeholders.

Impact of our research: Use by Speech Pathology Australia and the Australian government

The work of the Charles Sturt University’s speech research team has been used by Speech Pathology Australia and in three Australian Government Senate Committees and Reports, one NSW Government Briefing paper, and one Australian Broadcasting Commmission site:

1. Senate Community Affairs References Committee: Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia Report (12/03/2015). Our research is identified in points 3.20, 3.21, 3.22, 3.31. 3.33 in Chapter 3 (also points 5.31 (McCormack et al.), 4.20 (Verdon et al.) in subsequent chapters) here. For example
   

   3.21 There have been some significant studies in Australia into the prevalence of speech and language disorders among children. In one of her submissions to the inquiry, Professor Sharynne McLeod of Charles Sturt University, summarised the findings of her study of 14 514 children across 44 schools in New South Wales.

2. Education and Employment References Senate Committee (25/09/2015): Students with disability in the school system. Professor McLeod and Speech Pathology Australia President Dixon were invited to be interviewed and recorded in Hansard here 
   Subsequently, Speech Pathology Australia’s submission was identified in points 2.22, 2.35 of the Senate Education and Employment References Committee: Access to real learning: The impact of policy, funding and culture on students with disability—Report (January 2016) here
3. Speech Pathology Australia also used the CSU research regarding prevalence and impact of communication difficulties in their submission to the Productivity Commission's Education Evidence Base Inquiry – Submission 35 here
   Speech Pathology Australia’s full submission is here
4. Speech Pathology Australia also used our CSU research regarding prevalence and impact of communication difficulties in their submission to the NSW Parliamentary Committee addressing Students with a disability or special needs in New South Wales schools (2016-2017) here - Submission 125 is here
   
5.  NSW Parliamentary Research Service Briefing Paper No 12/2015 NSW School Education: NAPLAN, Measurement and Performance here
   

   Point 9.8 Children with Speech and Language Problems (pp. 26-27) describes research undertaken by CSU researchers (Professor McLeod, Professor Harrison and Dr Wang) into the identification of children with speech and language and their academic outcomes on NAPLAN testing. 

6. ABC Life at 7 Resources here include Risk factors associated with speech and language impairment at 4–5 years of age - Linda Harrison and Sharynne McLeod here

Australian Government Senate Inquiry on students with disability in the school system

Today Gaenor Dixon (President of Speech Pathology Australia) and I were invited to give evidence to the Australian Government Senate  Standing Committee on Education and Employment  addressing Current levels of access and attainment for students with disability in the school system, and the impact on students and families associated with inadequate levels of support. The terms of reference of the Senate  Standing Committee on Education and Employment are here

Gaenor Dixon (SPA President) and Sharynne McLeod presenting at the Senate Inquiry

As part of the submission Linda Harrison, Cen (Audrey) Wang and I were commissioned by Speech Pathology Australia to undertake research into the NAPLAN outcomes for children with communication impairment.

• Speech Pathology Australia's submission is here 
• Speech Pathology Australia's news release is here
• Charles Sturt University's news release is here

Australia's media covered our presentation in most of the major newspapers (164 Australian newspapers on 25th September):

• The Australian
• Sydney Morning Herald
• The Age
• The Courier Mail
• The Mercury

 Here is an excerpt from Speech Pathology Australia's submission

NAPLAN results were analysed for 4,332 children within the K cohort of LSAC whose parents responded to questions about children’s speech and language when children were 4-5 years and 6-7 years and who had linked data to NAPLAN... For this research, the Kindergarten (K) cohort’s NAPLAN results for years 3, 5 and 7 were analysed" (p. 22)

"Analysis showed significant differences in the NAPLAN outcomes for children with speech/language problems compared to children without these problems. This was even after controlling for sex, SEP [socio-economic position], LBOTE [language background other than English], disability and hearing problems. Children with speech/language problems had poorer NAPLAN outcomes for every NAPLAN test at every year of testing. Importantly, the results indicate that both groups of students’ NAPLAN outcomes did improve over time – however the children with speech/language problems had consistently lower scores and did not ‘close the gap’ in their NAPLAN outcomes over time" (p. 24)

 

Dr Ronelle Hutchinson (SPA policy), Senator Sue Lines (Chair),
Gaenor Dixon (SPA President) and Sharynne McLeod (CSU)

Australian Senate Community Affairs Reference Committee's final report

The Senate Community Affairs Reference Committee's final report for the inquiry into the prevalence of different types of speech, language and communication disorders and speech pathology services in Australia was released on 2nd September 2014 and can be found here. The tabling of the Senate report is here. Speech Pathology Australia's response is here.

The work of my students and colleagues at CSU has been cited a number of times in the report. It is exciting to see that our work has been useful in advocating for services. The CSU media release is here.

In an email to members of Speech Pathology Australia posted today Gail Mulcair, CEO of Speech Pathology Australia summarized the report as follows:

The Committee made ten detailed recommendations - which direct the Australian Government Department of Health to progress a program of work that will identify, improve, support and expand speech pathology services in Australia. The time for talking is over - the time for government action is at hand. Recommendations include:

• That governments, when developing policy and programs, consider the costs to individuals and the Australian community of failing to intervene to address speech and language disorders.
• That a gap analysis be undertaken of what data is available to identify the current and future need for speech pathology services and how these information gaps could best be filled.
• Improvements to data on communication disabilities collected through the National Census and other governmental data collection systems.
• An analysis of the current service delivery model of speech pathology services in the aged care sector and how this relates to the federal government's aged care reforms.
• A project that maps language support services across Australia against the Australian Early Development Index information about vulnerable children.
• An immediate audit of the current speech pathology services for children in Australia.
• The development of a position paper on the impact of the NDIS on speech pathology services in Australia.
• A strategy to broaden the opportunities for speech pathology students to undertake clinical placements that satisfy the profession's competency based occupational standards.
• An investigation into the geographical and demographic clustering of speech pathology services in Australia with a focus on new graduate positions.
• A cost benefit study of the current level of funding for public speech pathology positions, various service delivery models and the impact on individuals, the speech pathology profession and the Australian community.
• A position paper (jointly developed by the federal Department of Health in collaboration with state and territory governments) on the most effective models of speech pathology services in:
  
  • Early childhood intervention services
  • The educational system
  • The justice system
  • The health system
  • The residential aged care environment.

Submissions to the Australian Senate Inquiry

The Australian Senate has launched an inquiry into the prevalence of different types of speech, language and communication disorders and speech pathology services in Australia.

My colleagues and I uploaded seven submissions to the inquiry on the following topics

• Prevalence of speech, language, and communication needs in Australia’s children
• The prevalence of different types of speech, language and communication disorders in Australia from the Sound Start Project
•  Speech pathology services to support Australian children from culturally and linguistically diverse backgrounds
• Aboriginal and Torres Strait Islander children: Incidence and prevalence of speech and language disorder
• Evidence of the social cost of failing to treat communication disorders
• The experiences of individuals with a history of childhood speech impairment
• Applying the Recommendations of the World Report on Disability to the speech, language, and communication needs of Australia’s children

The submissions from over 200 people and groups are (gradually being) uploaded here. A Charles Sturt University media release about the submissions is here. Speech Pathology Australia's 118 page submission also references recent work we have undertaken as part of the ARC Future Fellowship and Discovery grants. We look forward to the next phase of this important inquiry.