Associate Professor Sally Hewat

This study explored intercultural communication from the perspectives of partners from different cultural and linguistic backgrounds. We used a culturally responsive form of video-reflexive ethnography to study intercultural communication processes between Yol¿u, pronounced Yolngu (First Nations people from the region that is now called North-East Arnhem Land, Northern Territory, Australia) and Balanda (non-Indigenous people). Yol¿u and Balanda researchers worked collaboratively throughout the study (2017¿2021). In a very remote Yol¿u community in northern Australia, five early childhood assessment interactions were recorded and analysed by the 40 Yol¿u and Balanda participants. Researchers analysed data collaboratively using an approach aligned with constructivist grounded theory. We connected key research findings about intercultural communication processes to a place-based metaphor which foregrounds Yol¿u cultural knowledge and encourages reflection on deeper ways of thinking about how we connect, collaborate and communicate interculturally.

Purpose: With increasingly multicultural and linguistically diverse societies, speech-language pathologists (SLPs) are being challenged with the task of working with clients who speak foreign languages. However, there is still a lack of evidence exploring how well SLPs are able to make reliable measurements of stuttering in languages other than their own. This study expands on existing knowledge and offers new reliability data for a different language that is commonly spoken worldwide, Vietnamese, enabling comparisons to be made to other foreign languages. Methods: This study was undertaken to estimate the reliability of English-speaking SLPs¿ use of a severity rating (SR) scale, to measure severity of stuttering in a familiar (English) and foreign (Vietnamese) language. Fifty-nine English-speaking SLPs rated 20 audio speech samples (10 English and 10 Vietnamese) of adults who stutter using a 9-point SR scale on two separate occasions. Results: Results of the present study concur with previous studies identifying that language familiarity plays a pivotal role with SLPs¿ abilities to reliably measure severity of stuttering. SLPs showed better agreement measuring severity of stuttering for mild and severe stuttering, regardless of familiarity with language. However, greater variability (poorer reliability) was found in the moderate range of the scale for both familiar (English) and foreign (Vietnamese) languages. Conclusion: Results highlight the need for future research to focus on finding ways to assist SLPs to improve their reliability in the middle range of the scale, and further support stuttering measurement training packages to be developed in different languages.

Purpose: To conduct long-term follow-up assessment on children who had previously undergone concurrent, direct treatment for co-occurring stuttering and speech sound disorder. Methods: Four children (6;10¿7;7 years) were followed-up approximately 40 months after commencing Stage 1 of the Lidcombe Program. The primary outcome for stuttering, percentage of syllables stuttered, was assessed on within¿¿ and beyond-clinic samples. Percentage of consonants correct, the primary speech outcome, was gathered on single-word and connected-speech samples. Primary outcomes were analysed for statistically significant change and to assess stability of treatment gains. Additionally, formal assessment of phonological awareness ability was conducted. Results: At long-term follow-up, 2 participants had experienced relapse of stuttering. Three of the four children were within age-expected norms for percentage of consonants correct, while one participant was rated at a mild-moderate severity level on this measure. All four children had assessment scores that were within normal limits for phonological awareness. Conclusion: Children with co-occurring stuttering and speech sound disorder may be treated concurrently using direct therapy approaches in the short-term, however may be more prone to relapse across both disorders. For this caseload of children, a longer maintenance period is recommended, with regular assessments being undertaken to ensure stability of treatment gains in the long-term.

Speech Pathology programs usually send students to workplaces to learn clinical skills necessary for practice. During COVID-19, programs needed to respond quickly to ensure that students continued to gain the necessary experiences and skills required to progress through their program and graduate as clinicians, while simultaneously complying with COVID-19 requirements. Case studies from seven different universities in Australia, Ghana and Hong Kong described the diverse ways in which placements were adapted to be COVID-safe, taking into account local needs. Some practices which had been included in placement education prior to the pandemic, such as telepractice and simulation-based learning, were extended and developed during this time. Educators, students, clinicians and clients responded to the rapidly changing needs of the time with flexibility and innovation, utilising a variety of technologies and tools to support case-based and virtual learning opportunities. Feedback from these diverse stakeholders about the experiences was positive, despite inevitable limitations and less-than-ideal circumstances. The positive findings provided insights for consideration in the future: could strategies implemented in response to the pandemic continue to be incorporated into placement experiences, enhancing current practices and maintaining student performance outcomes? Exceptional circumstances prompted exceptional responses; flexibility and innovation were accelerated in response to the pandemic and may transform future placement-based learning opportunities.

Background: Research suggests that some speech¿language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech¿language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech¿language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students¿ clinical skills, students¿ perceptions of participating in stuttering simulation-based learning are yet to be explored. Aims: To investigate speech¿language pathology students¿ comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme. Methods & Procedures: This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech¿language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students¿ comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students¿ responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students¿ perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students¿ perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment. Conclusions & Implications: Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject Simulation is a teaching approach used within speech¿language pathology to support the development of students¿ clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge This study explored students¿ perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation-based learning programme. It describes a stuttering simulation-based learning programme that can be embedded into speech¿language pathology programme curricula. What are the potential or actual clinical implications of this work? The stuttering simulation-based learning programme detailed in this study can be applied and embedded in speech¿language pathology curricula. It can be used to support the development of students¿ confidence in the assessment and management of stuttering.

Purpose: Speech-language pathologists¿ (SLPs) ability to measure stuttering reliably has been of interest over time. However, speech samples used in stuttering measurement research have varied in duration. This study was undertaken to examine whether the duration of speech samples influences the reliability of measurement of severity of stuttering by SLPs. Methods: Ten specialist SLPs rated 27 audio, English speech samples of three different durations (9 × 1-minute, 9 × 3-minutes, 9 × 5-minutes) of adults who stutter, using a 9-point severity rating (SR) scale. Results: The speech sample durations produced similar results when using the SR scale to measure severity of stuttering. Thus, samples of 1, 3 and 5-minute durations were found to be equally appropriate for reliability research and training purposes. Variability was found to be larger in the moderate severity range than the mild and severe ranges. Conclusions: Data trends suggest that SLPs and researchers should focus more attention on practice and training in the middle ranges of the SR scale, due to increased variability in this range.

Purpose: In mainland China, speech therapy is an emerging profession, and it estimated around 13 million people stutter. Currently, best practice for treating stuttering in young children is considered to be implementation of the Lidcombe Program. The Lidcombe Program is a behaviourally based treatment approach which involves parents delivering feedback to their child¿s stuttered and stutter-free speech in structured and unstructured conversations, in a natural environment. Currently, there is no published research documenting implementation of the Lidcombe Program in mainland China. Given the cultural differences that exist between Australia (where the treatment was developed) and China, an investigation into the feasibility of the treatment into this cross-cultural context is warranted. Methods: This study investigates implementation of the Lidcombe Program to two Mandarin-speaking children using a descriptive single case study design. The primary outcome, percent syllables stuttered (%SS), was measured within¿¿ and beyond-clinic at two assessment points, and analysed for statistically significant change. Results: Both participants in the study achieved a significant reduction in stuttering rates, suggesting the Lidcombe Program may be a viable option to treat some children in a Mandarin-speaking population in China. Additionally, the treating therapists provided feedback on cultural considerations when implanting the program to this population. Conclusion: There is a need for research into effective and evidence-based stuttering treatments for Mandarin-speaking children in mainland China. This study is a preliminary investigation into the effectiveness of the Lidcombe Program in this context.

Despite the cultural and linguistic diversity of the Australian population, research suggests that speech pathologists do not feel confident when providing services to Cultural and Linguistic Diversity (CALD) clients and would benefit from further education and training in this area. Cultural empathy has been described as a precursor to cultural competence and previous research has demonstrated the positive impact on nursing students' cultural empathy toward CALD clients following an interactive cultural simulation experience. This study investigated the feasibility and effectiveness of an online cultural simulation activity in developing the cultural empathy of speech pathology students. Students completed an online cultural simulation in their own time, followed by a tutorial debrief. Both the simulation and debrief were considered to comprise the 'simulation activity'; which was a component of a first-year introduction to clinical practice course. Participants completed a pre-survey and post-survey, containing the Comprehensive Empathy Scale (CES) and demographic questions. Results were analysed using the Wilcoxon Signed Rank test and a Paired Sample t-test, and a power analysis was conducted to direct future studies. Ten students participated and improved an average of 11.3 on the CES (p=0.14). A power analysis revealed that a minimum of 45 participants would be needed in future studies to observe any statistically significant results. The online application of the cultural simulation activity was feasible, and results indicate an improvement in cultural empathy, although the improvement did not reach statistical significance. Implications for future studies are discussed.

Due to increased student numbers and workforce limitations, speech pathology students have fewer opportunities to develop skills in working with adult populations in traditional clinical placements. Using simulation-based learning has proven to be advantageous in other disciplines. The use of simulation to develop clinical skills in speech pathology range of practice areas, including speech, language and swallowing in adults, has been less well researched. The aim of this study was to investigate students' overall perceptions about simulation-based learning, particularly their confidence related to specific clinical skills and perceived anxiety about working with adult clients. Six final year speech pathology students enrolled in either a 4-year undergraduate or 2.5-year masters program participated in this research. Students engaged in five simulation-based learning activities across one day. Purposefully developed pre- and post- surveys were completed to explore students' anxiety levels and perceptions of confidence regarding clinical skills across domains of foundation knowledge, case history, assessment, intervention, interaction and clinical reasoning, and anxiety levels. The Satisfaction with Simulation Experience (SSE) Scale was completed post-simulation experience. Students also participated in a focus group discussion following the simulation experience. Student median ratings of clinical skills improved from pre- to post-simulation across the six domains. All students reported that the simulation-based learning experience was valuable and reported increased levels of confidence and enhanced preparedness for their clinical placements. Findings from this study suggested that students value simulation-based learning and future research should explore learning outcomes from a longer, more intensive simulation program.

Background: Simulation-based learning provides students with a safe learning environment, guaranteed exposure to specific clinical scenarios and patients, time for reflection and repetition of tasks, and an opportunity to receive feedback from multiple sources. Research including studies specific to allied health training programmes have demonstrated that simulation-based learning also helps increase learners¿ confidence and reduces anxiety related to clinical environments, activities and skills. Such evidence, together with increasing challenges in provision of workplace clinical education, has supported an expansion of integrating simulation-based learning into university curricula. Aims: To provide detailed information about the processes and considerations involved in the development of a simulation-based learning programme for speech¿language pathology. Methods & Procedures: Through reflection on the development process of a 5-day simulation-based learning programme, and in light of existing research in simulation, this paper outlines the important steps and considerations required for the development of a simulation-based learning programme to support student competency development in adult speech pathology range of practice areas. Main Contribution: A proposed framework for the development of future simulation-based learning programmes in speech¿language pathology. Conclusions & Implications: The framework can be applied to simulation-based learning for university programmes and/or workplace training in speech¿language pathology and across several other health disciplines.

Background: Clinical placements are crucial to the development of skills and competencies in speech¿language pathology (SLP) education and, more generally, a requirement of all health professional training programmes. Literature from medical education provides a context for understanding how the environment can be vital to all students¿ learning. Given the increasing costs of education and demands on health services, students who struggle or fail on clinical placement place an additional burden on educators. Therefore, if more is known or understood about these students and their experience in relation to the clinical learning environment, appropriate strategies and support can be provided to reduce the burden. However, this literature does not specifically explore marginal or failing students and their experience. Aims: To review existing research that has explored failing and struggling health professional students undertaking clinical placements and, in particular, SLP students. Methods & Procedures: A critical narrative review was undertaken. Three electronic databases, ProQuest, CINAHL and OVID (Medline 1948¿), were searched for papers exploring marginal and failing students in clinical placement contexts across all health professions, published between 1988 and 2017. Data were extracted and examined to determine the breadth of the existing research, and publications were critically appraised and major research themes identified. Main Contribution: Sixty-nine papers were included in the review. The majority came from medicine and nursing in the United States and United Kingdom, with other allied health disciplines less well represented. The review identified key themes with the majority of papers focused on identification of at risk students and support and remediation. The review also highlighted the absence of literature relating to the student voice and in the allied health professions. Conclusions & Implications: This review highlighted the limited research related to failing/struggling student learning in clinical contexts, and only a handful of papers have specifically addressed marginal or failing students in allied health professions. The complexity of interrelated factors in this field has been highlighted in this review. Further research needs to include the student's voice to develop greater understanding and insights of struggle and failure in clinical contexts.

Speech therapy is an emerging profession in Vietnam, and there is an estimated 910 000 Vietnamese people who stutter. No research to date has examined Vietnamese speech therapists¿ reliability when measuring severity of stuttering in their native language (Vietnamese) and other languages (e.g. English, a common second language). Twenty-five Vietnamese speech therapists rated 20 speech samples (10 Vietnamese, 10 English) of adults who stutter using a 9-point severity rating (SR) scale on two occasions. Approximately half of the judges were able to measure severity of stuttering reliably in Vietnamese. Judges¿ performance in English was poorer than in their native language. Irrespective of language, judges showed greater variability of their use of the scale in the moderate range. Results highlight the need for judges to develop intra- and interjudge agreement when using the scale to measure stuttering in their native and other languages. Research into the development and evaluation of practice and/or training packages would be beneficial to this population, in all languages, with a focus in the moderate range of the scale.

Purpose: Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. Method: A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. Conclusions: The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs.

Speech sound disorders reportedly co-occur in young children who stutter at a substantial rate. Despite this, there is a paucity of scientific research available to support a treatment approach when these disorders co-exist. Similarly, little is known about how clinicians are currently working with this caseload given that best practice for the treatment of both disorders in isolation has evolved in recent years. This study used a qualitative approach to explore current clinical management and rationales when working with children who have co-occurring stuttering and speech sound disorder. Thirteen participant SLPs engaged in semi-structured telephone interviews. Interview data were analysed based on principles derived from grounded theory. Several themes were identified including multi-faceted assessment, workplace challenges, weighing-up the evidence, and direct intervention. The core theme, clinical reasoning, highlighted the participants' main concern, that not enough is known about this caseload on which to base decisions about intervention. There was consensus that little is available in the research literature to guide decisions relating to service delivery. These findings highlight the need for further research to provide evidence-based guidelines for clinical practice with this caseload. © 2013 The Speech Pathology Association of Australia Limited.