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Background: The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims: To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper addsWhat is already known on the subjectENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high‐risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID‐19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research.What this paper adds to existing knowledgeThis study provides a discussion of the threats and opportunities from the COVID‐19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership.What are the potential or actual clinical implications of this work?The COVID‐19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post‐COVID era. [ABSTRACT FROM AUTHOR]

Background Following content analyses of the first 30 years of the UK speech and language therapy professional body's journal, this study was conducted to survey the published work of the speech (and language) therapy profession over the last 50 years and trace key changes and themes. Aim To understand better the development of the UK speech and language therapy profession over the last 50 years. Methods & Procedures All volumes of the professional journal of the Royal College of Speech and Language Therapists published between 1966 and 2015 ( British Journal of Communication Disorders, European Journal of Communication Disorders and International Journal of Language and Communication Disorders) were examined using content analysis. The content was compared with that of the same journal as it appeared from 1935 to 1965. Outcomes & Results The journal has shown a trend towards more multi-authored and international papers, and a formalization of research methodologies. The volume of papers has increased considerably. Topic areas have expanded, but retain many of the areas of study found in earlier issues of the journal. Conclusions & Implications The journal and its articles reflect the growing complexity of conditions being researched by speech and language therapists and their professional colleagues and give an indication of the developing evidence base for intervention and the diverse routes which speech and language therapy practice has taken over the last 50 years. [ABSTRACT FROM AUTHOR]

Background: Those supporting children and young people who use augmentative and alternative communication (AAC) contribute to ongoing complex decision‐making about communication aid selection and support. Little is known about how these decisions are made in practice and how attributes of the communication aid are described or considered. Aims: To understand how communication aid attributes were described by those involved in AAC recommendations and support for children and young people, and how these attributes were described as impacting on AAC use. Methods & Procedures: A secondary qualitative analysis was completed of interview and focus group data from 91 participants involved in the support of 22 children and young people. Attributes of communication aids described by participants were extracted as themes and this paper reports a descriptive summary of the identified software (non‐hardware) attributes. Main Contribution: Decisions were described in terms of comparisons between commercially available pre‐existing vocabulary packages. Attributes related to vocabulary, graphic representation, consistency and intuitiveness of design, and ease of editing were identified. Developmental staging of vocabularies, core and fringe vocabulary, and vocabulary personalization were attributes that were described as being explicitly considered in decisions. The potential impact of graphic symbol choice did not seem to be considered strongly. The physical and social environment was described as the predominant factor driving the choice of a number of attributes. Conclusions & Implications: Specific attributes that appear to be established in decision‐making in these data have limited empirical research literature. Terms used in the literature to describe communication aid attributes were not observed in these data. Practice‐based evidence does not appear to be supported by the available research literature and these findings highlight several areas where empirical research is needed in order to provide a robust basis for practice. What This Paper Adds: What is already known on the subject: Communication aid attributes are viewed as a key consideration by practitioners and family members in AAC decision‐making; however, there are few empirical studies investigating language and communication attributes of communication aids. It is important to understand how those involved in AAC recommendations and support view communication aid attributes and the impact different attributes have. What this paper adds to existing knowledge: This study provides a picture of how communication aids are described by practitioners and family members involved in AAC support of children and young people. A range of attributes is identified from the analysis of these qualitative data as well as information about how participants perceive these attributes as informing decisions. What are the potential or actual clinical implications of this work?: This study provides a basis on which practitioners and others involved in AAC support for children and young people can review and reflect on their own practice and so improve the outcomes of AAC decisions. The study provides a list of attributes that appear to be considered in practice and so also provides a resource for researchers looking to ensure there is a strong empirical basis for AAC decisions. [ABSTRACT FROM AUTHOR]

Background: Following a content analysis of the first 10 years of the UK professional journal Speech, this study was conducted to survey the published work of the speech (and language) therapy profession in the 20 years following the unification of two separate professional bodies into the College of Speech Therapists. Aim: To understand better the development of the speech (and language) therapy profession in the UK in order to support the development of an online history of the speech and language therapy profession in the UK. Methods & Procedures: The 40 issues of the professional journal of the College of Speech Therapists published between 1946 and 1965 (Speech and later Speech Pathology and Therapy) were examined using content analysis and the content compared with that of the same journal as it appeared from 1935 to the end of the SecondWorldWar (1945). Outcomes & Results: Many aspects of the journal and its authored papers were retained from the earlier years, for example, the range of authors' professions, their location mainly in the UK, their number of contributions and the length of papers. Changes and developments included the balance of original to republished papers, the description and discussion of new professional issues, and an extended range of client groups/disorders. Conclusions & Implications: The journal and its articles reflect the growing maturity of the newly unified profession of speech therapy and give an indication both of the expanding depth of knowledge available to speech therapists and of the rapidly increasing breadth of their work over this period. [ABSTRACT FROM AUTHOR]

Purpose: Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends. Methods: We conducted multiple, art‐informed interviews on the topic of friendship with 14 children with LD at the age of 6–8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships. Results: The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends. Conclusion: There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art‐informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children. WHAT THIS PAPER ADDS: What is already known on the subject: Children with Language Disorder (LD) are at risk of peer relationship difficulties. Studies to date are based on sociometrics and adult reports. Only a few studies employ participatory approaches to research with children, directly engaging children with LD when exploring their friendships What this paper adds: This paper directly asks children with LD about their understanding of friendship and strategies for making friends.Physical proximity and play are important to children.s understanding of friendship especially in recognising good and bad friends. This indicates potential reasons for children with LD being susceptible to false friendsAdditionally, children with LD do not perceive language and communication as a barrier to making friends. What are the potential or actual clinical implications of this work?: Concepts around friendship and good/bad friends should be routinely assessed and targeted (if appropriate) in interventions. The study highlights the need to continue discussing practices around sharing diagnoses with children with LD. [ABSTRACT FROM AUTHOR]

Background and Objectives: Evidence suggests telehealth in speech and language therapy can enhance access to care, cost‐effectiveness and satisfaction. However, little is known about use of telehealth in the United Kingdom. Moreover, many assessments/outcome measures for aphasia have been tested for face‐to‐face administration only, posing challenges to reliable use within the telehealth context. We explored the experiences and views of speech and language therapists (SLTs) working with people with aphasia on using telehealth to conduct assessments/outcome measures, perceived barriers and facilitators in telehealth, and their priorities for research in telehealth aphasia assessment. Method: We explored views of UK SLTs through an online cross‐sectional survey (2021) delivered through the Qualtrics platform. The survey covered three main areas: (i) participant demographics; (ii) experience of using telehealth and doing telehealth assessments with people with aphasia post‐stroke during the COVID‐19 pandemic; and (iii) plans for telehealth post‐pandemic. Response formats included yes/no, multiple choice, 5‐point Likert scales and open‐ended text responses. The survey was expected to take no more than 10 min to complete. Survey data were analysed through descriptive statistics and content analysis of open‐ended questions. Results: One hundred twenty‐four SLTs responded to the survey. The majority (>80%) used telehealth during the COVID‐19 pandemic and >90% planned to continue to use telehealth in the future. The most used platforms were Zoom, Microsoft Teams and Attend Anywhere. Access to internet and telehealth platforms, and practical problems (e.g., difficulties sharing resources online, limited functionality of telehealth platforms for assessment) were common barriers. Therapists highlighted that training, resources and materials that assist the administration of assessments were important. Most participants responded that there was a need for existing measures to be tested for administration via telehealth (n = 68, 70.8%). Participants overall felt there was a need for online interactive assessments, more online resources that have been trialled for use via telehealth, accessible formats for resources for people with aphasia and clear instructions for how people with aphasia can access resources. Conclusions: This study provides new insights into the current use of telehealth assessment with people with aphasia in the United Kingdom and directions for future research. Barriers and facilitators identified can support the implementation of telehealth assessment in SLT services. WHAT THIS PAPER ADDS: What is already known on the subject: The use of telehealth in speech and language therapy has advantages in terms of access to care, cost‐effectiveness and satisfaction with care. However, little is known about the use of telehealth in aphasia rehabilitation in the United Kingdom, especially in the area of assessment and outcome measurement. What this paper adds to existing knowledge: This study identified that the majority (>80%) of aphasia therapists used telehealth during the COVID‐19 pandemic and >90% planned to continue to use telehealth in the future. A need was identified for existing measures to be tested for administration via telehealth and for training, resources (e.g., online interactive assessments) and materials (e.g., accessible formats for people with aphasia). What are the potential or actual clinical implications of this work?: To facilitate the successful implementation of telehealth assessment, there is a need for measures validated for use via telehealth and more online resources that have been trialled for use via telehealth. [ABSTRACT FROM AUTHOR]

Background Aims Methods & Procedures Outcomes & Results Conclusions & Implications What this paper adds What is already known on this subject What this paper adds to the existing knowledge What are the potential or actual clinical implications of this work? Attainment inequalities exist for ethnic minority students graduating from higher education institutes (HEIs) in the UK. Previous research has investigated the outcomes and experiences of students from ethnic minority backgrounds on health and social care programmes. However, studies exploring ethnic minority speech and language therapy (SLT) students’ experiences have only focused on international students and were conducted in Australia. No known studies exploring the experiences of both home‐domiciled and international SLT students from ethnic minority backgrounds have been conducted in the UK.To explore the experiences of home‐domiciled and international ethnic minority students on a SLT training programme and to identify ways to improve these experiences.All SLT students attending a pre‐registration postgraduate course who identified as being from an ethnic minority background were invited to participate. Two focus groups, one for three international students and one for six home students, were conducted. Data were analysed using reflexive thematic analysis.Three themes were identified that illustrated students’ current experiences and how experiences could be improved: (1) feeling an outsider, explores students’ sense of belonging in SLT education; (2) finding ways to manage, describes the strategies used by students to cope with their experiences of marginalization, and how adopting these strategies impact on their well‐being; and (3) promoting inclusion, explains how the training programme could be modified to improve the experience of ethnic minority students.A better understanding of the experiences of ethnic minority SLT students can help others to support them more effectively. The findings suggest that making changes to SLT training programmes could improve ethnic minority students’ outcomes and experiences. These include: more training for staff and students, support groups for ethnic minority students, sharing lived experiences of students and experienced SLTs from ethnic minority backgrounds, and clearer ways of reporting racist incidents. International students would benefit from receiving more information on HEI support services and cultural practices in the UK. Previous studies have investigated the experiences of ethnic minority students on a range of HEI programmes, including those for students of physiotherapy and occupational therapy. The only studies investigating the experiences of ethnic minority SLT students are those exploring how international SLT students in Australia can be supported on professional placement. This study explores the experiences of home and international SLT students in the UK who identify as being from minority ethnic backgrounds. Findings suggest that these students feel like outsiders, affecting their sense of belonging. The need to find and implement strategies to manage their feelings of marginalization impacts on their well‐being. The findings suggest measures to promote the inclusion of ethnic minority SLT students to improve their experiences and support their well‐being. These include more training for all staff and students and the creation of a ‘lived experiences library’ where students and experienced SLTs from ethnic minority backgrounds could share positive experiences as well as ways of dealing with challenges. Clearer ways of reporting racist incidents would be beneficial for all students. International students would benefit from receiving more information on HEI support services and cultural practices in the UK. It is important that ethnic minority SLT students are involved in developments that aim to improve their experiences. [ABSTRACT FROM AUTHOR]

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Background: People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. Aims: To inform the development of a patient‐reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. Methods & Procedures: A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south‐west of the UK. Four semi‐structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. Outcomes & Results: The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross‐case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. Conclusions & Implications: This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. WHAT THIS PAPER ADDS: What is already known on this subject: We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient‐reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge: This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work?: This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across. [ABSTRACT FROM AUTHOR]

Background: We explore the theoretical and methodological aspects of decolonising speech and language therapy (SLT) higher education in the United Kingdom. We begin by providing the background of the Rhodes Must Fall decolonisation movement and the engagement of South African SLTs in the decoloniality agenda. We then discuss the evolution of decoloniality in SLT, highlighting its focus on reimagining the relationships between participants, students, patients and the broader world. Objective: The primary objective of this discussion is to fill a gap in professional literature regarding decoloniality in SLT education. While there is limited research in professional journals, social media platforms have witnessed discussions on decolonisation in SLT. This discussion aims to critically examine issues such as institutional racism, lack of belonging, inequitable services and limited diversity that currently affect the SLT profession, not just in the United Kingdom but globally. Methods: The methods employed in this research involve the engagement of SLT academics in Critical conversations on decolonisation. These conversations draw on reflexivity and reflexive interpretation, allowing for a deeper understanding of the relationship between truth, reality, and the participants in SLT practice and education. The nature of these critical conversations is characterised by their chaotic, unscripted and fluid nature, which encourages the open discussion of sensitive topics related to race, gender, class and sexuality. Discussion points: We present our reflections as academics who participated in the critical conversations. We explore the discomfort experienced by an academic when engaging with decolonisation, acknowledging white privilege, and the need to address fear and an imposter syndrome. The second reflection focuses on the experiences of white academics in grappling with their complicity in a system that perpetuates racism and inequality. It highlights the need for self‐reflection, acknowledging white privilege and working collaboratively with colleagues and students toward constructing a decolonised curriculum. Finally, we emphasise that while action is crucial, this should not undermine the potential of dialogue to change attitudes and pave the way for practical implementation. The paper concludes by emphasising the importance of combining dialogue with action and the need for a nuanced understanding of the complexities involved in decolonising SLT education. Conclusion: Overall, this paper provides a comprehensive overview of the background, objectives, methods and key reflections related to the decolonisation of SLT higher education in the United Kingdom. It highlights the challenges, discomfort and responsibilities faced by academics in addressing decoloniality and emphasizes the importance of ongoing critical conversations and collective action in effecting meaningful change. WHAT THIS PAPER ADDS: What is already known on this subject: Prior to this paper, it was known that the decolonial turn in speech and language therapy (SLT) was a recent focus, building on a history of professional transformation in South Africa. However, there was limited literature on decoloniality in professional journals, with most discussions happening on social media platforms. This paper aims to contribute to the literature and provide a critical conversation on decolonising SLT education, via the United Kingdom. What this paper adds to existing knowledge: This paper adds a critical conversation on decolonising SLT higher education. It explores theoretical and methodological aspects of decoloniality in the profession, addressing issues such as institutional racism, lack of sense of belonging, inequitable services and limited diversity. The paper highlights the discomfort experienced by academics in engaging with decolonisation and emphasizes the importance of reflection, collaboration and open dialogue for meaningful change. Notably we foreground deimperialisation (vs. decolonisation) as necessary for academics oriented in/with the Global North so that both processes enable each other. Deimperialisation is work that focuses the undoing of privilege exercised by academics in/with the Global North not only for localising their research and education agenda but checking their rite of passage into the lives of those in the Majority World. What are the potential or actual clinical implications of this work?: The paper highlights the need for SLT practitioners and educators to critically examine their practices and curricula to ensure they are inclusive, decolonised and responsive to the diverse needs of communities. The discussions emphasise the importance of addressing institutional racism and promoting a sense of belonging for research participants, SLT students and patients. This paper offers insights and recommendations that can inform the development of more equitable and culturally responsive SLT services and education programmes. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) can affect social interaction and communication as well as motor and cognitive processes. Speech is affected in PD, as is the control of voluntary eye movements which are thought to play an important role in 'turn taking' in conversation. Aims: This study aimed to measure eye movements during spoken conversation in PD to assess whether differences in patterns of eye gaze are linked to disrupted turn taking and impaired communication efficiency. Methods & Procedure: Eleven participants with mild PD and 14 controls completed a two‐player guessing game. During each 3 min game turn, one of the players had to guess the names of as many objects as possible based only on the other player's description. Eye movements were recorded simultaneously in both participants using mobile eye trackers along with speech onset and offset times. Outcomes & Results: When people with PD played the role of describer, the other player guessed fewer objects compared to when controls described objects. When guessing objects, people with PD performed just as well as controls. Analysis of eye fixations showed that people with PD made longer periods of fixation on the other player's face relative to controls and a lower number of such 'gaze on face' periods. Conclusions & Implications: A combination of oculomotor, cognitive and speech abnormalities may disrupt communication in PD. Better public awareness of oculomotor, speech and other deficits in the condition could improve social connectedness in people with Parkinson's. WHAT THIS PAPER ADDS: What is already known on this subject?: Parkinson's disease is known to affect the control of voluntary eye movements. Direction of eye gaze is important in spoken conversation as a cue to turn‐taking, but no studies have examined whether eye movements are different during communication in people with Parkinson's. What this paper adds to existing knowledge?: People with Parkinson's showed longer periods of eye fixation during conversations compared to controls. Delays and overlaps between speech turns were also affected in patients. What are the clinical implications of this work?: Better knowledge of the effect of the disease on eye gaze control amongst clinicians may help improve communication and social connectedness for patients in the future. [ABSTRACT FROM AUTHOR]

Background: Spoken discourse impairments post‐traumatic brain injury (TBI) are well‐documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech–language pathologist (SLP) is recommended for adults with discourse impairments post‐TBI, with an emphasis on context‐sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. Aims: To explore the under‐researched area of clinical practice for spoken discourse interventions with adults post‐TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi‐structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Outcomes & Results: :Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight‐building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client‐specific factors and rationales prioritized tailored, context‐sensitive and goal‐directed treatment. Conclusions & Implications: This study provided insight into a previously under‐researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post‐TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post‐TBI, from initial assessment to outcome measurement, may help inform clinical decision‐making and the transfer of research to practice. WHAT THIS PAPER ADDS: What is already known on the subject: Spoken discourse impairments occur in dialogic and monologic productions post‐TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision‐making for discourse interventions post‐TBI are limited. What this paper adds to existing knowledge: This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post‐TBI. It details the factors that influence clinical decision‐making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work?: This study identifies the broad and complex considerations required to deliver context‐sensitive discourse intervention post‐TBI. It indicates the need for an in‐depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience. [ABSTRACT FROM AUTHOR]

Background: Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID‐19 restrictions have reduced in‐person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in‐person. Aims: To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls. Methods & Procedures: A total of 20 individuals with TBI and 20 healthy controls, aged 18–55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post‐injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non‐parametric analyses were used to analyse the performance of the two groups. Outcomes & Results: Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures. Conclusions & Implications: Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed. WHAT THIS PAPER ADDS: What is already known on this subject: Although little research has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra‐structural and macro‐linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge: Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive–communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work?: Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech–language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time‐consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic‐induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed. Aims: To survey the impact of COVID‐19 remote working on UK paediatric SLTs' digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM‐B) model. Methods & Procedures: An online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open‐response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM‐B behaviour change model. Outcomes & Results: A total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians' perception of their frequency, convenience and confidence with digital practice during COVID‐19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service‐specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school‐based provisions. Conclusions & Implications: During COVID‐19, paediatric SLTs' recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long‐term digital enhancement of SLT services. WHAT THIS PAPER ADDS: What is already known on the subject: The COVID‐19 pandemic led to an unprecedented interest in the use of technology across SLT practice. Studies are emerging nationally and internationally to identify the digital priorities of the SLT workforce, the areas of digital SLT provision that are thriving or lacking, and the evidence to guide clinical practice and service development. What this study adds to existing knowledge: This is the first UK‐wide COVID‐19 survey solely focusing on the digital practice of paediatric SLTs. The findings provide critical insights into SLT perception of how practice has been impacted in the early stages of the COVID‐19 pandemic, including digital trends that are service, condition and demographic specific. Tools and channels required to support sustained beneficial change are also discussed. What are the potential or actual clinical implications of this work?: This paper demonstrates the potential for digital solutions to enhance SLT practice, as long as implementation is guided by clinicians' experiences and perspectives. The findings lay groundwork for service development work, such as the creation of training packages, updating of clinical guidelines and care pathways, and development of processes to ensure equitable allocation of evidence‐based resources. [ABSTRACT FROM AUTHOR]

Background: Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. Aims: To assess the experiences of amateur singers, their use of warm‐up and cool‐down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. Methods and Procedures: A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm‐up and cool‐down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. Outcome and Results: Most choirs used warm‐up sessions but few used cool‐down. Singers who participated in choir warm‐ups experienced significantly less vocal symptoms. Individual warm‐ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. Conclusions and Implications: Warm‐up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS: What is already known on this subject: Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge: This survey demonstrates that choir warm‐ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work?: We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) describes a group of language‐led dementias. PPAs are complex, diverse and difficult to diagnose, and therefore conventional models of aphasia and dementia treatment do not meet their needs. The research evidence on intervention for PPA is developing, but to date there are only a few case studies exploring the experiences of people with PPA (PwPPA) themselves. Aims: To explore the experiences and opinions of PwPPA and their communication partners (CPs) to understand how speech and language therapy (SLT) services can better meet their needs. Methods & Procedures: A qualitative research approach was used whereby PwPPA and their friends or family members were recruited to participate in focus groups, via advertisements in the Rare Dementia Support PPA group newsletters. Consenting participants were allocated to attend one of four focus groups hosted on an online video conferencing platform. Participants were asked about their communication difficulties, and how SLT could address these needs. All meetings were transcribed, and data were examined using reflexive thematic analysis. Outcomes & Results: Six PwPPA and 14 CPs representing all three PPA variants and mixed PPA participated in the focus groups. Four main themes were identified during the analysis of the focus group discussions: (1) CPs' burden, (2) adjusting to the diagnosis, (3) communication abilities and difficulties and (4) beyond language. A further 10 subthemes were identified. Conclusions & Implications: This study provides a greater understanding of the experiences and needs of PwPPA and their families in relation to SLT. This work underlines the importance of a person‐centred approach that considers the broader needs of both the PwPPA and the people around them. This will enable service providers to deliver SLT that meets the needs of PwPPA and their families and will also inform future research in this field. WHAT THIS PAPER ADDS: What is already known on this subject: We know that PwPPA can maintain or even make improvements in word retrieval and speech fluency with SLT exercises. There is also developing evidence of the benefits of interventions such as CP training, communication aid support and other functional interventions. What this paper adds to existing knowledge: This study provides an understanding of the experiences and opinions of people living with PPA and their families in relation to SLT. Results demonstrate that PwPPA and their families have to navigate a complex journey, identifying strategies to support communication but also the influence of personality and other cognitive symptoms. SLT was useful, but not always available. What are the potential or actual clinical implications of this work?: This study will enable service providers to better plan, justify funding for and delivery of SLT that will meet the needs of PwPPA and their families. Most importantly this work underlines the importance of a person‐centred approach, incorporating the broader needs of the person with PPA and those around them. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Background: Developmental language disorder (DLD) has clear functional ramifications in the areas of social competency, emotion recognition, emotional well‐being and literacy skill, which have been found to persist from childhood to adolescence. These domains are important factors during the transition from primary to secondary school in typical development (TD). Nevertheless, there is a paucity of research on the transition from primary to secondary school for adolescents with DLD and low language (LL) ability. Aims: To investigate the association between psychosocial domains, literacy skill and concerns about school during the transition to secondary school for adolescents with DLD, LL and their TD peers. The first research question examined whether levels of social competency, emotion recognition, emotional well‐being and literacy skill predicted school concern for the three groups. The second research question explored the longitudinal relationship between school concern and psychosocial and literacy indicators over the transition. Methods & Procedures: Participants (aged 10–11 years) with DLD (n = 30), LL ((n = 29) and TD (n = 42) were recruited for this longitudinal study from eight UK primary schools. Standardized language and psychosocial assessments were administered in the spring and summer terms of the final year of primary school, and the autumn and summer terms of the first year in secondary school. Outcomes & Results: Regression analyses showed pre‐transition school concern to be predicted by emotion recognition for the DLD group, by social competence and emotional well‐being for the LL group, and by social competence for the TD group. Post‐transition concern was predicted by emotional well‐being for the LL group; with no significant predictors for the DLD/TD groups. Path analyses revealed an association between literacy skill and emotion recognition for the DLD group. A developmental cascade illustrated a relationship between social competence and emotional well‐being for the TD group. Conclusions & Implications: This study concludes that transition interventions must be differentiated according to language ability; support for DLD adolescents should focus on emotion recognition skill, provision for LL adolescents should centre on emotional well‐being, and TD participants should be particularly supported in the domain of social competence in advance of the move to secondary school. Additionally, this study emphasizes the importance of the inclusion of a LL group, as their outcomes cannot be predicted using DLD/TD research. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research exploring the transition from primary school to secondary for adolescents with DLD or LL ability. Research on TD has highlighted vulnerable domains at this time. As these key areas are evidenced spheres of difficulty in DLD and LL, there was a strong impetus for this study. What this paper adds to existing knowledge: This study reveals differences between language ability groups in the predictors of school concern both pre‐ and post‐transition. Concerns of adolescents with DLD were predicted by emotion recognition, those of adolescents with LL were predicted by emotional well‐being, and a longitudinal link between social competence and emotional well‐being was evidenced for TD adolescents. What are the potential or actual clinical implications of this work?: This study has implications for researchers and clinicians, as a need has been identified for a new clinical group. It also has practical implications for transition support planning for educational practitioners, families and adolescents. [ABSTRACT FROM AUTHOR]

Background: In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop et al., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. Aims: To investigate how UK SLTs' expressive language assessment practices reflect the CATALISE documents' emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non‐standardised sources are combined in clinical decision‐making, and how clinical observation and language sample analysis are utilised. Methods and Procedures: An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK‐based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants' familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. Outcomes and Results: The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Conclusions and Implications: Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment. What This Paper Adds: What is already known on the subject: The CATALISE consortium documents on Developmental Language Disorder (DLD) were published in 2016/17. The extent to which expressive language assessment practice in the United Kingdom reflects the new definition and statements on assessment has not previously been investigated. What this paper adds to existing knowledge: This survey indicates that speech and language therapists in the United Kingdom assessing children for DLD mostly balance standardised language test scores with other sources of information in clinical decision‐making, and utilise clinical observation and language sample analysis to consider functional impairment and the impact of the language disorder. However, important questions are raised regarding the robustness and objectivity with which these key parameters are currently defined and evaluated. What are the potential or actual clinical implications of this work?: Clinicians, individually and at service level, are encouraged to reflect on their assessment of functional impairment and the impact of language disorder and to take steps to incorporate this where necessary. Professional guidance and clinical tools to facilitate robust, objective assessment would support clinical practice that aligns with expert consensus. [ABSTRACT FROM AUTHOR]

Background: Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. Aim: To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. Methods & Procedures: Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi‐structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. Outcomes & Results: Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. Conclusions & Implications: Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision‐making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma. What This Paper Adds: What is already known on the subject: Inconsistency in terminology for paediatric language diagnoses has been broadly discussed, mostly in reference to variation within research literature. The Royal College of Speech and Language Therapists' (RCSLT) position statement on developmental language disorder (DLD) and language disorder made recommendations for SLTs to use these terms in clinical practice. There is some evidence that SLTs face challenges in operationalizing diagnostic criteria in practice, particularly given financial and resource constraints. What this paper adds to existing knowledge: SLTs disclosed several issues that either supported or were obstructive to the practice of diagnosing paediatric clients and delivering this information to families. Whilst most SLTs faced constraints related to the practicalities and demands of clinical practice, a number also held reservations about the impact of a lifelong diagnosis for young clients. These issues resulted in considerable avoidance of formal diagnostic terminology, in favour of description or informal terminology. What are the potential or actual clinical implications of this work?: If diagnoses are not given, or if SLTs are using informal diagnostic terms as an alternative strategy, clients and families may experience reduced opportunities to yield benefits associated with a diagnosis. Clinical guidance that specifically addresses the prioritization of time and provides directives for clinical action in instances of uncertainty may support SLTs to feel confident in giving diagnoses. [ABSTRACT FROM AUTHOR]

Background: Phonetic transcription is recognized in regulatory standards as an essential skill for Speech and Language Therapists (SLTs) in the assessment, diagnosis and management of clients with speech difficulties. Previous research has identified that approaches to phonetic transcription vary, and that SLTs often lack confidence in transcribing. However, SLTs' views and working practices have not been investigated in detail, particularly in terms of whole service approaches and following the recent increase in telehealth. Aims: To investigate SLTs' views about phonetic transcription, their working practices at both individual and service levels, and the factors that influence these. Methods & Procedures: A total of 19 SLTs from the UK were recruited to online focus groups via social media and local networks. Participants discussed their views of, and practices in, phonetic transcription. Themes were identified using reflexive thematic analysis. Outcomes & Results: Three broad themes were generated division and unity; one small part of a big job; and fit for purpose. SLTs were uniformly proud of their ability to phonetically transcribe and viewed this as a unique skill, but clear differences existed between different groups of SLTs in their views and practices. Investing in phonetic transcription was not always a priority for SLTs or services, and although many felt under‐confident in their skills they considered these to be adequate for the populations they usually encounter. SLTs make an early judgement about possible therapy targets, which influences the level of detail used in their phonetic transcription. Practical barriers are often not addressed at service level, and assessment via telehealth poses some specific challenges. Conclusions & Implications: SLTs and services would benefit from increased investment in phonetic transcription in terms of time, opportunities for continuing professional development (CPD) and initiatives such as electronic patient records (EPRs) which support the use of phonetic symbols. Identifying target sounds at an early stage raises questions about the implications of disregarding other features of speech, and the selection of appropriate intervention approaches. Further research is needed to analyse actual rather than reported practices, and to consider the relationship between phonetic transcription and intervention approaches. Future studies could also identify precise CPD requirements and evaluate the effectiveness of CPD. What this paper adds: What is already known on the subject: Previous research has demonstrated that SLTs often lack confidence in phonetic transcription and that practices are varied, with relatively little use of narrow transcription. SLTs are interested in opportunities to maintain and develop transcription skills but do not often undertake CPD for transcription. What this paper adds to existing knowledge: By using focus groups as a forum for discussions, this study provides a rich and detailed insight into SLTs' views about clinical transcription and their working practices, with previously unreported details about the reasons for these practices in a clinical context and at a service‐wide level. What are the potential or actual clinical implications of this work?: Transcription is often de‐prioritized in non‐specialist contexts, with practical barriers and a lack of clear and consistent protocols at a whole‐service level. There is an opportunity for service managers to address the systemic difficulties in using transcription effectively by raising the profile and value of transcription amongst clinicians, and promoting CPD opportunities, using the findings of this study as a rationale for funding this. Together, these recommendations have the potential to improve client outcomes through more accurate assessment and diagnosis, and hence more appropriate intervention. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. Aims: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Methods and Procedures: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID‐19. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes and Results: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%–87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%–89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. Conclusions and Implications: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS: What is already known on the subject: There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds: A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study: Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles. [ABSTRACT FROM AUTHOR]

Background: Oral comprehension difficulties are prevalent in preschool children with language difficulties and are frequently the target of speech and language therapy (SLT) intervention. To support the implementation of research to practice, there is a need to identify effective interventions for this population and to describe their components. To date, reviews of oral comprehension intervention have not used inclusion criteria aligned with common clinical practice, particularly in the United Kingdom. No studies have previously used the Template for Intervention Description and Replication (TIDieR) checklist to describe developmental SLT interventions. Aims: To identify intervention studies effective for oral comprehension in preschool children with language difficulties, using the UK definition of 'preschool' as children under 5 years; to describe the components of these interventions. Method: This followed two phases: (1) an International Prospective Register of Systematic Reviews registered search, which identified 20 systematic reviews; and (2) an exploration of individual studies within these reviews. Seventeen individual studies described effective intervention for children from 1 to 5 years old with language difficulties. Data were extracted from each study against headings from the TIDieR checklist. Findings were analysed and reported using narrative synthesis. Main contribution: A wide variety of rationales, techniques, procedures, settings and intensities were associated with effective intervention. The TIDieR checklist highlighted components that were unreported or under‐described. Conclusions: Studies show that intervention can be effective for improving oral comprehension in preschool children with language difficulties. Analysis of intervention components has relevance to clinical practice and research, and highlights the importance of naturally occurring interactions, cross‐over between oral comprehension and expressive language and the variety in delivery models and dosage. WHAT THIS PAPER ADDS: What is already known on this subject: There is a reported lack of research into interventions developing oral comprehension in children with language difficulties. Intervention checklists such as the Template for Intervention Description and Replication are valuable tools for understanding interventions and supporting the application of research to practice, but none have been used to describe interventions for children with language difficulties. What this study adds: There is evidence that intervention developing oral comprehension in preschool children (using UK definition, those under 5 years) with language difficulties can be effective. Analysing intervention components reveals key points for consideration by clinicians. What are the clinical implications of this work?: Intervention components identified by this study support the implementation of research to practice by highlighting particular areas for consideration by clinicians. For researchers, gaps in reporting demonstrate the need to describe all aspects of intervention to support replication and implementation. [ABSTRACT FROM AUTHOR]

Background: Between 90% and 95% of deaf children are born to hearing parents who often need support with how to adapt their communication. Parent–child interaction (PCI) is an important predictor of deaf children's future language development. It is therefore necessary for professionals to assess parents' strengths and needs to identify areas for intervention. Qualified teachers of the deaf (QToDs), speech and language therapists (SLTs), psychologists, and national deaf child and adolescent mental health (NDCAMHS) professionals regularly support families with deaf children. With no current evidence‐based tool available to assist with the assessment of PCI in deafness, it is important to gather information on current professional practice as this may differ from known practices within research. Aims: To survey the practices of UK‐based professionals in the assessment of PCI where the deaf infant is aged 0–3 years. Professionals were QToDs, SLTs, psychologists or psychiatrists and professionals working at NDCAMHS services. Methods & Procedures: After a pilot phase, an 85‐item survey was distributed electronically through a range of professional and social media networks. Survey items were based on a systematic review of PCI with deaf infants. Survey questions were focused on parent behaviours that were assessed, methods of assessment, goal planning and service provision. Analysis was conducted using descriptive and inferential statistics. Outcomes & Results: A total of 190 professionals from across the UK completed part 1 of the survey; this decreased to 148 in part 4. Respondents were primarily female, hearing, used spoken English and had 16 years or more experience. Results indicate that PCI is routinely assessed by a large proportion of professionals and there is a substantial overlap in which parent behaviours are assessed. Some parent behaviours are assessed that do not feature in the research. Methods of assessment are informal and predominantly consist of observation and note making, with professionals using their own skills and experience to analyse interaction. Goal setting practices were largely similar between professionals, with many jointly deciding goals with parents. Conclusions & Implications: This survey highlights the range of parent behaviours assessed by UK professionals in PCI with deaf children aged 0–3. This survey provides valuable information about and for professionals who assess PCI and set intervention goals with parents. Information from research and professional practice is important to consider in the design of a future PCI assessment. Implications are included for future research in this area. What This Paper Adds: What is already known on this subject: Parental involvement is one of the greatest predictors of deaf children's language outcomes. With many deaf children born to hearing parents, parents often need guidance with how to facilitate effective communication. A recent systematic review identified the range of parent behaviours and methods used to analyse PCI in international research studies, but little evidence or guidance exists on how professionals assess this phenomenon in practice. What this study adds: This is the first survey to generate large, valuable practice‐based evidence for the assessment of parents' communication behaviours as they interact with their deaf infants aged 0–3. The survey recruited a range of multidisciplinary professionals working on interaction within this field: SLTs, qualified teachers of the deaf, psychologists or psychiatrists, and professionals working within deaf child and adolescent mental health services. The study reports on which behaviours these professionals assess and how, and includes information on the goal setting behaviours of practitioners. Most respondents were highly experienced; the survey, therefore, reveals expert practice within the field. What are the potential or actual clinical implications of this work?: We recommend the following practice: (1) incorporate a range of parent‐based behaviours in PCI assessments, including establishing joint engagement and parental sensitivity, as well as communication‐focused behaviours; (2) video record PCI assessments where possible to enable professionals and parents to watch and reflect together; (3) following assessment, set parent‐focused goals in collaboration with families, ensuring parents' skills, particularly their strengths, are considered. All primary caregivers should be included in the process where possible; and (4) reassess PCI regularly (at least termly) to monitor and encourage families' progress. The timing of reviews should be discussed between parent and professional. [ABSTRACT FROM AUTHOR]

Background: Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID‐19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision‐making. Aims: To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision‐making and advance care planning during the COVID‐19 pandemic. Methods & Procedures: This descriptive, cross‐sectional study used an online survey to collect quantitative and qualitative data about SLTs' practice experiences between August and November 2020. SLTs working with a range of adult clinical populations in different care settings were sampled purposively from all UK jurisdictions. Participants were recruited through professional networks and social media. Quantitative data were summarized using descriptive statistics. Qualitative data were analysed thematically. Outcomes & Results: Data were collected from 107 SLTs working in a range of settings across all four UK nations. The sample included SLTs working with people with neurological conditions, learning disabilities, mental health conditions and acute confusion. The need for SLT support appeared to increase during the pandemic. Most respondents were still able to offer support; however, the amount and nature of support varied. Quality of support was impacted by adjustments associated with social distancing and infection control restrictions. Personal protective equipment (PPE) was identified as a barrier to communication. Indirect working methods (e.g., telehealth) were inaccessible to some people with communication disabilities. Most respondents felt confident that legal requirements were upheld, but suggested this group was less able to engage in decision‐making and had reduced access to support to manage their own health conditions. Conclusions & Implications: Some SLT services were limited in their ability to meet the decision‐making support needs of people with communication disabilities during the COVID‐19 pandemic due to structural and systemic barriers. This suggests that existing inequities in the provision of care for people with communication disabilities in the UK were amplified during the pandemic. What this paper adds: What is already known on the subject: People with communication disabilities may require support from healthcare professionals, including SLTs, to make decisions and communicate their wishes and preferences about their care, in line with mental capacity legislation. There is a lack of published evidence relating to how changes in staff deployment and resource during the COVID‐19 pandemic may have impacted on the ability of SLTs to provide this support. What this paper adds to existing knowledge: This study provides novel evidence about the ways in which UK SLTs supported people with communication disabilities to engage in mental capacity assessments, best interests decision‐making and advance care planning during the COVID‐19 pandemic. In some cases, the amount and quality of decision‐making support available was affected negatively due to changes in healthcare delivery and resource management and SLT working practices. What are the potential or actual clinical implications of this work?: This study suggests that some people with communication disabilities experienced greater barriers to receiving professional support to maximize their autonomy and manage their health conditions during the COVID‐19 pandemic. Speech and language therapy services and healthcare commissioners should consider how best to ensure equitable service delivery to this population in resource‐limited situations. [ABSTRACT FROM AUTHOR]

Background: Children with persistent speech disorder (PSD) are at higher risk of difficulties with literacy, with some evidence suggesting an association with poorer educational attainment. However, studies to date have either used small clinical samples, which exclude children who have not been referred to clinical services, or relied on parent–teacher report of children's speech development. There is a need for an inclusive study to investigate the impact of PSD on educational outcomes using a population‐based sample and robust measures of speech development. Aim: Using a large prospective UK population‐based study—the Avon Longitudinal Study of Parents and Children (ALSPAC)—this study investigated: (1) how children identified with PSD at age 8 years perform on educational attainment tests at ages 10–11 and 13–14 years in comparison with children without PSD; and (2) whether children identified with PSD at age 8 years are more likely to receive a label of special educational needs (SEN) in secondary school. Methods & Procedures: We examined the data for 263 children with PSD and 6399 controls who had speech assessed at age 8 years in a research clinic. Educational attainment was measured using data from English school standard attainment tests. Data on SEN categorization were obtained between 11 and 13 years of age. Children with PSD and controls were compared using regression analyses adjusted for biological sex, maternal age, verbal, performance and full‐scale IQ. Outcomes & Results: Children with PSD at age 8 years were more likely to achieve lower attainment scores at ages 10–11 years in English and mathematics and across all three subjects of English, mathematics and science at ages 13–14 years after controlling for biological sex and maternal education; score below target levels for English at both time points after controlling for verbal IQ, and at ages 13–14 years after controlling for performance IQ; and receive a label of SEN (typically for the category of cognition and learning needs or communication and interaction needs) in secondary school. Conclusions & Implications: PSD identified at age 8 years is associated with poor educational attainment at ages 10–11 and 13–14 years in the core subjects of English, mathematics and science. Children with PSD at age 8 years are more likely to be identified with SEN at ages 11–13 years, particularly cognition and learning needs, and communication and interaction needs. We need to be aware of the potential for the long‐term impact of PSD on educational attainment in providing appropriate and effective support throughout school. What this paper addsWhat is already known on the subjectSpeech‐sound disorder is associated with reading and spelling difficulties, with some evidence to suggest that PSD is associated with a higher risk of literacy difficulties. Limited evidence also suggests that speech‐sound disorder may be associated with poorer educational attainment. However, studies to date have used small clinical samples or parent–teacher report of speech development and there is a need to determine whether the association is observed in larger and more inclusive population‐based samples.What this paper adds to existing knowledgeThis prospective, longitudinal study of a large community‐based sample of English children has shown that PSD is associated with poorer educational attainment at the end of primary school and at ages 13–14 years. Children with PSD are also more likely to be identified as having SEN in secondary school, especially communication and interaction needs but also including cognition and learning needs.What are the potential or actual clinical implications of this work?Understanding the long‐term implications of PSD on educational attainment highlights the importance of ongoing monitoring and support to enable children to reach their potential throughout primary and secondary school. The identification of children with a history of PSD during transition to secondary school will enable effective support to be put in place. The intervention for children with PSD should involve close collaboration between speech and language therapists and education professionals. [ABSTRACT FROM AUTHOR]

Background: Treatment fidelity refers to the degree to which an intervention is implemented as intended. Promoting treatment fidelity is important to achieve a valid comparison in intervention research. However, it is often underreported: few studies detail the use and development of fidelity measures. This study aims to promote the treatment fidelity of a modified version of the Derbyshire Language Scheme (M‐DLS), a manualised intervention for children with language difficulties, by exploring participants' opinions on training and intervention delivery. Results inform development of a checklist and scoring system to monitor and promote treatment fidelity in a comparison trial. Method: Ten student speech and language therapists (SLTs) and two research assistants (RAs) participated in the study. All received training on the M‐DLS, and 10 were video‐recorded completing role‐plays of an M‐DLS session in small groups. Feedback was gathered after training and role‐plays in focus groups and interviews. Feedback was interpreted using the constructs of the Theoretical Domains Framework (TDF). A treatment fidelity checklist was then developed using the feedback. The first author and two RAs rated role‐play videos using the checklist to trial it to inform amendments and to promote interrater reliability. Interrater agreement was calculated using Spearman's test of correlation. Results: Participants discussed the importance of having clear materials and time to practise sessions. They suggested amendments to the materials and training to promote treatment fidelity. The checklist and scoring system accounted for participants' suggestions, with amendments detailed in a log. Spearman's correlation results suggested agreement between the raters was strong. Conclusions: Results emphasise the importance of training quality, practice and reflective opportunities and clear materials to promote treatment fidelity. The construction of the checklist and scoring system was described in detail, informing the development of future checklists. After further trialling, the checklist can be used to ensure the M‐DLS is delivered with high treatment fidelity in the comparison trial. What this paper adds: What is already known on this subject: Treatment fidelity is an essential component of intervention effectiveness and efficacy studies, ensuring the intervention is delivered as intended. It is also an essential component of evidence-based clinical practice. However, few research studies report the treatment fidelity process or publish the checklists used, depriving clinicians of useful information for implementation. What this study adds: This study describes in detail the iterative process of treatment fidelity checklist development, engaging those implementing the intervention in development. This ensured clarity and interrater reliability of the checklist. Furthermore, a novel scoring system was developed so that accuracy of implementation can be easily compared across users and across practice attempts. What are the clinical implications of this work?: The importance of treatment fidelity when implementing effective and efficacious interventions cannot be overstated. The treatment fidelity checklist developed for research can be easily adopted to support accurate implementation in clinical practice through an audit process. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapy (SLT) education must meet the needs of the future workforce, training enough students who are competent practitioners able to meet the workforce demands. Increasing student numbers and the impact on placement providers mean students must be equipped for learning on placement. Simulation is a way of supporting students to develop their clinical skills and decision‐making in a safe, supportive environment. Aims: To explore the perspectives of SLT students who were introduced to simulation during their undergraduate degree at a UK university as part of a pilot study. The aim of the pilot was to listen to the students' voices to begin to understand their lived experiences of simulation and to gather views on how simulation can support their clinical learning. Methods & Procedures: Focus groups and semi‐structured interviews were carried out with second‐year BSc SLT students in semester 2 following the simulated learning activities and clinical placement. Qualitative data were gathered and thematic analysis was applied to the data to identify the barriers and enablers to students' clinical learning in simulation. Outcomes & Results: A total of 11 students responded out of a cohort of 38. Three key themes were identified from the analysis: individual learning needs, facilitator skill and programme‐level organization. Conclusions & Implications: Student experience of simulation was positive. One of the key elements students found to support their clinical skills was the importance of the safe space; support for learning instead of correction led them to engage in active learning. Key barriers to simulation related to having sufficient prior knowledge, the skills of the facilitator, group size and the wider learning landscape of the programme. In response to this pilot, there are plans to continue developing this model of simulation and embed simulation across the programme, led by a sound pedagogical approach with clear preparation and planning and building the necessary infrastructure. Other SLT programmes and practice educators developing simulation as part of their programmes or placement may wish to consider some of these findings to support the use of simulation in their workplace. What this paper adds: What is already known on this subject: Simulation as a teaching methodology is widely used in medicine and nursing programmes. It is now used in various allied health professions and in some SLT programmes. There is evidence to suggest simulation increases student confidence and clinical skills without increasing the capacity on those offering clinical placements in practice. What is already known on this subject: This study offers a practical example of introducing simulation in an established undergraduate programme for SLT students. It explains the background to this innovative way of teaching clinical skills and explains why this approach could be beneficial for the future speech and language therapist. What are the clinical implications of this work?: This study gives practical examples of how simulation can work to facilitate student clinical learning and knowledge. It may offer ideas to those working in clinical practice to organize placements differently or add simulation elements to improve the student experience. Other educational establishments and placement educators may find the recommendations helpful in developing their own simulation approach. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

Background: At least 25% of autistic children worldwide have the potential to grow up in a bilingual environment. However, many autistic children are being denied opportunities to access additional languages and the cultural, familial and community connections that come with this. There is little evidence identifying the barriers to language learning and access, and no research addressing the perspectives of speech and language therapists (SLTs), who are crucial in supporting parents to make informed choices about bilingualism with their child. Aims: The aim of this research was to understand the experiences of SLTs working with autistic bilingual children, to understand the main considerations when working with families, and the opportunities and barriers for training, including the sources of information that current practice is based on. Methods and Procedures: Twelve SLTs from across the United Kingdom were recruited for this study. All participants were experienced in working with autistic bilingual children and their families (M = 7 years, range 4–23 years). Semi‐structured interviews were conducted and focused on the experiences of SLTs regarding familial bilingual experiences, the effect of sociocultural factors of practice, and the extent to which practice is based on current research. Outcomes and Results: Data were analysed using reflexive thematic analysis. Three central themes were identified from the interviews: (1) participants discussed parental uncertainties as to whether they were doing the right thing for their child, (2) while participants were in support of bilingualism, they were not always confident that they were providing the right advice and found it difficult to in keep up to date with relevant, evidence‐based research, and (3) participants highlighted a need to shift towards a more inclusive and culturally diverse practice. Conclusions and Implications: This is the first qualitative study to understand the perspectives of SLTs working with autistic bilingual children. We identify several key difficulties in supporting access to language learning, and these findings have immediate and longer‐term implications for supporting SLTs, and in turn, the children and families they support. WHAT THIS PAPER ADDS: What is already known on the subject: Research suggests that autistic children currently have fewer opportunities to maintain bilingualism compared to neurotypical peers. Despite the lack of evidence, many families remain concerned that bilingualism will have a negative impact on their child's development. To date, little is known about the perspectives of speech and language therapists (SLTs) who play a significant role in supporting the development of autistic bilingual children. This is the first study to provide an in‐depth qualitative analysis of the experiences of SLTs working with autistic bilingual children and their families in the United Kingdom. What this study adds: The results highlight a number of reoccurring barriers in providing optimal support: first, frequently cited concerns about bilingualism from parents that link to a lack of understanding about autism and the role of SLTs more generally. Second, SLTs do not have confidence in the assessments and tools available and described a lack of emphasis on cultural factors in practice. Many SLTs were concerned about the limited options for resources and interventions available in other languages, which could be challenging for parents who were less proficient or confident communicating in English. Third, SLTs reported having limited opportunities to keep up to date with relevant research to support their decision‐making processes. What are the clinical implications of this work?: These results have several important implications for practice—they highlight the need for more inclusive practices where possible, a need for more diversity within the profession and further opportunities to be provided with evidence‐based advice around good practice. The results also suggest a benefit of providing accessible, evidence‐based resources for parents about autism and bilingualism, to ensure that research key findings are reaching families. [ABSTRACT FROM AUTHOR]

Background: Research evidence suggests aphasia therapy must be delivered at high intensity to effect change. Comprehensive therapy, addressing all domains of the International Classification of Functioning, Disability and Health, is also called for by people with aphasia and their families. However, aphasia therapy is rarely intense or comprehensive. Intensive Comprehensive Aphasia Programmes (ICAPs) were designed to address this challenge, but such programmes are not widely implemented. Aims: This study surveyed the views of UK‐based speech and language therapists (SLTs) regarding intensive and comprehensive aphasia therapy. It explored definitions of intensive and comprehensive therapy, patterns of provision, views about candidacy and barriers/facilitators. It also investigated awareness of ICAPs and perceived potential of this service model. Differences across UK regions and workplace settings were explored. Methods & Procedures: An e‐survey ran for 5 months. Quantitative data were analysed using descriptive and inferential statistics. Qualitative free text comments were analysed using content analysis. Outcomes & Results: Two hundred twenty‐seven respondents engaged in the e‐survey. Definitions of intensive aphasia therapy did not reach UK clinical guideline/research‐level thresholds for most of the sample. Those providing more therapy provided definitions with higher standards of intensity. Mean therapy delivered was 128 min/week. Geographical location and workplace setting influenced the amount of therapy delivered. The most frequently delivered therapy approaches were functional language therapy and impairment‐based therapy. Cognitive disability and fatigue were concerns for therapy candidacy. Barriers included lack of resources and low levels of optimism that issues could be solved. 50% of respondents were aware of ICAPs and 15 had been involved in ICAP provision. Only 16.5% felt their service could be reconfigured to deliver an ICAP. Conclusions & Implications: This e‐survey evidences a mismatch between an SLT's concept of intensity and that espoused by clinical guidelines/research. Geographical variations in intensity are concerning. Although a wide range of therapy approaches are offered, certain aphasia therapies are delivered more frequently. Awareness of ICAPs was relatively high, but few respondents had experience of this model or felt it could be executed in their context. Further initiatives are needed if services are to move from a low‐dose or non‐comprehensive model of delivery. Such initiatives might include but not be confined to wider uptake of ICAPs. Pragmatic research might also explore which treatments are efficacious with a low‐dose model of delivery, given that this model is dominant in the United Kingdom. These clinical and research implications are raised in the discussion. What this paper adds: What is already known on this subject: There is a gap between the high intensity of aphasia treatment provided in research versus mainstream clinical settings. A lower standard of 45 min/day set by UK clinical guidelines is also not achieved. Although speech and language therapists (SLTs) provide a wide range of therapies, they typically focus on impairment‐based approaches. What this study adds: This is the first survey of UK SLTs asking about their concept of intensity in aphasia therapy and what types of aphasia therapy they provide. It explores geographical and workplace variations and barriers and facilitators to aphasia therapy provision. It investigates Intensive Comprehensive Aphasia Programmes (ICAPs) in a UK context. What are the clinical implications of this work?: There are barriers to the provision of intensive and comprehensive therapy in the United Kingdom and reservations about the feasibility of ICAPs in a mainstream UK context. However, there are also facilitators to aphasia therapy provision and evidence that a small proportion of UK SLTs are providing intensive/comprehensive aphasia therapy). Dissemination of good practice is necessary and suggestions for increasing intensity of service provision are listed in the discussion. [ABSTRACT FROM AUTHOR]

Background: There is very little awareness of the speech, language and communication needs (SLCN) of rough sleepers. The small amount of documentation that does exist involves a wider group of homeless adults (not just rough sleepers), and reports that communication needs are an area of concern. Aims: To investigate: (1) the reported prevalence of SLCN amongst UK nationals recorded on the Combined Homeless and Information Network (CHAIN) as sleeping on the streets of London; (2) whether rough sleepers with reported SLCN differ from those without; and (3) what factors best predict patterns of rough sleeping and accommodation stays. Methods & Procedures: A data set of 513 participants was provided by CHAIN, which contained information relating to all new rough sleepers and people with long‐term histories of rough sleeping (UK nationals only) recorded by street outreach teams in London between 1 April and 30 June 2013. Also included was data about UK nationals provided with support by the Homelessness and Brain Injury Project. The data set contained information including basic demographics, communication skills, health and social care needs, and institutional background and extended to a 5‐year period. Outcomes & Results: (1) SLCN data were often not recorded with data available for only 62% of individuals on the CHAIN databases. However, for those with SLCN data, the prevalence of SLCN was significantly higher than for the general population (17.1%; p < 0.001). (2) There were no significant differences between those with and without SLCN on additional risk factors, quarters rough sleeping, accommodation stays or staff‐recorded alerts. (3) There was a positive correlation between rough sleeping and additional risk factors for those with SLCN (r = 0.32, p < 0.001) and for those without (r = 0.25, p < 0.001). Regression analysis indicated that additional risk factors were more predictive than SLCN in explaining the number of quarters rough sleeping and accommodation stays. Conclusions & Implications: SLCN are highly prevalent amongst rough sleepers and significantly greater than for the UK general population. SLCN are not clearly related to rough sleeping behaviour, but the presence of additional risk factors is highly significant in this regard. Homelessness organizations should provide training for staff in SLCN in order to promote better recording of SLCN, inclusive communication and appropriate support to people who are homeless. Further research is also needed to understand better the communication needs of rough sleepers. What this study addsWhat is already known on the subjectThere is very little literature concerning the SLCN of rough sleepers, but that which exists suggests that communication needs are an area of concern. There is relatively little awareness of SLCN in practice in this field.What this paper adds to existing knowledgeThis study is the first to provide information on SLCN recording in this population. It reports large‐scale prevalence data on SLCN in rough sleepers, showing a significantly higher risk in this group. Unexpectedly, SLCN did not clearly relate to patterns of rough sleeping and accommodation, but this may be due to the relatively crude data available in routine practice.What are the potential or actual clinical implications of this work?Wider awareness and training on SLCN in the homelessness sector is needed coupled with more systematic and objective assessment of communication in rough sleepers. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well‐being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia‐related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims: To establish the current practices of SLTs managing dementia‐related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & Procedures: An anonymous, cross‐sectional web‐based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open‐ended questions were analysed using conventional content analysis. Outcomes & Results: A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self‐rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & Implications: The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well‐being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper addsWhat is already known on the subjectResearch indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice.What this paper adds to existing knowledgeThis paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints.What are the potential or actual clinical implications of this work?These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia‐related dysphagia and mealtime difficulties effectively. [ABSTRACT FROM AUTHOR]

Background: Whilst research into the wide‐ranging needs of family members following traumatic brain injury (TBI) is well established, investigation into the specific needs of families in relation to supporting cognitive–communication difficulties, relationships and social participation is limited. Aims: To identify the family needs for cognitive‐communication difficulties following TBI and to explore whether current services are meeting these needs. Methods & Procedures: Following a successful pilot, family members from the UK and Australia were invited via posters, social media and e‐mail to take part in an anonymous, communication needs survey. Data arising from the thirty two closed questions (six eligibility, nine demographic and seventeen needs questions) were analysed using SPSS descriptive statistics. Data arising from one open question were analysed using qualitative content analysis. Outcomes & Results: A total of 102 family members from the UK (n = 89, 87%) and Australia (n = 13, 13%) completed the survey. The majority of respondents were female (n = 76; 75%), between the ages of 30 and 69 (n = 88; 87%), and either a parent or a partner of the person following TBI (n = 78;76%). Respondents rated information about expected recovery from cognitive‐communication difficulties and training in helpful strategies as their most important needs. The majority of respondents (more than 60%) were not satisfied that any of their cognitive–communication needs had been fully met and high levels of unmet need remained evident at three years or more post‐injury. Written information, communication partner training and counselling were identified as key supports. Conclusions & Implications: Families report high levels of unmet need for managing cognitive‐communication difficulties following TBI. Access to written information and communication partner training should be available to families at various time points following TBI and not just in the early stages. What this paper addsWhat is already known on this subjectAttempting to support a person who has cognitive‐communication difficulties following TBI has been found to be highly burdensome for family members. However, few studies have asked how families perceive their needs in relation to cognitive‐communication difficulties or measured how well current services are meeting their needs.What this paper adds to existing knowledgeThis study demonstrates that current speech and language therapy services are not yet meeting the needs of the relatives of individuals with cognitive‐communication difficulties following TBI. Important insights into the information, training and support families' rate as important are identified in addition to how these needs develop over time.What are the potential or actual clinical implications of this work?Speech and language therapy service design requires to reflect the ongoing nature of familial needs for cognitive‐communication difficulties following TBI. Families require access to appropriate literature, speech and language therapy support, and communication partner training in the longer term, not just in the acute phase. [ABSTRACT FROM AUTHOR]

Background: Autistic people require varying levels of support at different stages of their lives. Yet, the healthcare needs of autistic adults are largely unmet. Speech and language therapy (SLT) is one healthcare service that has an important role in supporting autistic people: both with initial diagnosis, and with the ongoing support needed to navigate different communicative challenges across the lifespan. Despite recommendations for such support, currently there is no clear SLT pathway for autistic adults, and a lack of established approaches to support autistic adults' speech, language and communication needs. Aims: To seek autistic adults' views on (1) their communication skills and support needs; (2) the type of support SLT could offer; and (3) how such support could be provided. Methods & Procedures: A total of 18 autistic adults were interviewed in their preferred mode of communication (e.g., face to face, phone call, text messaging, e‐mail), expressing their views on their communication skills and needs. Interview data were analysed using thematic analysis. Outcomes & Results: Autistic adults presented complex views on communication, identifying the benefits of communication, while also emphasizing the significant negative impact that communication difficulties can have on their everyday lives. Identifying a range of internal (e.g., personal feelings) and external (e.g., the communication partner) factors, they highlighted the need for support at both individual levels (for specific life situations) and broader societal levels (to increase awareness and acceptance of communication difficulties). Conclusions & Implications: Considering the negative impact that communication difficulties can have for autistic adults, a need for support was emphasized. Despite recognition of this need within current legislation (in the UK) and positive steps toward providing support, more needs to be done. As experts in supporting individuals with communication difficulties, speech and language therapists could play a pivotal role in providing support at an individual level, as well as increasing awareness of communication differences more widely. What this paper addsWhat is already known on this subjectThere is a growing population of autistic adults with unmet support needs. A core characteristic of autism is difficulty with neurotypical social communication and interaction, which persists into adulthood and impacts across various life domains.What this paper adds to existing knowledgeAutistic adults outlined the types of communication difficulties they experience, and how these can negatively impact on physical and mental health. Results highlight how these difficulties are not just rooted within the person themselves but can be influenced by external factors (e.g., the environment and the communication partner).What are the potential or actual clinical implications of this work?Some autistic adults may benefit from direct support from SLT services. However, increased awareness and respect for communication differences at a broader societal level is also needed. Speech and language therapists can play an important role in increasing this level of awareness, positively highlighting differences in communication and ways to support people with communication difficulties/differences. [ABSTRACT FROM AUTHOR]

Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]

Background: Discourse assessment and treatment in aphasia rehabilitation is a priority focus for a range of stakeholder groups. However, a significant majority of speech and language therapists (SLTs) infrequently conduct discourse analysis, and do not feel competent in doing so. Known barriers identified in other countries, specifically a lack of time, training, expertise and resources, affect use of discourse analysis in clinical practice. Aims: To investigate UK SLTs' reported practices and views of discourse analysis, barriers and facilitators, and clinical feasibility in aphasia rehabilitation. Methods & Procedures: An online survey of 52 questions adapted from existing research and incorporating behaviour change literature was created for the study and piloted. UK SLTs working in aphasia rehabilitation for at least 6 months were invited to participate. Potential participants were contacted through national and local clinical excellence networks, a National Health Service (NHS) bespoke e‐mail list, and national magazine advertisement, and the study was also advertised on social media (Twitter). Therapists read an online participant information sheet and submitted individual electronic consent online; then progressed to the Qualtrics survey. Descriptive, correlational and inferential statistical analyses were conducted, and content analysis was carried out on the questions requiring text. Outcomes & Results: A total of 211 valid responses were received from primarily female SLTs, aged 20–40 years, working full‐time in the NHS in England, in community, inpatient and acute/subacute multidisciplinary settings. A total of 30% SLTs collected discourse analysis often, were mostly very experienced, and working part‐time in community settings. Years of experience was predictive of use. Discourse was most often collected using standardized picture descriptions and recounts during initial assessment. Samples were infrequently recorded, and typically transcribed in real‐time. Most SLTs (53–95%) reported making clinical judgements or manually counted words, sentences, communication of ideas and errors, and were confident in doing so. Barriers included time constraints; lack of expertise, confidence, training, resources and equipment; and patient severity. Discourse 'super‐users' were distinguished by significantly higher professional motivation for discourse and workplace opportunity than other SLTs, and 'non‐users' were distinguished by significantly less knowledge and skills in discourse analysis than other SLTs. SLTs reported a desire and need for training, new/assistive tools and time to do more discourse analysis in practice. Conclusions & Implications: Clinicians were highly engaged and relatively active in at least some aspects of discourse analysis practice. Interventions that target individual clinicians as well as organizations and systems are needed to improve the uptake of discourse analysis in practice. What this paper addsWhat is already known on the subject?Discourse in aphasia rehabilitation is a priority in clinical practice and research. However, the majority of clinicians infrequently collect and analyse discourse. Research in Australia and the United States indicated that lack of time, assessment resources and relevant knowledge and skills are the main barriers to use.What this paper adds to existing knowledgeCompared with existing research, UK SLTs were more likely to see discourse analysis as part of their role and experienced fewer barriers, and more SLTs did it at least sometimes in clinic. However, practices were limited by lack of training, giving rise to challenges in selecting and interpreting findings for clients. More use was predicted by more experience and commitment to discourse analysis, particularly where workplaces supported this approach. Less use was associated with less knowledge and skills in discourse analysis. Practice and decision‐making were influenced by client factors and constrained to a lesser degree by logistical challenges.What are the potential or actual clinical implications of this study?Education and training in discourse analyses and in specific procedures are needed to improve individual clinicians' knowledge, skills and confidence in using discourse analysis for clients' rehabilitation. Equally, organizational and systems changes are needed to promote, support and reinforce discourse analysis in the workplace. [ABSTRACT FROM AUTHOR]

Background: Silent aspiration (SA) is common post‐stroke and associated with increased risk of pneumonia, length of stay and healthcare costs. Clinical swallow examinations (CSEs) are unreliable measures of SA. There is no consensus on the clinical components that best detect SA. Cough reflex testing (CRT) is an alternative/adjunct whose SA detection accuracy also lacks consensus. Aims: To investigate the feasibility of CSE versus CRT against gold standard flexible endoscopic evaluation of swallowing (FEES) for SA identification and to estimate its prevalence in a hyperacute stroke setting. Methods & Procedures: A single‐arm preliminary, prospective, feasibility study of patients less than 72 h post‐stroke, over a 31‐day period on a hyperacute stroke unit: the Royal Victoria Infirmary, Newcastle‐upon‐Tyne, UK. Ethical approval for the study was obtained. The study tested the feasibility and acceptability of introducing CRT and developing a standardized CSE. Consent/assent was obtained for all participants. Patients unfit for study were excluded. Outcomes & Results: A total of 62% of patients less than 72 h post‐stroke (n = 61) were eligible. A total of 75% of those approached (n = 30) consented. A total of 23 patients completed all tests. The principal barrier was anxiety regarding FEES. Mean test time for CRT = 6 min; CSE = 8 min; FEES = 17 min. Patients rated CRT and FEES on average as moderately uncomfortable. A total of 30% (n = 7) of participants who received FEES presented with SA. Conclusions & Implications: CRT, CSE and FEES are feasible in 58% of hyperacute stroke patients in this setting. FEES anxiety is the main recruitment barrier and is not always well tolerated. Results support further work to establish optimum methods and differential sensitivity/specificity of CRT and CSE in hyperacute stroke for SA identification. WHAT THIS PAPER ADDS: What is already known on this subject: SA significantly increases the risk of pneumonia in the early days post‐stroke. CSEs are unreliable for identification of SA risk in this population. CRT is gaining popularity as a potential tool to identify stroke patients at risk of SA, though there are questions regarding the efficacy of the clinical protocol currently being used in the UK. What this study adds to existing knowledge: This study demonstrates that it is practical and feasible to carry out a larger scale study in this setting to compare CSE and CRT including a consideration of an approach combining both methods for clinical identification of SA versus FEES. Preliminary findings suggest that CSE may have higher levels of sensitivity than CRT for SA identification. What are the potential or actual clinical implications of this work?: The results of this study suggest that further work is needed to establish the optimum methods and differential sensitivity/specificity of clinical tools for SA detection in hyperacute stroke. [ABSTRACT FROM AUTHOR]

Background: After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. Aims: (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. Methods & Procedures: A self‐administered 10‐min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post‐registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. Outcomes & Results: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. Conclusions & Implications: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under‐resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring‐fenced for therapy are available for tracheoesophageal speakers to receive the support they require. WHAT THIS PAPER ADDS: What is already known on this subject: Total laryngectomy results in life‐altering changes to communication. Clinical guidelines advocate for speech and language therapy intervention; however, there is no clear information on what SLTs should do to optimize tracheoesophageal voice and the evidence base to support practice is lacking. What this study adds to existing knowledge: This survey identifies what interventions SLTs provide in clinical practice to rehabilitate tracheoesophageal voice; and it explores the barriers and facilitators that influence the provision of tracheoesophageal voice therapy. What are the potential or actual clinical implications of this work?: Specific training, clinical guidelines, increased research and audit are required to support clinical practice in laryngectomy rehabilitation. Service planning should address the under‐resourcing of staff, expert practitioners and therapy allocated time. [ABSTRACT FROM AUTHOR]

Background: Silent aspiration (SA)—airway entry of food, drink or other material without a cough response—is common post‐stroke. Clinical swallowing examination misses up to 40% of dysphagic patients with SA. This may put these patients at risk of aspiration pneumonia, prolonged length of hospital stay and increased healthcare costs. After stroke, the laryngeal cough reflex is frequently impaired with significant relationships between pneumonia rates and reduced cough strength and sensitivity. There has been a significant amount of recent interest in cough reflex testing (CRT) as a potential means to improve clinical identification of patients at risk of SA. However, there is a lack of consensus regarding the methodology and protocols for use of CRT with widely varying outcomes reported in the literature. Aims: To provide an overview of current practice in the UK with regards to clinical use of CRT by speech and language therapists (SLTs) in acute stroke settings and to explore the perceptions regarding its potential application in clinical dysphagia management and the barriers and facilitators associated with adopting CRT in clinical practice. Methods & Procedures: A cross‐sectional web‐based survey was developed, piloted and delivered. The survey targeted all UK‐based SLTs working in acute stroke settings. Outcomes & Results: A total of 129 SLTs with varying levels of experience of CRT from all regions of the UK responded. Only four SLT services in the UK were reported to be currently using CRT clinically with acute stroke patients. A total of 29% of respondents who were not using CRT were considering introducing CRT into their service's dysphagia protocol. Variation was reported in the procedures and protocols. Overall, users reported improved confidence in the clinical detection of SA and felt that the introduction of CRT had improved their patient‐related outcomes. Issues included difficulties procuring citric acid, implications for SLT time (including service set‐up and delivery of CRT) and restricted access to instrumental assessments. Conclusions & Implications: This survey gives valuable insight into the current practice and perceptions of SLTs in the UK working in acute stroke settings in relation to CRT. It highlights discrepancies between reported approaches and recommendations from existing guidelines and validation studies. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. What this study addsWhat is already known on the subjectCRT is gaining popularity as a screening tool for the clinical identification of SA with acute stroke patients. However, there is a lack of consensus in the literature regarding the methodology and protocols with widely varying outcomes. Further work needs to be done to standardize its use, especially if it is to be incorporated into dysphagia protocols for use in the acute stroke setting.What this paper adds to existing knowledgeThis survey of SLTs working in acute stroke settings highlights variability in practice in CRT service delivery in the UK, reflecting findings from the existing CRT literature.What are the potential or actual clinical implications of this work?The findings of this study support the need for further research relating to clinical screening tests for SA and standardization of methodology and protocols for CRT use if its use is to be continued clinically. [ABSTRACT FROM AUTHOR]

Background: The Royal College of Speech and Language Therapists (RCSLT) celebrates its 75th anniversary in 2020. The historical study of speech and language therapy (SLT) has been very limited. A small number of publications have traced the changes in the profession over time, but to date there has been no comprehensive work undertaken to gain an insight into the experiences of UK speech therapists who entered the newly formed profession after 1945. Aims: To use an oral history methodology to explore the life stories of early members of the profession. Methods & Procedures: Participants were recruited through RCSLT networks. Interviews were held across England and Scotland. Conversations were audio recorded and analysed using thematic network analysis. Archive material was used to complement participants' narratives. Outcomes & Results: Participants were 19 women who qualified between 1945 and 1968. Three global themes emerged: personal, professional and political stories. On a personal level, each reported steps towards autonomy and agency within the social constraints they experienced. Professionally, all commented on the vast expansion in the range of identifiable clinical fields between 1945, when the first participant qualified, and 2008, when the last participant retired. Politics and social policies impacted upon their lives and, sometimes to their surprise, the participants found themselves campaigning politically in pursuit of fairness for their profession. Conclusions & Implications: This paper offers a unique insight into the challenges and achievements participants experienced over their careers as early practitioners in the UK profession. [ABSTRACT FROM AUTHOR]

Abstract: Background: The critical role of phonetic transcription in the assessment, diagnosis and management of speech disorders is well established and thus pre‐registration degrees dedicate numerous hours to phonetic training. However, this training is not always fully used in clinical work and clinicians may find it difficult to maintain their skills, suggesting a ‘theory/practice gap’. Aims: This paper surveys speech and language therapists’ (SLTs) views of their training, practice and maintenance of transcription in order to investigate the posited theory/practice gap and to explore how education in phonetics is translated into practice. Methods & Procedures: A total of 759 SLTs from the UK were surveyed via an online questionnaire. Multiple‐choice questions were analysed using descriptive statistics, and free‐text comments were analysed thematically. Outcomes & Results: Thirty‐five per cent of SLTs found learning phonetics quite easy, and 30% quite difficult. Respondents suggested that more time was needed to practise transcription in and out of the classroom; nevertheless, the majority felt at least equipped to undertake transcription after their training. A total of 75% of SLTs require transcription for their role, with 61% using it often or all the time. Some 45% use a mix of broad and narrow transcription, with 41% using only broad transcription. Those not using narrow transcription attributed this to lack of confidence. A total of 57% of SLTs did not feel supported to maintain transcription skills in the workplace, and 80% had never attended a refresher course in transcription, with 75% wishing to do so. Conclusions & Implications: As many clinicians found it difficult to learn transcription, there is an opportunity to provide more transcription practice both in and beyond the classroom. Despite most clinicians feeling equipped to undertake transcription upon completion of their training, and a large majority requiring transcription for their role, a theory/practice gap is apparent in the relatively small number of clinicians using narrow transcription exclusively, and those not using it expressing lack of confidence in their skills. Additionally, as many clinicians have never attended refresher training in transcription, and rely on their course notes to maintain their skills, more provision of opportunities for revision should be made available. With clinicians remembering a need for more practice during their training, and expressing a desire for more training opportunities in practice, there is an opportunity for clinicians, educators and regulatory bodies to work together to provide packages of transcription training material that can be used by students and practitioners to maintain and extend their skills. [ABSTRACT FROM AUTHOR]

Background: People with a total laryngectomy (PTL) rely on a permanent opening in their neck (stoma) to breathe. This altered anatomy may increase susceptibility to contracting and transmitting SARS-CoV-2. Aims: To report on (1) the frequency and characteristics of PTL who tested positive for COVID-19, (2) the receipt of advice regarding shielding and patient selfreports of shielding, (3) hospital admissions and length of stay, and (4) mortality rates in this group during the first UK national lockdown. Methods & Procedures: This is a cross-sectional survey and case note review. National Health Service (NHS) centres providing care to PTL were invited to participate via the Royal College of Speech and Language Therapists' (RCSLT) Head & Neck Clinical Excellence Networks and through socialmedia. PTL were reviewed by their speech and language therapist either in person or via telehealth between 30 March and 30 September 2020. Data were collected within the time frame covered by the Control of Patient Information (COPI) notice issued for COVID-19 and included information on COVID-19 testing, shielding, hospital admissions, length of stay and deaths. Information was submitted to the lead NHS site using a custom designed data-capture worksheet. Analysis was performed using descriptive statistics, including proportions and frequency counts. Pearson's Chi squared tests were used to compare categorical data using a 5% significance level. Outcomes & Results: Data were obtained from 1216 PTL from26 centres across the UK.Atotal of 81%were male;mean agewas 70 years (28-97 years). Of the total group, 12% received a COVID-19 test. A total of 24 (2% of total sample) tested positive for COVID-19. Almost one-third of PTL (32%) received a government letter or were advised to shield by a healthcare professional. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1-133 days), interquartile range (IQR) = 17 days. A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days, IQR = 49 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19. Conclusions & Implications: This study highlighted the lack of routine national data for neck-breathers with which to compare the current findings. Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation. [ABSTRACT FROM AUTHOR]

Background The Dysarthria-in-Interaction Profile's potential contribution to the clinical assessment of dysarthria-in-conversation has been outlined in the literature, but its consistency of use across different users has yet to be reported. Aims To establish the level of consistency across raters on four different interaction categories. That is, how reliable clinicians are when rating a series of videos. A secondary aim was to investigate the relationship between raters' estimates of dysarthric speech intelligibility and their rating of each dyad's overall interaction. Methods & Procedures Ten UK speech and language therapists rated independently a series of 40 video samples featuring people with progressive dysarthria in conversation with family members. An equal number of video samples was selected from a collection of recordings featuring four different types of interactional relationship. Outcomes & Results The results show that practising speech and language therapists can rate consistently, and with a high degree of agreement, a series of everyday conversation videos featuring dyads with progressive dysarthria and presenting at different interaction levels. The results also indicate that speech intelligibility does not predict the level of impairment in the interaction in a systematic way suggesting that conversation contains elements that are not directly related to speech intelligibility. Conclusions & Implications Further work is required to establish the clinical functionality of this tool, but the results presented here support the development of this conversation profiling system, particularly for people experiencing significant intelligibility problems but remaining highly interactive/communicative. [ABSTRACT FROM AUTHOR]

Background: In the UK, there is increasing pressure on ear, nose and throat (ENT) clinicians and departments, which is anticipated to amplify in the coming months and years due to the coronavirus disease 2019 pandemic and other workforce pressures. In the context of a national drive to advance practice of Allied Health Professionals to address some key challenges facing the National Health Service, we explored whether UK speech and language therapists (SLTs) felt it is possible to utilize and extend their existing skills to patients on the urgent 2-week wait (2ww) ENT pathway. Aims: To explore SLTs' views of extending their role to work with patients referred on the ENT 2ww pathway. Methods&Procedures: Two separate focus groupswere conducted using nominal group technique to generate and rank benefits and challenges of the proposed extension of role. Participants were invited to take part through Clinical Excellence Networks relevant to head and neck cancer and voice sub-specialties. Participants were competent in performing nasendscopy in at least a highly specialist role in voice or head and neck subspecialties. Outcomes & Results: Nine SLTs from England, Wales and Northern Ireland attended two focus groups. All were employed in band 8 roles in head and neck and/or voice. Eight were competent to Royal College of Speech and Language Therapists' scoping level 3. Important benefits of the proposed novel service delivery model were generated and ranked by participants, with both groups identifying improved quality and efficiency of service for patients among the most important. Disadvantages were then generated and ranked across the two groups with potential for misdiagnosis ranked as the most important by both. Conclusions & Implications: Participants responded that extending the SLT role into assessment of 2ww patients would provide benefits for quality of care, healthcare efficiency and the SLT workforce. The identified disadvantages require addressing if the proposed SLT-led model of service delivery is piloted in the UK. These include practical matters such as referral and prescribing rights, alongside wider implications such as support, governance, indemnity, acknowledgement and remuneration for the extended role. Nationally agreed competencies and training for the role are required if this model is to be successful. [ABSTRACT FROM AUTHOR]

Background: There is no consensus in the UK regarding the types of speech samples or parameters of speech that should be assessed at 3 years of age in children with cleft palate ± cleft lip (CP±L), despite cleft units routinely assessing speech at this age. The standardization of assessment practices would facilitate comparisons of outcomes across UK cleft units; earlier identification of speech impairments—which could support more timely treatments; and more reliable recording of therapy impacts and surgical interventions. Aims: To explore assessment practices used to assess speech in 3‐year‐old children with CP±L, including speech parameters, methods of assessment and the nature of the speech sample used. Methods & Procedures: A broad examination of the literature was undertaken through the use of a scoping review conducted in accordance with Joanna Briggs Institute guidelines. Search terms were generated from a preliminary search and then used in the main search (Medline, CINAHL, Embase, AMED and PsycINFO). Main Contribution: A combination of approaches (medical, linguistic, developmental and functional) is required to assess CP±L speech at age 3. A developmental approach is recommended at this age, considering the complexity of speech profiles at age 3, in which typically developing speech processes may occur alongside cleft speech characteristics. A combined measure for both nasal emission and turbulence, and an overall measure for velopharyngeal function for speech, show potential for assessment at this age. Categorical ordinal scales are frequently used; the use of continuous scales has yet to be fully explored at age 3. Although single‐word assessments, including a subset of words developed for cross‐linguistic comparisons, are frequently used, more than one type of speech sample may be needed to assess speech at this age validly. The lack of consensus regarding speech samples highlights a need for further research into the types of speech samples 3‐year‐olds can complete; the impact of incomplete speech samples on outcome measures (particularly relevant at this age when children may be less able to complete a full sample); the impact of different speech samples on the validity of assessments; and the reliability of listener judgements. Conclusions & Implications: Whilst a medical model and linguistic approaches are often central in assessments of age‐3 cleft speech, this review highlights the importance of developmental and functional approaches to assessment. Cross‐linguistic single‐word assessments show potential, and would facilitate the comparison of UK speech outcomes with other countries. Further research should explore the impact of different speech samples and rating scales on assessment validity and listener reliability. [ABSTRACT FROM AUTHOR]

Background: Awake craniotomy with electrical stimulation has become the gold standard for tumour resection in eloquent areas of the brain. Patients' speech during the procedure can inform the intervention and evidence for language experts to support the procedure is building. Within the UK a burgeoning speech and language therapist awake craniotomy network has emerged to support this practice. Further evidence is needed to underpin the specific contribution of speech and language therapists working within the awake craniotomy service. Aims: To investigate and analyse the current practices of speech and language therapists: their role, pre‐, intra‐ and postoperative assessment, and management practice patterns and skill set within awake craniotomy. Methods & Procedures: Speech and language therapists in the UK, who work in awake craniotomy, were invited to complete an online questionnaire. Participants were recruited via several networks supported by a social media campaign. Data were analysed using a mixed methodology approach including descriptive statistics, summative and conventional content analysis. Outcomes & Results: A total of 24 speech and language therapists completed the survey, an unknown proportion of the available population. All four UK countries were represented. The majority were highly specialist clinicians 58% (n = 14) with the remainder clinical leads 25% (n = 6) or specialist clinicians 17% (n = 14). Only 29% (n = 7) had funding for awake craniotomy or had awake craniotomy in their job description. Median experience with awake craniotomy was 3 years. Median estimated contact time per case was 10.3 h. Current intraoperative practice is characterized by a sustained period of real‐time, dynamic, informal assessment of speech, language, oromotor and cognitive functions. Respondents described a range of intraoperative clinical deficits that, once detected, are immediately communicated to surgeons. There was evidence of variable and diverse language mapping practices and barriers to the translation of information at multidisciplinary team level. Barriers to participation in awake craniotomy included lack of: standardized validated language mapping methods, funding, standardized training methods and guidance to direct practice. Conclusions & Implications: The evidence suggests areas of consistent practice patterns in preoperative preparation and intraoperative assessment. However, considerable variability exists within language testing and mapping that would benefit from validation. These speech and language therapists support improved outcomes of awake craniotomy by real‐time intraoperative speech, language, oromotor and cognitive assessment, rapid detection of clinical deterioration and immediate communication to surgeons. Further research exploring intraoperative language testing, consistent use of language mapping terminology, and selection of test methods is recommended. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) describes a heterogeneous group of language‐led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. Aims: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. Methods & Procedures: A 37‐item, pilot‐tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. Outcomes & Results: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke‐related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment‐focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision‐making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. Conclusions & Implications: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence‐based care pathways for people with PPA in order to advocate for further commissioning of clinical services. [ABSTRACT FROM AUTHOR]

Background: Although language and communication difficulties are common in secondary school students, there has been limited research into the efficacy of interventions for adolescents with language and communication difficulties. Aims: To investigate the efficacy of teaching assistant (TA)‐delivered narrative and vocabulary interventions to mainstream secondary school‐aged students with language disorder. Methods & Procedures: A randomized controlled trial (RCT) of a language and communication intervention was used to evaluate the efficacy of vocabulary and narrative interventions to improve the vocabulary and narrative performance of adolescents (mean age = 12.8 years) with language disorder. The language and communication programmes (narrative, vocabulary and combined narrative and vocabulary) were delivered by TAs in the classroom, three times per week, for 45–60 min each, over 6 weeks, totalling 18 sessions. Standardized and intervention‐specific measures were used as outcomes. Outcomes & Results: Twenty‐one schools with 358 eligible participants were recruited. The three intervention groups showed significant improvements (d =.296) on a narrative latent variable defined by a standardized narrative assessment (the Expression, Reception and Recall of Narrative Instrument—ERRNI), but there were no significant improvements on an overall vocabulary latent variable compared with the waiting control group. Differential effects were found on some non‐standardized intervention‐specific measures with the narrative group making significantly more progress on narrative tasks compared with the waiting control group, the vocabulary group showing the same pattern on specific vocabulary tasks, and the combined narrative and vocabulary group making significantly more progress on some of the intervention‐specific narrative, and all the intervention‐specific vocabulary outcomes compared with the waiting control group. Conclusions & Implications: It is possible to improve narrative but not vocabulary skills, as assessed by standardized measures, in secondary school students with a relatively brief group TA‐delivered intervention. There were differential effects for both narrative and vocabulary with intervention‐specific measures. Future work is required to explore whether more intensive and longer lasting interventions would be more effective and to identify which students in this age group are most likely to benefit from such interventions. [ABSTRACT FROM AUTHOR]

Background: Speech–language therapists use counselling to address the psychological well‐being of people affected by post‐stroke aphasia. Speech–language therapists report low counselling knowledge, skill and confidence for working in post‐stroke aphasia which may be related to a lack of counselling training specific to the needs of this client group. Aims: To identify current training in counselling for speech–language therapists to address psychological well‐being in people affected by post‐stroke aphasia. Specifically, the intent was to establish the objectives, content, amount, teaching methods and outcomes of counselling training provided to speech–language therapists working with people affected by post‐stroke aphasia. Methods & Procedures: Eleven databases were searched from inception to January 2018 using terms relating to counselling, psychological well‐being, speech–language therapy, stroke, aphasia and training. Studies using any research methodology and design were included. Nine studies were critically appraised and synthesized as a systematic review using the Search, AppraisaL, Synthesis and Analysis (SALSA) framework. Main Contribution: Information on counselling training came from the UK, United States and Australia. Student speech–language therapists received training in goal‐setting and generic counselling skills. After qualification, speech–language therapists received counselling training from mental health professionals within stroke workplaces, from external providers and further education. A range of teaching techniques and counselling approaches were described. Self‐report and themes from qualitative data were the primary measures of counselling training outcomes. Moderate correlations were reported between counselling training and levels of speech–language therapists' knowledge, comfort, confidence and preparedness to counsel people affected by post‐stroke aphasia. Conclusions: Research in counselling training for speech–language therapists working in post‐stroke aphasia is limited, with a small number of primarily low‐quality studies available. Training in generic counselling skills and brief psychological approaches with support from mental health professionals in the stroke workplace enabled speech–language therapists to feel knowledgeable, skilled and confident to address the psychological well‐being of people affected by post‐stroke aphasia. Evidence about the effectiveness of counselling training on speech–language therapists' confidence and competence in practice and on client outcomes in psychological well‐being in post‐stroke aphasia is required. [ABSTRACT FROM AUTHOR]