Search

Abstract: Background: Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. Aims: To explore speech and language therapists’ perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post‐stroke. Methods & Procedures: Twenty‐two, in‐depth, semi‐structured interviews were conducted with speech and language therapists working with people with aphasia post‐stroke. Qualitative data were analysed using inductive thematic analysis. Outcomes & Results: Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists’ responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. Conclusions & Implications: The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non‐verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Developmental language disorder (DLD) presents a considerable barrier for young adults to engage in further education and training. Early studies with young adults with DLD revealed poor educational achievement and lack of opportunities to progress in education. More recent studies have provided more positive findings. Relatively sparse data exist, however, on current cohorts and the factors that predict outcomes. Aims: To examine educational and employment outcomes in young adulthood in a sample of people with histories of DLD compared with an age‐matched peer group without DLD. We ask: How do educational pathways and early jobs compare between those with and without DLD? Are young adults with DLD receiving similar levels of income as their peers? To what extent are language and literacy abilities associated with outcomes? Methods & Procedures: Participants included 84 individuals with DLD (67% males) and 88 age‐matched peers without DLD (56% males). Participants were on average 24 years of age. They completed a battery of psycholinguistic, literacy and nonverbal skills assessments. Data were also collected on educational qualifications, current educational status, extent of educational support received, employment status, history and support, as well as current income. Outcomes & Results: Those with DLD obtained lower academic and vocational qualifications. Higher educational/vocational qualifications were associated with better language, better reading and higher performance IQ (PIQ). There were few differences between the two groups in terms of engagement with education, but the mean age at leaving education was significantly earlier in the participants with DLD. Substantially more participants with DLD reported receiving support or dispensation from their educational institution. There was no significant difference between groups in the proportion of young people currently employed, though a higher proportion of the age‐matched peers was in work full time. Participants with DLD were much more likely to be in non‐professional occupations. However, when examining pay in relation to types of occupation, the groups’ incomes were broadly comparable. Conclusions & Implications: At the group level, young people with a history of DLD more commonly have less skilled employment and more rarely achieve professional roles. At the individual level there is considerable variation with smaller but not trivial proportions of young adults with a history of DLD showing good educational and employment outcomes. There are positive aspects to early adult outcomes for some young people with a history of DLD. [ABSTRACT FROM AUTHOR]

Background Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings. Aim To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England. Methods & Procedures A four-phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two-round Delphi process. Outcomes & Results Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus. Conclusions & Implications There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings. [ABSTRACT FROM AUTHOR]

Background Well-documented associations exist between socio-economic background and language ability in early childhood, and between educational attainment and language ability in children with clinically referred language impairment. However, very little research has looked at the associations between language ability, educational attainment and socio-economic background during adolescence, particularly in populations without language impairment. Aims To investigate: (1) whether adolescents with higher educational outcomes overall had higher language abilities; and (2) associations between adolescent language ability, socio-economic background and educational outcomes, specifically in relation to Mathematics, English Language and English Literature GCSE grade. Method & Procedures A total of 151 participants completed five standardized language assessments measuring vocabulary, comprehension of sentences and spoken paragraphs, and narrative skills and one nonverbal assessment when between 13 and 14 years old. These data were compared with the participants' educational achievement obtained upon leaving secondary education (16 years old). Univariate logistic regressions were employed to identify those language assessments and demographic factors that were associated with achieving a targeted A*-C grade in English Language, English Literature and Mathematics General Certificate of Secondary Education (GCSE) at 16 years. Further logistic regressions were then conducted to examine further the contribution of socio-economic background and spoken language skills in the multivariate models. Results & Outcomes Vocabulary, comprehension of sentences and spoken paragraphs, and mean length utterance in a narrative task along with socio-economic background contributed to whether participants achieved an A*-C grade in GCSE Mathematics and English Language and English Literature. Nonverbal ability contributed to English Language and Mathematics. The results of multivariate logistic regressions then found that vocabulary skills were particularly relevant to all three GCSE outcomes. Socio-economic background only remained important for English Language, once language assessment scores and demographic information were considered. Conclusions & Implications Language ability, and in particular vocabulary, plays an important role for educational achievement. Results confirm a need for ongoing support for spoken language ability throughout secondary education and a potential role for speech and language therapy provision in the continuing drive to reduce the gap in educational attainment between groups from differing socio-economic backgrounds. [ABSTRACT FROM AUTHOR]

Background Entry to speech and language therapy (SLT) undergraduate pre-registration programmes in the UK is usually achieved through qualifications attained at school (e.g. A-levels). A smaller number of people who did not succeed academically at school enter through qualifications achieved post-schooling, e.g. Access to Higher Education courses. This second group of students are attractive recruits to SLT training programmes as they bring different experiences and backgrounds to the programme and to the SLT profession. However, there are no published studies that explore the academic performance or degree and employment outcomes of students who enter university through this route. Aims To investigate the success of non-traditional entry students, specifically those with Access qualifications, on one pre-registration SLT undergraduate degree at a university in the UK. Success is measured in terms of module results, obtaining a degree, the ability to register as an SLT and first employment destination post-graduation. Methods & Procedures University applications were reviewed and students who entered via an Access course were identified for a ten-year period. Results for modules, individual assessments and final degree classification were obtained from their files and were compared against the mean score of traditional entry students on the years of the course covered by this study using a series of one sample t-tests. Outcomes & Results The students who entered through the non-traditional academic route are generally successful in completing their degree and in registering to work as an SLT. However, as a group they perform less well on the degree overall, on individual modules and on written examinations and they do not close this performance gap over the four years of the degree. In contrast, however, they perform on a par with their peers on other types of assessment (e.g. clinical placement, case study, data exercise). The Access students were more likely than traditional entry students to be working as an SLT six-months post-qualification. Conclusions & Implications These results suggest that some types of assessment may be more effective at tapping the skills of students from non-traditional academic backgrounds, and that more tailored support could be provided for this group of students in tackling university written examinations throughout all years of the programme. Despite limited preparation for university-level study and mixed performance on assessment, students from non-traditional academic backgrounds can do well at university and successfully gain employment as SLTs. [ABSTRACT FROM AUTHOR]

Background: Children with specific language impairment (SLI) are at risk of low self-esteem during their school years. However, there is a lack of evidence of the self-esteem of young people with a history of SLI during adolescence, as they transfer from compulsory schooling to post-compulsory education, employment or training. Aims: To examine the self-esteem of young people with a history of SLI at the transition from compulsory education (16 years) to the first year of post-compulsory education, employment and training (17 years) in England. Methods & Procedures: A total of 54 young people identified as having SLI at 8 years were followed up at 16 and at 17 years. The young people completed two measures of self-esteem: the Self-perception Profile for Adolescents (16 years) and the Self-perception Profile for College Students (17 years). Assessments of language, literacy and non-verbal ability were also conducted. Outcomes & Results: Perceptions of scholastic competence were significantly lower than the norm at 16 years; the female students also had lower self-esteem in the social and physical appearance domains and global self-worth. However, at 17 years there were no significant differences from the norm for these self-esteem domains. There was evidence of stability within self-esteem domains over this period but also an improvement in self-perceptions of scholastic and job competence, physical appearance and athletic competence, and also global self-worth, but not the three social domains. Non-verbal cognitive ability was not correlated with any measures of self-esteem, at 16 or 17 years. Language and literacy ability, especially spelling, were correlated with scholastic and job competence at 16 years but only spelling correlated at 17 years. Conclusions & Implications: This study has provided evidence for improvements in self-esteem for young people with SLI after they leave school and enter the world of non-compulsory education (typically at a college), employment and training. The study has also indicated the importance of addressing self-esteem as a multi-dimensional construct and the consequent necessity to use instruments that assess different domains of self-esteem. [ABSTRACT FROM AUTHOR]