Perspectives of Australian speech-language pathologists
Research by Melvin et al. (2020), in plain language
What’s this study about?
This study looks at what it means exactly for a family to be “engaged” in their child’s speech therapy.
Why did they do this study?
When doing therapy with young children, a key thing is for the family to be “engaged”. That’s because they’re the child’s first and main “teacher” during the early years. In the Australian healthcare system, young children are counted as aged 0-8 years. Therapy with young children, or ‘early intervention’, generally tries to work with the family as a whole. Research shows that this gives better results than when therapy focuses on the child alone. The problem is, we don’t have a clear idea of what exactly it means for a family to be engaged.
Whether or not a family is engaged used to just be how regularly they show up for therapy and their drop-out rates. But, being engaged is a lot more than this. Studies show that being engaged is something that’s built together based on relationships. Being engaged involves feelings, thought processes, and actions that make therapy work, both inside and outside of a session.
In early intervention speech therapy, some families are engaged right from the start while others need a bit of time and help. According to an Australian survey study, most speech pathologists working with children say that therapy doesn’t work when the family’s not engaged. If speech pathologists have a better idea of what exactly it means for a family to be engaged, they can be better at helping them. In doing so, they can make therapy more effective. So, the researchers in this study wanted to map out and describe what exactly it means for a family to be “engaged” in their child’s speech therapy.
How did they do this study?
The researchers created an online study. They did a national call out through professional networks and social media for Australian speech pathologists doing early intervention speech therapy to take part in the study. Speech pathologists from all states of Australia, except the Northern Territory, volunteered to take part. The speech pathologists who took part were working in different types of settings (e.g. hospital, community health, private practice) and had different levels of work experience (from under five years to over 15 years). The study had a brainstorming activity, a sorting activity, and a rating activity. The speech pathologists could do all three, but also had the option to not proceed to the next activity.
For the brainstorming activity, the researchers showed the speech pathologists six cartoons of different ways speech pathologists might work with young children and their families. They also presented the prompt “I can tell that a family is engaged in early speech-language pathology intervention when…”. The speech pathologists had to come up with as many statements as they could. Their statements were anonymous but they could see others’ anonymous statements. At the end, the speech pathologists were shown the full list of statements and could mark any that were irrelevant. 58 speech pathologists, all from South East Queensland, did this activity.
For the sorting activity, the speech pathologists had to look over the list of statements from the brainstorming activity and sort them into groups. They then had to come up with a name for each group. They were told to group the statements in a way that made sense to them, that there was no right or wrong, and that a statement could be in its own group if it was unrelated to other statements. They were also told not to make groups based on how important or hard to do the different statements were, and not to name groups as ‘miscellaneous’. 34 speech pathologists did this activity.
For the rating activity, the speech pathologists had to rate how important each statement was on a scale of one to five. 29 speech pathologists did this activity.
Based on these activities, the researchers came up with a concept map showing the speech pathologists’ main ideas. The researchers also calculated the average importance rating for each statement, and the importance rating for each main idea. This was based on the ratings of the statements relating to that main idea.
What did they find in this study?
Based on the speech pathologists’ 85 different statements, the researchers came up with seven main ideas about what exactly it means for a family to be “engaged” in their child’s speech therapy.
Number one, the family is reliable and ready for therapy. This means that the family shows up for appointments, is prepared, and lets the speech pathologist know if they can’t make an appointment. 12 of the statements related to this main idea.
Number two, the family has an open, honest relationship with the speech pathologist. This means that there’s good communication between the family and the speech pathologist, and that the family is open about what they think and what they expect from therapy. 23 of the statements related to this main idea, which was rated most important.
Number three, the family actively takes part and comes up with their own ideas. This means that the family gets in there with their child during a therapy session, and that they come up with new ways of helping their child. 17 of the statements related to this main idea, which was rated least important.
Number four, the family works together with the speech pathologist to plan therapy. This means that the family and the speech pathologist work together as a team to solve problems, plan therapy, and set goals. 18 of the statements related to this main idea.
Number five, the family sees and celebrates their child’s improvement. This means that the family takes notice of how far their child has come in therapy and celebrates their child’s gains with the speech pathologist. 9 of the statements related to this main idea.
Number six, the family does homework. This means that the family makes an effort to practice the tasks and strategies they learnt in therapy at home. 16 of the statements related to this main idea, which was rated second most important.
Number seven, the family understands therapy and stands up for their child. This means that the family has a good idea about what they’ve learnt in therapy and can teach others in their child’s life. 13 of the statements related to this main idea, which was rated second least important.
What do the findings mean?
This study shows that there is in fact a lot to a family being “engaged” in their child’s therapy. Speech pathologists have a similar idea as other early intervention clinicians, like occupational therapists and physiotherapists. They think that being engaged is something that takes feelings (having open conversations), thought processes (planning and understanding therapy), and actions (joining in on doing therapy), both inside and outside the therapy session. A lot of it comes down to having a good relationship with the family, which might include members other than the child’s parents. It’s about helping the family as a whole, and thinking about how different people might play a part in helping the child.
Therapy doesn’t work unless the family believes and feels that therapy is working.
That’s why it’s important for the family to take notice of their child’s improvement and to celebrate it. Research shows that when a family sees improvement, they get the feeling of being able to make a difference. This helps them stay motivated, and engaged, in therapy over time. The family also needs to know that it’s up to them to help their child and that the speech pathologist’s job is to teach them how. But, studies show that families often don’t know this when they first start therapy. In fact, some families feel uncomfortable being the ones responsible for helping their child.
Things outside of a therapy session – putting things into practice at home, trying out strategies in different situations, understanding and explaining their child’s difficulties to others – are also a part of being engaged. But, studies show that many families struggle with taking what they’ve learnt in therapy and putting it into practice at home. Also, not all families are ready to explain their child’s difficulties to others.
These findings show that in order to help families be engaged in therapy, speech pathologists need to make sure they gain the family’s trust, and that the family feels heard and understood. In saying that, it’s important to reminder that the family has a right to decide how exactly they want to take part in their child’s therapy. It’s best if this can be decided together, not just based on the speech pathologist’s idea of an “engaged” family. Speech pathologists can also help families by supporting them in putting things into practice at home. This could be suggesting specific home routines, times of day, or activities for trying out things learnt in therapy.
The researchers point out that this study was only done with a relatively small number of speech pathologists. The findings only show the speech pathologist’s point of view and might be linked to the specific work settings of the speech pathologists who took part in this study. There might also be differences in what it means exactly for a family to be engaged for children of different ages between 0-8 years. More research, especially on the family’s point of view, can give a better idea of which aspects of being engaged make the biggest difference to whether or not early intervention works.
Where can I learn more?
This blog post is based on the following paper:
Melvin, K., Meyer, C., & Scarinci, N. (2020). What does a family who is “engaged” in early intervention look like? Perspectives of Australian speech-language pathologists. International Journal of Speech-Language Pathology, 1-11. doi:10.1080/17549507.2020.1784279
You can read the original paper here: