Effectiveness of a workshop to improve community speech language therapists’ ability to assess and provide appropriate intervention for cleft palate and related speech disorders

Abstract

Background and purpose: The current study investigated the impact of a workshop on community-based speech language therapists' (SLTs) assessment and management of cleft palate and related speech disorders, and changes in their self-ratings of confidence. There is a paucity of studies evaluating SLT performance before and after a professional development course in cleft, and community-based SLTs in New Zealand have limited opportunities to attend such courses. Study design and methods: A simplified cleft speech assessment tool measured the accuracies of SLTs' perceptual analyses of speech recordings. These were compared to Cleft Specialist SLTs' ratings to measure performance. Confidence was surveyed for working as SLTs with children, and working with children with cleft and velopharyngeal impairment (VPI-related speech disorders, and clinical skills relevant to their role in the community. Seventy-two community-based SLTs took part in the study, across three identical workshops presented by the Regional Cleft Team SLTs. Performance and confidence were measured before, immediately after, and 4-6 weeks after the workshop. Results: There was a statically significant improvement in SLTs' ability to evaluate Acceptability of speech, with most participants giving the same ratings as the experts. There was significant improvement in identifying hypernasal tone, abnormal nasal air emission, and glottal articulation immediately after the workshop. Over 80% of participants were able to accurately identify a nasal fricative. The SLTs had difficulty identifying a backing speech pattern both before and after the workshop. There was a significant deterioration in the accuracy of their proposed management of less severe cleft speech disorder, however most participants identified the need to refer a child with moderate to severe hypernasal resonance to the local cleft team. The greatest improvements appear to be in areas which were concentrated on in the workshop and that included additional exemplars and demonstrations. Post-workshop, there was a significant improvement in the SLTs' confidence in the assessment and management of children with cleft speech. These ratings appear to reduce at the follow up session, however remain higher than before the workshop.Summary and conclusion: A short, specialist-led workshop can improve the clinical skills and confidence of community-based SLTs in working with cleft and VPI related speech disorders. Clinicians in the community require ongoing learning and supervision to support children with these difficulties. The workshop improved engagement between the community and Cleft SLTs, supporting the goal of working towards a collaborative model of care.