Challenges and practical strategies
for speech pathologists working with
children in Out of Home Care
(OOHC)
Tania Lyddiard
Speech Pathologist
Kaleidoscope, HNELHD
August 2014
Tania.Lyddiard@hnehealth.nsw.gov.au
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
What is speech pathology?
• Assess children/adults with communication and feeding difficulties
• Provide intervention for children/adults with communication and feeding
difficulties
• Communication encompasses:
− Receptive language (comprehension)
− Expressive language (spoken language)
− Articulation (speech skills)
− Pragmatics (social skills)
− Play skills
(Speech Pathology Australia, 2013)
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Effects of Trauma
• Trauma impacts on development across domains
• Trauma impacts significantly on speech and
language development
(Allen & Oliver, 1982; Culp et al, 1991; Eigsti & Cichetti, 2004; HwaFroelich, 2012; Nathanson & Tzioumi, 2007)
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Effect of trauma on speech & language
development
• Speech difficulties - 45% of maltreated children
under 5 years of age
• Language difficulties – 20% of older children
• 55% of foster carers had taken a child to see a
speech pathologist
(Nathanson & Tzioumi, 2007; McLeod & McKinnon, 2007; Jessup, Ward ,
Cahill & Keating, 2008; Golding, Williams &Leitao, 2011)
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Children in OOHC in New South Wales
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Kaleidoscope Speech Pathology Service
• Paediatric service providing speech pathology
assessment and management
• 3 local government areas
• Increase in referrals of children in Out of Home
Care (OOHC)
⁻ Policy
⁻ Knowledge
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Kaleidoscope Speech Pathology Service – Referral
Demographics
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Identified issues
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Unique client group
Increase in referral rate of children in OOHC
Support systems and processes required
Consistency of service and documentation
Staff support required
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
The child
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
The foster carer
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
The caseworker
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
The speech pathologist
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
The speech pathology service
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Conclusion
• Unique challenges when working with
children in OOHC
• Strategies to ensure children in OOHC
maintain links with services despite changes
• Other services may face different challenges
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Future Directions
• Ongoing education of the effects of maltreatment
on predicting speech/language delay.
• Improved mechanisms to support speech
pathologists
• Linking in with other multidisciplinary services
• Intervention based on evidenced based practice
• Development of standardised assessment
protocols for children in OOHC
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
Acknowledgements
• Dr Nicole Byrne, Team Leader & Co-author
• Kaleidoscope Community Based Services Speech
Pathology team
• Karen Kemp, HNELHD OOHC Coordinator
• Nic Mensforth, OOHC Policy Officer for NSW Kids
and Families
• Julie Hull, HNELHD Health Case Manager
• HNELHD OOHC Health Services
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
References
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Allen, R., & Oliver, J. (1982). The effect of child maltreatment on language development. Child
Abuse and Neglect, 6(3), 299–305
Australian Institute of Health and Welfare (AIHW). (2012). Child protection Australia 2010–
11. Child Welfare series no. 53. Cat. no. CWS 41. Canberra: Author.
Byrne,N., & Lyddiard, T. (2013). Challenges and practical strategies for speech pathologists
working with children in out of home care (OOHC).Journal of Clinical Practice in SpeechLanguage Pathology, 15(3), 131-137
Council of Australian Governments (COAG). (2009).Protecting children is everyone’s business:
National Framework for Protecting Australia’s Children 2009–2020. Retrieved from
http://www.fahcsia.gov.au/sites/default/files/documents/child_protection_framework.pdf
Culp, R., Watkins., R, Lawrence, H., Letts, D., Kelly, D., & Rice, M. (1991). Maltreated children’s
language and speech development: Abused, neglected, and abused and neglected. First
Language, 11(33), 377–389.
Eigsti, I., & Cicchetti, D. (2004). The impact of child maltreatment on expressive syntax at 60
months. Developmental Science, 7(1), 88–102
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
References (continued)
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Golding, S., Williams, C., & Leitão, S. (2011). Speech and language development:
Knowledge and experiences of foster carers. ACQuiring Knowledge in Speech,
Language and Hearing, 13(1), 12–19.
Henry, J., Sloane, M., & Black-Pond., C. (2007). Neurobiology and
neurodevelopmental impact of childhood traumatic stress and prenatal alcohol
exposure. Language,Speech, and Hearing Services in Schools, 38(2), 99–108.
Hunter New England Health Local Health District (HNELHD). (2012). HNELHD
Community Paediatric Clinical Priority Tool. Newcastle, NSW: Author.
Hwa-Froelich, D. (2012). Childhood maltreatment and communication
development. Perspectives on School-Based Issues, 13(2), 43–53.
Jessup, B., Ward, E., Cahill, L., & Keating, D. (2008). Prevalence of speech and/or
language impairment in preparatory students in northern Tasmania. International
Journal of Speech-Language Pathology, 10(5), 364–77.
Lyddiard, T. (2012a). Speech and language development in children – Education
package. Newcastle, NSW: Hunter New England Local Health District.
Challenges and practical strategies for speech
pathologists working with children in Out of Home Care
(OOHC)
References (continued)
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Mcleod, S., & McKinnon, D.H. (2007). The prevalence of communication disorders compared
with other learning needs in 14,500 primary and secondary school students. International
Journal of Language and Communication Disorders, 42(S1), 37–59.
Nathanson, D., & Tzioumi, D. (2007). Health needs of Australian children living in out-of-home
care. Journal of Paediatrics and Child Health, 43(10), 695–699.
NSW Department of Premier and Cabinet. (2009). Keep them safe report: A shared approach
to child wellbeing. Retrieved from
http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0004/57145/Keep_Them_Safe.pdf
Speech Pathology Australia (2013). Retrieved from
http://www.speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_What_is_a_
Speech_Pathologist.pdf
Webster, S., Temple-Smith, M. & Smith, A. (2012). Children and young people on out-of-home
care: improving access to primary care. Australian Family Physician, 41(10), 819–822
Westby, C., (2007). Child maltreatment: A global issue. Language, Speech and Hearing
Services in Schools, 38(2), 140–148.Westby, 2007
Tania Lyddiard
Speech Pathologist
Kaleidoscope , HNELHD
http://www.kaleidoscope.org.au/
Tania.Lyddiard@hnehealth.nsw.gov.au