Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10

Abstract

Purpose

Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia.

Result

A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+.

Conclusion

This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.

Keywords:

• Communication disability
• diversity
• workforce
• cultural responsiveness
• speech-language pathology
• Sustainable Development Goals (SDGs)
• good health and well-being (SDG 3)
• quality education (SDG 4)
• decent work and economic growth (SDG 8)
• reduced inequalities (SDG 10)

The authors acknowledge the Traditional Custodians of lands, seas and waters throughout Australia, and pay respect to Elders past, present and future. They recognise that the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples are grounded in continued connection to culture, country, language, and community, and acknowledge that sovereignty was never ceded.

Introduction

The Sustainable Development Goals (United Nations, 2015) are a “universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity” (United Nations Development Programme, 2022). Specific targets to help achieve these goals include ensuring access to quality healthcare (Target 3.8; good health and well-being, SDG 3); improving equity of access to education, eliminating disparities in education and decolonising the curriculum to ensure that learners have the knowledge and skills to promote sustainable development (Targets 4.3, 4.5, and 4.7; quality education, SDG 4); stimulating economic growth and promoting equitable employment (decent work and economic growth, SDG 8); and ending discrimination and inequality (Targets 10.2 and 10.3; reduced inequalities, SDG 10). This commentary explores the diversity of the speech-language pathology workforce in Australia, drawing on survey data from speech-language pathologists (SLPs), and discusses the implications of a diverse speech-language pathology workforce in relation to the SDGs.

Background

Traditionally, allied health professions, including speech-language pathology, have been viewed as homogenous groups. Supported by a medical model, white, middle-class women have made up the majority of the speech-language pathology workforce in English-speaking countries, which has shaped the values, norms, and expectations of the profession (American Speech-Language-Hearing Association [ASHA], 2021; Royal College of Speech & Language Therapists, 2020; Speech Pathology Australia [SPA], 2015). Until recently, there has been limited reflection of the importance of diversity in the development of allied health professional identities, including speech-language pathology.

Professional preparation curricula and standards set for the allied health professions in English-speaking, postcolonial countries (i.e., Australia, United States, United Kingdom) have been informed by perspectives perpetuated by colonising worldviews of Western nations through a discourse of power of whom can claim to know and produce knowledge, while excluding and silencing differing worldviews and knowledge production (Abrahams et al., 2019; Delbridge, Garvey, et al., 2022). These have contributed to workforce homogeneity through the need to acquire and maintain specific levels of skills and knowledge; safety to practice; alignment with other professions; and professional attributes, values, terminology, behaviours and cultural norms (Abrahams et al. 2019; Frost & Regehr, 2013; McAllister & Nagarajan, 2015). Some of these requirements sought to enhance legitimacy, transparency, accountability, and standards of care for service users, but also maintained power and superiority of majority cultures (Delbridge, Garvey, et al., 2022; Frost & Regehr, 2013). The construction of professional identities involves aspects of standardisation which can be at odds with the need to increase diversity within professions and reduce inequalities (Frost & Regehr, 2013; SDG 10).

The concept of diversity recognises and highlights difference, but in doing so assumes normative perspectives. Discussions around diversity in allied health professions have largely focussed on discrete categories that define difference, such as race (Atwal et al., 2021), gender (Adams, 1998, 2010; Nicholls & Cheek, 2006; Ottosson, 2016), and social class (Adams, 1998). Research regarding diversity in the speech-language pathology profession has included supporting the needs of people from culturally and linguistically diverse backgrounds (Fannin & Mandulak, 2021; Verdon et al., 2016), the impact of socioeconomic status on access to training (Brosnan et al., 2016), and heteronormative assumptions in healthcare (Brooks et al., 2018; Law et al., 2015). These categories have arisen from discourses around marginalisation, discrimination, and oppression experienced by people from various groups or who possess certain characteristics (Abrahams et al., 2019), yet data on some diverse identities remain unreported and invisible. Systems, policies, and governance frameworks within allied health professions and the broader societal contexts in which people live and work can oppress and disadvantage those who do not fit the ‘norm’ or majority culture, impacting opportunities for all people to receive quality education (SDG 4) and engage in and experience decent work and economic growth (SDG 8).

Intersectionality recognises the intersection of multiple different forms of marginalisation such as gender, ethnicity/race, sexuality, and socioeconomic status, with other systems of power, including class and disability (Crenshaw, 1989). Personal characteristics and aspects of individual identity or culture co-exist and interact without being reduced to singular positions (Styhre & Eriksson‐Zetterquist, 2008). Intersectionality provides a lens for gaining insight into inequalities faced by service users in achieving good health and well-being (SDG 3), quality education (SDG 4) and decolonisation of curriculum, as well as considering strengths and challenges among the professions in ensuring decent work and economic growth (SDG 8), and reduced inequalities (SDG 10). An intersectional perspective provides a way to understand diversity that challenges entrenched stereotypes and normative perspectives while embracing the “political nature of transforming health and social systems towards social justice” (Delbridge, Jovanovski et al., 2022, p. 91).

Sociocultural positioning statement

Most of the authors of this paper are English-speaking women who largely identify with the dominant demographic of the speech-language pathology profession in Australia. One author, TL, is an Iman woman who speaks English and has been privileged to learn some traditional language from her father and Elders. The authors acknowledge their experiences, views, and personal and professional identities that have shaped their perspectives, including growing up in migrant families; living and working in varied geographic locations; engaging in education, training, and employment in institutions; practising as allied health professionals; and experiences of living with and caring for people who have varied health conditions.

The authors acknowledge that this commentary touches on sensitive and critically important issues and that their discussion of these concepts is limited as systems and governance structures have been constructed to privilege themselves over others. However, this commentary highlights Speech Pathology Australia’s (SPA’s) voice and commitment to Reconciliation, inclusion, and cultural safety and responsiveness, and is an important contribution towards understanding and enhancing the diversity of the Australian speech-language pathology workforce.

Method

A national survey of the Australian speech-language pathology workforce was undertaken between November-December 2021 to explore factors that may contribute to workforce shortages or oversupply, influence recruitment and retention, and support SLPs to remain in the profession. As speech-language pathology is a self-regulating profession in Australia and membership of SPA is not a requirement to practise, there is no complete national workforce database and respondents were therefore recruited using multiple approaches. The survey was distributed online to the SPA membership database (n = 10,337) and non-members via employer organisations and networks (such as state government, disability services, education providers, and primary health networks). Response rates were monitored for representation, for example, across sectors, membership groups, and geographic locations.

This commentary reports on the subset of questions that relate to SLPs’ self-reported personal characteristics and experiences via multiple choice, checkbox, and free-text items. Standard a priori categories were based on the existing SPA membership database fields and a previous workforce survey (State of Victoria, Department of Health and Human Services, 2016), such as gender and income, which were analysed using descriptive statistics. Respondents were invited to identify any lived experiences they have that may be relevant to service users, in relation to pre-determined categories (e.g., mental health conditions, communication disorders) and a free-text field was also provided. Respondents were then asked whether they considered themselves to have any other diverse perspectives or lived experiences and were invited to describe these. Finally, respondents were invited to provide any further information relating to the survey or their perceptions of the profession. Open-ended responses were analysed and coded thematically.

Respondents provided consent to participate in the survey and responded to an additional question to indicate consent for their de-identified results to be used in future publications. The survey was part of a needs analysis. Principles of the Declaration of Helsinki and ethical conduct were adhered to, for instance, respondents were informed about the purpose of the data collection and plans for data use, and all data were de-identified and stored securely. Only the subset of respondents who explicitly consented for their data to be used in publications have been reported in this commentary (n = 1638).

Results

The majority of respondents identified as female (96.6%) and were Australian citizens (99.1%). A small proportion (fewer than 1%) of respondents identified as being of Aboriginal or Torres Strait Islander descent. Respondents spoke many different languages, the most common being English (100%), followed by Mandarin, Cantonese, Greek, Italian, Arabic, and Spanish. The findings are similar to the 2021 Australian Census results (Australian Bureau of Statistics, 2021).

Almost 30% (n = 481) of respondents considered themselves to have lived experiences or personal characteristics that may be relevant to speech-language pathology service users. Of those respondents, in response to pre-determined categories, the most commonly reported experiences related to mental health conditions, caring for someone with a communication or swallowing disability, or having another condition, followed by having literacy or learning difficulties, or having a swallowing disability. A quarter of respondents (n = 410) described having other characteristics, perspectives, or lived experiences that were not explicitly asked in the survey or necessarily perceived as relevant to service users.

Respondents described a range of personal lived experiences and caring responsibilities. Lived experiences included communication disability, chronic illness, autism, neurodiversity, hearing impairment, vocal injury and voice disorders, acquired injuries, identifying as LGBTQI+, low socioeconomic status, experiences of trauma and domestic violence, and religious beliefs. Caring responsibilities included being a parent, and parenting/caring for people with attributes or experiences listed above.

Some respondents described their cultural and linguistic background, such as coming “from a migrant background”, and some described the potential for this to enhance their practice with individuals and communities:

I am multilingual and can directly relate ... to culturally and linguistically diverse family backgrounds.

Diverse views arising from working across multiple sectors and workplaces and living in different countries or geographical locations were also described, for example:

Grew up in a rural area with minimal access to services.

Lived in multiple countries where I had to learn different languages.

Respondents often identified multiple intersecting perspectives and characteristics. These included personal experiences as well as caring responsibilities, for example:

I have experienced navigating palliative care with family members … I have also experienced a chronic health condition.

When invited to provide any other information about the survey or profession, some respondents commented on the importance of enhanced workforce diversity, including the need for greater gender representation and more variation in cultural and linguistic background and socioeconomic status, and the potential impact on service users:

To deliver appropriate speech pathology care to diverse communities, the speech pathology profession needs to become far more diverse in terms of gender, ethnicity, linguistic and cultural backgrounds and disability.

Discussion

A range of intersecting personal experiences, attributes, and perspectives were described by SLPs in the survey, with some commenting on the relevance and potential value for their work with individuals and communities. Yet few of these characteristics, and their intersectionality, are routinely collected or explored in workforce surveys. Collection of this information can be challenging due to its complexity, sensitivity, and breadth, and the need for respondents to feel safe in disclosing such information. Not all survey respondents in the broader sample consented for their data to be used in future publications and the reasons for this were unknown. However, capturing more diverse perspectives will help professions gain a clearer picture of the workforce and inform initiatives to enhance and support workforce diversity. Part of the challenge will be how to act upon such information and implement meaningful initiatives to support and sustain a thriving workforce, including moving beyond initiatives such as diversity quotas, and acknowledging that systems, policies, and processes may need to be reimagined to reduce inequalities (SDG 10).

Several strategies have been adopted by Australian-based universities to enhance diversity in the speech-language pathology workforce, including widening accessibility of and participation in quality education (SDG 4) by providing online access, broader entry criteria, and programs at more universities (e.g., Easton et al., 2022); and supporting students from a range of linguistic and cultural backgrounds (Atwal et al., 2021; Howells et al., 2017; Pham, 2021). Diversification of the speech-language pathology profession is important, but not the only action needed to enhance equity and inclusion. SLPs’ personal characteristics and experiences may enhance their potential to understand, empathise, and support service users with similar characteristics. However, SLPs must also adopt practices to enhance self-awareness, reflectivity, and cultural responsiveness when working with people and communities with perspectives and identities that are different from their own (Hopf et al., 2021). Hopf et al. (2021) argued that SLPs from “the dominant culture must engage in the process of dismantling systems of oppression and commit to the promotion of human rights and antiracist practices” (p. 1951). SLPs may be guided by frameworks such as the Hopf et al. (2021) Culturally Responsive Teamwork Framework (CRTF) for holistic interprofessional practice, and the Indigenous Allied Health Australia Cultural Responsiveness Framework (Indigenous Allied Health Australia [IAHA], 2019) regarding culturally safe and responsive services for Aboriginal and Torres Strait Islander Peoples.

As examples of action at an organisational level, SPA has committed to cultural responsiveness for Aboriginal and Torres Strait Islander Peoples and Communities as defined by Aboriginal and Torres Strait Islander Peoples, the First Peoples of this country, through their Formal Apology, Reconciliation Action Plan, and the Strategic Plan 2020–2022 (SPA, n.d.; SPA, 2020). In collaboration with Aboriginal and Torres Strait Islander Peoples, an Aboriginal and Torres Strait Islander Advisory Committee was developed to guide SPA in culturally responsive practice, and mandatory cultural learning has recently been introduced for SPA Certified Practising Members. SPA also aspires to inclusive, respectful, and culturally safe services for all people and is developing a framework to enhance inclusion of people with varied backgrounds, experiences, and perspectives to reduce inequalities (SDG 10). Further transformation is needed to build upon the current initiatives and future steps may include enhanced consultation and partnerships, such as co-creation of curriculum, with individuals and communities whose voices are typically silenced and marginalised.

Reflective and transformative approaches, such as the frameworks proposed by Hopf et al. (2021) and IAHA (2019), and organisational commitments to action offer opportunities to recognise the breadth of views and values that each SLP, individual, and community holds; support the inclusion of intersecting identities; and facilitate more culturally responsive approaches to practice and service provision. Thus, we may begin to confront the tensions between identities and discourses to create a new discourse that recognises and affirms the value that individuals and their characteristics and experiences bring to the profession and to practice (Frost & Regehr, 2013).

Conclusion

Understanding workforce characteristics and perspectives can be limited by the questions asked. The SPA survey included questions regarding lived experiences and personal characteristics that cast a different lens on how workforce data is traditionally gathered, highlighting the value of broader definitions and categories. These questions may provide a framework for other professions to capture information about workforce characteristics.

The findings highlighted intersectional, and often invisible, identities and personal characteristics within the speech-language pathology workforce in Australia. Diversity in the speech-language pathology profession is important, and to recruit and retain diverse peoples in the workforce, systems and structures must be transformed. Identifying, embracing, and enhancing diversity of the speech-language pathology workforce in Australia may facilitate new professional identities which incorporate cultural knowledges and better respond to the unique needs of individuals and communities (Attrill et al., 2022), and support equity and inclusion within the profession and when delivering professional services (SDG 3, 4, 8, 10). Developing an awareness of one’s own views, identities, biases, and experiences is a starting point for developing a greater understanding of diversity and increasing engagement with people whose views may traditionally be marginalised or unheard to start to build a culture of equity, where an individual’s characteristics are recognised, accepted, and supported. Acknowledging and celebrating diversity provides opportunities to interrogate dominant perspectives underpinning modern speech-language pathology practice, reimagine professional identities, and address barriers and inequalities facing the current and future workforce and service users.

Disclaimer

To the best of the Speech Pathology Association of Australia Limited’s (‘the Association’) knowledge, this information is valid at the time of publication.

Acknowledgements

The authors thank the SLPs who participated in the survey for sharing their views. The authors also thank Speech Pathology Australia staff for their contributions.

Disclosure statement

This commentary draws upon findings from a needs analysis survey funded by Speech Pathology Australia (SPA). Authors SN and AM received payment from SPA as the leads/consultants. Other authors were involved as part of their usual employment with SPA.