INSPIRE: Inspiring practice innovation, research and engagement

The 2018 National Speech Pathology Australia Conference was held in Adelaide, an Australian city renowned for its church spires. Through its theme of INSPIRE 2018, the aim of this conference was to inspire scholarship and debate across three overlapping elements: Practice Innovation, Research and Engagement. The conference motive illustrated the three elements (or spires) reaching both up and out. This special issue of International Journal of Speech-Language Pathology reflects this important theme of the conference and aims to further inspire readers to become innovative practitioners and engage meaningfully with a broad range of consumers and research evidence.

The three internationally renowned keynote speakers − Professors Elizabeth (Liz) Ward, Ronald Gillam, and Dennis McDermott – along with the oral and poster presentations embodied the conference theme and a selection of these papers is included in this special edition. Ward is Professor at the Queensland Government’s Centre for Functioning and Health Research and The University of Queensland’s School of Health and Rehabilitation Sciences. In her Elizabeth Usher memorial lecture and paper, she paid homage to Elizabeth Usher, describing her as a remarkable practice innovator and calling on the profession to embrace the Practice Innovation theme of the conference (Ward, 2019, this issue). This call is in the face of changing community needs along with rising costs and complex problems in the health and education sectors. She cogently argued that speech-language pathology, as a maturing profession, must be flexible enough to enable advances in scope of practice and, at the very least, that all speech-language pathologists (SLPs) must work to their full scope. This is to ensure that we can achieve a “more client-centred, cost-effective health service” (n.d.). Her article outlines clear strategies to further develop practice innovation and expand the scope of practice in order for the speech-language pathology profession to have a “strong identity and the capacity to make meaningful contributions to the modern education and healthcare landscape” (n.d.).

Gillam is the Raymond and Eloise Lillywhite Endowed Chair in Speech-Language Pathology at Utah State University, where he is also the Co-Director of the Interdisciplinary Doctoral Program in Neuroscience. In this article, based on his keynote address, he provides a stimulating and excellent example for the Research theme. Testing the cognitive processing abilities of his audience, he took us on a deep dive into the cognitive neuropsychology underlying language. Summarising his own work, and the broader field to date, he sought to explicate the relationships between cognitive processing and sentence comprehension for school-age children with and without developmental language disorder (Gillam, Montgomery, Evans, & Gillam, 2019, this issue). Gillam and his colleagues have applied a rigorous psychometric approach to generate the Gillam-Evans-Montgomery (GEM) model. This model assigns a pivotal role to complex working memory in mediating the interaction between reasoning, attention, long-term language knowledge, and sentence comprehension, and identifies critical differences between typically developing children and those with developmental language disorders with regard to the magnitude of this effect. He suggested that SLPs who have a good understanding of the reciprocal relationships between language and working memory will be in a better position to understand and explain children’s profiles of strengths and weaknesses to their parents and teachers. On this basis, he challenged SLPs to incorporate a wide range of measures that examine underlying cognitive processes in their assessment of language but warned against taking a bottom-up approach to therapy by focussing on underlying cognitive deficits. Rather, he suggested a narrative-based and context-bound approach to language intervention and introduces us to the SKILL narrative instruction programme. Gillam’s message about language processing and implications for assessment and therapy traversed the paediatric-adult divide as many of the paradigms presented are equally relevant to acquired language disorders, specifically aphasia and cognitive-communication disorders.

McDermott is a Koori man with connections with Gamilaroi country (north-west NSW). At the time of the conference, McDermott was Director of Flinders University’s two Poche Centres for Indigenous Health and Well-Being (Adelaide and Northern Territory). He delivered a resounding address discussing the intersection of non-Indigenous SLPs and Indigenous Australia and epitomised the Engagement theme (McDermott, 2019, this issue). His discussion paper interwove Indigenous peoples’ knowledges with cultural competency and public health frameworks. He called for non-Indigenous SLPs to become culturally aware and sensitive in order to deliver culturally safe care to Australia’s First Nation’s people. He spoke of dadirri (inner, deep listening and quiet, still awareness, described by Miriam-Rose Ungunmerr-Baumann, Ngangiwumirr Elder), and seeing the world “two-ways”, as clinically useful concepts for non-Indigenous practitioners to consider. He also offered the Indigenous word ganma as a way of describing new knowledge that can be created from the coming together of Western and Indigenous knowledges. McDermott critically examined the Speech Pathology 2030 vision – Making Futures Happen (Speech Pathology Australia, 2016) and discussed how four elements of the vision might be viewed in relation to Australia’s First Nation’s people. He gently challenged the profession to be respectful of individuals’ specific, lived cultural experience and the social, geographical, economic and political realities that surround them, be alert to our own biases and consider how Indigenous knowledges and perspectives might contribute to greater connectedness with all of our clients. This paper is truly an inspirational piece.

In this issue, an additional six articles continue the Practice Innovation, Research and Engagement themes. The Practice Innovation theme was evident in McGill, McLeod, and Crowe (2019, this issue) where the authors conducted a three-staged study to explore the concept of “active waiting”. Given that some children in Australia have to wait 12 months or more for speech-language pathology services, “active waiting” involved the provision of information from authoritative sources to empower parents to engage with strategies to facilitate children’s speech and language development and alleviate some stress and uncertainty. The authors asked consumers what content and features of speech and language websites they rate highly while waiting for services, evaluated the quality of existing sites, and piloted a prototype of topics, formatting, features, and functions to include on a website about children’s speech and language. The authors describe the theory of “preparative waiting” (n.d.) as being a useful concept for service providers with long waiting times.

Dawes, Leitão, and Claessen, (2019, this issue) address both the Practice Innovation and Research themes in a robust study into the development of narrative comprehension in young children. They demonstrated that their freely available Squirrel Story Narrative Comprehension Assessment is a sensitive and reliable measure of the developmental progression of both literal and inferential comprehension in children between four and six years and can identify differences in these skills between typically developing children and children with developmental language disorders. This paper aligned with Gillam’s keynote address, reinforcing that effective discourse comprehension is a vital skill for communication and learning, and providing the profession with robust tools for assessment.

The Research theme is further represented in two articles. Barker, Doeltgen, Lynch, and Murray (2019, this issue) explored the perspectives of several health professional groups in stroke unit care (e.g. nurses, SLPs, doctors and dietitians) of using water protocols as a management strategy for patients with dysphagia. They reported a number of barriers and enablers that impact the implementation of water protocols in acute stroke care including nursing workload and skill. The findings are likely to inform future studies designed to evaluate the safety and effectiveness of water protocols, education and training approaches for health professionals, and will ultimately bridge the research-practice gap.

Gomez, McCabe, and Purcell (2019, this issue) surveyed SLPs about their judicious use of research in their clinical management of childhood apraxia of speech (CAS). They found that, despite valuing empirical evidence, a number of identified barriers resulted in the majority of SLPs using an eclectic mix of interventions at an intensity less than that suggested by the existing evidence. The authors explored the nexus between research and engagement, and the need to support clinicians to access, appraise and use empirical research. They also supported researchers making use of effective knowledge translation techniques to bridge the research-clinical gap, including researchers sharing resources and offering training to support clinicians to adopt evidence-based approaches.

The Engagement theme is highlighted in several articles. Ciccone, Armstrong, Hersh, Adams, and McAllister (2019, this issue) described the feasibility and acceptability of implementing The Wangi (talking) project as a model of rehabilitation for Aboriginal people with acquired communication disability after stroke. The innovative model of rehabilitation included, amongst other elements, involvement of an Aboriginal co-worker with the non-Aboriginal speech-language pathologist, principles of a yarning approach, and therapy in the stroke survivor’s home. Positive perceptions of the acceptability of the model from Aboriginal people, Aboriginal co-workers and SLPs were reported. This study exemplifies the possibility of delivering culturally safe and accessible services to Aboriginal people after acquired brain injury, aligning coherently with McDermott’s vision.

Millar, Mathisen, Carey and Fortune’s (2019, this issue) scoping review also highlighted the theme of Engagement, aiming to develop a working definition and set of capabilities that can be used to assess global citizenship amongst SLPs. From the literature review, the authors described nine common capabilities (e.g. social justice and valuing diversity). They used these concepts to propose a working definition of global citizenship for SLPs and health professionals more broadly, suggesting this definition may prove useful for exploring and assessing competency-based occupational standards.

We trust that the articles in this special edition will inspire the readership to be innovative in clinical practice, to engage critically with research evidence and be inspirational for, and culturally safe with, their consumers. The themes that they represent align with the Speech Pathology 2030 vision to ensure that effective communication and safe swallowing is a right for all Australians throughout their life.

Disclosure statement

No potential conflict of interest was reported by the authors.