https://orcid.org/0000-0002-5552-6312
Abstract
Purpose
This commentary describes the development of global partnerships, capacity-building, and the basis for the creation of a website (Leadersproject.org) used throughout the world that contains free educational resources for the assessment and treatment of people with communication disabilities (PWCD). This website contains speech-language assessment and treatment materials, online skill-building courses, over 200 instructional videos, train-the-trainer course materials, and syntheses of important research and trainings in over 30 languages. This commentary relates the work from leadersproject.org to the United Nations Sustainable Development Goals (SDGs).
Result
Through this website, the authors have established ongoing global partnerships with other health and education professionals. Moreover, PWCD and their families have used the website for information and support throughout the world. Speech-language pathologists (SLPs) and other health and education professionals use these materials to host capacity-building trainings and to support the development of knowledge and skills to local professionals for the benefit of PWCD. The Leadersproject.org resources have been influential and impactful as measured by approximately 24 000 visits from over 130 countries throughout the world.
Conclusion
The authors of this paper continue to establish partnerships worldwide to spread education and increase the quality of care provided to PWCD. This commentary paper focuses on the United Nations 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), partnerships for the goals (SDG 17).
The United Nations adopted the 2030 Agenda for Sustainable Development, which contains 17 Sustainable Development Goals (SDGs; United Nations, Citation2015). These goals are intended to guide people from all nations “in a global partnership” for a prosperous present and future (United Nations, Citation2015). This commentary will discuss the development of Leadersproject.org, a website that was created in 2013 to spread knowledge of evidence-based assessment and treatment of people with communication disabilities (PWCD). Since its development, the authors have established partnerships with speech-language pathologists (SLPs) worldwide, which has led to many PWCD receiving evidence-based speech-language pathology services. The creation of this website and establishing collaborations have helped to ensure good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), and partnerships for the goals (SDG 17).
Access to SLPs is limited in low- and middle-income countries (LMICs), which may be due to a lack of established university programs (Baigorri et al., Citation2021; Crowley et al., Citation2013; Wylie et al., Citation2013). With their focus on capacity-building, the authors of Leadersproject.org wanted to create and offer materials to anyone throughout the world to learn more about the field of speech-language pathology and how to care for PWCD. By offering these resources online for free, and eliminating copyright restrictions, anyone with internet can access all the materials. Leadersproject.org offers speech-language assessment and treatment materials, online skill-building courses, over 200 instructional videos, train-the-trainer course materials, and syntheses of important research, in over 30 languages (See for a review of the Leadersproject.org resources). Content areas include culturally and linguistically appropriate evaluations, including School-age Language Assessment Measures (SLAM; Leadersproject.org, Citation2015), which are regularly used in Ghana and Jamaica and have been translated to over 10 languages; cleft palate speech assessment and treatment; culturally responsive augmentative and alternative communication (AAC), and literacy development.
Table I. Resources available on Leadersproject.org.
According to data from Google Analytics, each month the Leadersproject.org receives approximately 24 000 visits from over 130 countries. A majority of the Leadersproject.org users are in the United States (US; approximately 74%), but of the top 20 countries using the website in the most recent month, seven are in Asia, two are in Africa, and five are in Latin America. In this commentary the authors share how the website has evolved from AAC resources for PWCD to building sustainable cleft palate speech education programs, as well as the impact of these resources on clinical practice throughout the world.
Augmentative and alternative communication (AAC) resources
Before the beginning of Leadersproject.org, students from the masters of speech-language pathology program at Teachers College, Columbia University, US (TC) went to Ghana each year since 2008 to organise a professional development (Crowley et al., Citation2013). The authors collaborated with the Ministry of Education of Ghana, Special Education Division to develop the curriculum with the use of AAC, for the annual 3-day professional development retreats, which began in 2009, with the instruction shared by both the TC Team and Ghana’s Special Education Team. The AAC approaches were developed collaboratively with the unit school teachers and modified over time. They are used throughout Ghana because they are effective in facilitating community engagement and communication for PWCDs, thereby ensuring good health and well-being (SDG 3), and reducing inequalities (SDG 10) for PWCD. The AAC initiative is sustainable because the authors have created instructional videos on each individual AAC resource and made these available on Leadersproject.org. These instructional videos are all narrated by one of the unit school teachers and are used to ensure that all teachers understand how these AAC approaches are created and used in the classroom and community. An overview and references to these videos can be seen in .
Table II. Augmentative and alternative communication (AAC) video resources available on YouTube.com.
Cleft palate capacity training for sustainable programs
After beginning work with PWCD and AAC in Ghana, the authors realised the need for working with children with cleft lip and palate (CLP) throughout the globe. Children with CLP encounter issues with feeding and speech. As stated earlier, there is a lack of educational training programs for SLPs and thus a limited number of SLPs worldwide to work with children with CLP. Thus, PWCD related to CLP may encounter barriers to accessing speech and feeding services throughout the globe (Baigorri et al., Citation2021; Sommer et al., Citation2021). To combat this lack of education and disparity in healthcare worldwide, Leadersproject.org created a free online modules series and assessment, as well as a Train-the-Trainer initiative. While ensuring good health and well-being (SDG 3) and reducing inequalities (SDG 10) for individuals with CLP, this initiative also advances decent work and economic growth (SDG 8), promotes international cooperation for teacher training (SDG 4) and enhances global partnerships (SDG 17) for professionals working with individuals with CLP.
Cleft palate speech and feeding video tutorials
Leadersproject.org partnered with Smile Train in 2015 to create a free online tutorial series in Spanish (Crowley & Baigorri, Citation2014), English (Crowley, Baigorri, & Sommer, Citation2017), and, most recently, in French. These videos were developed to train SLPs as well as other medical providers who may treat the speech of children with CLP in the case that SLPs do not exist in a region. These modules have also been used in the US when students did not take a course in cleft palate (Baigorri, Crowley, & Sommer, Citation2020). Trainees watch all the videos and then take an assessment they need to pass to prove they have knowledge of how sounds are produced, anatomy and physiology, and cleft palate speech assessment and treatment.
Multilingual access to the CLP course
To make the modules accessible worldwide, the authors wanted to remove any linguistic barrier. The training modules (Crowley et al., Citation2017) have subtitles in English; however, anyone can change the language of the subtitles on YouTube, which has approximately 300 subtitled languages. Furthermore, the authors’ global partners have suggested using a slightly slower speech rate so that they can read the subtitles and have time to watch the videos and illustrations to increase the learning potential. Currently, the assessment part of the online course is on Leadersproject.org and is available in English, Spanish, French, and Bahasa. Watching and passing the assessment for these online modules are the necessary foundational components needed to attend an in-person training.
In-person capacity trainings for sustainable care
The in-person trainings are for 4–5-days. During the in-person training, the authors identify strong SLPs and professionals who have the skills to conduct the work the authors do independently. During this training, material is taught in the morning, and in the afternoon, trainees apply their newly learned information to clinical practice with children who have repaired CLP. The authors are constantly working on establishing new global partners and creating materials needed in their language(s). Wherever the trainings happen, part of the product is to create materials in the local languages so that they can be used and sustainable in speech therapy practice. When materials are developed, there is careful consideration for cultural and linguistic differences to ensure that these materials are easily used. Moreover, providing materials in the local language(s) allows the caregivers to also be involved in speech therapy and use the materials to continue practice in the home environment.
These trainings, primarily funded by Smile Train, each had approximately 20 SLPs and medical professionals in the following countries, with attendees from those countries, as well as attendees from surrounding countries represented in parentheses: Indonesia, Philippines, Colombia, Peru, Ecuador, Guatemala, Côte d’Ivoire (Senegal, Burkina Faso, Sudan, Guinea-Bissau, Congo, Togo, Benin), Cameroon, Ethiopia (Kenya, Uganda, Tanzania), Zimbabwe (Zambia, Malawi) Nigeria, and Ghana. These trainings have now been in progress for over 10 years. The first in-person training was in Guatemala in spring 2012 and the most recent training was in Madagascar in Spring 2022. Moreover, the authors have recently begun live online webinars. All the medical professionals who are not SLPs in their country but have completed the online course and the in-person training are referred to as “cleft speech interventionists”.
Global connections to medical providers and the cleft healthcare system
Those chosen for the in-person trainings are trained SLPs in the country or those medical professionals who may be interested and already work with a cleft palate team. This means that the people who are trained are already integrated into the existing health care system available for children born with CLP. During the in-person course, the patients at the partner hospitals then become part of developing team care. The patients provide the trainees with an opportunity to apply their newly learned knowledge and skills under the supervision of a specialist SLP who regularly works with children with CLP. The patient, while getting free services, receives a speech assessment and treatment session. This program not only helps to build the capacity needed to carry out these health services, but it is a sustainable program.
Train-the-trainer
After the authors leave the country where the in-person training was held, they select the next trainers who will train the next set of SLPs. Therefore, the next training in that country or region is done by someone trained in the earlier training. These chosen trainers are SLPs who developed expertise in the area and demonstrated strong clinical and teaching skills. Once the new trainer is selected, the authors provide the trainers with all the materials needed to do a 5-day CLP speech training. The Train-the-Trainer course for in-person training contains videos, PowerPoints, exams, and handouts, which are available in English, French, and Spanish.
Trainees→trainers: Local leaders
Since these in-person trainings, local SLPs have independently led 12 trainings with 10–20 people in each training in the Philippines, Benin, Cameroon, Kenya, Ethiopia, Ghana, Indonesia, and Peru. Some of the trainees have been teaching university courses on CLP and providing sustainable speech therapy for children with CLP and PWCD. One of the trainees has been providing speech therapy camps in an effort to give children with CLP access to speech services. Smile Train has estimated that in 2019 over 5000 children had received cleft palate speech therapy because of this training initiative and the Train-the-Trainer program. That number has grown as the number of trainings have continued to expand. The success of this model is only possible due to the global partnerships that are committed to providing quality sustainable care to children with cleft palate.
Connecting to the cleft healthcare system
Once the training is complete and the trainees have the capacity to provide speech therapy for PWCD with CLP, trainees connected to a Smile Train partner can upload their assessments of the child and document their progress in speech therapy, which are reviewed by SLP specialists who work with children with CLP. This process ensures that quality services are provided on an ongoing basis. Additionally, by Smile Train providing direct funding to the local trainees for the services, this ensures that the services continue to be sustainable.
Ongoing mentoring with our global partners
Mentoring is a part of the support after the in-person trainings. The authors have collaborated with Smile Train to create the Mentoring Alliance for Global Speech (MAGS) whereby cleft speech therapy specialists are paired with speech providers throughout the world (Horne et al., Citation2022). Mentors and their mentees meet one to two times a month for mentoring. Each mentor and mentee who participate in MAGS will be given a professional conference registration by Smile Train to ensure that capacity-building for cleft speech services continues to grow and strengthen throughout the world.
Summary
Leadersproject.org and its leaders have helped to advance SDG 17 by creating multiple worldwide partnerships for the goals (SDG 17). These partnerships have advanced SDG 3 by ensuring good health and well-being through the unit schools in Ghana and through the hospitals and clinics that work with children with CLP (United Nations, Citation2015). These global partnerships promote sustainability by building materials and resources to help children with their communication. Finally, the Train-the-Trainer’s initiative has provided advanced quality education (SDG 4) to many SLPs and others in the medical field. Above all, these trainees from the professional developments and the Train-the-Trainers have continued to provide services to PWCD, which underscores the success and sustainable work of Leadersproject.org. This work has helped to advance decent work and economic growth (SDG 8) by providing locals with employment. Finally, Leadersproject.org has helped to reduce inequalities (SDG 10) for PWCD and children with CLP by providing therapists worldwide with the resources to help clients communicate.
Throughout the inception of Leadersproject.org, the mission has been to provide free and easily accessible resources to ensure PWCD and children with CLP receive culturally and linguistically appropriate speech assessment and treatment resources. This website and its leaders have created sustainable collaborations globally. All efforts thus far have assisted in advancing SDG 3, SDG 4, SDG 8, SDG 10, and SDG 17. This work will continue to be fuelled by the authors’ mission and passion to teach others and provide free services to PWCD.
Declaration of interest
Chelsea, Cate, Edouardo, Veronica, Kimmy, and Nkeiruka work with Smile Train and Pam is a former employee at Smile Train. Cate is the director of Leadersproject.org and Chelsea is the codirector of cleft education on Leadersproject.org. Evelyn, Gemma, Belinda, Duncan, and Miriam have no relevant relationships to disclose.
References
- Baigorri, M., Crowley, C.J., Sommer, C.L., & Moya-Galé, G. (2021). Barriers and resources to cleft lip and palate speech services globally: A descriptive study. The Journal of Craniofacial Surgery, 32, 2802–2807. doi:10.1097/SCS.0000000000007988
- Baigorri, M., Crowley, C., & Sommer, C. (2020). Addressing the gap in education for cleft palate: A module training series for craniofacial assessment and treatment. Perspectives of the ASHA Special Interest Groups, 5, 662–668. doi:10.1044/2020_PERSP-19-00138
- Crowley, C.J., Baigorri, M., & Sommer, C.L. (2017). Cleft palate speech and feeding video tutorials. https://www.leadersproject.org/2017/03/23/english-cleft-palate-speech-therapy-evaluation-treatment-playlist/
- Crowley, C., & Baigorri, M. (2014). Terapia del habla para paladar hendido. Leadersproject.org YouTube.com. https://www.youtube.com/watch?v=sZa7rTp6DyE&list=PL2toYybtLe68X-pUeEL5exhiocZZ7a0dW
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- Horne, S., Crowley, C., Sommer, C., Baigorri, M., Yu, V., & Lico, M. (2022). The development and impact of an international clinical mentorship program to expand practitioner competency and cleft speech care [Poster presentation]. Cleft Congress, Edinburgh, Scotland.
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