Speech pathologists should take a holistic approach to assessment and management that is aligned to an Aboriginal and Torres Strait Islander worldview.
NHMRC level of Evidence: GPP
Rationale: This may include:
i) Working closely with family (including family members non-Aboriginal and Torres Strait Islander Australians would call 'extended family').
ii) Working jointly with other allied health colleagues (joint sessions in a multidisciplinary approach).
iii) Making pre-discharge links with the client's local Aboriginal Medical Service if they are associated with one.
iv) Being flexible with therapy context e.g. include home visits.
v) Making opportunities for the client to participate in yarning and social activity if they would like it.
vi) Traditional healing.
In line with research proposing and evaluating service delivery models in Aboriginal and Torres Strait Islander populations (Isaacs et al., 2010; Reibel & Walker 2010; Keightly et al., 2009) , people-centred primary care is a central notion, with communities being involved in all steps of the development of viable and sustainable programs. A recent study (Gauld, Smith & Kendall, 2011) noted that Community Based Rehabilitation (CBR) (Helander, 2007) for people with TBI was only successful if extensive community consultation occurred, with all key stakeholders included in the development of such programs.
The importance of developing services which are deeply embedded in both family and community contexts is also reflected in the findings of the first Australian study related to ACD in Aboriginal Australians by Armstrong et al. (2012). Results from this study suggested that the lack of attendance at formal speech pathology services did not imply that communication was considered of low priority. Interviewees sought opportunities for yarning through social and community contacts, and existing community networks were proposed as potentially important ways of delivering more relevant, accessible and culturally appropriate services as well as raising awareness of ACD.
A recent national survey (Hersh, Armstrong, & Panak, submitted) involving 112 speech-language pathologists investigated their levels of contact with Aboriginal and Torres Strait Islander clients; their assessment, intervention, and discharge practices; liaison with family, involvement with Aboriginal Health Workers (AHW), Aboriginal Liaison Officers (ALO) and interpreters; as well as reports of cultural competency training and potential sources of support. Among other findings, two thirds of respondents who currently worked with Aboriginal and Torres Strait Islander clients (N=63) felt they had insufficient knowledge about Aboriginal and Torres Strait Islander culture, insufficient support and lower levels of confidence with these clients than with non-Aboriginal and Torres Strait Islander clients. They felt their Aboriginal and Torres Strait Islander clients required flexible services, good access to interpreters, and culturally appropriate assessments and treatments delivered in culturally appropriate settings.
Only one study to date (Armstrong, Hersh, Hayward, Fraser & Brown, 2012) has documented the experiences of three Aboriginal people with aphasia after stroke. Another study (Missing Voices: Communication difficulties after stroke and traumatic brain injury in Aboriginal Australians funded by NH&MRC 2013-2015) is underway which is exploring client perspectives on aphasia assessments and treatment across Western Australia. The 2012 study revealed a view of stroke consequences by the participants framed within a broader health context where people had a range of co-morbidities which were often considered more significant than the aphasia, a resilience and a strong ‘getting on with life’ attitude, little focus on communication difficulties yet an emphasis on the importance of communication for maintaining family and community connection, and strong community re-integration following brain injury utilising Aboriginal community based services and links rather than traditional speech pathology input.
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Professor Linda Worrall