1. Janine Standen – Clinic Manager, La Trobe Communication Clinic
How is La Trobe Communication Clinic helping trans and gender diverse individuals and those who stutter?
Janine Standen – Clinic Manager, La Trobe Communication Clinic
16 October 2018

2. Services we provide:
Speech Pathology
Audiology

3. About the La Trobe Communication Clinic (LCC)
Health service situated within a University
Our consumers are members of the public and students on placement
University subsides services
Almost all services are student delivered (supervised by expert clinicians)
Student clinicians are enthusiastic providers and clients acknowledge this
Educating the future workforce
High expectations placed on the students as they are assessed for competency on placement
Close liaison with academic experts ensures best practice provision
Our services are supported by research and outcomes published. In some fields results demonstrate our student delivered treatment is equivalent to or better than results published from experienced clinicians

4. Overview of LCC Programs
Audiology Clinic
Adolescent and Adult Fluency Clinic
Voice Clinic
Trans and Gender Diverse Services in partnership with Monash Gender Clinic
General Voice Clinic
Paediatric Fluency Clinic
Phonological Awareness for Literacy Clinic – primary school age clients
Preschool Speech and Language Clinic
See
Audiology Clinic
Commenced in 2018 maintain focussed at the La Trobe Community but services will be expanded.
Adol/ Adult Flu
This clinic supports adolescents and adults who stutter.
Each clinic occurs once a year.
We offer a 2 month therapy program - 3 to 5 day intensive to teach fluency promoting techniques and then 7 weekly evening follow up sessions to assist with maintenance and generalisation
There are also 4 to 6 review days which I will explain in more detail later
Voice Clinic
Primarily see trans and gender diverse clients however we do assist others with general voice issues.
We receive funding from the Monash Health to deliver the trans speech pathology services due to our wealth of expertise in the area. We are working to enhance services available in the community
We provided 1:1 therapy which typically involves weekly sessions. The clinic runs year round.
In addition we offer Education Days and Review Days which I will explain in more detail
Paed
Our paediatric services are funded by DHHS and we receive community health funding. In addition to seeing preschool fluency, speech, language and voice clients, we are also able to see school age children who stutter all year round.
In addition we offer a Phonological Awareness for Literacy Program for 5 weeks in April/May where we see children in Grades 2-6 who have reading and spelling difficulties. We can offer these programs at schools in addition to the clinic.

5. Impact of the disorders we treat on mental health
People affected by stuttering, language and literacy disorders or identifying as trans and gender diverse are more likely to present with mental illnesses such as:
Anxiety
Depression
Socio-emotional problems
Significant mental health consequences, potentially leading to suicide, have been established in these client groups.

6. Trans
and
Gender Diverse

7. Mental health of trans and gender diverse individuals
This population is at increased risk for poor mental health outcomes such as:
Poor self image and reduced self esteem
Emotional difficulties such as generalised & social anxiety, depression, fear, anger, & suicidal ideation
Social withdrawal, reduced social integration
Discrimination, violence, harassment, bullying & inequality of vocational opportunity
(Davies & Goldberg, 2006; McNeil, 2006; Dacakis, 2002)
See emma’s presentation about barriers

8. Voice and gender identity
What is the issue?
Voice plays a major role in gender identity
The negative consequences of intolerances in our community to gender non- conformity means that a gender incongruent voice contributes to:
Discrimination
Loss of employment
Abuse
Those perceived as visual-non-conformers (identified by others as not matching how they should look and sound for a given gender) are at greater risk of the negative consequences (Grant et al, 2011).

9. Population seeking LCC’s services
We see people with any gender position who feel that their voice does not align with their true self, and therefore desire voice modification to address the incongruence
Our clients are mostly Birth Assigned Males who identify as Female. We have fewer Birth Assigned Females who identify as Male or non-binary clients
In birth assigned males, hormones do not change the pitch of the voice
In birth assigned females hormones (testosterone) increase the bulk of the vocal folds resulting in a lower pitch
Of 71 new referrals to our service so far this year, 20 clients come from the North East Melbourne region. Which equates to 28% of our caseload; nearly a 1/3
Stuff around male voice in female appearance and what we actually do.

10. How can speech pathology assist?
Identifying goals collaboratively with the individual
Assessment:
Establishing the impact of the voice
Taping the voice for analysis on computer software
Identifying personal goals
Voice Training
Providing individualised training in line with recommended techniques to achieve pitch and resonance change
On request, body language, eye contact and non speech sounds e.g. laughing, coughing, sneezing
Stuff around male voice in female appearance and what we actually do.

11. How LCC assist the trans and gender diverse community?
Provide a comprehensive and lifespan service encompassing
Group education days (Health Promotion Activity)
Individualised assessment, training and generalisation
Group review days (Health Promotion Activity)
Flexible service delivery
Spaced (weekly/fortnightly)
Group
Individual
Telehealth
Play with format – table with two sections

12. Stuttering

13. Stuttering and mental health
Stuttering is associated with:
Poorer mental health outcomes
Social anxiety social phobia
Children who stutter are more likely to be teased by their peers.
Older children and adults who stutter often fail to achieve their educational or career potential and may experience significant anxiety in social situations.

14. How LCC assists those who stutter?
Providing a comprehensive and lifespan service encompassing
Fluency instatement
Generalisation
Maintenance (Health Promotion Activity)
Relapse (Health Promotion Activity)
Flexible service delivery
Intensive / Spaced (weekly/fortnightly)
Individual / Group
Telehealth
Play with format – table with two sections

15. Health
Promotion

16. Our health promotion approach
Improving Mental Health
Victorian public health and wellbeing plan
Receive funding from DHHS
Specific target groups
Trans and gender diverse individuals who are aligning their voice and communication characteristics with their gender identity
Those who stutter
Poorer outcomes if communication issues aren’t addressed and skills aren’t maintained
Conscious effort to maintain stutter free speech or gender congruent voice

17. These specific groups need more than the usual population focussed health promotion approach
Service delivery as prevention (health promoting interventions)
There is a place for targeted interventions for at risk populations

18. Health promotion activities at LCC
Fluency services
Stuttering in adolescents/adults is prone to relapse & thus impacts wellbeing
Fluency Review Days (4 – 6 annually) for adolescents and adults who have had prior therapy (usually at LCC) and wish to work on maintenance or relapse strategies
Promotes wellbeing, self management and fluency maintenance: includes opportunities for guided skill practice, transfer, group presentations etc
Evaluation: pre and post surveys, objective measures
Voice services
Voice Education Days (2 - 3 annually) to promote overarching knowledge of voice, gender differences, and vocal health
Voice Review Days (1 - 2 annually) to promote maintenance of voice and the chance to ‘refresh’ and update knowledge and skills with new evidence based changes in training techniques
Socialisation and education regarding services in the community
Evaluation: pre and post surveys
Stuttering
Input from a variety of service providers (DET, CEO, private practice)
Work with Australian Speak Easy Association
Maintenance – coming in to avoid relapse
Relapse – are stuttering again

19. Our successes
Participants return year after year Rapid change as a result of review days (stuttering reduces) Increased confidence in using voice / fluency techniques Increased confidence when communicating in social activities as a result of their review day attendance Attendees report reduced anxiety following participation
We are well known within the trans and gender community and are involved heavily with ANZPATH (aus NZ professional association for trans health)
TVQ – transsexual voice questionnaire shows improved outcomes post training
Stuttering
Input from a variety of service providers (DET, CEO, private practice)
Work with Australian Speak Easy Association
Maintenance – coming in to avoid relapse
Relapse – are stuttering again

20. Future directions
Join with local services to continue health promotion work to improve the mental health of the community
Trans and gender diverse
Social support networks / services
Rainbow Tick Accreditation
Online module and webinar development to support other Speech Pathologists to work with the community and provide voice training
Stuttering
Service development, public information forums, clinician education
Paediatric populations – focus on literacy, early stuttering
Other ideas?
SpeakEasy – support their weekly meetings by rostering students to attend to facilitate feedback and practice
Students participate in their booster days (review days) and staff

21. Thank
you