1. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Tania Lyddiard Speech Pathologist Kaleidoscope, HNELHD August 2014 Tania.Lyddiard@hnehealth.nsw.gov.au

2. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) What is speech pathology? Assess children/adults with communication and feeding difficulties Provide intervention for children/adults with communication and feeding difficulties Communication encompasses: − Receptive language (comprehension) − Expressive language (spoken language) − Articulation (speech skills) − Pragmatics (social skills) − Play skills (Speech Pathology Australia, 2013)

3. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Effects of Trauma Trauma impacts on development across domains Trauma impacts significantly on speech and language development (Allen & Oliver, 1982; Culp et al, 1991; Eigsti & Cichetti, 2004; Hwa- Froelich, 2012; Nathanson & Tzioumi, 2007)

4. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Effect of trauma on speech & language development Speech difficulties - 45% of maltreated children under 5 years of age Language difficulties – 20% of older children 55% of foster carers had taken a child to see a speech pathologist (Nathanson & Tzioumi, 2007; McLeod & McKinnon, 2007; Jessup, Ward, Cahill & Keating, 2008; Golding, Williams &Leitao, 2011)

5. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Children in OOHC in New South Wales

6. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Kaleidoscope Speech Pathology Service Paediatric service providing speech pathology assessment and management 3 local government areas Increase in referrals of children in Out of Home Care (OOHC) ⁻Policy ⁻Knowledge

7. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Kaleidoscope Speech Pathology Service – Referral Demographics

8. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Identified issues Unique client group Increase in referral rate of children in OOHC Support systems and processes required Consistency of service and documentation Staff support required

9. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) The child

10. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) The foster carer

11. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) The caseworker

12. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) The speech pathologist

13. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) The speech pathology service

14. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Conclusion Unique challenges when working with children in OOHC Strategies to ensure children in OOHC maintain links with services despite changes Other services may face different challenges

15. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Future Directions Ongoing education of the effects of maltreatment on predicting speech/language delay. Improved mechanisms to support speech pathologists Linking in with other multidisciplinary services Intervention based on evidenced based practice Development of standardised assessment protocols for children in OOHC

16. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) Acknowledgements Dr Nicole Byrne, Team Leader & Co-author Kaleidoscope Community Based Services Speech Pathology team Karen Kemp, HNELHD OOHC Coordinator Nic Mensforth, OOHC Policy Officer for NSW Kids and Families Julie Hull, HNELHD Health Case Manager HNELHD OOHC Health Services

17. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) References Allen, R., & Oliver, J. (1982). The effect of child maltreatment on language development. Child Abuse and Neglect, 6(3), 299–305 Australian Institute of Health and Welfare (AIHW). (2012). Child protection Australia 2010– 11. Child Welfare series no. 53. Cat. no. CWS 41. Canberra: Author. Byrne,N., & Lyddiard, T. (2013). Challenges and practical strategies for speech pathologists working with children in out of home care (OOHC).Journal of Clinical Practice in Speech- Language Pathology, 15(3), 131-137 Council of Australian Governments (COAG). (2009).Protecting children is everyone’s business: National Framework for Protecting Australia’s Children 2009–2020. Retrieved from http://www.fahcsia.gov.au/sites/default/files/documents/child_protection_framework.pdf Culp, R., Watkins., R, Lawrence, H., Letts, D., Kelly, D., & Rice, M. (1991). Maltreated children’s language and speech development: Abused, neglected, and abused and neglected. First Language, 11(33), 377–389. Eigsti, I., & Cicchetti, D. (2004). The impact of child maltreatment on expressive syntax at 60 months. Developmental Science, 7(1), 88–102

18. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) References (continued) Golding, S., Williams, C., & Leitão, S. (2011). Speech and language development: Knowledge and experiences of foster carers. ACQuiring Knowledge in Speech, Language and Hearing, 13(1), 12–19. Henry, J., Sloane, M., & Black-Pond., C. (2007). Neurobiology and neurodevelopmental impact of childhood traumatic stress and prenatal alcohol exposure. Language,Speech, and Hearing Services in Schools, 38(2), 99–108. Hunter New England Health Local Health District (HNELHD). (2012). HNELHD Community Paediatric Clinical Priority Tool. Newcastle, NSW: Author. Hwa-Froelich, D. (2012). Childhood maltreatment and communication development. Perspectives on School-Based Issues, 13(2), 43–53. Jessup, B., Ward, E., Cahill, L., & Keating, D. (2008). Prevalence of speech and/or language impairment in preparatory students in northern Tasmania. International Journal of Speech-Language Pathology, 10(5), 364–77. Lyddiard, T. (2012a). Speech and language development in children – Education package. Newcastle, NSW: Hunter New England Local Health District.

19. Challenges and practical strategies for speech pathologists working with children in Out of Home Care (OOHC) References (continued) Mcleod, S., & McKinnon, D.H. (2007). The prevalence of communication disorders compared with other learning needs in 14,500 primary and secondary school students. International Journal of Language and Communication Disorders, 42(S1), 37–59. Nathanson, D., & Tzioumi, D. (2007). Health needs of Australian children living in out-of-home care. Journal of Paediatrics and Child Health, 43(10), 695–699. NSW Department of Premier and Cabinet. (2009). Keep them safe report: A shared approach to child wellbeing. Retrieved from http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0004/57145/Keep_Them_Safe.pdf Speech Pathology Australia (2013). Retrieved from http://www.speechpathologyaustralia.org.au/library/2013Factsheets/Factsheet_What_is_a_ Speech_Pathologist.pdf Webster, S., Temple-Smith, M. & Smith, A. (2012). Children and young people on out-of-home care: improving access to primary care. Australian Family Physician, 41(10), 819–822 Westby, C., (2007). Child maltreatment: A global issue. Language, Speech and Hearing Services in Schools, 38(2), 140–148.Westby, 2007

20. Tania Lyddiard Speech Pathologist Kaleidoscope, HNELHD http://www.kaleidoscope.org.au/ Tania.Lyddiard@hnehealth.nsw.gov.au