Graves Judy
Forest CLDT, Belle Vue Centre, Cinderford, UK.
Int J Lang Commun Disord. 2007 Mar;42 Suppl 1:103-21. doi: 10.1080/13682820601171373.
The working context for speech and language therapists (SLTs) delivering interventions to adults who have a learning disability has changed following the reorganization of care provision from hospitals to the community. Consequently, SLTs often deliver their care within a social model of disability through indirect intervention in collaboration with carers. However, there has been little research into how this approach works in practice.
To gain insight into the working context by identifying the key factors that influence indirect SLT interventions as perceived by SLTs and by paid carers from a range of service providers. To explore the implications of the results for the delivery of indirect SLT interventions and provide direction for further research.
METHODS & PROCEDURES: Semi-structured interviews were used to collect data from an opportunistic sample of five SLTs working in Community Learning Disability Teams (CLDTs) and 12 carers from residential and day care services who had had experience of working with SLTs. The data were analysed inductively using a grounded theory framework.
OUTCOMES & RESULTS: Two broad themes emerged for SLTs: roles and expectations, and changing carer behaviour through training. The key themes for carers were roles and values, awareness of communication needs, and motivation and opportunity to implement interventions. Four broad factors are suggested as having the potential to influence indirect interventions: diversity in the working context; possible conflict between the guiding values of SLTs and carers, particularly residential carers; collaboration and support for implementation; and SLT doubts about the effectiveness of formal carer communication training.
The results add to the evidence that the delivery of indirect speech and language therapy interventions to people with learning disabilities is a complex activity demanding specialist skills from SLTs. The findings suggest that these should include expertise in professional collaborative and relational skills, and training methods and strategies. Action research is needed to test the validity of the findings and document their impact on indirect interventions in day-to-day practice. More research is needed on the effectiveness of modelling or demonstration as a training technique with carers.
随着护理服务从医院向社区的重新组织，为有学习障碍的成年人提供干预措施的言语和语言治疗师（SLTs）的工作环境发生了变化。因此，言语和语言治疗师通常通过与护理人员合作进行间接干预，在社会残疾模式下提供护理。然而，对于这种方法在实际中如何运作的研究很少。
通过确定言语和语言治疗师以及来自一系列服务提供商的付费护理人员所认为的影响间接言语和语言治疗师干预的关键因素，深入了解工作环境。探讨结果对间接言语和语言治疗师干预实施的影响，并为进一步研究提供方向。
采用半结构化访谈从一个机会样本中收集数据，该样本包括在社区学习障碍团队（CLDTs）工作的五名言语和语言治疗师，以及来自住宿和日托服务机构、有与言语和语言治疗师合作经验的12名护理人员。使用扎根理论框架对数据进行归纳分析。
言语和语言治疗师出现了两个广泛的主题：角色与期望，以及通过培训改变护理人员行为。护理人员的关键主题是角色与价值观、对沟通需求的认识，以及实施干预的动机和机会。建议有四个广泛因素可能影响间接干预：工作环境的多样性；言语和语言治疗师与护理人员（特别是住宿护理人员）的指导价值观之间可能存在的冲突；实施的协作与支持；以及言语和语言治疗师对正式护理人员沟通培训效果的怀疑。
结果进一步证明，为有学习障碍的人提供间接言语和语言治疗干预是一项复杂的活动，需要言语和语言治疗师具备专业技能。研究结果表明，这些技能应包括专业协作和关系技能方面的专业知识，以及培训方法和策略。需要进行行动研究来检验研究结果的有效性，并记录其对日常实践中间接干预的影响。需要更多关于将示范或演示作为与护理人员的培训技术的有效性的研究。
