Department of Human Development and Family Studies, The Pennsylvania State University, University Park.
Child Language Doctoral Program, University of Kansas, Lawrence.
Am J Speech Lang Pathol. 2022 Mar 10;31(2):854-880. doi: 10.1044/2021_AJSLP-21-00024. Epub 2022 Feb 4.
Most research on language acquisition and impairments is neutral to work setting; however, work settings (e.g., schools, health care) are expected to differ in alignment with overlaid workplace models (e.g., education, medical). These differences may affect clinical service provision for individuals with specific language impairment (SLI). This article evaluates potential effects of work setting on top-down advocacy initiatives and clinical service provision for children with symptoms of SLI.
Speech-language pathologists serving pediatric populations in health care-based ( = 140) and school-based ( = 423) work settings completed a three-part survey: (a) participant demographics, (b) report of case/workload and practice patterns, and (c) clinical vignettes and eligibility belief. Data analysis included descriptives and chi-square tests.
The work setting groups reported differences in eligibility terminology, eligibility criteria, and practice patterns from the point of referral through discharge. The reported differences aligned with overlaid workplace models. As compared to the school-based group, health care-based participants reported fewer eligibility restrictions in the workplace, agreed more often with a belief in less restrictive eligibility criteria, and reported more sensitive clinical decisions when operating under neutral workplace circumstances. Despite these findings, health care-based participants reported a smaller proportion of individuals with language impairment only on their caseload.
Work setting variations influence the underidentification of individuals with SLI for speech-language pathology services. Differences in responses by workplace indicate the need for unique and targeted advocacy efforts. Shifting diagnostic terminology and criteria will be insufficient in closing the gap unless advocacy efforts also address speech-language pathologists' workplace realities.
大多数关于语言习得和障碍的研究对工作环境是中立的；然而，工作环境（例如学校、医疗保健）预计会因重叠的工作场所模式（例如教育、医疗）而有所不同。这些差异可能会影响到特定语言障碍（SLI）患者的临床服务提供。本文评估了工作环境对自上而下的倡导举措和儿童 SLI 临床服务提供的潜在影响。
在医疗保健（n=140）和学校（n=423）工作环境中为儿科人群服务的言语语言病理学家完成了三部分调查：（a）参与者人口统计学信息，（b）报告病例/工作量和实践模式，以及（c）临床案例和资格认定信念。数据分析包括描述性统计和卡方检验。
工作环境组报告了从转介到出院点资格认定术语、标准和实践模式的差异。报告的差异与重叠的工作场所模式一致。与学校组相比，医疗保健组的参与者在工作场所报告的资格限制较少，更同意限制较少的资格认定标准，并且在中性工作场所环境下做出更敏感的临床决策。尽管有这些发现，但医疗保健组报告的仅语言障碍患者比例较小。
工作环境的变化影响了言语语言病理学服务中对 SLI 个体的识别不足。工作场所回应的差异表明需要独特和有针对性的倡导努力。除非倡导努力还解决言语语言病理学家的工作场所现实问题，否则改变诊断术语和标准将不足以缩小差距。
