Binns Amanda V, Cunningham Barbara Jane, Andres Allison, Oram Cardy Janis
Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; School of Communication Sciences and Disorders, Western University, London, Ontario, Canada; The Institute for Education Research, University Health Network, Toronto, Ontario, Canada.
School of Communication Sciences and Disorders, University of Western Ontario, London, Canada; CanChild, McMaster University, Hamilton, Ontario, Canada.
Autism Dev Lang Impair. 2022 Aug 29;7:23969415221120768. doi: 10.1177/23969415221120768. eCollection 2022 Jan-Dec.
Speech-language pathology services are among the most frequently accessed services for young autistic children. Therefore, understanding the nature of these services, what challenges these clinicians face, and what supports they value is critical for developing appropriate policies and practices that can maximize positive outcomes for children and families. This study had two primary aims. The first was to examine the self-reported assessment and intervention practices of community-based Speech Language Pathologists (SLPs) and communicative disorders assistants (CDAs; who provide services under the supervision of a SLP) in supporting preschool children with suspected and diagnosed autism. The second aim was to identify barriers and supports (facilitators) to providing services in the community using the Consolidated Framework for Implementation Research (CFIR) as a framework.
A cross-sectional online survey was used to collect qualitative and quantitative data from clinicians in Ontario Canada who were providing speech and language services to preschool children with suspected or diagnosed autism. Quantitative data were used to describe clinicians" practices, and qualitative data captured their perspectives on barriers and supports to providing services.
A total of 258 clinicians participated in the survey. On average, clinicians reported almost half of the preschoolers on their caseload had either diagnosed or suspected autism. There was consistency across the skill development areas assessed by SLPs, and targeted during therapy sessions, with the top four areas targeted being: foundational social communication, language, play and pragmatics. However, there was wide variation in speech and language assessment and intervention practices reported by this sample of clinicians (i.e., service delivery models, tools or programs used, length and duration of therapy services, level of collaboration with other professionals). Clinicians identified several barriers to providing services: limited funding and time, lack of inter-professional collaboration, difficulty accessing services, community messaging about autism services, family readiness and clinician knowledge. Supports (facilitators) included: access to autism-focused professional development, inter- and intra-professional collaboration, and access to additional supports in the community.
言语语言病理学服务是幼儿自闭症患者最常接受的服务之一。因此，了解这些服务的性质、这些临床医生面临的挑战以及他们重视的支持措施，对于制定能够为儿童和家庭带来最大积极成果的适当政策和实践至关重要。本研究有两个主要目标。第一个目标是调查社区言语语言病理学家（SLP）和言语交流障碍助理（CDA；在SLP的监督下提供服务）在支持疑似和确诊自闭症的学龄前儿童方面自我报告的评估和干预实践。第二个目标是使用实施研究综合框架（CFIR）作为框架，确定在社区提供服务的障碍和支持因素（促进因素）。
采用横断面在线调查从加拿大安大略省为疑似或确诊自闭症的学龄前儿童提供言语和语言服务的临床医生那里收集定性和定量数据。定量数据用于描述临床医生的实践，定性数据记录了他们对提供服务的障碍和支持因素的看法。
共有258名临床医生参与了调查。临床医生平均报告称，他们病例中的学龄前儿童几乎有一半被诊断或疑似患有自闭症。SLP评估并在治疗过程中针对的技能发展领域具有一致性，排在前四位的领域是：基础社交沟通、语言、游戏和语用学。然而，该临床医生样本报告的言语和语言评估及干预实践存在很大差异（即服务提供模式、使用的工具或项目、治疗服务的时长和持续时间、与其他专业人员的合作程度）。临床医生确定了提供服务的几个障碍：资金和时间有限、缺乏跨专业合作、难以获得服务、关于自闭症服务的社区宣传、家庭准备情况以及临床医生的知识。支持因素（促进因素）包括：获得以自闭症为重点的专业发展机会、跨专业和专业内合作以及在社区获得额外支持。
