Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review.

Background: Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. Objective/Aim: The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. Methods/Design: A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results: Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. Conclusion: This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.

Cleft Lip and/or Palate in Infants Prenatally Exposed to Opioids.

OBJECTIVE: To determine the prevalence and odds ratios for cleft lip and/or palate (CL/P) among infants prenatally exposed to opioids with or without neonatal opioid withdrawal syndrome (NOWS). DESIGN: This study represents an exploratory, retrospective cohort study design of newborn medical health records from 2011 to 2016. SETTING: Records were drawn from a regional health system located in South Central Appalachia. POPULATION AND STUDY SAMPLE: The original population yielded 3 cohorts of infants: (1) infants with opioid exposure (OE) but not requiring pharmacological intervention (OE; N = 168); (2) infants with NOWS requiring pharmacological intervention (N = 294); and (3) infants with no opioid exposure (NOE; N = 16 090), the primary comparison group. MAIN OUTCOME: Infants in the NOWS and OE groups showed significantly increased prevalence and odds ratios for CL/P when compared to those in the NOE group. RESULTS: Prevalence rates per 1000 live births for infants with OE (35.71) and infants with NOWS (6.80) were significantly higher than those for infants with NOE (1.37). Comparison of infants with OE to the NOE group revealed significantly increased odds for CL/P, isolated cleft palate (CP), cleft lip (CL), and cleft lip and palate (CLP) (27.05, 41.81, 19.26, 19.37, respectively; all Ps < .008). The odds ratios for infants with NOWS compared to the NOE group were significantly higher for CL/P and CP (5.00 and 10.98, respectively; Ps < .03) but not for CL and CLP. CONCLUSION: The results provide additional evidence that prenatal OE should be considered among the critical environmental risk factors that can contribute to CL/P.

A model for cross-cultural translation and adaptation of speech-language pathology assessment measures: Application to the Focus on the Outcomes of Communication Under Six (FOCUS©).

PURPOSE: In the absence of a gold standard, this study illustrates the process involved in the cross-cultural translation and adaptation of the FOCUS© and its shortened version, FOCUS-34© (the Parent Form and Instruction Sheet, as well as the Clinician Form and Instruction Sheet), while also determining the social validity and clinical applicability of the translated measure. The target language used as example was Afrikaans, one of the 11 official languages of South Africa. METHOD: A two-phase cross-cultural translation model was employed in which Phase 1 (comprising a six-step blind back-translation procedure) was sequentially followed by Phase 2 (social validation and clinical applicability of the measure, using focus groups with stakeholders). RESULT: The extensive process followed in Phase 1 resulted in a clear and appropriate translation acceptable to both stakeholder groups (parents and speech-language pathologists). Both groups questioned the meaning of certain concepts, explored cultural differences and requested the extension of some items. Parents also shared their emotional reactions towards assessment, while therapists focussed on editorial changes to the measures. CONCLUSION: A framework is proposed for cross-cultural translation and adaptation of assessment measures with suitability in the speech-language pathology discipline.

Personal Commitment Statements: Encouraging the Clinical Application of Continuing Professional Development Events for Health Practitioners in Low- and Middle-Income Countries.

INTRODUCTION: Statements of commitment to change are commonly used to evaluate continuing medical education. However, this approach is new to evaluating the continuing professional development (CPD) of other health care practitioners such as audiology, speech-language therapy, occupational therapy, and physiotherapy in low- and middle-income countries. This study explored the use of Personal Commitment (to change) Statements (PCSs) as an evaluation tool of continuing education for health professionals in low- and middle-income countries, and its impact on the integration of new knowledge and skills with previous knowledge and clinical practice. METHODS: PCSs were used in a case study conducted at a 1-day interprofessional CPD event held for health practitioners in South Africa. A qualitative thematic analysis was made of these PCSs, and results were synthesized into main themes. RESULTS: Thirty-two participants turned in a PCS at the end of the CPD event with a total of 71 text statements. Three main domains were identified: (1) applying new knowledge in practice (61.97%); (2) increasing training-related content knowledge (21.12%); and (3) sharing information, skill, and resources (16.9%). DISCUSSION: This study demonstrated that personal commitment statements can be used to describe the outcomes of CPD events for audiologists, speech-language, occupational, and physiotherapists. Participants engaged in reflection generated by the personal commitment statement, which contained no guiding statements, yet elicited responses showing that participants were more aware of the assessment tools and how they could use them in practice. Further study is warranted into the process and the role of follow-up regarding health practitioners' commitment to change in clinical practice.

Mixed-methods research: A tutorial for speech-language therapists and audiologists in South Africa.

BACKGROUND:  Mixed-methods research (MMR) offers much to healthcare professions on clinical and research levels. Speech-language therapists and audiologists work in both educational and health settings where they deal with real-world problems. Through the nature of their work, they are confronted with multifaceted questions arising from their efforts to provide evidence-based services to individuals of all ages with communication disorders. MMR methods research is eminently suited to addressing such questions. Objective: The aim of this tutorial is to increase awareness of the value of MMR, especially for readers less familiar with this research approach. Method: A literature review was conducted to provide an overview of the key issues in MMR. The tutorial discusses the various issues to be considered in the critical appraisal of MMR, followed by an explanation of the process of conducting MMR. A critical review describes the strengths and challenges in MMR. Results: MMR is less commonly used or published in the fields of speech-language therapy and audiology. Conclusion: Researchers working in teams can draw on the strengths of different disciples and their research approaches. Such collaborative enterprises will contribute to capacity building. Researchers, SLTs and audiologists are encouraged to make use of MMR to address the complex research issues in the multicultural, multifaceted South African context. MMR makes an important contribution to the understanding of individuals with communication disorders, and in turn, researchers in the two disciplinary fields of speech-language therapy and audiology can contribute to the development of this research approach. MMR is well suited to the complexity of South African contexts and its populations, as it can provide multiple perspectives of a topic.

Communication characteristics of young children with HIV in South Africa as reported by some physicians.

HIV has been shown to have significant effects on the development of a child. Currently, there is limited South African research regarding HIV and specific characteristics of communication development, and the treatment thereof, in the child infected with HIV. The objective of the research was to describe the communication characteristics of a group of children between the ages of 0 and 5 years infected with HIV at a hospital in Gauteng, South Africa. Clinic records of 203 children infected with HIV between the ages of 0 and 5 years were reviewed using a pre-designed checklist within the outreach clinic of a large regional hospital. A questionnaire was completed by four medical practitioners working with this population within the outreach clinic. A total of 91.62% of the infected children were diagnosed as being either in Stage III or IV of the disease (according to the WHO classification system of 2005), with all infants presenting with a CD4 count of ≤ 60. Most (75.37% of the total sample) were receiving Highly Active Antiretroviral Therapy (HAART) at the time the data were collected. According to their medical, social, communication and general development, almost all the children qualified for Early Communication Intervention (ECI) but were not recorded as being referred for such services. A large proportion of the target population presented with opportunistic infections and/or HIV associated conditions. The results highlight the developmental characteristics of children living with HIV, and identify the need for medical doctors and allied health professionals to be provided with relevant literature or training regarding the communication development of children infected with HIV. This will facilitate appropriate referrals for ECI services.

Continued professional development of teachers to facilitate language used in numeracy and mathematics.

Learners in South African schools have been found to perform poorly in mathematics because they do not understand the language used in solving mathematical problems. In order to improve academic performance teachers need to be made aware of the importance of language in the development of numeracy. A continued professional development (CPD) programme addressed this need. The purpose of the research was to understand how the participants implemented the strategies developed during the programme and how they perceived the support provided by the programme. The research was conducted over 2 years in semi-rural and urban contexts. As part of a more comprehensive mixed method study, the qualitative data referred to in this article were obtained through open-ended questions in questionnaires, focus groups,I reflections in portfolios, and a research diary. Results showed that numeracy terminology was often used by learners that differed from standard terminology prescribed by the curriculum. The participants themselves did not necessarily understand the numeracy terminology and thus found it a challenge to implement curriculum outcomes. Issues related to language use of the participants in teaching numeracy were associated with the lack of resources available in the language of learning and teaching (LoLT). Some of the participants taught numeracy in English, rather than LoLT. The results indicated low teacher expectations of the learners. The CPD programme was considered valuable and effective. SLPs in schools need to be expand their role to provide CPD opportunities for teachers.

The development of a neonatal communication intervention tool.

Neonatal communication intervention is important in South Africa, which has an increased prevalence of infants born with risks for disabilities and where the majority of infants live in poverty. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists (SLTs) and audiologists in neonatal nurseries in the South African context. SLTs have the opportunity to provide the earliest intervention, provided that intervention is well-timed in the neonatal nursery context. The aim of the research was to compile a locally relevant neonatal communication intervention instrument/tool for use by SLTs in neonatal nurseries of public hospitals. The study entailed descriptive, exploratory research. During phase 1, a survey was received from 39 SLTs and 2 audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which depended on the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but resourceful in their attempts to adapt tools/materials. Participants expressed needs for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During phase 2, a tool for parent guidance titled Neonatal communication intervention programme for parents was compiled in English and isiZulu. The programme was piloted by three participants. Suggestions for enhancements of the programme were made, such as providing a glossary of terms, adapting the programme's language and terminology, and providing more illustrations. SLTs and audiologists must contribute to neonatal care of high-risk infants to facilitate development and to support families.

Speech-language therapists supporting foundation-phase teachers with literacy and numeracy in a rural and township context.

Language is required for learning, but educators often find it difficult to facilitate listening and language skills while they have to adapt to a new national curriculum with an outcomes-based approach for which they have not necessarily been adequately trained. A multifaceted support programme was developed for foundation-phase educators to facilitate listening and language for literacy and numeracy, with a particular focus on language for numeracy. The aim of the research was to determine the value of this particular support programme for foundation-phase educators in two different contexts (a semi-rural and a township context). A mixed methods approach with a concurrent, equal status triangulation design was used, where qualitative data were transformed to quantitative data in order to be compared in a matrix. The results show that the participants benefited to varying degrees from the programme. The combination of workshops, practical and mentoring components proved to be an effective means of support. The results indicate a need for pre-training selection procedures as more effective support can be provided to homogeneous groups.

Incidence and description of dysphagia in infants and toddlers with tracheostomies: a retrospective review.

OBJECTIVE: An increasing number of infants and toddlers with tracheostomies were identified at a large paediatric referral hospital in South Africa. They are at risk for swallowing and feeding difficulties, however, there is limited literature reporting the incidence and describing the dysphagia in this population, and no literature specific to a developing country. The purpose of this study was therefore to report the incidence and describe the dysphagia in infants and toddlers with tracheostomies at a large paediatric referral hospital in South Africa. METHOD: A retrospective, descriptive review of the medical records of 80 infants and toddlers (0-3 years) with tracheostomies between 2002 and 2004 was conducted. RESULTS: Eighty percent (64/80) of the participants presented with dysphagic symptoms. Oral phase dysphagia was reported in 81.25% (52/64), pharyngeal phase dysphagia in 60.9% (39/64) and oesophageal phase dysphagia in 79.7% of the dysphagic participants. CONCLUSIONS: Infants and toddlers with tracheostomies are at increased risk for dysphagia. Multiple risk factors for dysphagia associated with tracheostomies, underlying medical conditions and the context of a developing country were identified in the study population.

A novel service delivery model for infant hearing screening in developing countries.

Newborn hearing screening is the procedure of choice for ensuring optimal outcomes for infants with hearing loss, whether in a developed or developing country. Unfortunately, apart from a small number of recent exceptions, newborn hearing screening has been a practice reserved for the developed world. Despite the prevailing challenges towards implementing hearing screening in developing countries, there are existing structures in these countries that need to be investigated as possible platforms from which programs can be actualized. Immunization clinics, constituting part of a primary healthcare approach characteristic of developing countries, offer one such a platform. A novel service delivery model, based on initial results from a pilot study, was developed for infant hearing screening at immunization clinics in South Africa as an integrated part of primary, secondary, and tertiary levels of healthcare. This type of model is a first step toward ensuring that infants with hearing loss in developing communities are afforded opportunities for optimal development and societal integration through accountable and contextually relevant early hearing detection and intervention services.

High frequency immittance for neonates: a normative study.

CONCLUSION: High frequency immittance measurements demonstrate promise in clarifying middle ear status for neonates but age- and gender-specific norms should be consulted. OBJECTIVE: To describe high frequency immittance measurements using a 1000 Hz probe tone for a sample of 278 neonatal ears (0-4 weeks of age) in order to compile normative tympanometric and acoustic reflex criteria. SUBJECTS AND METHODS: Assessment of neonatal ears included 1000 Hz probe tone immittance measurements (tympanograms and ipsilateral acoustic reflexes), and distortion product oto-acoustic emission (DPOAE) screening. Results were compared and normative values were compiled for immittance measures in ears controlled for normal middle ear functioning (n=250). RESULTS: Comparison of immittance results to OAE screening outcome provides estimates of sensitivity and specificity for middle ear fluid with tympanometry of 57% and 95%, and 57% and 90% for acoustic reflex presence, and 58% and 87% for combined tympanogram and acoustic reflex results, respectively. Normative data indicate that static peak admittance values differ significantly across gender and age with the 5th percentile cut-off value for the entire sample at 1.4 mmho. The 90% range of tympanic peak pressure normative values increases with increasing age from 140 daPa for neonates 1 week of age to 210 daPa for neonates 2-4 weeks of age. Acoustic reflexes were elicited at 93+/-9 dB with a 90% normality range of 80-105 dB.

Auditory processing disorders: training of speech-language therapists and audiologists within the South African context.

This study examined the nature of the undergraduate curricula for Auditory Processing Disorders (APD) for communication pathologists (speech-language therapists and audiologists) within the South African context. An exploratory descriptive survey design was utilised. The respondents (N=9) were the authoritative voices in the area of APD, i.e. academics based at training institutions involved in the training of Speech-Language Therapists and Audiologists in the field of APD. They represented the five institutions providing training in APD at the time of data collection. A specifically designed questionnaire and the course descriptors and/or study guides were used to obtain information on the APD training programmes at each institution. A curriculum analysis framework was utilised to analyse the curricula (Jansen & Reddy, 1998). The study found no standard with regard to lecture and clinical time allocation. The time allocated to the theoretical training in APD across the training institutions varied significantly from 4 hours 30 minutes to 53 hours and that for clinical training varied from 7 to 48 hours. However, the results showed that the curricula offered in APD at all training institutions compared favourably with international trends. Information was not forthcoming on how the South African social and contextual issues were incorporated into training in APD.

Infant hearing screening at immunization clinics in South Africa.

OBJECTIVE: Benefits of early identification and subsequent intervention for hearing loss are not accessible to infants in developing countries like South Africa. There are no systematic screening programs and traditional platforms for newborn hearing screening, such as well-baby and intensive care nurseries, do not provide sufficient coverage due to the high incidence of births at home or in primary healthcare facilities. Primary healthcare structures, in the form of immunization clinics, have been proposed as an alternative screening platform. The current study, therefore, investigates a hearing screening program implemented at two immunization clinics in a representative South African community. METHODS: The two clinics in the current study were selected by a convenience sampling method in a community representative of large sections of the population. The hearing screening program was conducted over a 5-month period, and enrolled 510 infants (0-12 months of age). The screening protocol included Distortion Product Oto-Acoustic Emissions (DPOAE) and a high frequency probe tone (1000 Hz) tympanogram. Referral was based on one or both ears referring the DPOAE screen. Follow-up screening and diagnostic evaluations were scheduled for referred subjects. RESULTS: Coverage with DPOAE amounted to 95% of the sample ears (93% of sample subjects) compared to tympanogram coverage amounting to 94% (93% of sample subjects). OAE pass rates were 93% for the sample ears with neonatal ears indicating a higher pass rate of 95% compared to 92% for infant ears (5-52 weeks of age). Eighty-seven percent of the sample ears indicated peaked tympanograms indicative of normal middle-ear functioning and neonatal ears presented with an increased incidence of peaked tympanograms (92%). A highly significant association between the DPOAE and high frequency tympanometric result was found. Follow-up screening appointments were scheduled for 68 subjects (14% of screened sample). Only 40% returned for the second follow-up and 44% for the third follow-up. CONCLUSIONS: Immunization clinics indicate promise as infant hearing screening platforms, but identification of only bilateral hearing losses may be warranted initially to keep referral rates acceptably low. In addition to this efficient tracking systems are necessary to ensure acceptably high follow-up return rates are reached over time.

Facilitating cleft palate team participation of culturally diverse families in South Africa.

OBJECTIVE: The Facial Cleft Deformities Clinic, University of Pretoria, Pretoria, South Africa, provides interdisciplinary team services to patients with cleft lip and palate and craniofacial anomalies. They represent the "rainbow nation" of South Africa and reflect the multicultural and multilingual nature of the population, which poses a challenge to effective and accountable service delivery. The aim of this study was to explore some cultural variations that exist in black families that influence their participation in the team approach and to describe the assets of families that may be used to empower them and to enhance service delivery. DESIGN: A descriptive survey research design. A questionnaire-by-interview procedure was utilized during routine visits of 35 black families to the Facial Cleft Deformities Clinic. RESULTS: The results are discussed from an ethnographic perspective of the family and describe the knowledge base of the participants, the diagnosis and treatment of the children's cleft lip and palate, family structure and support systems, family income and education, and the geographical distribution of the participants. Implications for building family partnerships and for improving professionals' cultural competence in order to improve the quality of service delivery are presented. CONCLUSIONS: By viewing cultural differences on a continuum, following the asset-based approach, applying knowledge based on contextually relevant research, and recognizing family uniqueness, families may be empowered to participate fully in the team approach to support their children with cleft lip and palate and craniofacial anomalies in attaining their full potential in the South African context.

[Young children's use of communication functions before and after cochlear implants]. / Jong kinders se gebruik van kommunikasiefunksies vóór en ná kogleêre inplanting.

This paper describes the communication functions of five young children with cochlear implants in order to study the influence of these children's early intentional communication on their individual communication skills after cochlear implantation. Video recordings of each of the five participants in unstructured free play interaction with their, caregivers, before cochlear implantation and twelve and eighteen months after cochlear implantation, were used to identify the type and occurrence of their communication functions over time. The Communicative Intention Inventory (Coggins & Carpenter, 1981) was used to classify the communicative behaviour of the participants according to the types of communication functions that were used. Results of the study show that the type and occurrence of the communication functions differed before and after cochlear implantation and demonstrated the participants' increased ability to participate in conversation. Individual differences amongst the participants in their use of informative and heuristic communication functions could possibly account for interclient variability in the rate of verbal communication development after cochlear implantation. The results are seen as meaningful in clinical decision-making regarding the suitability of young children under the age of three with a profound hearing loss for cochlear implantation and their therapeutic management. The results also contribute to the identification of an objective protocol for the evaluation of the early communication of young children with a profound hearing loss who are in a prelinguistic stage of language development.

The needs of teachers of children with hearing loss within the inclusive education system.

In South Africa, the current movement towards the inclusion of children with disabilities, including children with hearing loss, is likely to have far-reaching consequences for both teachers and learners. Undoubtedly, needs will arise from teachers during the transition, especially in the areas pertaining to the audiological and educational management of children with hearing loss. Therefore, a descriptive research design was developed comprising of a questionnaire survey followed by focus group interviews to determine teachers' needs. The questionnaire survey explored the needs of 664 teachers while focus group interviews were conducted with 19 teachers of children with hearing loss. Teachers were mostly from special schools as only a very small number of children are educated outside these establishments. Findings revealed that, although participants realised the importance of various aspects of development of the child with hearing loss, they generally did not realise the importance of receiving support from an educational audiologist.

Clinical training of undergraduate communication pathology students in neonatal assessment and neonate-caregiver interaction in South Africa.

Developing an undergraduate clinical training module in Early Communication Intervention (ECI) that provides sufficient opportunity for students' learning experiences, and that allows contextually relevant and ethically accountable services to clients, as well as the dissemination of the latest scientific findings to both students and clients, poses a significant challenge. The article describes the development of a clinical training block and the development of an appropriate instrument for the assessment of neonatal communication skills that was used in this student practical. A qualitative research approach, employing a series of formative assessments, was used to refine the instrument. The results indicated changes in the content and use of the neonatal assessment instrument regarding the approach to infant and caregiver risk assessment; caregiver beliefs about neonatal capabilities; newborn state observation; caregiver training; language, cultural and age barriers; collaboration with nurses; kangaroo mother care; involvement of caregivers during the assessment; and adolescent mothers. The results confirmed the need for the ongoing refinement of an instrument to ensure quality training of students in the difficult field of neonatal assessments and neonate-caregiver interaction. The results also highlighted to the importance of initiating ECI services before birth in communities at risk for infant neglect and abuse, and the close relationship between ECI service delivery and student training.