Transitioning Speech-Language Assessment to a Virtual Environment: Lessons Learned From the ELLA Study.

Purpose The COVID-19 pandemic has necessitated a quick shift to virtual speech-language services; however, only a small percentage of speech-language pathologists (SLPs) had previously engaged in telepractice. The purpose of this clinical tutorial is (a) to describe how the Early Language and Literacy Acquisition in Children with Hearing Loss study, a longitudinal study involving speech-language assessment with children with and without hearing loss, transitioned from in-person to virtual assessment and (b) to provide tips for optimizing virtual assessment procedures. Method We provide an overview of our decision making during the transition to virtual assessment. Additionally, we report on a pilot study that calculated test-retest reliability from in-person to virtual assessment for a subset of our preschool-age participants. Results Our pilot study revealed that most speech-language measures had high or adequate test-retest reliability when administered in a virtual environment. When low reliability occurred, generally the measures were timed. Conclusions Speech-language assessment can be conducted successfully in a virtual environment for preschool children with hearing loss. We provide suggestions for clinicians to consider when preparing for virtual assessment sessions. Supplemental Material https://doi.org/10.23641/asha.14787834.

Evaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC.

PURPOSE: There are no evidence-based guidelines informing which patients with head and neck cancer (HNC) require regular speech pathology (SP) support during radiation treatment (RT). Hence, some services use a "one-size-fits-all" model, potentially over-servicing those patients at low risk for dysphagia. This study evaluated the clinical safety and efficiency of an interdisciplinary service model for patients identified prospectively as "low risk" for dysphagia during RT. METHODS: A prospective cohort of 65 patients with HNCs of the skin, thyroid, parotid, nose, and salivary glands, receiving curative RT, were managed on a low-risk pathway. Patients with baseline dysphagia (functional oral intake score ≤ 5) were excluded. The model involved dietitians conducting dysphagia screening at weeks 3, 5, and 6/7 within scheduled appointments. Patients at risk of dysphagia were referred to SP for assessment, then management if required. To validate the model, SP assessed swallow status/toxicities at week 5/6/7 during RT and confirmed dysphagia status at weeks 2 and 6 post RT. RESULTS: Most (89.3%) patients did not require dysphagia support from SP services. Of the 18 patients identified on screening, only 7 (10.7%) had sufficient issues to return to SP care. Week 5/6/7 SP review confirmed low levels of toxicity. No post-treatment dysphagia was observed. There was an incremental benefit of A$15.02 for SP staff costs and a recovery of 5.31 appointments per patient. CONCLUSION: The pathway is a safe and effective service model to manage patients with HNC at low risk for dysphagia during RT, avoiding unnecessary SP appointments for the patient and service.

Implementation of speech pathology telepractice services for clinical swallowing assessment: An evaluation of service outcomes, costs and consumer satisfaction.

INTRODUCTION: Timely assessment of swallowing disorders (dysphagia) by speech pathologists helps minimise patient risk, optimise quality of life, and limit healthcare costs. This study involved a multi-site implementation of a validated model for conducting adult clinical swallowing assessments via telepractice and examined its service outcomes, costs and consumer satisfaction. METHODS: Five hub-spoke telepractice services, encompassing 18 facilities were established across a public health service. Service implementation support, including training of the telepractice speech pathologists (T-SP) and healthcare support workers in each site, was facilitated by an experienced project officer. New referrals from spoke sites were managed by the hub T-SP as per published protocols for dysphagia assessments via telepractice. Data was collected on existing service models prior to implementation, and then patient demographics, referral information, session outcomes, costs and patient and T-SP satisfaction when using telepractice. RESULTS: The first 50 sessions were analysed. Referrals were predominantly for inpatients at spoke sites. Telepractice assessments were completed successfully, with only minor technical issues. Changes to patient management (i.e. food/fluid changes post assessment) to optimise safety or progress oral intake, was required for 64% of patients. Service and cost efficiencies were achieved with an average 2-day reduction in waiting time and an average cost benefit of $218 per session when using the telepractice service over standard care. High clinician and patient satisfaction was reported. CONCLUSION: Telepractice services were successfully introduced across multiple sites, and achieved service and cost benefits with high consumer satisfaction.

Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia.

OBJECTIVE: Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA. DESIGN: Cross-sectional. SETTING: Administrative data from acute care hospitals in the state of North Carolina. PARTICIPANTS: Individuals (N=4381) with poststroke aphasia. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of care. METHODS: The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data were analyzed to examine the effect of rural or urban residence on LOS, SLP service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (non-Hispanic white and non-Hispanic black). Outcomes were analyzed using generalized linear model. RESULTS: Both rural and urban black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural white counterparts after adjusting for differences in their demographics and stroke or illness severity. The differences were attenuated after controlling for the hospital where they received care. CONCLUSIONS: For PWA, race-ethnicity has a larger effect on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care.

Economic Analysis of a Three-Arm RCT Exploring the Delivery of Intensive, Prophylactic Swallowing Therapy to Patients with Head and Neck Cancer During (Chemo)Radiotherapy.

Research advocates for the use of intensive, prophylactic swallowing therapy to help reduce the severity of dysphagia in patients receiving (chemo)radiotherapy ([C]RT) for head/neck cancer (HNC). Unfortunately, the intensity of this therapy, coupled with growing patient numbers and limited clinical resources, provides challenges to many international cancer facilities. Telepractice has been proposed as a potential method to provide patients with greater support in home-practice, whilst minimising burden to the health service. This study investigated the clinical and patient-attributable costs of delivering an intensive, prophylactic swallowing therapy protocol via a new telepractice application "SwallowIT" as compared to clinician-directed FTF therapy and independent patient self-directed therapy. Patients (n = 79) with oropharyngeal HNC receiving definitive (C)RT were randomised to receive therapy via a: clinician-directed (n = 26), patient-directed (n = 27), or SwallowIT-assisted (n = 26) model of care. Data pertaining to health service costs (service time, consumables, therapy resources), patient-attributable costs (travel and wages) and patient-reported health-related quality of life (QoL) (AQoL-6D) were collected. SwallowIT provided a cost-efficient model of care when compared to the clinician-directed model, with significant cost savings to both the health service and to HNC consumers (total saving of $1901.10 AUD per patient; p < 0.001). The SwallowIT model also proved more cost-effective than the patient-directed model, yielding clinically significantly superior QoL at the end of (C)RT, for comparable costs. Overall, when compared to the alternate methods of service-delivery, SwallowIT provided a financially viable and cost-effective method for the delivery of intensive, prophylactic swallowing therapy to patients with HNC during (C)RT.

Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer.

BACKGROUND: The purpose of this study is to report the economic outcomes of a new synchronous telepractice service providing speech pathology intervention to patients with head and neck cancer at nonmetropolitan facilities. METHODS: A multisite randomized controlled trial comparing standard care versus a new synchronous telepractice model was conducted within a large Australian public cancer service. Data pertaining to health service costs (staff wages, equipment, and patient travel reimbursement), patient +/- carer costs (travel and wages), and patient-reported quality of life (Assessment of Quality of Life questionnaire 4D) were collected. RESULTS: Eighty-two referrals (39 standard care and 43 synchronous telepractice care) were managed. The new telepractice service reported average cost savings of 12% (P < .0058) for the health service and $40.05 saving per patient per referral. An equivalent positive increase in quality of life (0.04) was reported for both groups. CONCLUSION: The synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.

The PD COMM trial: a protocol for the process evaluation of a randomised trial assessing the effectiveness of two types of SLT for people with Parkinson's disease.

BACKGROUND: The PD COMM trial is a phase III multi-centre randomised controlled trial whose aim is to evaluate the effectiveness and cost-effectiveness of two approaches to speech and language therapy (SLT) compared with no SLT intervention (control) for people with Parkinson's disease who have self-reported or carer-reported problems with their speech or voice. Our protocol describes the process evaluation embedded within the outcome evaluation whose aim is to evaluate what happened at the time of the PD COMM intervention implementation and to provide findings that will assist in the interpretation of the PD COMM trial results. Furthermore, the aim of the PD COMM process evaluation is to investigate intervention complexity within a theoretical model of how the trialled interventions might work best and why. METHODS/DESIGN: Drawing from the Normalization Process Theory and frameworks for implementation fidelity, a mixed method design will be used to address process evaluation research questions. Therapists' and participants' perceptions and experiences will be investigated via in-depth interviews. Critical incident reports, baseline survey data from therapists, treatment record forms and home practice diaries also will be collected at relevant time points throughout the running of the PD COMM trial. Process evaluation data will be analysed independently of the outcome evaluation before the two sets of data are then combined. DISCUSSION: To date, there are a limited number of published process evaluation protocols, and few are linked to trials investigating rehabilitation therapies. Providing a strong theoretical framework underpinning design choices and being tailored to meet the complex characteristics of the trialled interventions, our process evaluation has the potential to provide valuable insight into which components of the interventions being delivered in PD COMM worked best (and what did not), how they worked well and why. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN12421382 . Registered on 18 April 2016.

Management of swallowing in thrombolysed stroke patients: Implementation of a new protocol.

PURPOSE: There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012. METHOD: Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012-2014), and non-thrombolysed stroke patients (n = 43). RESULT: Following the implementation of this clinical protocol, the average time patient remained nil by mouth reduced by 9.5 h, the percentage of patients who were malnourished or at risk reduced by 24% and the number of patients who developed aspiration pneumonia reduced by 11%. The cost of hospital stay reduced by $1505. Service compliance with best practice in dysphagia management in thrombolysed patients increased from 67% to 96% in the thrombolysed patient groups. CONCLUSION: The outcomes suggest that a clinical protocol for dysphagia management in thrombolysed patients has the potential to improve service outcomes, reduce complications from dysphagia, have financial benefits for the hospital and increase service compliance. Furthermore, the results lend support for speech pathology services to manage dysphagia on weekends.

Transcranial direct current stimulation in post-stroke sub-acute aphasia: study protocol for a randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising new technique to optimize the effect of regular Speech and Language Therapy (SLT) in the context of aphasia rehabilitation. The present study focuses on the effect of tDCS provided during SLT in the sub-acute stage after stroke. The primary aim is to evaluate the potential effect of tDCS on language functioning, specifically on word-finding, as well as generalization effects to verbal communication. The secondary aim is to evaluate its effect on social participation and quality of life, and its cost-effectiveness. METHODS: We strive to include 58 stroke patients with aphasia, enrolled in an inpatient or outpatient stroke rehabilitation program, in a multicenter, double-blind, randomized controlled trial with two parallel groups and 6 months' follow-up. Patients will participate in two separate intervention weeks, with a pause of 2 weeks in between, in the context of their regular aphasia rehabilitation program. The two intervention weeks comprise daily 45-minute sessions of word-finding therapy, combined with either anodal tDCS over the left inferior frontal gyrus (1 mA, 20 minutes; experimental condition) or sham-tDCS over the same region (control condition). The primary outcome measure is word-finding. Secondary outcome measures are verbal communication, social participation, quality of life, and cost-effectiveness of the intervention. DISCUSSION: Our results will contribute to the discussion on whether tDCS should be implemented in regular aphasia rehabilitation programs for the sub-acute post-stroke population in terms of (cost-)effectiveness. TRIAL REGISTRATION: Nederlands Trail Register: NTR4364 . Registered on 21 February 2014.

Refinements of the Medicare Outpatient Therapy Annual Expenditure Limit Policy.

BACKGROUND: A Medicare beneficiary's annual outpatient therapy expenditures that exceed congressionally established caps are subject to extra documentation and review requirements. In 2011, these caps were $1,870 for physical therapy and speech-language pathology combined and $1,870 for occupational therapy separately. OBJECTIVE: This article considers the distributional effects of replacing current cap policy with equal caps by therapy discipline (physical therapy, occupational therapy, and speech-language pathology) or a single combined cap, and risk adjusting the physical therapy cap using beneficiary characteristics and functional status. METHODS: Alternative therapy cap policies are simulated with 100% Medicare claims for 2011 therapy users (N=4.9 million). A risk-adjusted cap for annual physical therapy expenditures is calculated from a quantile regression estimated on a sample of physical therapy users with diagnoses and clinician assessments of functional ability merged to their claims (n=4,210). RESULTS: Equal discipline-specific caps of $1,710 each for physical therapy, occupational therapy, and speech-language pathology result in the same aggregate Medicare expenditures above the caps as 2011 cap policy. A single combined-disciplines cap of $2,485 also results in the same aggregate expenditures above the cap. Risk adjustment varies the physical therapy cap by as much as 5 to 1 across beneficiaries and equalizes the probability of exceeding the physical therapy cap across diagnosis and functional status groups. LIMITATIONS: One limitation of the study was the assumption of no behavioral response on the part of beneficiaries or providers to a change in cap policy. Additionally, analysis of risk adjusting the therapy caps was limited by sample size. CONCLUSIONS: Equal discipline-specific caps for physical therapy, occupational therapy, and speech-language pathology are more equitable to high users of both physical therapy and speech-language pathology than current cap policy. Separating the physical therapy and speech-language pathology caps is a change that policy makers could consider. Risk adjustment of the therapy caps is a first step in incorporating beneficiary need for services into Medicare outpatient therapy payment policy.

Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue.

OBJECTIVES/HYPOTHESIS: This study investigated financial and treatment implications of a speech-language pathologist (SLP) performing a voice evaluation at the initial laryngologic visit. STUDY DESIGN: Retrospective chart review. METHODS: Medical records from 75 consecutive adult voice therapy patients during a 3-month period were categorized into two groups: group 1 (n = 37) represented patients who underwent a medical speech evaluation (MSE) at the initial voice assessment with the laryngologist (+SLP), and group 2 (n = 38) represented patients who did not receive an MSE (-SLP). Data collected included age, gender, voice diagnosis, number of therapy sessions attended and cancelled, reason for discharge, and pre- and post-voice therapy Voice Handicap Index-10 (VHI-10) scores. RESULTS: Patients in the +SLP group had fewer cancellations (P = 0.001), greater change in VHI-10 from pre- to post-therapy (P = .001), and were more likely to be discharged from therapy having met therapeutic goals (P = .007) than patients in the -SLP group. In addition, lost revenue over 3 months due to cancellations/no-shows was $2,260 in the +SLP group compared to $7,030 in the -SLP group (P < .001). CONCLUSIONS: Concurrent voice evaluation by an SLP and laryngologist at initial diagnostic visit affects therapy attendance, voice therapy outcomes, and ultimately SLP and departmental billing revenue. Results may be due to more appropriate therapy referrals from SLP assessment of patients in conjunction with a laryngologist. LEVEL OF EVIDENCE: 4.

Practices and challenges in community aphasia groups in Australia: Results of a national survey.

PURPOSE: This study reports on practices and challenges in developing community aphasia groups in Australia. METHOD: A 24-item web-based survey addressed the structure of existing community aphasia groups, funding models, group activities, facilitator satisfaction, challenges to group development and maintenance and suggestions for improvement. A total of 156 surveys were completed, mostly by speech-language pathologists (SLPs), with 66% urban and 34% regional/rural/remote participants representing all Australian states/territories consistent with their populations. RESULT: Seventy respondents indicated running a total of 86 groups, reflecting a substantial under-representation of service in proportion to the population of people with aphasia. Further, 23.6% of respondents reported dissatisfaction with aspects of their groups. The primary barriers to achieving satisfaction relate to limited resources and staffing, inability to run sufficient numbers of groups and to tailor them effectively, dispersed populations beyond major cities, group dynamics and a lack of group promotion and referral to groups. Respondents suggested means for improvement including changes to group structure, improved SLP training, dedicated funding and staffing, development of specific resources and better liaison and promotion. CONCLUSION: The major features differentiating the community aphasia groups run in Australia from those running overseas are discussed and practical ways to achieve service improvement are suggested.

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study.

PURPOSE: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. METHOD: Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. RESULT: It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. CONCLUSION: Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Analyzing international clinical education practices for Canadian rehabilitation students.

BACKGROUND: Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university. METHODS: In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research. RESULTS: Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing. CONCLUSIONS: International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Retrospective cost-effectiveness analysis of treatments for aphasia: an approach using experimental data.

PURPOSE: Evidence supports the effectiveness of speech-language treatment for individuals with aphasia, yet less is known about the cost-effectiveness of such treatments. The purpose of this study was to examine the incremental cost and cost-effectiveness of aphasia treatment using previously published data. METHOD: The authors completed a retrospective cost-effectiveness analysis using experimental data that they extracted from 19 previously published aphasia treatment studies. Average and incremental cost-effectiveness ratios were calculated based on participants' pre- and posttreatment proficiency scores. RESULTS: The average cost-effectiveness ratio for all sessions was $9.54 for each 1% increase in the outcome of interest. Measures of incremental cost-effectiveness indicated that aphasia treatments resulted in statistically significant improvements up to and including 17 treatment sessions. Increases in proficiency occurred at a cost of approximately $7.00 per 1% increase for the first 3 sessions to more than $20.00 in the 14th session; the ratio was either not statistically significant or dominated (more costly and less effective) in later sessions. CONCLUSIONS: This cost-effectiveness analysis demonstrated that initial aphasia treatment sessions resulted in relatively larger and more cost-effective benefits than did later aphasia treatment sessions. The findings reported here are preliminary and have limitations. Prospective studies are needed to examine the cost-effectiveness of speech-language treatment for individuals with aphasia.

Educating globally conscious speech-language pathologists for collaborative professional practice.

Speech-language pathologists (SLPs) practicing in the US are facing significant changes in reimbursement, billing and practice in both health care and educational settings. Health care professionals need to convey and demonstrate the value of their services, measure functional patient outcomes and assess patient satisfaction. Documentation procedures for patient and student progress are changing, becoming more abbreviated and electronic. The content of curricula in accredited graduate programs and professional development programs for maintenance of certification for SLPs will need modifications to address the myriad of changes in clinical practice. University programs that design interprofessional education opportunities for students in speech-language pathology programs and educate students in other health professional programs, e.g. physical therapy, occupational therapy, nursing and pharmacy, will help practitioners who are prepared to engage in collaborative practice with other health care professionals in hospitals, schools and community-based environments. The American Speech-Language-Hearing Association (ASHA) is actively engaged in several initiatives to facilitate interprofessional education for graduate students, faculties and practicing professionals. Individuals and families with communication disorders in the US represent an array of cultures, and SLPs need to be prepared to work effectively with individuals from different cultural and linguistic backgrounds.

Rural speech-language pathologists' perceptions of working with allied health assistants.

Workforce shortages are forecast for speech-language pathology in Australia, and will have a more significant impact on rural and remote areas than on metropolitan areas. Allied health (AH) disciplines such as physiotherapy and occupational therapy address the problem of workforce shortages and growing clinical demand by employing allied health assistants (AHAs) to provide clinical and administrative support to AH professionals. Currently, speech-language pathologists (SLPs) don't work with discipline-specific allied health assistants in all states of Australia (e.g., New South Wales). This paper aims to provide insight into the perceptions of SLPs in one Australian state (NSW) regarding working with AHAs. Semi-structured interviews were conducted with eight rural SLPs. Qualitative analysis indicated that participants perceived they had deficits in skills and knowledge required to work with AHAs and identified further training needs. Participants perceived the SLP role to be misunderstood and were concerned about poor consultation regarding the introduction of AHAs into the profession. Ambivalence was evident in overall perceptions of working with AHAs, and tasks performed. While previous research identified benefits of working with AHAs, results from this study suggest that significant professional, economic, and organizational issues need addressing before such a change should be implemented in speech-language pathology.

A pilot trial of a speech pathology telehealth service for head and neck cancer patients.

We explored the feasibility of providing access to specialist speech pathology services via telehealth for patients with head and neck cancer. A weekly telehealth clinic was conducted between the speech pathology departments of a tertiary hospital and a regional hospital in Queensland. Over a 5-month period, 50 telehealth sessions were conducted for 18 patients. There were 38 patient consultations, nine case discussions between clinicians and three clinical training sessions relating to the skills needed for specific client management (e.g. voice prosthesis selection). Eight sessions had multidisciplinary involvement. All cases were successfully managed via telehealth. All patients agreed that they were comfortable using telehealth and would be happy to use it again in future. Both clinicians agreed that they could competently assess patients using the telehealth system. There appeared to be financial benefits for the patient, because by receiving specialist intervention at a local facility their travel expenses were lower. There was also the opportunity for workforce training and development through online case discussion and clinical consultation.

Dysphagia training for speech-language pathologists: implications for clinical practice.

There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians' perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs.