Supporting children's recovery from bushfires: Stakeholders' views about the impact of a community-based intervention program on children.

INTRODUCTION: A multidisciplinary Bushfire Recovery Program was developed by Royal Far West focused on reducing the short- and medium-term impacts of the 2019-2020 bushfires in Australia on children's wellbeing and resilience. OBJECTIVES: To evaluate the impact of the Program's psychosocial groups on children's wellbeing and resilience. DESIGN: A two-phase mixed method approach was used, involving post-intervention surveys and interviews of children impacted by the 2019-2020 bushfires in Australia who participated in the Bushfire Recovery Program, their parents/carers, teachers, and the facilitators of the workshops. Statistical analysis was undertaken with quantitative data and content and thematic analysis of qualitative data. FINDINGS: Children learnt to talk to and trust adults, share thoughts and experiences with others, recognise they were not alone in their experiences, build connections with peers, understand and manage feelings, and implement strategies that enabled them to cope with change. DISCUSSION: Psychosocial groups delivered in preschools and schools as part of the Bushfire Recovery Program reportedly led to significant learning and positive impacts for children in the areas of coping, wellbeing, and peer connections. Similar themes occurred across surveys and interviews and findings reflected the perceptions of the children who participated in the groups, and key adults around the children. CONCLUSIONS: Community-based psychoeducational interventions can provide effective support in the short- and medium-term post-bushfire for children to develop strategies and skills to enable them to cope with changes and their emotional reactions.

A new survey tool for evaluating pandemic preparedness in health services.

BACKGROUND: Rapid decision-making with limited resources and prior research to draw upon posed challenges for health service leaders globally when preparing for COVID-19. How do health services prepare for a pandemic and evaluate if the preparation has been effective? This study aimed to explore health workers' perceptions and knowledge regarding preparedness for COVID-19 at a regional health service in Australia. METHODS: A 32-item online survey was developed to evaluate preparedness across five scales: 1) Clinical, 2) Communication, 3) Environment, 4) Human Resources, and 5) General Preparedness. Data were analyzed using parametric and non-parametric statistics and qualitative content analysis. RESULTS: Ninety-three employees completed the survey, with most working in clinical roles (58.1%). Respondents largely felt the health service was well-prepared (84.0%) and they were personally prepared (74.4%) to respond to COVID-19. Clinical and communication scale scores varied by role type. Respondents faced personal risk and resource shortages impacted their sense of safety; others felt adequately supported. CONCLUSIONS: A coordinated "whole hospital response", accessible and inclusive communication, education, adequate resourcing, and employee wellbeing supports are necessary when preparing health services for sentinel events. This survey tool offers health services an approach to evaluating pandemic preparation. Continued advocacy for resources and wellbeing needs of health workers is paramount in future preparations.

Randomised Controlled Trial Evaluating Active versus Passive Waiting for Speech-Language Pathology.

INTRODUCTION: High demand for speech-language pathology means children sometimes wait over 12 months for services, missing out on timely support. Waiting can be a time of stress, concern, and powerlessness for caregivers. Provision of information via a website may support families and encourage active waiting. OBJECTIVE: The aim of this study was to compare children's speech, intelligibility, language, and literacy outcomes, and caregivers' satisfaction and empowerment in active versus passive waiting conditions. METHODS: Ninety-seven preschool-aged children referred to a community health speech-language pathology service in Australia were screened for eligibility. Eligible children (n =42) with speech/language difficulties were randomly allocated to: (a) active waiting (provision of a purpose-built website; n = 20), or (b) passive waiting (control group; n = 22). Pre- and post-assessments (after 6 months on a waiting list) were completed with children and caregivers by a speech-language pathologist blinded to group allocations. RESULTS: Intention to treat (n =36) and per-protocol analyses (n =30) were conducted to measure group differences in child and caregiver outcomes at post-assessment using one-way ANCOVA, controlling for baseline scores. There were no statistically significant differences between groups for children's speech, intelligibility, language, and literacy, or caregivers' empowerment and satisfaction. Children in both groups made minimal gains over 6 months. CONCLUSIONS: Provision of an active waiting website did not lead to statistically significant change in child or caregiver outcomes, and children in both groups made little progress over a 6-month period. Early speech-language pathology intervention delivered with appropriate dosage is needed to optimise children's outcomes. Until timely and effective speech-language pathology intervention can be provided for all who need it, provision of early assessments may be beneficial. There remains a need for effective ways to support children and families on waiting lists.

Discovery of Novel Nonactive Site Inhibitors of the Prothrombinase Enzyme Complex.

The risk of serious bleeding is a major liability of anticoagulant drugs that are active-site competitive inhibitors targeting the Factor Xa (FXa) prothrombin (PT) binding site. The present work identifies several new classes of small molecule anticoagulants that can act as nonactive site inhibitors of the prothrombinase (PTase) complex composed of FXa and Factor Va (FVa). These new classes of anticoagulants were identified, using a novel agnostic computational approach to identify previously unrecognized binding pockets at the FXa-FVa interface. From about three million docking calculations of 281,128 compounds in a conformational ensemble of FXa heavy chains identified by molecular dynamics (MD) simulations, 97 compounds and their structural analogues were selected for experimental validation, through a series of inhibition assays. The compound selection was based on their predicted binding affinities to FXa and their ability to successfully bind to multiple protein conformations while showing selectivity for particular binding sites at the FXa/FVa interface. From these, thirty-one (31) compounds were experimentally identified as nonactive site inhibitors. Concentration-based assays further identified 10 compounds represented by four small-molecule families of inhibitors that achieve dose-independent partial inhibition of PTase activity in a nonactive site-dependent and self-limiting mechanism. Several compounds were identified for their ability to bind to protein conformations only seen during MD, highlighting the importance of accounting for protein flexibility in structure-based drug discovery approaches.

The impact of climate-related disasters on children's communication and wellbeing: Addressing Sustainable Development Goals.

PURPOSE: Natural disasters can significantly impact children's health, development, and wellbeing, as well as their access to education and support services (including speech-language pathology). Children's needs are often overlooked in the urgent aftermath of natural disasters. This is especially true for children with communication difficulties. This commentary explores the impacts of bushfire on Australian children, to propose a sustainable, community-based approach to supporting children's health, wellbeing, and communication. RESULT: The Royal Far West Bushfire Recovery Program, a multidisciplinary allied health program, supported children's recovery, resilience, and development in the aftermath of Australia's Black Summer bushfires in 2019-2020. Children learnt coping strategies and were more able to communicate with adults and peers about their feelings and experiences, but residual impacts of bushfires remained for some children. Allied health telepractice services, including speech-language pathology, enhanced access for vulnerable children, highlighting the potential for technology to provide high-quality services to support recovery, particularly in remote areas. CONCLUSION: Climate change increases the frequency and severity of bushfires and other natural disasters with significant consequences for vulnerable and at-risk communities. Children with communication needs are particularly vulnerable during and following these disasters. High quality, evidence-based interventions are needed to support the health, wellbeing, and communication needs of children, with opportunities for involvement of speech-language pathologists. This commentary paper focusses on SDG 1, SDG 3, SDG 4, SDG 9, SDG 10, SDG 11, SDG 13, and SDG 15.

Diversity in the Australian speech-language pathology workforce: Addressing Sustainable Development Goals 3, 4, 8, and 10.

PURPOSE: Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia. RESULT: A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+. CONCLUSION: This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.

Waiting lists and prioritization of children for services: Speech-language pathologists' perspectives.

BACKGROUND: Waiting lists occur when the availability of speech-language pathology services does not meet the demand. Speech-language pathologists (SLPs) commonly manage waiting lists and their consequences using prioritization. AIMS: The aims of this study were to: (1) describe speech-language pathology waiting lists for children and factors associated with their presence in workplaces throughout the world, and (2) describe factors considered in and influencing SLPs' prioritization of children for services. METHODS: A questionnaire about pediatric waiting lists and prioritization was completed by 267 SLPs from 10 countries working in health, disability, education, and private sectors. Valid responses to closed questions from 264 SLPs were analyzed quantitatively. RESULTS: Most (73.6 %) SLPs reported having a waiting list in their workplace. Waiting lists were most common in community health centres (97.4 %). Waiting times ranged from 0 to 42 months (M = 8.09, SD = 5.84). High priority was assigned to infants (77.4 %), toddlers (65.3 %), children with feeding difficulties (88.5 %), and children who stutter (47.4 %). Prioritization parameters ranked as most important were: severity (M = 4.34), availability of resources (M = 4.11), diagnosis (M = 4.04), and age (M = 3.91). CONCLUSIONS: Many workplaces have long waiting lists for speech-language pathology services. Young children, feeding, and stuttering were most often considered high priority; however, prioritization can be complex, implicit, and influenced by external factors. Collaborative development of explicit, transparent waiting list and prioritization guidelines within workplaces, and the development and evaluation of active waiting strategies for children and families are recommended.

"Many wasted months": Stakeholders' perspectives about waiting for speech-language pathology services.

Purpose: High demand for speech-language pathology services is reflected in long waiting lists. Waiting can be active or passive and has implications for stakeholders, including consumers, professionals, and organisations. The present study explored experiences and perspectives regarding waiting for speech-language pathology services through analysis of stakeholders' written submissions to an Australian Government Senate Inquiry.Method: Written submissions (n = 337) were screened for terms related to waiting. Included submissions (n = 133) were written by organisations (36.8%), speech-language pathologists (29.3%), parents (27.8%), individuals with communication and/or swallowing difficulties (5.3%), and others.Result: Inductive thematic analysis identified three themes. (1) Duration. Consistently described as long. (2) Consequences. Consumers' consequences included: burden on physical health, finances, time, emotional wellbeing, and relationships, reduced continuity of care, and increased intervention needs. Professional consequences included: stress and burnout impacting job satisfaction, and reduced effectiveness. Societal consequences included: social and ethical burden, and a drain on health and legal systems. (3) Actions. Consumers advocated and sought alternatives (e.g. threats to harm their child, relocation to a capital city), professionals implemented service delivery and policy actions, and organisations lacked effective system-wide strategies.Conclusion: Existing services did not appear to meet stakeholders' needs. Action is needed to improve speech-language pathology waiting lists and access to services, and minimise possible consequences for stakeholders.

Waiting for speech-language pathology services: A randomised controlled trial comparing therapy, advice and device.

Purpose: To compare children's speech, language and early literacy outcomes, and caregivers' empowerment and satisfaction following provision of 12 sessions of direct intervention (therapy), or face-to-face advice or a purpose-built website (device) while waiting for therapy.Method: A four-stage randomised controlled trial was undertaken involving three- to six-year-old children referred to speech-language pathology waiting lists at two Australian community health centres over eight months (n = 222). Stage 1 (screening): 149 were eligible to participate. Stage 2 (pre-assessment): 117 were assessed. Stage 3 (intervention): 110 were randomised to advice (33), device (39) or therapy (38). Stage 4 (post-assessment): 101 were re-assessed by a speech-language pathologist blinded to the intervention condition.Result: After controlling for baseline levels, children's speech (percentage of consonants correct) was significantly higher in the therapy group compared to the advice and device conditions. Caregivers' satisfaction was also significantly higher in the therapy condition compared to the device condition. There were no significant differences between the three conditions for children's intelligibility, language and early literacy or caregivers' empowerment.Conclusion: Therapy resulted in significantly higher speech outcomes than the advice and device conditions and was associated with significantly greater caregiver satisfaction. Provision of a website containing evidence-based material or a single session of advice may be a viable alternative while children wait for therapy targeting intelligibility, language and early literacy, and to empower caregivers.

Aspirations for a website to support families' active waiting for speech-language pathology.

Purpose: Children sometimes wait 12 months or longer to access speech-language pathology services. Information on websites may support families' active waiting for speech-language pathology; however, there are few user-friendly, evidence-based websites specifically designed for children and families for this purpose. The current study aimed to: (1) ascertain appropriate website content, format, features and functions; (2) evaluate the quality of existing speech and language sites and (3) obtain feedback on a prototype website. Method: A three-stage explanatory sequential mixed-methods design was employed. Stage 1 involved 119 participants completing an online questionnaire recommending website content, format, features and functions. Stage 2 involved evaluating the quality of 25 online sites about children's speech and language. Stage 3 involved focus groups with 16 participants to explore aspirations and feedback on a website to support active waiting. Result: Participants wanted information about typical development and services to access while waiting; strategies to stimulate children's speech and language development; simple web architecture; and high readability. High scoring sites contained evidence-based information from trustworthy sources. Strategies from the theory of preparative waiting arose in the focus groups. Conclusion: Participants considered easily identifiable, trustworthy sources of information, and user-friendly strategies and resources to be important on a website to support active waiting for speech-language pathology. The theory of preparative waiting may be a viable framework informing waiting for speech-language pathology for children with speech and language difficulties.