Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico.

PURPOSE: International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. METHOD: Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. RESULTS: Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). CONCLUSIONS: Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Global partnerships to create communication resources addressing Sustainable Development Goals 3, 4, 8, 10, and 17.

PURPOSE: This commentary describes the development of global partnerships, capacity-building, and the basis for the creation of a website (Leadersproject.org) used throughout the world that contains free educational resources for the assessment and treatment of people with communication disabilities (PWCD). This website contains speech-language assessment and treatment materials, online skill-building courses, over 200 instructional videos, train-the-trainer course materials, and syntheses of important research and trainings in over 30 languages. This commentary relates the work from leadersproject.org to the United Nations Sustainable Development Goals (SDGs). RESULT: Through this website, the authors have established ongoing global partnerships with other health and education professionals. Moreover, PWCD and their families have used the website for information and support throughout the world. Speech-language pathologists (SLPs) and other health and education professionals use these materials to host capacity-building trainings and to support the development of knowledge and skills to local professionals for the benefit of PWCD. The Leadersproject.org resources have been influential and impactful as measured by approximately 24 000 visits from over 130 countries throughout the world. CONCLUSION: The authors of this paper continue to establish partnerships worldwide to spread education and increase the quality of care provided to PWCD. This commentary paper focuses on the United Nations Sustainable Development Goals (SDGs): good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), partnerships for the goals (SDG 17).

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study.

BACKGROUND: Although a number of international cleft organizations and cleft professionals in low- and middle-income countries (LMICs) have built and supported comprehensive cleft care and speech therapy models to address the shortage of speech services in LMICs, the specific speech needs of individuals with cleft lip and palate (CLP) in such countries remain unknown. The objective of this study was to evaluate the barriers to accessing speech services for patients with CLP as well as the resources and models of speech services that are currently available for individuals with CLP in LMICs, with the goal of better understanding the needs of this population. METHODS: Qualitative and quantitative methods consisted of Smile Train partner surveys that were distributed June 25th to July 31st, 2018 worldwide. Surveys were distributed through Smile Train's online medical database, Smile Train Express, which every Smile Train partner uses to report their Smile Train sponsored treatment outcomes. A total of 658 Smile Train partners responded to the surveys. Respondents included surgeons, speech therapists, orthodontists, administrators and nurses who represented non-governmental organizations, hospitals (private or public), hospital groups, and private clinics. RESULTS: Results indicated that lack of resources, including access to local speech providers and language materials, as well as financial constraints such as patient travel and speech treatment costs, are the most commonly reported barriers to accessing speech services across all geographic regions surveyed. CONCLUSIONS: Improving access to CLP speech services in LMICs may require strategies that address lack of speech providers, language materials, and financial constraints.

Perception of American-English Vowels by Early and Late Spanish-English Bilinguals.

Increasing numbers of Hispanic immigrants are entering the US and learning American-English (AE) as a second language (L2). Previous studies investigating the relationship between AE and Spanish vowels have revealed an advantage for early L2 learners for their accuracy of L2 vowel perception. Replicating and extending such previous research, this study examined the patterns with which early and late Spanish-English bilingual adults assimilated naturally-produced AE vowels to their native vowel inventory and the accuracy with which they discriminated the vowels. Twelve early Spanish-English bilingual, 12 late Spanish-English bilingual, and 10 monolingual listeners performed perceptual-assimilation and categorical-discrimination tasks involving AE /i,ɪ,ɛ,ʌ,æ,ɑ,o/. Early bilinguals demonstrated similar assimilation patterns to late bilinguals. Late bilinguals' discrimination was less accurate than early bilinguals' and AE monolinguals'. Certain contrasts, such as /æ-ɑ/, /ʌ-ɑ/, and /ʌ-æ/, were particularly difficult to discriminate for both bilingual groups. Consistent with previous research, findings suggest that early L2 learning heightens Spanish-English bilinguals' ability to perceive cross-language phonetic differences. However, even early bilinguals' native-vowel system continues to influence their L2 perception.

Collaborations to address barriers for people with communication disabilities in Ghana: considering the World Report on Disability.

The World Health Organization's World Report on Disability underscores the need to identify and address barriers that limit people with disabilities from having access to services. Wylie, McAllister, Davidson, and Marshall (2013) consider the impact of that report on people with communication disabilities (PWCD). Over the past 5 years, the authors have worked together in Ghana to address the needs of PWCD. With only about 10 university-trained speech-language pathologists (SLPs) in Ghana, the barriers to PWCD receiving services are quite high. The authors are working together and with others to establish the first speech-language pathology program in Ghana. The authors also work to identify ways to share with PWCD and their families knowledge and skills on how to improve the communicative function of PWCD. In doing so, the authors have learned valuable lessons about the role of an SLP, especially when considering under-served PWCD, lessons that are applicable to both Majority and Minority World countries. This commentary describes the authors' work over the past 5 years, and describes initiatives that have had some measure of success in reducing barriers to access to information and services needed by PWCD and their caregivers and communities.