The impact of the COVID-19 pandemic on speech and language therapy services in Ireland: A mixed-methods survey at two time points during the pandemic.

BACKGROUND: During the COVID-19 pandemic, Ireland implemented a series of stringent public health measures, including lockdowns and suspension of non-urgent clinical services. AIMS: To investigate the impact of the COVID-19 pandemic on the demand for and delivery of speech and language therapy (SLT) services in Ireland in 2020. METHODS & PROCEDURES: Two iterations of a cross-sectional, mixed-methods online survey were distributed to speech and language therapists (SLTs) and SLT students in Ireland in the spring and autumn of 2020 using a combination of purposive and snowball sampling. The spring survey yielded 407 responses (including 14 from SLT students), while 197 respondents took part in the autumn (13 students). Survey analysis focused on questions related to the impact of the COVID-19 pandemic on delivery and demand for SLT services (student responses were excluded from analysis owing to low response rate). The largest group in respect of experience were senior SLTs (58% in both surveys). The work settings most strongly represented were HSE primary care (34.4%) and disability services (26.5%) in the spring, and HSE primary care (39.1%), acute hospitals (22.8%) and disability services (20.8%) in the autumn. We used descriptive statistics, including distribution analysis, to analyse the quantitative data. Free text data were interrogated through a variant of a conventional qualitative content analysis. OUTCOMES & RESULTS: In the spring, cessation of face-to-face services featured prominently (reported by 65.6% versus 14.2% in the autumn), across SLTs' work settings, except acute hospitals. Lower demand was reported by 42.5% in the spring, while in the autumn, 48.7% indicated that demand was higher. SLTs experienced large-scale redeployment (spring: 45.9%, autumn: 38.4%), with HSE primary care SLTs redeployed most (spring: 71.7%; autumn: 62.3%). The need to suddenly pivot to telehealth was a significant challenge in terms of training, technology and logistics. New ways of working emerged and gradually, telehealth became more embedded. SLTs also had to adapt to working with evolving public health measures, such as space restrictions and personal protective equipment (PPE) requirements. Across the two survey iterations, SLTs reported tensions between demands and capacity: while referrals and demand initially decreased in the spring, this led to increased backlog and longer waiting lists, ongoing and increasing pressure on clinicians and services, and negatively impacted clients and families. CONCLUSIONS & IMPLICATIONS: The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists. WHAT THIS PAPER ADDS: What is already known on this subject The negative impact of the COVID-19 pandemic on SLT services has been examined in several countries. Ireland imposed more stringent pandemic-management measures than many other countries, and it was therefore warranted to investigate how SLT services in the country were affected. What this study adds to the existing knowledge Face-to-face SLT services effectively ceased in most non-urgent contexts in spring 2020. This coincided with large-scale redeployment of SLTs to non-SLT contexts. By autumn 2020, demand had increased again, but not all services had recommenced, and redeployment was still a factor. Although SLTs adapted to the ongoing changes imposed by the pandemic, they voiced concern about increasing backlogs and longer waiting lists, ongoing and increasing pressure on both SLTs and services, and negative impacts on clients and families. What are the actual and clinical implications of this work? The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists.

Correction: Global TALES feasibility study: Personal narratives in 10-year-old children around the world.

[This corrects the article DOI: 10.1371/journal.pone.0273114.].

Feasibility of Using the Global Tales Protocol to Elicit Personal Narratives in 10-year-Old Children in Ireland.

INTRODUCTION: This small-scale study explored the feasibility of the Global TALES protocol in eliciting personal narratives in typically developing monolingual Irish children, using the online Zoom platform. We investigated children's performance on measures of productivity (total number of utterances; total number of words) and syntactic complexity (MLU in words). We also documented the topics children talked about in response to the six emotion-based prompts contained in the Global TALES protocol. METHODS: Nineteen typically developing children (6 male, 13 female), aged between 10.0 and 10.11 years produced personal narratives in response to the Global TALES protocol. Given COVID-19 pandemic-related public health restrictions, the language samples were elicited using Zoom. All stories were transcribed and analysed using Systematic Analysis of Language Transcripts software. Qualitative content analysis was used to code the topics of the children's stories. RESULTS: Sixteen participants responded to all prompts. One participant only responded to three of the six prompts. The prompt that was least successful in eliciting a response was the "problem" prompt; 15.7% (n = 3) of the children did not provide a response to this prompt. On average, children produced 40 utterances, although individual variability was high. On average, MLU was 8.7, ranging from 6 to 11. Children's topics closely resembled those reported in the Global TALES feasibility study despite the fact, the current study took place during the COVID-19 pandemic. The most frequent topics were related to family (events, illnesses, relationships, siblings) and finding or fixing something. CONCLUSION: The Global TALES protocol was successful in eliciting personal narratives from 10-year-old Irish English-speaking children. Future larger scale studies are now needed to investigate if the results generalise to the wider Irish population with a view to create local benchmarks of personal narrative performance.

Global TALES feasibility study: Personal narratives in 10-year-old children around the world.

Personal narratives make up more than half of children's conversations. The ability to share personal narratives helps build and maintain friendships, promotes physical and emotional wellbeing, supports classroom participation, and underpins academic success and vocational outcomes. Although personal narratives are a universal discourse genre, cross-cultural and cross-linguistic research into children's ability to share personal narratives is in its infancy. The current study addresses this gap in the research by developing the Global TALES protocol, a protocol comprising six scripted prompts for eliciting personal narratives in school-age children (excited, worried, annoyed, proud, problem situation, something important). We evaluated its feasibility with 249 ten-year-old children from 10 different countries, speaking 8 different languages, and analyzed researchers' views on the process of adapting the protocol for use in their own country/language. At group-level, the protocol elicited discourse samples from all children, although individual variability was evident, with most children providing responses to all six prompts. When investigating the topics of children's personal narratives in response to the prompts, we found that children from around the world share many commonalities regarding topics of conversation. Once again individual variability was high, indicating the protocol is effective in prompting children to share their past personal experiences without forcing them to focus on one particular topic. Feedback from the participating researchers on the use of the protocol in their own countries was generally positive, although several translation issues were noted. Based on our results, we now invite clinical researchers from around the world to join us in conducting further research into this important area of practice to obtain a better understanding of the development of personal narratives from children across different languages and cultures and to begin to establish local benchmarks of performance.

Understanding the perspectives of children and young people with speech, language and communication needs: How qualitative research can inform practice.

Much of the published research is "on" rather than "with" children and young people with speech, language and communication needs (SLCN). According to the UN Convention on the Rights of the Child (1989), children's views must be considered and taken into account in all matters affecting them. In this paper, we discuss ways in which innovative qualitative methods have been used to explore the views of children and young people with SLCN. We also discuss how we can apply concepts from qualitative research, in particular critical reflexivity, to shape our thinking, inform our practice, and lead to innovation in our work with children and young people with SLCN.

New perspectives, theory, method, and practice: Qualitative research and innovation in speech-language pathology.

Purpose: Research in speech-language pathology has been dominated by experimental, empirical, and scientific approaches, which build on hypothesis testing and logical, deductive reasoning. Qualitative approaches stem from a different paradigm or world view which imply different questions and methodologies which, for example, emphasise codesign, reciprocity, individual experience and context. This article explores the relationship between qualitative inquiry in the field of speech-language pathology and innovation. It aims to show how the aspirations of the profession can be supported, and how innovation can be achieved, through research which sheds light on the lived experiences and perceptions of clients and families and builds an understanding of how they function in their everyday contexts.Method: We summarise qualitative approaches in speech-language pathology, explain the notion of innovation, and review qualitative research as a source of theoretical, methodological, and practice innovation in speech-language pathology.Result: Not only has qualitative inquiry underpinned examples of theoretical, methodological and practice innovations in speech-language pathology, but it can also play a part in enhancing translation and implementation of research innovations.Conclusion: An explicit consideration of what we mean by innovation is useful for speech-language pathologists. Qualitative research complements other forms of research in the field and has prompted new theoretical understandings, new methodologies and methods of research, and new ways to deliver our services in ways that are responsive to our clients and communities.

A Qualitative Evidence Synthesis of Parental Experiences and Perceptions of Parent-Child Interaction Therapy for Preschool Children With Communication Difficulties.

Purpose Parent-child interaction therapy refers to a number of interventions mediated by trained parents to treat developmental difficulties, including speech, language, and communication. Understanding the experiences of parents who take part in parent-child interaction therapy is a key aspect of determining how this intervention can be implemented successfully. However, to date, there has been limited work on synthesizing parental views of this intervention. Method We used qualitative evidence synthesis that involved searching the literature for qualitative studies addressing the experiences and perceptions of parent-child interaction therapy for parents of preschool children with communication difficulties. We identified 27 studies (from 32 publications) and synthesized the data using thematic synthesis. We appraised the quality of included studies using Critical Appraisal Skills Programme (CASP) and assessed our confidence in the review findings using GRADE Confidence in the Evidence from Reviews of Qualitative research (CERQual). Results At the beginning of this intervention, parents may have competing demands and varied expectations about the intervention. Their engagement is facilitated when the intervention is tailored to their individual family, their preferences for learning, and when they have a trusting relationship with the clinician. At the end of the intervention, although most parents perceive an improvement in their child's communication and feel empowered to facilitate this, they have concerns about their child's future needs. Conclusions It is important that clinicians explore parents' readiness for this intervention by discussing their needs and preferences openly, and that they facilitate their engagement through a supportive relationship. They also need to consider how parents will transition out of the intervention and continue to support their child's language development. Supplemental Material https://doi.org/10.23641/asha.14978454.

"So, I told him to look for friends!" Barriers and protecting factors that may facilitate inclusion for children with Language Disorder in everyday social settings: Cross-cultural qualitative interviews with parents.

PURPOSE: Although researchers have explored parental perspectives on childhood speech and language disorders, this work has mostly been conducted in English-speaking countries. Little is known about parental experiences across countries. Participation in the COST Action IS1406 'Enhancing children's oral language skills across Europe and beyond' provided an opportunity to conduct cross-cultural qualitative interviews. The aims were to explore how parents construe inclusion and/or exclusion of their child and how parents involve themselves in order to facilitate inclusion. METHOD: Parents from nine countries and with a child who had received services for speech-language disorder participated in semi-structured qualitative interviews. We used thematic analysis to analyze the data. RESULTS: Two overarching themes were identified: 'Language disabilities led to social exclusion' and 'Promoting pathways to social inclusion'. Two subthemes were identified Interpersonal relationships are important and Deliberate proactiveness as stepping stones for social inclusion. CONCLUSIONS: Across countries, parents report that their children's hidden disability causes misunderstandings that can lead to social exclusion and that they are important advocates for their children. It is important that the voices and experiences of parents of children with developmental disabilities are understood and acknowledged. Parents' recommendations about how to support social inclusion need to be addressed at all levels of society.

Exploring Parental Perspectives of Childhood Speech and Language Disorders Across 10 Countries: A Pilot Qualitative Study.

Purpose Although researchers have explored parental perspectives of childhood speech and language disorders, most studies have been conducted in English-speaking countries. Little is known about parental experiences across countries, where procedures of language screening and services for language disorders differ. The authors participated in the COST 1 Action network IS1406, "Enhancing Children's Oral Language Skills Across Europe and Beyond," which provided an opportunity to conduct cross-country qualitative interviews with parents. The aim of this pilot study was to explore ways in which parents construed and described speech and language disorders across countries. Method Semistructured qualitative interviews were conducted with parents from 10 families in 10 different countries. The data were analyzed using thematic analysis. Findings The overall theme was "acknowledging parental expertise." The parents described, in detail, ways in which their children's speech and language (dis)abilities had an impact on the children's everyday life. Three subthemes were identified: impairment, disability, and changes over time. Conclusions The findings suggest that, across a range of countries, parents demonstrated contextualized understandings of their children's speech and language (dis)abilities, along with the everyday functional implications of the disorders. Hence, despite not holding professional knowledge about language disorders, the voices, views, understandings, and personal experiences of parents in relation to their child's disorder should be listened to when planning therapy services. Supplemental Material https://doi.org/10.23641/asha.14109881.

Impact of language disorders on children's everyday lives from 4 to 13 years: Commentary on Le, Mensah, Eadie, McKean, Schiberras, Bavin, Reilly and Gold (2020).

This paper by Le et al. (2020) is a valuable addition to the literature because it provides evidence regarding the trajectories of health-related quality of life (HRQoL) in children with language disorders from the ages of 4-13 years. The authors found that higher language scores were associated with better HRQoL particularly in the school and social domains. Of the children in the low language group, 40% were in the stable-high HRQoL trajectory, while the others were in the reduced-slow-decline (26%) and low-rapid-decline (34%) HRQoL groups. Despite the prevalence of language disorder and its impact on many aspects of children's everyday lives, many professionals and members of the public are still unaware of this condition and its potential consequences. The publication of the Le et al. (2020) paper is timely because it coincides with a call to action to support these children by McGregor (2020). McGregor (2020) argued that we fail children with developmental language disorders both in terms of research and service provision. In her recent discussion paper, she provided evidence that these children face significant risks with regard to academic achievement: they are 6 times more likely to have reading disabilities, 6 times more likely to have spelling difficulties, 4 times more likely to have difficulties with mathematics and 12 times more likely to present with all three difficulties.

Cultural and Linguistic Practice with Children with Developmental Language Disorder: Findings from an International Practitioner Survey.

BACKGROUND: The cultural and language diversity across many European countries presents a range of challenges and opportunities for speech and language therapists and other practitioners working with children with developmental language disorders (DLD) and their families. OBJECTIVE: The aim of this study was to explore practitioners' perceptions of cultural and linguistic differences in response to children with DLD across different countries. METHODS: A survey was developed by practitioners and researchers working with children with DLD across Europe and beyond as part of the work of Cost Action IS1406. Data from 1,358 practitioners from 8 European countries - Ireland, UK, Bulgaria, Poland, Croatia, Spain, Norway and Sweden - and 2 neighbour countries - Turkey and Lebanon - were included in the present analyses, which address two groups of questions. The first focuses on practitioners' perceptions of the way that parents think about cultural differences and their relationship to language development in their children. The second concerns the extent to which practitioners consider themselves to have the skills to work with children from other cultures and using different languages. RESULTS/CONCLUSIONS: Most countries present a similar profile with intermediate results about their perception of cultural issues, but Lebanon and Turkey are the group with the most positive responses. In terms of bilingual issues most practitioners indicated that they only worked in their country's primary language. The only country where this was not the case was Lebanon. Professionals from Spain and Lebanon form a subgroup in terms of their confidence to work with different cultural/language groups. The paper highlights both the universal importance of cultural and linguistic competence in managing young children's needs and indicates that in most cases professionals do not think they have the necessary expertise to work with cultural and linguistic diversity.

Collaboration between parents and SLTs produces optimal outcomes for children attending speech and language therapy: Gathering the evidence.

BACKGROUND: Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children's outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. AIMS: To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. METHODS & PROCEDURES: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda. DISCUSSION & CONCLUSIONS: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology. What this paper adds Current policy in education, health and social care advocates for family-centred care and collaborative practice with parents. Thereby, collaborative practice is the preferred practice for SLTs and parents. In this paper, we explore collaborative practice and use a realist evaluation approach to achieve the aim of setting a research agenda in this area. Researchers use realist evaluation, a methodology originally developed by Pawson and Tilley in the 1990s, to explore the causal link between interventions and outcomes, summarized as what works, how, for whom, in what circumstances and to what extent. Realist evaluation provides a framework to explore configurations between contexts (C), mechanisms (M) and outcomes (O). We used this methodology to take a first step at making explicit what collaborative practice is and how it might be achieved in different contexts. We did this by drafting a preliminary programme theory about collaborative practice, where we made explicit what context factors and mechanisms might influence outcomes in collaborative practice between parents and SLTs. Based on this programme theory, we argue for the need to develop a research agenda on collaborative practice with parents of children with speech, language and communication needs. The steps between a programme theory and a research agenda could entail exploring each CMO, or step in the programme theory, and evaluating it against the existing literature-both within and beyond speech and language therapy-to see how far it stands up. In this way, gaps could be identified that could be converted into research questions that would stimulate debate about a research agenda on collaborative practice. Understanding how collaborative practice can be achieved in different contexts could support SLTs to use mechanisms to optimise collaborative practice intentionally and tailor interventions to the specific needs of families, thereby enhancing collaborative practice between parents and SLTs.

Language assessment of monolingual and multilingual children using non-word and sentence repetition tasks.

The number of children speaking more than one language as well as the number of languages spoken in Ireland has increased significantly posing a problem for timely identification of children with language disorder. The current study aims to profile performance of monolingual and multilingual children on language processing tasks: non-word repetition (NWR) and sentence repetition (SR). We used: (1) Crosslinguistic (CL) and English Language-Specific (LS) NWR and (2) SR in English, Polish and Russian. Children's socioeconomic status, language emergence, the age of exposure (AoE) to English and the percentage of English spoken at home were recorded. The study included 88 children age 5-8 attending a school in a disadvantaged area.CL and LS NWR yielded similar distribution of scores for monolinguals and multilinguals. The tasks identified small number of children who performed significantly lower than the mean while there were no significant differences between the groups. In English SR, monolinguals significantly outperformed multilinguals. Comparison of SR in English and Polish/Russian indicated that some children showed balanced performance in both of their languages while others showed marked differences performing better in either Polish/Russian or English depending on their AoE to English and percentage of English spoken at home.The pilot study suggests that CL-NWR is a promising screening tool for identifying monolingual and multilingual children with language disorder while SR provides more detailed information on children's language performance relative to their language exposure. SR task is recommended to be used only if comparable tasks are available in all of children's languages.

Working with the parents and families of children with developmental language disorders: An international perspective.

BACKGROUND: The relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries. METHODS: In this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries. FINDINGS: Respondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches. CONCLUSIONS: Despite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).

Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol.

Background: Parent-child interaction therapy is an early intervention for children with speech, language and communication difficulties. It involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement this with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesizing parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed papers addressing the experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: The findings from this synthesis will help to guide best practice and policy for the implementation of parent child interaction therapy by considering the views of parents.

Listening to the voice of children with developmental speech and language disorders using narrative inquiry: Methodological considerations.

There are policy and theoretical drivers for listening directly to children's perspectives. These perspectives can provide insights to children's experiences of their daily lives and ways in which they construct their multiple identities. Qualitative methodology is a useful research paradigm with regard to exploring children's experiences. However, listening to the perspectives of children with speech and language disorders is a relatively new field of research. Therefore, it is important that researchers share their experiences of using methods and reflect on the strengths and limitations of these methods. The authors have used narrative inquiry with children with speech and language disorders to explore ways in which these children make sense of their experiences and construct their identities. In this paper, the authors reflect on methodological considerations when using narrative inquiry with children with speech and language disorders. They critically discuss three methodological considerations: narrative inquiry as a methodological choice, methods for data generation, limitations, and rigour.

Well-Being and Resilience in Children With Speech and Language Disorders.

Purpose: Children with speech and language disorders are at risk in relation to psychological and social well-being. The aim of this study was to understand the experiences of these children from their own perspectives focusing on risks to their well-being and protective indicators that may promote resilience. Method: Eleven 9- to 12-year-old children (4 boys and 7 girls) were recruited using purposeful sampling. One participant presented with a speech sound disorder, 1 presented with both a speech and language disorder, and 9 with language disorders. All were receiving additional educational supports. Narrative inquiry, a qualitative design, was employed. Data were generated in home and school settings using multiple semi-structured interviews with each child over a 6-month period. A total of 59 interviews were conducted. The data were analyzed to identify themes in relation to potential risk factors to well-being and protective strategies. Results: Potential risk factors in relation to well-being were communication impairment and disability, difficulties with relationships, and concern about academic achievement. Potential protective strategies were hope, agency, and positive relationships. Conclusion: This study highlights the importance of listening to children's narratives so that those at risk in relation to well-being can be identified. Conceptualization of well-being and resilience within an ecological framework may enable identification of protective strategies at both individual and environmental levels that can be strengthened to mitigate negative experiences.

Communication as a human right: Citizenship, politics and the role of the speech-language pathologist.

According to Article 19 of the Universal Declaration on Human Rights "Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers." The purpose of this paper is to elucidate communication as a human right in the life of a young man called Declan who has Down syndrome. This commentary paper is co-written by Declan, his sister who is a speech-language pathologist (SLP) with an advocacy role, his SLP, and academics. Declan discusses, in his own words, what makes communication hard, what helps communication, his experiences of speech-language pathology, and what he knows about human rights. He also discusses his passion for politics, his right to be an active citizen and participate in the political process. This paper also focuses on the role of speech-language pathology in supporting and partnering with people with communication disabilities to have their voices heard and exercise their human rights.

Social participation for people with communication disability in coffee shops and restaurants is a human right.

Although Article 19 of the Universal Declaration of Human Rights states that "everyone has a right to freedom of opinion and expression", for people with communication disability this may not be a reality. This commentary shares a practical example of how people with communication disabilities together with speech-language pathology (SLP) students, academics and clinical staff co-designed and co-implemented a Communication Awareness Training Programme for catering staff to enable communication access in coffee shops and restaurants. This is an example of how SLPs can embrace their social responsibility to break down barriers for people with communication disabilities. This commentary shares the reflections of those involved and how they felt empowered because they had learned new skills and made a difference. This commentary highlights the need for co-design and co-delivery of programs to raise awareness of communication disability among catering staff and how the stories of people with communication disabilities served as a catalyst for change. It also highlights the need to SLPs to move intervention to a social and community space.

Labels, identity and narratives in children with primary speech and language impairments.

PURPOSE: There has been debate about labels in relation to speech and language impairments. However, children's views are missing from this debate, which is risky considering that labels with negative associations may result in stigma. The aim of this study was to explore the range of identities which children with primary speech and language impairments presented in their narratives and to investigate their evaluations of these identities with a view to understanding the values they attach to labels. METHOD: Eleven children aged 9-12 years with primary speech and language impairments were recruited to the study. Fifty nine semi-structured interviews were conducted with the aim of generating storied accounts of everyday experiences. The data were analysed using thematic analysis. Two themes were identified in the data: desired identities and undesired identities. RESULT: The findings suggest that the children were actively involved in identity construction and wanted to be seen in positive ways. They disliked labels assigned by others, which they considered portrayed them in negative ways. CONCLUSION: The debate about labels could be progressed by consulting with children themselves asking for their ideas in relation to labels in specialist education, and speech and language pathology.