'I think that's what I heard? I'm not sure': Speech and language therapists' views of, and practices in, phonetic transcription.

BACKGROUND: Phonetic transcription is recognized in regulatory standards as an essential skill for Speech and Language Therapists (SLTs) in the assessment, diagnosis and management of clients with speech difficulties. Previous research has identified that approaches to phonetic transcription vary, and that SLTs often lack confidence in transcribing. However, SLTs' views and working practices have not been investigated in detail, particularly in terms of whole service approaches and following the recent increase in telehealth. AIMS: To investigate SLTs' views about phonetic transcription, their working practices at both individual and service levels, and the factors that influence these. METHODS & PROCEDURES: A total of 19 SLTs from the UK were recruited to online focus groups via social media and local networks. Participants discussed their views of, and practices in, phonetic transcription. Themes were identified using reflexive thematic analysis. OUTCOMES & RESULTS: Three broad themes were generated division and unity; one small part of a big job; and fit for purpose. SLTs were uniformly proud of their ability to phonetically transcribe and viewed this as a unique skill, but clear differences existed between different groups of SLTs in their views and practices. Investing in phonetic transcription was not always a priority for SLTs or services, and although many felt under-confident in their skills they considered these to be adequate for the populations they usually encounter. SLTs make an early judgement about possible therapy targets, which influences the level of detail used in their phonetic transcription. Practical barriers are often not addressed at service level, and assessment via telehealth poses some specific challenges. CONCLUSIONS & IMPLICATIONS: SLTs and services would benefit from increased investment in phonetic transcription in terms of time, opportunities for continuing professional development (CPD) and initiatives such as electronic patient records (EPRs) which support the use of phonetic symbols. Identifying target sounds at an early stage raises questions about the implications of disregarding other features of speech, and the selection of appropriate intervention approaches. Further research is needed to analyse actual rather than reported practices, and to consider the relationship between phonetic transcription and intervention approaches. Future studies could also identify precise CPD requirements and evaluate the effectiveness of CPD. WHAT THIS PAPER ADDS: What is already known on the subject Previous research has demonstrated that SLTs often lack confidence in phonetic transcription and that practices are varied, with relatively little use of narrow transcription. SLTs are interested in opportunities to maintain and develop transcription skills but do not often undertake CPD for transcription. What this paper adds to existing knowledge By using focus groups as a forum for discussions, this study provides a rich and detailed insight into SLTs' views about clinical transcription and their working practices, with previously unreported details about the reasons for these practices in a clinical context and at a service-wide level. What are the potential or actual clinical implications of this work? Transcription is often de-prioritized in non-specialist contexts, with practical barriers and a lack of clear and consistent protocols at a whole-service level. There is an opportunity for service managers to address the systemic difficulties in using transcription effectively by raising the profile and value of transcription amongst clinicians, and promoting CPD opportunities, using the findings of this study as a rationale for funding this. Together, these recommendations have the potential to improve client outcomes through more accurate assessment and diagnosis, and hence more appropriate intervention.

Everywhere and nowhere: Work-based learning in healthcare education.

The shortage of healthcare professions is a global issue, which has highlighted the need to establish effective practice learning. In 2015 the UK government introduced a change to the way that healthcare education is funded. A subsequent fall in applications to healthcare programmes and high levels of vacancies across the sector in the UK have led to widespread concern about workforce shortages, especially nurses. Subsequently, initiatives that both address the shortage and aim to bridge the gap between registered nurse and healthcare support worker have been introduced, presenting opportunities to further develop the clinical workplace as a learning environment for employees. A sample of nine healthcare professionals was recruited; seven nurses and two allied health professionals. Semi-structured interviews were conducted between March and June 2018. These were recorded verbatim, transcribed and thematically analysed. Respondents identified opportunities for work-based learning and factors for success. The importance of an effective learning culture, commitment to work-based learning and time were identified as factors for success. Despite the richness of learning opportunities in healthcare, respondents identified challenges for both learners and supervisors in identifying these opportunities in the workplace. These findings have immediate relevance to healthcare education systems internationally. Areas for future research include the relationship between supervisor and learner and further insight into why the busiest areas might be identified as more effective learning environments.

Clinicians' views of the training, use and maintenance of phonetic transcription in speech and language therapy.

BACKGROUND: The critical role of phonetic transcription in the assessment, diagnosis and management of speech disorders is well established and thus pre-registration degrees dedicate numerous hours to phonetic training. However, this training is not always fully used in clinical work and clinicians may find it difficult to maintain their skills, suggesting a 'theory/practice gap'. AIMS: This paper surveys speech and language therapists' (SLTs) views of their training, practice and maintenance of transcription in order to investigate the posited theory/practice gap and to explore how education in phonetics is translated into practice. METHODS & PROCEDURES: A total of 759 SLTs from the UK were surveyed via an online questionnaire. Multiple-choice questions were analysed using descriptive statistics, and free-text comments were analysed thematically. OUTCOMES & RESULTS: Thirty-five per cent of SLTs found learning phonetics quite easy, and 30% quite difficult. Respondents suggested that more time was needed to practise transcription in and out of the classroom; nevertheless, the majority felt at least equipped to undertake transcription after their training. A total of 75% of SLTs require transcription for their role, with 61% using it often or all the time. Some 45% use a mix of broad and narrow transcription, with 41% using only broad transcription. Those not using narrow transcription attributed this to lack of confidence. A total of 57% of SLTs did not feel supported to maintain transcription skills in the workplace, and 80% had never attended a refresher course in transcription, with 75% wishing to do so. CONCLUSIONS & IMPLICATIONS: As many clinicians found it difficult to learn transcription, there is an opportunity to provide more transcription practice both in and beyond the classroom. Despite most clinicians feeling equipped to undertake transcription upon completion of their training, and a large majority requiring transcription for their role, a theory/practice gap is apparent in the relatively small number of clinicians using narrow transcription exclusively, and those not using it expressing lack of confidence in their skills. Additionally, as many clinicians have never attended refresher training in transcription, and rely on their course notes to maintain their skills, more provision of opportunities for revision should be made available. With clinicians remembering a need for more practice during their training, and expressing a desire for more training opportunities in practice, there is an opportunity for clinicians, educators and regulatory bodies to work together to provide packages of transcription training material that can be used by students and practitioners to maintain and extend their skills.

CitySCaPE: Moving beyond indifference in education for pre-registration nurses about learning disability.

People with learning disabilities and Autism continue to suffer from the delivery of ineffective and inadequate care from health services CitySCaPE (City Simulated Community and Practice Environment) is a multi media resource delivering a simulation of situations student nurses may encounter in relation to service users with learning disabilities. The resource is applicable to adult, mental health and children's nursing. It is delivered in a blended approach to students in the first part of their programme as part of their simulated practice. Following the implementation of the resource an evaluation of student experience was undertaken using a mixed methods approach. 146 responses were obtained to a questionnaire containing quantitative and qualitative data. The findings indicate that this is a pedagogy that suits a variety of learning styles, is deemed to be realistic and improves the understanding of nursing students about the care of people with learning disabilities in generic practice areas. It is anticipated that CitySCaPE can be used as a model for delivery of practice based learning in areas that are often challenging to teach and demonstrate using a service user and person centred approach.

Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.

Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. BACKGROUND: In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. METHODS: Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.

Perceptual Judgments of Resonance, Nasal Airflow, Understandability, and Acceptability in Speakers With Cleft Palate: Ordinal Versus Visual Analogue Scaling.

OBJECTIVE: To investigate the reliability of ordinal versus visual analogue scaling (VAS) ratings for perceptual judgments of nasal resonance, nasal airflow, understandability, and acceptability in speakers with cleft palate. DESIGN: Within-subjects comparative study. SETTING: Multisite. PARTICIPANTS: Five specialist speech and language therapists from U.K. Regional Cleft Centres. OUTCOME MEASURES: Participants rated 30 audio speech samples obtained from the Speech and Language Therapy archives of Great Ormond Street Hospital. They rated the identified speech parameters using each scaling method, with 1 month between rating tasks. The model of best fit was determined to examine validity, and both intra- and inter-rater reliability were also computed. RESULTS: VAS ratings were valid for all parameters when plotted against ordinal ratings, and the model of best fit revealed only a slightly stronger curvilinear than linear relationship between the scaling methods. Intra-rater reliability was high for both rating methods across all six speech parameters. There was also high inter-rater reliability for both ordinal and VAS ratings of hypernasality, nasal emission, nasal turbulence, understandability, and acceptability, and for the ordinal ratings of hyponasality. CONCLUSIONS: Perceptual judgments of nasal resonance, nasal airflow, understandability, and acceptability were similar using VAS and ordinal scaling, indicating that both scaling methods were appropriate for measuring the cleft speech parameters. VAS, however, may offer statistical advantages, and there is a growing body of evidence advocating its use for the measurement of prothetic speech parameters.

Ingressive speech errors: a service evaluation of speech-sound therapy in a child aged 4;6.

BACKGROUND: A pattern of ingressive substitutions for word-final sibilants can be identified in a small number of cases in child speech disorder, with growing evidence suggesting it is a phonological difficulty, despite the unusual surface form. Phonological difficulty implies a problem with the cognitive process of organizing speech into sound contrasts. AIMS: To evaluate phonological therapy approaches in the remediation of non-pulmonic speech errors. Thus, adding to evidence concerning the nature of ingressive substitutions and their remediation whilst highlighting their occurrence within child speech disorder population for practising and training speech and language therapists. METHODS & PROCEDURES: Child KO, a boy aged 4;6, was identified through a screening of speech, language and communication needs at his school. Word-final, non-pulmonic-egressive substitutes for fricatives and plosives were identified using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Treatment took place in five, weekly school-based sessions with a care-giver present, and targeted two phonemes /f/ and /ʃ/ in word-final position. Word-final /s/ was monitored throughout to capture any change in other word-final fricatives. Phonemes /ɡ/ and /p/ were used as controls, as no change was expected in word-final plosives as a result of therapy targeting fricatives. Production of single words in the DEAP, pre- and post-therapy were transcribed by two independent therapists, (transcription agreement was 86.6% (pre) and 83.7% (post), with all 140 consonants within the DEAP transcribed), and change in consonants correct was analysed using a Wilcoxon test. Picture description tasks and telling of familiar stories were videoed post-therapy to analyse use of word-final fricative egression in connected speech. OUTCOME & RESULTS: Percentage consonants correct in single-words post-treatment was significantly higher than pre-treatment at single-word level. Generalization of target fricatives into connected speech and modest generalization of non-target phonemes occurred. CONCLUSIONS & IMPLICATIONS: Although ingressive speech sounds are largely absent in the sound system of English, they do occur as speech-sound errors in child speech disorder and respond to phonological therapy within the context of home and school environment. Therefore, training in the phonetic identification of speech sounds outside the system of English is essential. Additionally, non-lexical factors associated with ingression also influence the child's intelligibility and should be explored further in future research.

Speech production in children with Down's syndrome: The effects of reading, naming and imitation.

People with DS are known to have difficulties with expressive language, and often have difficulties with intelligibility. They often have stronger visual than verbal short-term memory skills and, therefore, reading has often been suggested as an intervention for speech and language in this population. However, there is as yet no firm evidence that reading can improve speech outcomes. This study aimed to compare reading, picture naming and repetition for the same 10 words, to identify if the speech of eight children with DS (aged 11-14 years) was more accurate, consistent and intelligible when reading. Results show that children were slightly, yet significantly, more accurate and intelligible when they read words compared with when they produced those words in naming or imitation conditions although the reduction in inconsistency was non-significant. The results of this small-scale study provide tentative support for previous claims about the benefits of reading for children with DS. The mechanisms behind a facilitatory effect of reading are considered, and directions are identified for future research.

Cross-accent intelligibility of speech in noise: long-term familiarity and short-term familiarization.

Listeners must cope with a great deal of variability in the speech signal, and thus theories of speech perception must also account for variability, which comes from a number of sources, including variation between accents. It is well known that there is a processing cost when listening to speech in an accent other than one's own, but recent work has suggested that this cost is reduced when listening to a familiar accent widely represented in the media, and/or when short amounts of exposure to an accent are provided. Little is known, however, about how these factors (long-term familiarity and short-term familiarization with an accent) interact. The current study tested this interaction by playing listeners difficult-to-segment sentences in noise, before and after a familiarization period where the same sentences were heard in the clear, allowing us to manipulate short-term familiarization. Listeners were speakers of either Glasgow English or Standard Southern British English, and they listened to speech in either their own or the other accent, thereby allowing us to manipulate long-term familiarity. Results suggest that both long-term familiarity and short-term familiarization mitigate the perceptual processing costs of listening to an accent that is not one's own, but seem not to compensate for them entirely, even when the accent is widely heard in the media.

Transcribing nonsense words: The effect of numbers of voices and repetitions.

Transcription skills are crucially important to all phoneticians, and particularly for speech and language therapists who may use transcriptions to make decisions about diagnosis and intervention. Whilst interest in factors affecting transcription accuracy is increasing, there are still a number of issues that are yet to be investigated. The present paper considers how the number of voices and the number of repetitions affects the transcription of nonsense words. Thirty-two students in their second year of study for a BSc in Speech and Language Therapy were participants in an experiment. They heard two nonsense words presented 10 times in either one or two voices. Results show that the number of voices did not affect accuracy, but that accuracy increased between six and ten repetitions. The reasons behind these findings, and implications for teaching and learning, and further research are discussed.

The shape of nuclear falls and their effect on the perception of pitch and prominence: peaks vs. plateaux.

This article investigates the perceptual effect of a high plateau in the intonation contour. Plateaux are flat stretches of contour and have been observed associated with high tones in Standard Southern British (SSB) English. The hypothesis that plateaux may make the accents with which they are associated sound higher in pitch than sharp peaks of the same maximum frequency is tested experimentally. In the first experiment listeners heard pairs of resynthesized utterances where the nuclear accent differed only in shape, not frequency. They indicated which stimulus they thought contained the higher pitched accent. Results showed that plateau-shaped accents sound higher than peaks. In the second experiment the effect of a plateau on prominence relations within an utterance is investigated. Listeners heard resynthesized sentences, and compared two accents. One group indicated which accent sounded higher in pitch and the other indicated which sounded more prominent. Results again indicated that plateau-shaped accents sound higher in pitch and also more prominent; judgments of pitch and prominence were very similar to one another. The results from both experiments indicated that accent shape is a perceptually important variable, although such a fine level of detail is not taken into account by autosegmental-metrical theories of intonation.