What is speech and language therapy?
Speech and language therapy is a profession devoted to assessment, diagnosis, habilitation, rehabilitation, counseling, and prevention services for individuals from birth through old age who have some type of speech, voice, language, fluency, cognitive-communicative, or swallowing problems due to delayed development or as a result of an injury, cancer, stroke or progressive neurological disease. Speech and language therapy aims to help all people to have an effective means of communication and of swallowing, to allow them to learn and engage in activities of daily living, thereby facilitating their educational attainment, employment and social inclusion, and to maintain and/or increase their quality of life.
Some causes of speech and language disorders include hearing loss, neurological disorders such as Parkinson’s Disease and Multiple Sclerosis, stroke, traumatic brain injury, intellectual disabilities, dementia, drug abuse, cerebral palsy, craniofacial anomalies including cleft lip or palate, head and neck cancer and vocal abuse or misuse. Frequently, however, the cause is unknown.
In developed countries speech and language therapy is an allied health profession which provides services for patients with communication and swallowing impairments, as well as to family members, parents, care – givers and other professionals, such as teachers, nurses, occupational therapists and doctors who care for those with communication and swallowing impairments.
Needs for speech and language therapy
The World Report on Disability[1] noted that 15% of the world’s population experiences some form of disability. Many of these people will have communication disabilities. Communication disorders are a high prevalence condition. In the U.S, nearly 1 in 12 (7.7 percent) of Americans have communication disorders.[2] Between 6 and 8 million people in the United States have some form of language impairment[3]. While prevalence varies between the different conditions defined under the term “communication disorders”, in Australia it is estimated that overall approximately 5% of the population are affected (Senate Community Affairs Reference Committee, 2014). If applied to the Vietnamese context this would equate to approximately 4.5 million people who are in need of speech and language therapy. Some conditions, such as speech disorders in children, have been found to affect as many as 25% of the population of children prior to school entry (McLeod & Harrison, 2009).
As in most countries there are no concrete statistics on how many people in needs of speech and language therapy services live in Vietnam. According to the 2009 census, more than 6.1 million people over the age of 5, or 7.8 percent of the population, have a disability of blindness, deafness, mute, mobility, cognition and mental disorders. There is no data available for telling how much this population needs speech and language therapy services, however Kane (1999)[4] cited data suggesting that 17-27% of all people with disabilities in Viet Nam have problems with “hearing and speech”. Statistic reports from two biggest hospitals – Cho Ray hospital in HCM City and Bach Mai hospital in Hanoi indicate that about 200,000 people have stroke every year, comprising 2.5% of hospital admission cases. Adding these figures together with the group of developmentally delayed people and other people with disabilities, year by year, there are increasing numbers in need of speech and language therapy service in Vietnam. More seriously, if the percentage from the U.S is applicable in Vietnam, then the number is seriously higher when it includes around 7.7 million people with communication disabilities in need of speech and language therapy in Vietnam.
Information gathered through various studies showed that SALT needs should be identified as early as possible and SALT services need to be accessible, available and equitable to aim at preventing the development of communication barriers, swallowing-related health problems and cost saving benefits for SALT service users.
Without support from a speech therapist, communication disorders can have lifelong impacts including difficulties with “learning to read/write, attention and thinking, calculating, communication, mobility, self-care, relating to persons in authority, informal relationships with friends/peers, parent-child relationships, sibling relationships, school education, and acquiring, keeping and terminating a job” (McCormack, McLeod, McAllister and Harrison 2009, p. 163[5]). Untreated childhood communication disorders may persist into adulthood[6] affecting subsequent employment, social inclusion and mental health. People with communication impairments are more likely to be unemployed or in a lower income bracket (Felsenfeld et al., 1994). In the USA, for those unable to speak intelligibly the unemployment rate is 75.6% and the cost of communication impairment is said to be between 2.5 and 3% of the US Gross National Product (Ruben, 2000)[7].
[1] http:// www.who.int. World Health Organization. (2011). World Report on Disability. World Health Organization, Geneva.
[2]http://www.asha/org/About/news/Quick-Facts
[4]Kane, T. (1999). Disability in Vietnam in 1999. A metaanalysis of data. Accessed from http://pdf.usaid.gov/pdf_docs/Pnacg781.pdf on 4th May, 2011
[5] McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review of the association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology, 11(2), 155-170.
[6]Felsenfeld, S., Broen, P. A., &McGue, M. (1992). A 28-year follow-up of adults with a history of moderate phonological disorder: Linguistic and personality results. Journal of Speech & Hearing Research, 35(5), 1114-25.
Felsenfeld, S., Broen, P. A., &McGue, M. (1994). A 28-year follow up of adults with a history of moderate phonological disorder: Educational and occupational results. Journal of Speech and Hearing Research, 37, 1341-1353.
[7] Ruben, R. J. (2000). Redefining the survival of the fittest: Communication disorders in the 21st century. Laryngoscope, 110(2 part 1), 241-245.
Speech and language therapy in Việt Nam
Over almost 20 years working in community and especially supporting for people with disabilities in Vietnam, MCNV realizes that people who have a need of speech and language therapy services are still living in difficulty and with low quality of life due to speech and language and swallowing-related barriers as consequence of limitation of awareness and unavailability of resources to respond to the need. Education and rehabilitation for people with disabilities is available but attention to assessing and responding to the needs of speech and language therapy support, especially for patients in medical units, is seriously neglected[1].
The Ministry of Health (MOH) of Vietnam recognizes the important role of SALT. Therefore, in the Strategy of Rehabilitation Development in period 2014-2020 approved via the Decision 4039/QD-BYT, MOH set the target that 85% of rehabilitation hospitals have sufficient professional titles as specified by Article 4 of Circular no. 46/2013/TT-BYT, including Speech and Language Therapist beside Physical and Occupational Therapist and that 100% of rehabilitation departments and sections of medical schools must include in their curricula contents of training rehabilitation specialist, rehabilitation nurse, bachelor of medical technology, bachelor of speech therapy, physical therapist, activity therapist, speech therapist, orthopaedic instrument specialist, with courses provided in speech therapy and medical technology. It is seen as a strategy for the development in training for rehabilitation in general and in SALT workforce in particular in Vietnam. At the time being, in Vietnam there are more than 120 health units including 36 rehabilitation hospitals, 63 departments of rehabilitation in 63 provincial general hospitals, and more than 21 Central specialized hospitals to provide rehabilitation services. However, man power for speech and language therapy for these units has not been professionally and officially built.
[1]MCNV’s M&E system.
In 2016 a speech and language assessment by USAID analysed SALT situation in Vietnam and showed that SALT has been approached mainly from two perspectives of health and special education. From the health perspective, SALT is mainly supporting people with cleft lip/palate after surgeries, and for voice patients, including those with voice disorders arising from vocal misuse, head and neck cancer and various neurological conditions. There are some services developing for people with communication and swallowing disorders after stroke, and for children with disabilities such as autism. However, the support is quite rare due to the lack of SALT practitioners. From the special education perspective, SALT is provided mainly for children with disabilities by special education teachers who were trained merely by the special education colleges and universities[1]. To respond to the need of SALT clients and to meet the requirements of SALT practice, some hundreds of people have joined several variations of short SALT training across Vietnam, but there has been limited overall coordination and quality control of these courses, other than the 10 month and 2 year courses run by Trinh Foundation Australia. Although some people studied and completed entry level clinical Master degree or even did PhD researching on SALT but as they are actually not SALT clinician and when came back to Vietnam, they did not officially work as SALT trainers.
[1] USAID. 2016. Speech and Language Therapy Assessment in Vietnam
Training in speech and language therapy in Việt Nam
In last 10 years SALT training in Vietnam has developed with great contribution from TFA through pre-service training courses and primary training curriculum development. There was no official training in SALT in Vietnam until 2009 when TFA started to support the Medical University of Pham Ngoc Thach in Ho Chi Minh City to run the first two-years in – service course for a group of 18 people who were working with SALT clients and needed professional skills for their work. Since 2010, with support from TFA and Australian universities, three SALT training courses have been provided by the Medical University of Pham Ngoc Thach for 55 people, and have included students from Hanoi, Hue and Danang. However this training has not been officially integrated into the degree – rehabilitation training system. The SALT training programs at UPNT cover the full scope of practice of SALT: speech, language, voice, fluency, swallowing and multi-modal communication across the life span (birth to death). The programs have been delivered with the support of the speech therapy profession, primarily from within Australia but also from SALTs internationally. While the training programs use local Vietnamese staff whenever possible (e.g. to teach anatomy, physiology, developmental behavioural psychology and linguistics), there were no Vietnamese SALTs in Vietnam with clinical degrees in speech therapy (able to practice and teach speech therapy across the scope of practice). Therefore expertise for the SALT subjects was sourced from abroad. TFA enlisted the help of Australian Volunteers International, Australian Business Volunteers and more recently Scope Global to support long (12-24 month) and short-term assignments (1-3 month) of Australian SALT to Viet Nam. In the current SALT training program at UPNT, graduates of the 2 year SALT programs at UPNT are co-teaching subjects and clinical placements with volunteer Australian SALTs, to build the human resource needed for future degrees in Vietnam. TFA provided some financial assistance, as well as pre-departure, in-country and return-to-Australia briefing and support to more than 110 volunteer lecturers and clinical educators to date (March 2017) for the training programs, as well as workshop presenters and clinical mentors for the UPNT SALT program graduates. The curriculum validation, teaching materials and learning outcomes for the students at UPNT have been rigorously evaluated and refined over time as has the TFA SALT volunteer program[1]. The original 2-year training program curriculum outline was provided by TFA and extended and refined by successive long and short term volunteers teaching in the programs at UPNT 2012-2017. More than 30 CPD events delivered to graduates and other health professionals since 2014 have further added to the teaching resources available in Vietnamese.
[1]Atherton, M., Davidson, B. & McAllister, L. (2016). Building collaboration – a participatory research initiative with Vietnam’s first speech-language pathologists. Journal of Clinical Practice in Speech Language Pathology, 18(3), 108-115.
In 2013 TFA and The University of Sydney, with funding from AusAid’s Australian Leadership Awards Fellowship scheme brought academic staff from UPNT and Rehabilitation Department of Hanoi Medical University to develop a curriculum framework for Bachelor degrees in SALT. This framework is intended to use the existing teaching materials for each SALT subject which are already developed, delivered and validated in Vietnam from 2010 to 2017. However, this framework has not completed in details as well local universities has not planned to develop a package of education program to submit MoH and MoET for their approval.
In 2015, TFA ran an interpreter training program, with funding from a Speech Pathology Association of Australia development grant, in order to provide high quality interpreters and translators for 1) teaching SALT programs at UPNT, 2) SALT continuing professional development courses across Vietnam, and 3) SALT resource development in the Vietnamese language. TFA supported the development of a Vietnamese/English glossary of speech therapy terms to assist with the provision of high quality translation and interpreting.
By February 2017, there had been 54 people trained and have necessary knowledge and skills to provide SALT services in Vietnam. However, this number is inadequate to meet the demand. At least 55 countries have national professional organizations that focus on speech, language and communication disorders[1]. Vietnam is not one of the 55. Thus, the consistent provision of SALT services by trained practitioners is still a challenge in Vietnam both in rural and urban areas.
[1]Lubinski R. 2010. Speech Therapy or Speech-Language Pathology. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/333/
In order to contribute to the well-being of people with disabilities and strengthen the rehabilitation sector in Vietnam in general, there need to be a systematic SALT training program which could be initiated from a strong commitment, efforts, financial and man power investment of both Government and non – Government agencies.
MCNV
Bình luận
Be the First to Comment!