The Health Workforce Action Plan (HWAP) proposal was initiated jointly by the University of Alberta’s Faculty of Rehabilitation Medicine and Alberta Health Services to address:
- a shortage of Speech Language Pathology (SLP) services for adults in community settings, which reduces the ability of this vulnerable population to benefit from communication improvement;
- the long-term shortage of clinical placements, particularly in the area of adult neurogenic rehabilitation, affecting recruitment and retention of SLP students and new graduates;
- an increase in the student quota in the MScSLP training program at the University of Alberta.
The overarching goals of this initiative were to implement a creative service delivery model to provide communication and swallowing services for adults, necessary education to facility staff and caregivers, and combine best practice intervention in service delivery with opportunities for increasing the capacity for student training.
Specific goals were:
- To create four full-time speech pathology and audiology positions within Alberta Health Services Edmonton zone for adults where no service delivery previously existed and within three levels of care; facility living, community living, and home living (Seniors Health).
- To improve access to SLP services for adult Albertan’s with communication difficulties that experience deficits as a result of prevalent medical conditions such as stroke. An effective and efficient way to deliver services to this population is utilizing student resources through student placements.
- To enhance competency among staff and caregivers for making referrals and implementing communication strategies via provision of education by SLP’s and U of A SLP students.
- To provide high quality placements with adult clients for U of A SLP students. Students will be exposed to a variety of assessment and treatment opportunities in order to obtain a broad experience.
- To evaluate a ‘2 to 1’ model of clinical education and to demonstrate the effectiveness of the model. The “2 to 1” model is where a single clinician works with at least two students at a time (Ladyshewsky, 1993). This approach has been observed to increase students’ clinical competence on numerous variables such as patient evaluation, implementation of treatment, communication, management skills, and professional behaviour (Declute & Ladyshewky, 1993).
Service provision began in January 2009 with the hiring of the first SLP position. The second position was filled in July 2009, the third position in March 2010 and the final position in February 2011. With a staggered hiring process in place, this initiative resulted in:
- The creation of four AHS 1.0 FTE Speech Language Pathologists (SLPs) positions within Alberta Health Services Senior’s Health Edmonton Zone.
- provide SLP services to adults living in Senior’s Health Edmonton Zone
- provide clinical placement opportunities for University of Alberta Faculty of Rehabilitation Medicine’s Department of Speech Pathology and Audiology students with adults living in facility, supportive, and community living settings.
- 11 full-time and 39 part-time SLP student placements in Senior’s Health. Students experienced assessment and treatment opportunities with a diversity of clinical areas and clinical populations. Both SLP students and project SLPs report benefits of using the ‘2 to 1’ approach.
- 54 education sessions delivered by project SLPS and/or SLP students to over 500 individuals.
- A process for facility staff to refer adult client for SLP assessment or treatment. Over 400 clients from three streams have been referred and monitored when applicable to project SLPs and have been consulted by the SLP, SLP student, or both.
- Quantitative and qualitative data collection which support the benefits of the 2 to 1 clinical model of education. The model was highly rated by students, project SLPs and facility staff. Reported benefits included increased collaboration between students, high levels of support, and increased productivity.
- Some key findings from semi-structured interviews with facility staff, project SLPs, SLP students and family members revealed an initial lack of knowledge of the role of the SLP at start up sites, a need for an SLP as a vital part of the interdisciplinary team providing care for adults, a high degree of knowledge translation within a diverse group of staff was gained from the education sessions held by project SLPs and/or SLP students, and the knowledge gained resulted in functional improvements for clients and reduced stress for staff and family members.
- Dissemination of project model and results throughout the province and beyond. Some examples include:
- A media event which garnered news coverage on CTV, Global, CBC-TV, City TV, Omni TV, Edmonton Journal and CBC Radio. The story and photo also appeared on University of Alberta website and Alberta Health Services main website.
- An issue of the Faculty of Rehabilitation Medicine’s Rehab Dialogue Publication which highlights health related issues of concern to Albertan’s and how the Faulty of Rehabilitation Medicine researchers are collaborating to help meet these concerns.
- Presentations at five conferences in 2010-2011. A project poster submission won an award for clinical innovation at the 2011 Canadian Association of Speech Language Pathologists and Audiologists conference in Montreal, QC in April 2011.
- Publication underway of a brief report in the peer reviewed Journal of Canadian Association of Speech Language Pathologists and Audiologists (JCASLPA).
- Articles in various AHS internal publications, the Edmonton Journal and others.
- A teleconference with over 30 AHS operational leaders highlighting the project and translating a replicable model that could be implemented in other AHS zones to provide SLP services to adults.
Benefits of the service delivery and clinical education model were demonstrated with SLP students, preceptors, healthcare staff, and family members. SLP students benefitted by receiving high quality placements with an adult population and have been exposed to a variety of treatment and assessment opportunities. Residents and family members benefitted directly through service provision. Additionally, AHS facility staff has received training and education in high need areas prevalent in the adult population which increases the knowledge base and acts to optimize resident care. In regard to the ‘2 to 1 model’, preceptor and student observations include perceived increases in student collaboration and productivity over time as students increased their skill and knowledge in the practice setting.