Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting

Abstract

Purpose

The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist’s role in supporting young people to participate in the activities of the youth justice service studied.

Method

A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour.

Result

Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering.

Conclusion

Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Keywords:

• speech-language pathology
• youth justice
• perceptions
• qualitative

Introduction

The youth justice system (YJS) is an emerging area of practice for speech-language pathologists (SLPs) around the world. There is strong evidence demonstrating significant, often undiagnosed speech, language, and communication needs (SLCN) in young people in contact with the YJS, and emerging evidence demonstrating the relationship between these SLCN and offending behaviour (Snow & Powell, 2012; Winstanley et al., 2021). Conservative statistics show that up to 52% of young male offenders in Australia present with significant, often undiagnosed developmental language disorder (DLD; Snow, 2019). The SLCN of young people in contact with the YJS necessitates involvement from advocates who specialise in this area—SLPs. Yet speech-language pathology involvement in the YJS is a recent phenomenon, due to lack of awareness and funding (Caire, 2014a; Snow, 2019; Speech Pathology Australia, 2013).

A dearth of evidence of the effectiveness of speech-language pathology interventions in the YJS contributes significantly to this lack of awareness and funding—a causality dilemma. Emerging literature on the effectiveness of speech-language pathology in the YJS has identified the perceptions of youth justice staff of speech-language pathology as a foundational factor for success (Gregory & Bryan, 2011; Snow et al., 2018).

The epidemiology of youth offending

There is widely published agreement that an extensive but specific range of factors contribute to youth offending (Bryan et al., 2015; Hughes et al., 2017; Snow & Powell, 2012). Snow and Powell suggest that these factors are a “confluence of overlapping developmental disorders and risk factors” (2005, p. 2). Risk factors for youth offending are consistently identified as sex (75% of those in contact with the YJS are male), low socioeconomic status, poor parent-child attachment, trauma, maltreatment, out-of-home care (child protection orders), poor academic/vocational achievement, and ethnicity and language(s) spoken (Bryan, 2004; Bryan et al., 2007; Snow, 2019; Snow & Powell, 2005, 2012). In addition to these risk factors, some commonly observed comorbidities in young offenders include but are not limited to: neurodevelopmental disorders (for example, autism spectrum disorder, foetal alcohol spectrum disorder, intellectual disability, attention deficit hyperactivity disorder), learning difficulties, DLD, hearing loss, auditory processing disorder, mental health disorders, and sociobehavioural disorders (Caire, 2014a; Kippin et al., 2018; Snow & Powell, 2004; Speech Pathology Australia, 2019). Finally, in the youth context, it is imperative to acknowledge that cognitive maturation continues throughout adolescence, particularly the prefrontal cortices, the regions associated with planning, organisation, impulse control, emotional self-regulation, and perspective taking (Hsu et al., 2014; Snow, 2019), placing young people at a higher risk of offending.

The relationship between speech, language, and communication needs and youth offending

There is a growing body of evidence demonstrating clinically significant SLCN in young people who are in contact with the YJS (Gregory & Bryan, 2011; Hughes et al., 2017; Sanger et al., 2000; Snow, 2019). A high prevalence of clinically significant, previously undiagnosed DLD has been identified in male young offenders in numerous western countries around the world, for example, 46–52% in Australia, 20% in the USA, and 66–90% in the UK (Bryan, 2004; Bryan et al., 2007; Caire, 2014b; Hughes et al., 2017; Sanger et al., 2001; Snow & Powell, 2008). Notably, a positive correlation has been demonstrated between the severity of DLD and severity of offences committed by young people, and DLD has been shown to be a strong predictor of recidivism above other known risk factors (Snow & Powell, 2012; Winstanley et al., 2021).

How SLCN can impact a young offender’s participation in the youth justice system

The YJS is a language-rich environment, involving legal and formal language in both written and verbal formats (Martin, 2019; Snow & Powell, 2005). Crimes or allegedly committed crimes by young people aged 10–17 in Australia are dealt with in the YJS. Each state has its own legislation, policies, and practices, but the general processes are similar, where young people may be supervised in a community or a custodial setting whilst they await sentencing by the courts. Some young people may avoid a custodial sentence and be sentenced to supervision in the community. They may also be ordered to receive community supervision following a custodial sentence (Australian Institute of Health and Welfare, 2023). Substantial demands are placed on young offenders’ speech, language, and communication abilities during every step of their journey throughout the system (Martin, 2019; Snow & Powell, 2005). Comprehension of complex language is required to draw meaning in both community and custodial settings, including advice of the right to remain silent (Miranda Rights, in some countries), sentencing, bail conditions, and custodial facility rules and educational programs, such as anger management and substance abuse rehabilitation (Anderson et al., 2016; Bryan, 2004; Snow & Powell, 2005).

For the reasons outlined, participation in the activities of a youth justice setting can be a complex phenomenon for a young person. For the purposes of this paper, participation is referred to as “involvement in a life situation” and activity “the execution of a task or action by an individual,” as defined in the International Classification of Functioning, Disability and Health framework (World Health Organization, 2001).

The role of speech-language pathology in the YJS

The significant SLCN of young offenders necessitates speech-language pathology involvement in the YJS (Speech Pathology Australia, 2013), yet youth justice remains an emerging area of practice. Recognition of the role and value of speech-language pathology within the criminal justice system is slowly increasing, and the studies indicated below have identified a diverse and substantial scope of practice within the YJS for speech-language pathology. Scope may include advocacy for both the young people and the profession; expertise in assessment and intervention; collaboration with many stakeholders; and extended roles such as expert witness, intermediary, translator, and/or autism spectrum disorder (ASD) diagnostician. Future scope in speech-language pathology clinical practice has also been identified in predicted chronic SLCN and dysphagia in this population as they age. This work may occur in 1:1, group, or consultative format for child services, mental health services, education, policy, forensic interviews, court rooms, custodial settings, community settings, restorative justice sessions, and verbally-mediated therapies (Caire, 2014a, 2014b; The Communication Trust, 2014; Martin, 2019; Martin & Swain, 2019; Sanger et al., 2000; Snow, 2019; Snow & Powell, 2004; Speech Pathology Australia, 2013, 2019; Swain et al., 2020). The following quote demonstrates an informed understanding of the role and scope of practice for SLPs in the justice system.

I have to admit that in all the years I have been looking at prisons and the treatment of offenders, I have never found anything so capable of doing so much for so many people at so little cost as the work that speech and language therapists carry out. (Lord Ramsbotham, Her Majesty’s Chief Inspector of Prisons for England and Wales 1995–2001; The Communication Trust, 2014, p. 17)

Studies and economic modelling have demonstrated that costs associated with employing SLPs across the YJS are considerably less than those incurred by the incarceration of vulnerable young offenders, legal and health interventions, and recidivism (Addo et al., 2020; Caire, 2014a). Speech-language pathology is considered essential within the general community health context for SLCN (Speech Pathology Australia, 2013), begging the question as to why these essential services don’t apply within the YJS for some of the most vulnerable individuals in our society?

Effectiveness of speech-language pathology in the YJS

To date, only three studies have attempted to demonstrate the effectiveness of speech-language pathology interventions in the YJS (Gregory & Bryan, 2011; Snow & Woodward, 2017; Swain et al., 2020). Gregory and Bryan (2011) demonstrated, via case series design, that the evaluation of speech-language pathology intervention in the youth justice community setting was possible, and that therapy gains were detectable using standardised assessment tools. Seventy-five percent of the young offenders made improvements in all areas of communication targeted by therapy, and up to 88% experienced improved standardised scores. Snow and Woodward (2017) demonstrated via six case studies that young offenders can be effectively engaged in the custodial setting, make therapeutic gains, and the majority regarded therapy as useful. Similarly, Swain et al. (2020) demonstrated via four case studies that gains from therapy in the custodial setting were made and generally maintained. Participants and teachers both perceived the intervention as useful and reported improved communication. All three studies were limited by complex environments and participants, and acknowledge the need for higher-level evidence (JBI, 2019); yet, these results provide promising avenues for future research.

Perceptions of speech-language pathology in the YJS

Bryan and Gregory (2013) conducted a study in a community setting in the UK. They found that staff were largely positive about the experience of working with an SLP and saw great benefit in understanding SLCN—how it presents and why it is important. This knowledge assisted with general management of young offenders, something managers suggested led to culture change. Staff also expressed preference for direct access to the SLP, supporting findings from aforementioned studies on the importance of permanent embedment (Speech Pathology Australia, 2019). Another study by Snow et al. (2018) was conducted in an Australian custodial setting after a trial of speech-language pathology intervention with young offenders. It too found that staff held consistently positive views on working with an SLP; staff felt they had learned a lot about SLCN and could apply this knowledge in their own roles. Staff reported surprise at the level of engagement from the young offenders, and fully supported permanent embedment of the SLPs. To date, staff perceptions of speech-language pathology within the YJS have been studied once in the Australian context directly after an intervention. The aim of this project was to investigate the perceptions of non-SLP staff in a youth justice setting on the role of SLPs and the factors influencing the implementation, adoption, and impact of these services. A subaim of the project was to specifically explore how staff viewed the SLP’s role in supporting young people to participate in the activities of the youth justice system studied.

Method

This study received ethical approval from an Australian university human research ethics committee (approval number: 2568) and endorsement from the acting director of the Australian youth justice service studied. For the purpose of this paper, this will now be described as the “service studied.” The qualitative research design of narrative inquiry was selected to enable the researchers to explore the perceptions of individuals working in an Australian youth justice service and their experiences of speech-language pathology in supporting young people with SLCNs (Bazeley, 2013). The stories and lived experiences in this study were collected via semi-structured interviews and analysed for patterns (themes) using reflexive thematic analysis (Braun & Clarke, 2006). The researchers endeavoured to work reflexively where applicable, analysing data and recursively reflecting on possible author biases. The first author was the primary investigator for this study and did the participant recruitment and data collection. This author also did the first stage of data analysis and then consulted with the other three authors. The first author completed this project as part of an honours program in speech-language pathology. Two of the other researchers were SLPs with academic experience. One had specific expertise in trauma-informed clinical practice and the other had expertise in multidisciplinary service provision for people with complex social and care needs. The fourth researcher was an academic nurse practitioner with expertise in researching vulnerable groups, including homeless children.

Participants

Purposive and snowball sampling methods were utilised to recruit participants for this study (Johnson et al., 2020). Seven non-SLP participants consented to this study. All the participants were staff employed by the service studied in either the custodial or community setting and had directly supported young people in either setting. Staff who had not directly supported young people in either setting were not eligible to participate. These eligibility requirements were communicated clearly during the recruitment stage. All potential participants met the eligibility criteria. Following gatekeeper approval from the acting director of the service studied, a recruitment email was distributed by three team leaders. Following nil responses, Author 1 attended a weekly staff meeting at the service studied to provide information about the project and including that participation in it was voluntary. Following the meeting, the email was resent to all staff across custodial and community settings by one of the three original team leaders. Neither the team leaders nor the acting director of the service studied participated in the study, as they assisted with the recruitment process.

Two SLP participants who worked in the service studied also consented to participate in this study. The SLP participants were interviewed first to provide contextual background information about their role and offering. This information assisted the development of the interview questions used with the non-SLP participants. The SLP participants had worked at the service for 2.5 years prior to their interview. These interview data have not been reported here because the focus of this paper is the perspectives of the non-SLP youth justice staff of the role of speech-language pathology in a youth justice setting. The study’s participants have been assigned a number to protect their identity, for example, P1, P2. In the non-SLP participant sample (n = 7), four were in senior roles. There were two managers (case or operations), three allied health professionals (for example, social workers, occupational therapists), one executive, and one allied health student. Potential participants notified Author 1 via email and returned the completed participant information and consent form. A time, date, and location for the interview convenient to the participant was identified.

Data collection

A semi-structured interview protocol was developed to ensure a consistent approach to data collection. Two sets of questions were developed by Author 1: one for the SLPs and one for non-SLP youth justice staff (see Supplementary Material 1). The interview questions for the SLPs were developed to establish context prior to non-SLP staff interviews and related to the SLP role and offering. The interview questions for non-SLP staff included a description of their role within the service, the contact they had with young people and SLPs, perceptions of the SLP role and offering, and impact of speech-language pathology input on young people’s participation in activities of the youth justice service studied. The questions and approach were informed by relevant literature (Bryan & Gregory, 2013; Snow et al., 2018) and answers to the interview questions by the SLPs in this study. They were designed to be open-ended, allowing Author 1 to probe or clarify participant responses, thereby increasing credibility and confirmability (Johnson et al., 2020). Reflexive principles were applied to the protocol (Braun & Clarke, 2006; Johnson et al., 2020), with continued refinement of structure, questions, and probes based on learnings from previous interviews. This iterative approach helped identify an additional question for all participants regarding culturally responsive practice. Following written and verbal consent from non-SLP participants, all interviews were conducted in either the community (n = 4) or custodial (n = 3) setting between 20 August 2021–2 September 2021 and were audio recorded using a digital H5 Handy Recorder Zoom. Interviews for the non-SLP participants ranged from 20–42 minutes in duration. Recordings were deidentified and verbatim transcripts were produced then emailed to participants for member checking, where they were provided with the opportunity to confirm, query, or give feedback on the transcript’s accuracy and credibility (Creswell, 2014). Participant P6 requested that the transcript of their interview required minor alterations, relating to clarification of expression. The other six non-SLP participants provided written approval for use of transcripts without alteration.

Data analysis

Data analysis followed the six-step reflexive thematic analysis protocol developed by Braun and Clarke (2006). A manual approach was employed for coding and theming, allowing the authors to deeply familiarise with the data. Transcripts were entered line-by-line into a purpose-designed spreadsheet and codes identified. Codes were printed, cut out, and arranged into themes and subsequent subthemes. Subthemes were identified when a subject consistently occurred within a key theme, but was not substantial enough to be realised as a key theme.

Six measures were employed to provide rigour to the data analysis process. These included engaging in reflexivity (established reflexive data analysis protocol, recursive analysis of all activity, and reflection on author biases), frequent debriefing with peers and the research team, appraisal of a wide range of information sources from white and grey literature, member checking, and inter-rater coding (Creswell, 2014; Johnson et al., 2020). Author 1 managed member checking directly with participants by emailing verbatim transcripts for review and approval, and inter-rater coding was applied to 20% of transcripts to build consensus between Author 1 and Author 4. Authors 2 and 3 did not participate in the inter-rater coding process. This involved independent coding of the transcript by each author before meeting to discuss coding and identify discrepancies. A small number of discrepancies were discussed, and agreement reached on the preferred code.

Result

The semi-structured interviews for this study were conducted at the participants’ place of work. Six themes and six subthemes relating to the offering of SLPs in the service studied were identified in the interview data. An overview is provided below, in Figure 1. These themes were then considered in relation to the factors described by the participants as impacting speech-language pathology service provision in a YJS and the impact of SLCN on young people being able to participate in the activities of the service studied.

Figure 1. Summary of identified themes from interviews with youth justice staff.

Theme 1: SLP role and offering

All seven participants felt that the majority of staff within the service studied did not have a clear understanding of the SLP role and offering. Four of the seven who were clear on the SLP role and offering were in senior roles and/or worked closely with the SLPs on a regular basis. The staff knowledge gap around the SLP role and offering is further explored below in Theme 6. Theme 1 was further distilled into two subthemes: multifaceted, non-traditional role and service delivery.

Subthemes for Theme 1: Multifaceted, non-traditional role; service delivery

When asked to define the SLP role and offering within the service studied, participant responses varied significantly. Responses suggest that the SLP role was perceived as multifaceted and non-traditional, which included: communication, comprehension, collaboration, multi-disciplinary teamwork, advocacy, a voice for the young people, “translator” for young people, conflict resolution, communication partnership, access to services, literacy, behavioural management, production of youth-friendly resources, and staff support. P5, who worked in the community setting, said: “I worked with [SLP] with a client and she would sort of try and explain things in her nice way of talking, almost like a translator sort of thing.”

Three participants perceived the need for speech-language pathology to deliver service across three levels of the service. These levels were defined as primary (individual therapy), secondary (staff support and education), and tertiary (policy/systemic support and education). For example, P6 who worked in the community setting said: “So, it’s really three-pronged. You’ve got primary, secondary, and tertiary influence as well. So yes, supporting the system to influence clients, supporting the staff to influence clients, and then having that individual, that’s how I perceive it.”

The SLPs were perceived to have a broad skillset, which could be applied across all levels of the organisation. This skillset was also perceived to play a role in the second theme: culture change.

Theme 2: Culture change

All seven participants acknowledged the need for culture change within the service studied, towards client-centred practice. Six of seven participants felt that individuals in the custodial setting in particular held perceptions that young people were “bad kids” and deserved “punishment.” Four participants believed the culture to be in the process of changing, and perceived speech-language pathology as playing a role in this change. The SLPs were perceived to play a leading role in the culture change towards client-centred, culturally responsive practice. This was achieved through demonstration (modelling) and staff education. For example, P3 who worked in the custodial setting described this changing culture in the following ways:

Unfortunately we’ve got a long way to go, but the work that they [SLPs] are doing here, I think in the last couple of years have seen a real change in the way that people adapt what they’re doing and the expectations they’re placing on young people as well. And there are differing levels of understanding outside of our team, but there’s no doubt it’s changing, and I think it will continue to change.

I often see the speechies [SLPs] seeking out either guidance from Aboriginal cultural workers or cultural leaders within the system. Seeking out guidance from them or even working alongside them as a means of breaking down those initial barriers when first meeting young people.

Theme 3: Lack of resourcing

Resource allocation for speech-language pathology was perceived to be inadequate by six of seven participants. One participant expressed incredulity on learning there were only two SLPs employed by the service studied. Two distinct subthemes were identified within this theme: meeting demand and accessibility.

Subthemes for Theme 3: Meeting demand; accessibility

Five of seven participants perceived the SLPs as having a significant workload considering there were only two of them, making it challenging to meet demand across both the custodial and community settings. The SLPs were widely perceived as needing to “triage” work and prioritise the most urgent need, with this often being young people in the custodial setting. Four of seven participants perceived the demands of the community setting to be unmet by speech-language pathology, partly due to the custodial setting being prioritised, as young people there had the “highest needs.” For example, P4 described the demand for speech-language pathology services in the community setting and that the speech-language pathology current staffing levels were inadequate:

Out in the community sector, like I said, they [SLP] probably do more help with reforming things, because it’s such a huge number, we’ve got nearly 200 kids in the community, so there’s no way two people could service all their needs.

These same four participants expressed the desire for a larger team of SLPs to help meet demand across both the custodial and community settings. For example, P2, who worked in the custodial setting, said: “The two [SLPs] here are only part time, so it would be great if more value was placed on them and then they could have more involvement, more sessions. But I think every area wants that.”

Two participants did not know where the SLPs were based, and had not “seen them around.” One was unaware of the existence of the SLPs in the service. Two other participants described seeing SLPs “now and then.” Five participants perceived the need to have SLPs embedded in both custodial and community settings, to allow for constant and direct access. Overall, the SLPs were perceived by the participants to be undervalued by other staff and to lack visibility in the service studied. They simply did not have adequate time or resources to meet significant and ever-growing demand. This was highlighted by P4 who worked in the community setting and stated:

I think as I said, the difficulty is accessing them [SLPs] because there’s so much demand at the centre [custodial setting]. For community, it’d be nice to have a speechie [SLP] attached [embedded] to community. But the staff are totally comfortable accessing them, and it’s just if they were around a bit more the staff would go “oh yes, I could ask the speechie [SLP] for some tips on that.”

Theme 4: Young people as clients

All seven participants acknowledged that young people in the custodial and community settings led complex lives and were often “overprescribed” to assistance services. For example, P3 said: “A lot of our young people are very overprescribed with many different services, all trying to do their best, but not really working together.”

Four participants had witnessed the therapeutic benefit of speech-language pathology services but acknowledged the need to prioritise a young person’s basic needs over this therapeutic input. These four participants also perceived it as challenging for young people to understand the value of speech-language pathology, when they often did not perceive their own SLCN, had negative interactions with health professionals in the past, and/or when their SLCN prevented them from engaging appropriately. All seven participants perceived young people as challenging to engage therapeutically, but five believed the SLPs had demonstrated effective engagement techniques, and extended assistance with this to other staff.

Theme 5: Value of speech-language pathology for young people

All seven participants perceived speech-language pathology input as valuable to young people. Examples of the perceived value for young people included: creation and modification of accessible resources, SLPs as communication partners for the young people, facilitating increased comprehension leading to upholding of rights and increased safety, improved literacy, creation of tools for planning and routine, and culturally responsive care. For example, P2 discussed the impact of her role as a communication partner in the youth justice context: “And he’s [young person] also commented on understanding court better, as he uses either them [SLPs] or was using myself as a communication partner. And so, he seems to have responded really well to that.”

Despite a lack of understanding of the SLP role and offering (refer to Theme 1), its value for young people was widely perceived. The following quote from P3 acknowledges the value of speech-language pathology in the YJS and, critically, the role SLPs play in creating a two-way dialogue with some of society’s most vulnerable individuals:

If the Youth Justice System truly buys into what speech [-language pathology] can offer, it can truly be a game changer in terms of how we relate to the young people, but also how information is shared with them, and what we get back from the young people as well.

Theme 6: Staff education

The need for staff education within the service studied was perceived by six participants across two key areas, presented below as subthemes: SLP role and offering and impact of SLCN on young people’s participation.

Subthemes for Theme 6: Understanding the SLP role and offering; impact of speech, language, and communication needs on young people’s participation

As identified in Theme 1 (SLP role and offering), all seven participants, including the four participants who were unclear on the SLP role and offering within the service studied, felt that the majority of staff within the same service did not have a clear understanding of the SLP role and offering. The desire for staff education in this area was therefore a predictable finding. Some participants, such as P5 who worked in the community setting, felt that as a “newer form of therapy” to youth justice, siloed work streams and the staff knowledge gap on speech-language pathology were to be expected: “I feel like we could be better educated in [the] community [setting] about the role and the capabilities of the speechies [SLPs] and then we would know when to appropriately refer.”

As identified in Theme 2 (Culture change), six participants felt that individuals in the custodial setting in particular held outdated perceptions that young people were “bad kids” and deserved “punishment.” These perceptions may be attributed to a lack of understanding of SLCN and the impact it can have on young people’s participation in activities in the youth justice service studied. Many participants, including P2 who worked in the custodial setting, reported incidents of perceived “non-compliant” behaviour that was in actuality the result of unaddressed SLCN: “And so, I think, in educating staff, I think the speechies [SLPs] have a role to actually help staff understand that someone might not be deliberately being difficult.”

Participants felt strongly about the need for staff education in this area to improve the quality of care for the young people. A perceived flow-on effect of improved quality of care was an improved working environment for the staff, with fewer incidences of challenging behaviour and communication breakdowns. Additional quotes from participants are available in Supplementary Material 2.

Summary of results

In summary, six themes and six subthemes were identified in the interview data. These themes and subthemes explored the perceived role and offering of the SLPs in the service studied. This included SLPs taking on a multifaceted, non-traditional role; SLPs delivering service across multiple areas of the organisation; SLPs leading culture change towards client-centred practice; and SLPs providing input that was perceived as valuable by others. The participants identified a lack of resourcing and accessibility for speech-language pathology services, noting that priority was given to the custodial setting over the community setting. They reported the need for staff education on the SLP role and offering, in conjunction with information about the impact of SLCN on a young person’s ability to successfully communicate with others in the service studied. The young people in the service were perceived as challenging to engage and having difficulties with participation in the activities of the service studied, but some participants described how the SLPs were able to overcome these issues some of the time.

Discussion

The significant SLCN of young people in contact with the youth justice setting necessitates speech-language pathology involvement (Speech Pathology Australia, 2013). A stronger body of evidence demonstrating the value of speech-language pathology input for the young people and staff in this setting is necessary to improve awareness and generate increases in speech-language pathology employment and related research (Snow et al., 2018).

Scope of practice and perceived benefits of SLP role in a youth justice setting

Emergent research has identified YJS staff perceptions of the SLP role in facilitating the utilisation of speech-language pathology services for young people in contact with the youth justice setting (Gregory & Bryan, 2011; Snow et al., 2018). In response to this need, the purpose of this study was to explore how youth justice staff perceive the SLP role and provision in an Australian youth justice setting. This narrative inquiry took place with staff working in one Australian youth justice service where SLPs had been employed for approximately 2.5 years. Participants in the current study perceived that the scope of speech-language pathology practice and the provision of the services provided by the SLPs in the service were benefiting the young people in this setting. This scope of practice and delivery of service are in line with national speech-language pathology clinical guidelines and emerging literature, which suggest that the speech-language pathology profession is diverse, growing, responsive, and client-driven (Speech Pathology Australia, 2019; Ward, 2019). Following involvement in an independent inquiry by Youth Justice Queensland, SLP Stella Martin (2019) agrees that these aforementioned clinical guidelines and aspects of service provision are highly applicable in the rapidly-evolving Australian Youth Justice context. Extending the profession’s scope of practice to support interdisciplinary work and complex case management is not unique to speech-language pathology. There are workforce and resource pressures creating opportunities for other allied health professionals to further their skills and provide expertise in a range of underserved and unserved healthcare, disability, and social welfare sectors (Saxon, et al., 2014).

Culture change and emphasis on therapeutic services

In line with global trends for improving and upholding human rights, cultural safety, and client-centred practice (Speech Pathology Australia, 2019; United Nations, 2019), a prominent perception held by all non-SLP staff was that the culture change of a greater emphasis of therapeutic services for young offenders was occurring within the service studied. Speech-language pathology is one of a series of allied health and psychosocial care professions being engaged to offer interdisciplinary rehabilitation support (Young et al., 2017). The SLPs were perceived by the participants in management roles as central in changing long-held views that the young people in contact with the service studied deserved punitive measures. This involved continuously demonstrating (modelling) client-centred, culturally responsive practice and taking the time to train and educate staff on their role in supporting the young people in their care with and without SCLNs. In working towards making the service studied a safe, client-centred space for young people, the SLPs were also perceived as facilitating their participation in activities of the youth justice service studied. Notably, the perception of SLPs driving culture change was observed in Bryan & Gregory’s (2013) UK-based study, suggesting the SLP skillset is universally relevant in the youth justice setting.

Valuing speech-language pathology input to facilitate meaningful participation for young people

All participants perceived speech-language pathology input as valuable for young people in both the custodial and community settings. Whilst some participants had not had direct experience of the SLP service delivery in their work role, six of the seven participants were from allied health disciplines and drew on prior knowledge of speech-language pathology when answering the interview questions. Examples of value included production and modification of accessible resources, SLPs acting as communication partners for young people, increased comprehension leading to upholding of rights and increased safety, improved literacy, production of tools for independent planning and routine, and modelling culturally responsive practice. These contributions directly facilitated the young people’s participation in activities of the youth justice service studied. Staff perceived the value to extend beyond the young people and into their own roles, a similar finding to Bryan and Gregory (2013) and Snow et al. (2018). Likewise, many of the participants saw benefit in having the SLPs embedded in both the custodial and community settings, to facilitate meaningful participation for the young people.

Resourcing and knowledge gap influence access and outcomes

The findings in this study pertaining to the nature of young people as clients, a lack of resourcing for SLPs, and staff education on the SLP role and offering, as well as the impact of SLCN on young people, were in line with those from previous studies by Gregory and Bryan (2011), Snow and Woodward (2017), and Swain et al. (2020). A lack of resourcing was also perceived by participants. They felt there were not enough SLPs to meet demand across the custodial and community settings, and therefore the SLPs were not as accessible as needed in these settings. Participants universally felt this was a result of speech-language pathology being undervalued and underresourced by the service studied, therefore creating a barrier to facilitating participation of young people in activities of the youth justice service studied.

The expanding scope of practice for SLPs and matters of resourcing have been described in very few studies of settings where the role and service offering of an SLP is appreciated, but not well understood or accessibility is limited. In one study, Janes et al. (2021) explored the knowledge and perceptions of speech-language pathology held by regional mental health practitioners in Central Queensland, Australia, and found poor knowledge of an SLP’s role and offering in case scenarios where language-based problems were identified. The participant practitioners with prior experience of working with an SLP were more likely to have greater understanding of an SLP’s area of practice and agree with statements linking speech-language pathology with mental health.

As indicated above, nearly half of the participants were unclear on the SLP role and offering and all participants felt there was a significant knowledge gap in this area across the service studied as a whole. This lack of understanding resulted in lower value being placed on speech-language pathology input, thereby reducing the potential impact to improve the participation of young people. Their participation may be further reduced by the staff knowledge gap on the impact of SLCN. Participants who understood the role and offering of SLPs felt, in the absence of speech-language pathology input, a meaningful two-way dialogue between young people and staff of the service studied was lacking. This knowledge gap and need for staff education was also identified by Bryan and Gregory (2013) and Snow et al. (2018).

The current study further highlights the complexities faced by SLPs and also the managers working in the YJS. The aspiration for culture change through the emphasis of a therapeutic approach where SLPs with the skills and expertise drive a holistic understanding and strategies to improve participation of the young people with SLCN was strongly articulated by the study’s participants. However, the size of the task is significant in the context of limited resources and the knowledge gaps around the SLP value and offering, and the impact of SLCN on young people’s participation. These factors appear to be impeding a greater level of impact by the SLPs working in the service studied. Tailored implementation strategies could be utilised to support adoption and knowledge translation to overcome some of the barriers specifically identified in the service studied (Graham et al., 2006; Michie et al., 2011). The current study also provides further evidence to support government level policies and strategic directions such as the Victorian Government’s plan to emphasise individual-specific rehabilitation strategies in the youth justice system (Victorian Government, 2022). Ambitions such as these must be adequately resourced to ensure young people can access therapeutic interventions involving SLPs when appropriate.

In summary, the findings of this study suggest that the SLP skillset and was perceived to improve young people’s participation in activities of the youth justice service studied. However, several systemic factors were perceived to influence a young person’s access to speech-language pathology services in the service studied. The SLP skillset or approach were perceived to counteract these systemic barriers, but the SLPs were not always available to provide therapeutic input for the young people in the service studied. Notably, the participants in the current study, who were aware of the SLP’s role, valued speech-language pathology input for young people and described how this extended to staff within their youth justice service. This is an interesting finding in light of the perceived need for staff education on the role and offering of the SLPs, as well as the impact of SLCN on young people’s participation in activities of the youth justice service studied. The findings in this study may inform speech-language pathology service planning and education strategies, ultimately leading to a higher level of uptake and impact of speech-language pathology services in the youth justice setting.

Implications

The findings of this study support those of previous studies regarding staff perceptions of speech-language pathology in the youth justice setting. The SLP’s role and offering in a youth justice setting has been reported in other studies where speech-language pathology has been successful in engaging young offenders in therapeutic interventions and positively influencing the participation levels (Gregory & Bryan, 2011; Snow & Woodward, 2017; Swain et al., 2020). Other consistencies with studies on staff perceptions of SLPs in the youth justice setting included the need for staff education, the SLP role in culture change, and the perceived value of speech-language pathology input for both young people (improved participation) and YJS staff (improved understanding of impact of SLCN on participation; Bryan & Gregory, 2013; Snow et al., 2018). This alignment reinforces that the same challenges are likely to exist across YJS settings and impact the SLP role and offering in high income countries around the world. The semi-structured interviews with each participant in the current study allowed a more in-depth, contextual understanding of the issues at play in the service studied compared to previous research studies situated in similar settings where data collection methods included questionnaires, phone interviews, and focus groups (Bryan & Gregory, 2013; Snow et al., 2018).

The implications of this study’s findings may apply at both practice and policy level. The service studied and the YJS generally may consider these findings in evaluating the need and value of speech-language pathology, in adapting policies on speech-language pathology involvement, and in acknowledging the importance of client-centred practice to improving the participation of young people is upholding their human rights. The findings provide further indication for policy development and governmental frameworks to support increased funding levels for SLPs in the YJS.

Limitations

There were a number of limitations to this study’s methodology. The researchers acknowledge their professional (SLP, Academic Nurse Practitioner) backgrounds, preconceptions, and biases in relation to interpretation of the data (Johnson et al., 2020). Secondly, purposive and snowball sampling methods were used to recruit participants in a challenging-to-reach location, limiting the generalisability and representative nature of the findings (Creswell, 2014). There were a high number of allied health staff in the sample. These participants were more likely to have possessed knowledge about the SLP role and offering. There was also one student in the participant sample who might not have known the SLP role in a YJS. It is also recommended that researchers employing reflexive thematic analysis complete analysis and coding of the data as it is collected (Braun & Clarke, 2006). This was not possible due to the unprecedented rate of interviews.

Future directions

It is important to investigate the perceived barriers of SLPs in facilitating participation in young people, from the perspective of both non-SLPs and SLPs. This will assist with speech-language pathology service provision planning in the youth justice setting. Through this process, SLPs could attain valuable insights on what staff perceive as valuable for the young people and for themselves, thereby improving practice and young people’s participation in activities within the YJS. Another area to focus research is the evaluation of the effectiveness of speech-language pathology within the YJS further contributing to the body of evidence needed to improve awareness, funding and policy change. This process could involve the development of a definition for “effectiveness” within the YJS context, followed by an objective measure of young people’s participation in activities both before and after they receive speech-language pathology input. Perceptions held by young people, staff, and SLPs throughout this process could complement this. Finally, replicating this study in other youth justice settings would strengthen our understanding of key stakeholders’ perspectives of the SLP role and offering in this context.

Conclusion

This study’s key findings suggest that the value of speech-language pathology input was appreciated by the majority of the non-SLP staff participants in the service studied, despite systemic barriers such as a lack of resourcing and a significant need for staff education on the SLP role and offering. This study also provides further evidence for the need for staff perceptions to inform speech-language pathology service planning and education strategies, to enable a higher level of effectiveness in the YJS.

This study builds on and extends the findings of previous studies and provides an additional Australian perspective, with findings relevant to SLPs, the service studied, and the YJS in general. In this study, SLPs were perceived as being important to improving the participation of young people in the activities of the YJS.

Acknowledgements

Special thanks to the staff and participants from the service studied for bringing this project to life. We feel honoured to shine a light on the important work you are doing.

Disclosure statement

No potential conflict of interest was reported by the author(s).