Jennifer Halloran and Dr. David McPherson, Communication Disorders
I traveled to Amman, Jordan to evaluate the effectiveness of speech therapy as a volunteer service for children undergoing cleft palate surgery through Operation Smile. Other studies have determined that speech therapy is necessary in cleft palate rehabilitation. This study examined whether therapy is or can be effective in developing countries as a volunteer service. The effectiveness was determined based on pre-operative communication levels compared to post-therapy communication levels as well as parent satisfaction with therapy received. Further, the challenges facing speech therapists as volunteers was determined.
The final project enables reviewers to better understand that therapy can be effective despite the conditions present in a developing country using Operation Smile Jordan as a model. When we understand the efficacy of these services, we can invest in speech clinics worldwide. Such understanding can also be the foundation for improvements in current speech clinics and will lead to more effective therapy for their cleft palate patients.
To evaluate the effectiveness of speech therapy on communication skills, 2 groups of people were surveyed: parents of the children receiving intervention and speech therapists. 15 children between the ages of 2-17 were targeted. 5 out of the 15 subjects were male. The participant’s time spent in therapy varied, and 7 were in their first therapy session. 10 children needed only one surgery to correct their cleft palate.
Surveys were drafted to evaluate 15 parents, primarily mothers. The parent survey consisted of 7 questions designed to measure parental involvement in the speech therapy, previous knowledge of speech therapy services, how they valued speech therapy, and if changes had been perceived following therapy. The children were selected at random from Operation Smile’s clinic in Amman, Jordan. Prior to participation, a consent form was administered. A translator then orally administered previously drafted questions in Arabic. After the parent responded, the translator orally repeated the response to me in English. I recorded the responses in English.
Surveys were also drafted to evaluate 2 certified female speech therapists. The therapist survey consisted of 10 guideline questions designed to measure 6 areas: therapist’s general perception of speech therapy, parent involvement with the child, counseling of the parents about speech, the nature of speech therapy, information about the speech therapist’s methods for intervention, and especially the challenges that the speech therapist faces as a volunteer. The participants were selected at random from Operation Smile’s clinic in Amman, Jordan. Prior to participation, a consent form was administered. I conducted on oral interview and recorded the responses.
Information from the parent survey was placed in tables. Information from the speech therapist interviews was categorized as a narrative.
The parents of the 15 children were intimately involved in the speech therapy process. Only one child did not receive help from their parents with speech at home. When asked if appearance, feeding, or speech was most important to parents, one parent valued all three areas, two parents valued appearance, seven parents valued a combination of feeding and speech, two parents did not value speech, and three parents did not value feeding. Moreover, about half of the parents interviewed understood what speech therapy was prior to coming to Operation Smile’s clinic. Despite this lack of knowledge about speech services, every parent thought that speech was necessary, expected to help, and/or has helped. After surgery specifically, one parent stated that the child’s speech was worse after surgery, one parent stated that the child’s speech was the same, and the remaining parents claimed that their children’s speech was better after surgery. After therapy, for those who had received it, all parents said that their child’s speech improved.
The information from the 2 speech therapist interviews have been grouped into 6 sections: therapist’s general perception of speech therapy, parent involvement with the child, counseling of the parent regarding speech, nature of speech therapy, information about the speech therapists’ methods, and challenges that the speech therapists face. For this report, only information regarding the general perception of services and the challenges facing speech therapists will be included. All of the following claims are based on statements from the therapists themselves.
According to the therapists, surgery and therapy are equally important. Speech therapy corrects abnormal function while surgery corrects abnormal structure. Without surgery and thus proper structure, speech therapy can only provide compensatory strategies to improve overall intelligibility and speech quality. Similarly, surgery isn’t enough alone. The cleft creates poor speech habits and causes phonological, especially backing, problems.
There are many challenges to being a volunteer speech therapist. First, there are limited numbers of volunteers for many patients. Specifically, there are four therapists for about 100 patients. Second, speech therapists come to Operation Smile’s speech clinic once a week. Thus, it is hard to organize sessions with patients who live far away or who have limited means of transportation. Third, the therapists are volunteers who have other work. Therefore, they all prefer to work in the Operation Smile clinic on Saturdays; however, there is not enough space in the clinic for this to happen. Due to their other work and sometimes accompanying travel needs, volunteer therapists are forced to cancel sessions. Fourth, it is accepted in Arabic culture to be late. Not being on time is a problem for treatment. Similarly, some patients cancel sessions right before it begins and are thus seen less frequently. This is a problem because frequency and consistency are needed in speech therapy. Without these things, patients are limited in their progress. Overall, time and scheduling are pressing issues for volunteer therapists. Because there are a limited number of workers and a great number of patients, only one session a week for patients is possible even in cases that need more therapy or when more is requested my parents. The therapists think that more consistency with scheduling and time would be the most effective way to improve services and thus speech in their patients.
The results of the study supported my hypothesis that speech therapy is and can be effective in a developing country as a volunteer service. Operation Smile in Amman, Jordan provides a model for this possibility: all parents saw improvement in speech following therapy or expected improvement. During my research, I found that it was challenging to obtain the desired number of participants. Operation Smile was only able to find 15 parents and 2 therapists for me to interview. However, working with a translator was not as difficult as anticipated. In the future, research should be conducted with more participants to increase the validity of the results. Moreover, my mentor and I are continuing to run statistical analyses on my research to prove its validity.