Speech and Language Therapy workforce diversity: Three studies using an increasing Transformative Research framework

The lack of diversity in Speech and Language Therapy (SLT) workforces raises concerns of inadvertently perpetuating the same views and practices, thereby risking excluding marginalised groups, limiting the impact of SLT services, and widening inequities. The present thesis makes an original contribution to the emerging field of social justice-oriented research in SLT scholarship by seeking to recentre the voices of underrepresented therapists under a novel paradigmatic and theoretical framing. I conducted three studies on the experiences, practices, and research involvement of underrepresented groups of SLTs. Importantly, each subsequent study is characterised by a growing adoption of the tenets of the Transformative Research paradigm which aims to engage the marginalised members of our communities in ways that amplify their voices, value their knowledge, and empower them during the research cycle. Study 1 aimed to explore the experiences and practices of bilingual paediatric SLTs in the UK (n=19) through the lens of CHAT-ICF, a theoretical framework that I developed to conceptualise the activities of professionals working in the field of disability. I used Reflexive Thematic Analysis and mapped themes onto the CHAT-ICF framework. Findings revealed that being bilingual in a profession oriented towards language and communication disability profoundly impacts SLTs’ experiences and practices. It has deep ramifications to their professional identity, conceptualisation of languages, sense of inclusion in the profession, experiences of structural barriers, work relationships, and services for bilingual families. Based on these findings, I proposed bilingualism-focused recommendations to inform progress towards the UK SLT diversification efforts elaborated in the RCSLT strategic vision 2022-2027. Study 2 aimed to explore the experiences and practices of autistic SLTs (n=8) through the lens of the CHAT-ICF framework. I used Reflexive Thematic Analysis and mapped themes onto CHAT-ICF. I purposefully sought and read the work of autistic scholars and grounded this study in the neurodiversity movement to amplify the voices and notions expressed by autistic researchers on issues of disability, equity, inclusion, communication, and employment. Autistic SLTs revealed unique strengths and challenges to working in this profession. Most notably, they expressed the intricate links between their professional journey and the development of their autistic identity, central considerations of mental health and intersectionality, and the impact of their neurodivergent processing and communication skills to their professional activities. They also revealed issues related to employment and reasonable accommodations, experiences of stigma and ableism, and a sense of belonging and authenticity profoundly shaped by their work relationships. Finally, autistic SLTs expressed how their lived experiences helped them to build strong connections with autistic clients and deliver neurodiversity-affirming therapies. Consequently, I proposed recommendations to promote safer and more inclusive work environments for autistic SLTs, and to inform SLT services more aligned with the neurodiversity movement. Study 3 was a scoping review that I co-produced with three underrepresented SLTs. Together, we reviewed the characteristics of other published studies that included underrepresented SLTs as research participants. We aimed to better understand the knowledge that was generated, and the extent to which the authors of these studies could enable the empowerment of their participants. Among the 20 studies included, and accounting for contextual relevance, we found that bilingual and male SLTs were among the most included underrepresented groups in SLT research. Most studies were conducted in the USA (n=16) and used quantitative survey research designs. These studies’ findings provided valuable insights into the experiences and practices of several groups of underrepresented SLTs, and yielded practical solutions to foster inclusion and diversity in the profession. Finally, by reviewing these studies through the lens of the transformative checklist (Sweetman et al., 2010), we identified existing practices indicative of the Transformative Research paradigm and derived recommendations to further promote the inclusion and empowerment of underrepresented SLTs in future research. Overall, my thesis provided novel evidence on the underexplored and untapped, yet promising, epistemic value and transformational agency of underrepresented SLTs to shape SLT services and research. As the first research project to introduce the TR paradigm in SLT scholarship, I contributed a new lens and tools to rethink the how and why we conduct social justice-oriented research for, by, and with minority groups. Crucially, my CHAT-ICF informed analyses could capture the dynamic nature of SLTs’ experiences and practices, which underscored the need to identify and implement multi-factorial and integrated solutions to promote the sense of inclusion and agency of underrepresented SLTs in their workplace. All members of the SLT workforce have transformative agency which can be leveraged to make social change in the profession’s diversification efforts. In conclusion, this thesis calls for more research investigating the perspectives of, and done in collaboration with, underrepresented SLTs to promote epistemic justice and catalyse action for a more diverse, equitable, innovative, and inclusive profession.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2024

Author dc:creator

• Gréaux, Mélanie

Advisors dc:contributor.advisor

• Gibson, Jenny
• Katsos, Napoleon

• Speech and language therapy
• Diversity
• Workforce
• Transformative research
• DEI
• Bilingualism
• Autism
• Qualitative research
• Scoping review
• Allied health professions

Licence

• https://www.repository.cam.ac.uk/bitstreams/8827a924-dce6-4cf5-8a99-739e0caefe9e/download
• https://creativecommons.org/licenses/by/4.0/

Language dc:language

eng

DOI dc:identifier.doi

https://doi.org/10.17863/CAM.113747

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/376549