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Shortage of speech therapists thwarts children’s development

By Joyce Cheng and Katrina Lee

In a colourful classroom filled with toys and picture cards, a woman speaks slowly and clearly to a group of three children sitting around her, ensuring they articulate correctly and rectifying their pronunciation.

For most people, speaking is such a natural activity, they take it for granted and may not realise there are people around them, including children, suffering from communication disorder.

In recent years, families have become more aware of speech and communication problems, especially when parents find their children having difficulties in attaining certain language abilities expected for their age.

For instance, a three-year-old child should be able to say, “I want to eat apples.” But a child with language delay might keep repeating “apples, apples, apples,” or reverse the sentence structure. They might have trouble expressing themselves in simple sentences.

Communication disorders can affect a child’s learning, development and personality. Children who struggle to speak properly could eventually become less sociable and have lower self-confidence.

Language delay and communication disorders take many forms and have many different causes, some of them are genetic or developmental and some are acquired. They refer to impairments in the ability to receive, send and process sounds, words and visual language systems such as writing.

Children with conditions like autism or dyslexia, and children who lack an appropriate language-learning environment are among those who experience communication disorders.

“Speech disorder isn’t only about talking. For example pronunciation, voice problems, swallowing problems and even stuttering are all included in language problems,” says Jessi Chan, a private speech therapist at McKenzie & Associates Rehabilitation Services.

Speech therapists provide professional assessment and therapy to patients with communication disorders and play an important role in assisting and rectifying the language issues they are experiencing.

All therapeutic sessions are specifically designed for individuals to target their needs. Therapists use a variety of techniques such as training cards with phonetic articulations and pictures, facial massages and jaw, lip and tongue exercises to strengthen the muscles of the mouth. For children, games and toys are also used to facilitate their speaking and enhance their attention in a session that lasts between 30 minutes and one hour.

In Hong Kong, speech therapy is mainly provided by the public authorities, non-governmental organisations (NGOs) and private practitioners. Children need to be first referred to Child Assessment Centres before they can receive government treatments. If it is determined that speech therapy is needed, the child will then be put on the Central Waiting List.  However, they normally need to wait for at least a year before they get an appointment. Once they have made it through that lengthy process, they have to wait for a month before their next session.

The reason for the long wait is a lack of resources.  Patients with acute needs such as swallowing problems following stroke are given priority treatment.

“We first deal with these patients in hospital so resources for children are reduced. This is why the queue for public hospital treatments is long,” says Joshua, a speech therapist at Tuen Mun Hospital who is not disclosing his full name to avoid self-promotion.

Depending on the seriousness of their language problems, children may also apply for services provided by NGOs, including the Early Education and Training Centres, Integrated Programme in Child Care Centres for mild or moderate cases and Special Child Care Centres for severe cases.

As language problems can have an impact on a child’s overall learning and social development, some parents resort to private services despite the high costs. Wing Wong has a six-year-old son who was diagnosed with language delay when he was two. He is receiving both public and private treatment at the same time because Wong thinks the government service alone is not enough.

Wong is pleased with her son’s progress since he started speech therapy. She says he used to be unable to pronounce many words but is now able to express himself using sentences. His temperament has improved as a result.

Apart from speech therapists, it is also important that caretakers or parents also assist the child’s training. “We encourage parents to attend the treatment sessions. Firstly [we] hope parents can have a better understanding of the child’s situation. Secondly, [we] hope parents can pick up something from the session and teach their children at home,” says Tony Leung Chi-ho, speech therapist supervisor at Heep Hong Society.

As the mother of a child with speech problems, Cheng Yim-ha understands this well. Eleven years ago, Cheng was told that her three-year-old son Gideon had an articulation problem at a regular health check.

Gideon could not pronounce words beginning with an “s” sound. So the speech therapist gave Cheng a few pieces of paper with pictures and words beginning with “s”, and taught her how to practise the pronunciation with Gideon in the week before he was due to have his next treatment. Cheng spent around 20 minutes a day practising with her son and after constant practice, she felt a sense of achievement when she saw his gradual improvement.

“[Speech therapists] offered great help. They helped me understand his problem, taught me how to practise with him… although the method is quite simple, I would not know it [unless the speech therapist told me],” Cheng says.

Three months on, Gideon’s school teacher told Cheng there was an obvious improvement.

Both Wong and Cheng have found speech therapy very helpful in alleviating their children’s speech problems and rebuilding their confidence. They are impressed by how much speech therapy has changed their children.

But there are simply not enough speech therapists in Hong Kong to meet the needs of the children and hospital patients who need their help. According to the Hong Kong Association of Speech Therapists (HKAST), there are around 600 speech therapists in the city.

At the moment the University of Hong Kong (HKU) is the only institution that offers a degree in speech and hearing sciences. The programme produces around 40 graduates a year but vacancies in non-profit organisations, schools and private clinics are never filled up. The number of vacancies in the Hospital Authority and other organisations rose from 78 in 2010 to 89 in 2011.

The profession may get an injection of fresh blood in the future though, as the Hong Kong Polytechnic University (PolyU) is launching a master’s degree in speech therapy in September.

Professor Leung Man-tak, the programme leader says the bachelor’s degree offered by HKU does not produce enough graduates to meet the demand. “We need some mature people to be speech therapists. It is difficult for them to gain trust from clients if they are too young,” Leung says.

Having taught in the Division of Speech and Hearing Sciences at HKU for 18 years, Leung sees the new programme at PolyU as an “extension of territories” for speech therapy education in Hong Kong.

Leung says speech therapy services are culture-bound, so it is critical to train local speech therapists instead of hiring them from overseas. Although the course content of overseas programmes may be the same as in Hong Kong, the language they are taught in and the case studies seen in clinics would be different. Leung adds that speech therapy requires practical studies so the linguistic component is very important. According to Leung, returning to practise in Hong Kong after studying overseas would also be less than ideal.

Unlike other medical qualifications, there is no standard registration system for speech therapists to be recognised by law. “Actually we [HKAST] are striving for it now and waiting for the opportunity to come. Everything is ready except the government’s approval,” says the Tuen Mun hospital speech therapist, Joshua, who is also a representative of HKAST.

Although HKAST is generally recognised as a benchmark in the industry, it is not a legal accrediting body. It was established by some speech therapists in the 1980s with the aim of upholding the professional standards of speech therapists in Hong Kong.

Professor Leung of PolyU says the issue of registration for speech therapists is one that needs to be handled with care and he believes it will take some time before a system can be established. “We have been talking about putting speech therapists under the paramedical ordinance alongside physiotherapists and occupational therapists,” says Leung. “But it is quite strange to have speech therapists registered under this ordinance because over two-thirds of the time speech therapists are not doing any medical-related treatment.”

A standard registration system for speech therapists may not be on the horizon but at least more tertiary institutions will be training new members of the profession. For those awaiting treatment, that can only be good news.

Edited by Natalie Cheng