Exploring Concepts of Understanding in the Working Practice of Speech and Language Therapists in the UK: A...

All communication involves the expression and the reception of information, both of which are considered by speech and language therapists (SLTs) when assessing and planning intervention for language difficulties. Comprehension, or understanding, has to be inferred, whereas expressive behaviours are directly observable. Possibly because of the level of inference, views and assessments of a person's understanding often vary: between different practitioners, professionals, family members and carers. The aim of the research was to examine how and why such different perspectives occur and how they are managed. There were three research questions: (1) How is understanding conceptualised and addressed from the perspectives of: (a) SLT practitioners and (b) SLT educators? (2) Are discrepant views on a person's understanding recognised and encountered in SLT practice? and (3) if so, how are such differences explained and navigated in practice?

The research design used a survey methodology involving two bespoke online questionnaires aimed at: (i) SLT practitioners; and (ii) SLT educators. Purposive convenience samples were recruited via UK-based pre-registration programmes in Speech and Language Therapy and the Clinical Excellence Networks (CENs) of the Royal College of Speech and Language Therapists (RCSLT). The online questionnaires included demographic information followed by a mixture of closed and free-field questions exploring conceptualisation and assessment of understanding. Descriptive statistics were applied to closed question responses, and summative content analysis to the free-field responses.

A total of 80 completed questionnaires were returned: (i) SLT practitioners = 77; (ii) SLT educators = 3. Understanding was defined in different ways. Approaches to assessment focused on vocabulary and semantics, language processing, and responses to different communicative modalities. Differing views on a person's understanding were recognised to be a common issue encountered by SLTs, which were mainly associated with parents, partners and family members rather than fellow professionals.

SLTs seem to vary in the ways they conceptualise and address the question of understanding in their practice, and the findings confirm anecdotal suggestions that differences of opinion with other professionals, family members and carers are relatively common. Receptive communication, therefore, emerges as a contested field, which has implications for how successfully and thoroughly SLTs are able to plan and deliver effective interventions. Further clarification is needed regarding the relevant information and guidance provided in pre-registration training. Implementation science may provide some useful guidance as to the marrying of theory and research evidence.

What is already known on the subject Language involves both expression and comprehension, the one process being observable whereas the other is inferred. Various models of understanding are proposed, which speech and language therapists can apply in their therapeutic practice, but we know little about which they choose and why. Furthermore, there is anecdotal report of disagreements occurring between assessments made by the speech and language therapist and those of other professionals, family members and caregivers.What this paper adds to the existing knowledge The current study is the first reported survey into how understanding is conceptualised and operationalised in the practice of speech and language therapists in the UK. The findings revealed the different ways that understanding was defined with assessment approaches generally focusing on components within the architecture of language and communication. It appears that differing views on a person's understanding are often encountered by speech and language therapists.What are the potential or clinical implications of this work? This survey suggests that more work needs to be done to establish a unified theory of understanding to underpin speech and language therapy practice: one that combines social cognitive processes and psycholinguistic processes.