People, processes, and practice environment

cultural influences” (Verdon, McLeod, & Wong, 2015, p. 75), including Deaf consumers and those from Aboriginal and Torres Strait Islander backgrounds. Culturally responsive practice has been identified as key to providing accessible and appropriate services for all clients, regardless of their backgrounds. It contextualises cultural differences, challenges prejudice, encourages institutional change to promote inclusion, and supports a dynamic, flexible and relational approach to working across cultures (Gill & Babacan, 2012). It describes individual and systemic responsiveness to health care in diverse communities and requires action at system, organisation, professional, and individual levels (State of Victoria Department of Health, 2009). A systematic review of reviews (Truong, Paradies & Priest, 2014) identified that interventions to improve culturally responsive care in health settings led to better service access, increased service utilisation, consumer implementation of service recommendations, and better outcomes for consumers. Regardless of methodological issues in the included studies, the review concluded that cultural responsiveness is paramount to service evaluation and quality health service delivery. Despite consumer diversity and the importance of cultural responsiveness, this approach is not always implemented (Gill & Babacan, 2012). Speech-language pathologists (SLPs) often lack the confidence, knowledge, and skills to engage effectively and appropriately with CALD consumers (Guiberson & Atkins, 2012; Riquelme, 2007). Issues such as the shortage of available staff who speak a family’s preferred language, the lack of assessment tools for bilingual communication development, and the lack of training to work with CALD consumers have been identified (e.g., D’Souza, Bird & Deacon, 2012; Kohnert, Kennedy, Glaze, Kan & Carney, 2003; Kostich & Weiss 2007). However, almost all studies relating to speechlanguage pathology service delivery to CALD consumers have focused on the practice area of communication. Furthermore, previous studies have primarily surveyed American and Canadian SLPs, often in school settings (Roseberry-McKibbin, Brice & O’Hanlon, 2005), with rare involvement of Australian speech pathologists (Williams & McLeod, 2012). Thus, little is known about the current practices and perceived challenges of Australian SLPs working with CALD consumers in paediatric hospital settings. Moreover, literature regarding skills for working across cultures in speech-language pathology has predominantly focused on examining technical aspects of practice, including clinicians’ assessment and intervention practices within the confines of their “clinic rooms” (Caesar To be ethical, safe, and of high quality, speech-language pathology services must be responsive to the needs of culturally and linguistically diverse (CALD) consumers. However, cultural responsiveness is an ongoing challenge in Australian health care. A service evaluation conducted within the speech pathology department of a major Australian paediatric hospital explored the practices, challenges, and needs of speechlanguage pathologists (SLPs) and allied health assistants when working with CALD consumers. Twenty-nine clinicians across a range of communication and feeding caseloads were interviewed. Issues were identified in three key areas: people, processes, and the practice environment. Clinicians suggested improvements to service delivery spanned the levels of the individual, the profession, the organisation, and the overall health care system. The implications of these findings for SLPs and the broader health care workforce are discussed, and a framework for improving cultural responsiveness is proposed. Future directions for research in this area are also detailed.