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La Trobe University CRICOS Provider Code Number 00115M

How is La Trobe Communication Clinic helping trans and gender diverse

individuals and those who stutter?

Janine Standen – Clinic Manager, La Trobe Communication Clinic

16 October 2018

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Services we provide:

Speech Pathology

Audiology

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Health service situated within a University

– Our consumers are members of the public and students on placement

– University subsides services

Almost all services are student delivered (supervised by expert clinicians)

– Student clinicians are enthusiastic providers and clients acknowledge this

– Educating the future workforce

– High expectations placed on the students as they are assessed for competency on placement

Close liaison with academic experts ensures best practice provision

– Our services are supported by research and outcomes published. In some fields results demonstrate our student delivered treatment is equivalent to or better than results published from experienced clinicians

About the La Trobe Communication Clinic (LCC)

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Audiology Clinic

Adolescent and Adult Fluency Clinic

Voice Clinic

– Trans and Gender Diverse Services in partnership with Monash Gender Clinic

– General Voice Clinic

Paediatric Fluency Clinic

Phonological Awareness for Literacy Clinic – primary school age clients

Preschool Speech and Language Clinic

See www.latrobe.edu.au/ communication-clinic

Overview of LCC Programs

Presenter

Presentation Notes

Audiology Clinic Commenced in 2018 maintain focussed at the La Trobe Community but services will be expanded. Adol/ Adult Flu This clinic supports adolescents and adults who stutter. Each clinic occurs once a year. We offer a 2 month therapy program - 3 to 5 day intensive to teach fluency promoting techniques and then 7 weekly evening follow up sessions to assist with maintenance and generalisation There are also 4 to 6 review days which I will explain in more detail later Voice Clinic Primarily see trans and gender diverse clients however we do assist others with general voice issues. We receive funding from the Monash Health to deliver the trans speech pathology services due to our wealth of expertise in the area. We are working to enhance services available in the community We provided 1:1 therapy which typically involves 10-12 weekly sessions. The clinic runs year round. In addition we offer Education Days and Review Days which I will explain in more detail Paed Our paediatric services are funded by DHHS and we receive community health funding. In addition to seeing preschool fluency, speech, language and voice clients, we are also able to see school age children who stutter all year round. In addition we offer a Phonological Awareness for Literacy Program for 5 weeks in April/May where we see children in Grades 2-6 who have reading and spelling difficulties. We can offer these programs at schools in addition to the clinic.

http://www.latrobe.edu.au/communication-clinic

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Impact of the disorders we treat on mental health

People affected by stuttering, language and literacy disorders or identifying as trans and gender diverse are more likely to present with mental illnesses such as:

– Anxiety

– Depression

– Socio-emotional problems

Significant mental health consequences, potentially leading to suicide, have been established in these client groups.

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Transand Gender Diverse

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This population is at increased risk for poor mental health outcomes such as:

– Poor self image and reduced self esteem

– Emotional difficulties such as generalised & social anxiety, depression, fear, anger, & suicidal ideation

– Social withdrawal, reduced social integration

– Discrimination, violence, harassment, bullying & inequality of vocational opportunity

(Davies & Goldberg, 2006; McNeil, 2006; Dacakis, 2002)

Mental health of trans and gender diverse individuals

Presenter

Presentation Notes

See emma’s presentation about barriers

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Voice and gender identity

What is the issue?• Voice plays a major role in gender identity

• The negative consequences of intolerances in our community to gender non-conformity means that a gender incongruent voice contributes to:

• Discrimination

• Loss of employment

• Abuse

• Those perceived as visual-non-conformers (identif ied by others as not matching how they should look and sound for a given gender) are at greater ris k of the negative cons equences (Grant et a l, 2011).

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Population seeking LCC’s services• We see people with any gender position who feel that their voice does not

align with their true self, and therefore desire voice modification to address the incongruence

• Our clients are mostly Birth Assigned Males who identify as Female. We have fewer Birth Assigned Females who identify as Male or non-binary clients

• In birth assigned males, hormones do not change the pitch of the voice

• In birth assigned females hormones (testosterone) increase the bulk of the vocal folds resulting in a lower pitch

• Of 71 new referrals to our service so far this year, 20 clients come from the North East Melbourne region. Which equates to 28% of our caseload; nearly a 1/3

Presenter

Presentation Notes

Stuff around male voice in female appearance and what we actually do.

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How can speech pathology assist?Identifying goals collaboratively with the individual

• Assessment:

• Establishing the impact of the voice

• Taping the voice for analysis on computer software

• Identifying personal goals

• Voice Training

• Providing individualised training in line with recommended techniques to achieve pitch and resonance change

• On request, body language, eye contact and non speech sounds e.g. laughing, coughing, sneezing

Presenter

Presentation Notes

Stuff around male voice in female appearance and what we actually do.

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How LCC assist the trans and gender diverse community?

• Provide a comprehensive and lifespan service encompassing

• Group education days (Health Promotion Activity)

• Individualised assessment, training and generalisation

• Group review days (Health Promotion Activity)

• Flexible service delivery

• Spaced (weekly/fortnightly)

• Group

• Individual

• Telehealth

Presenter

Presentation Notes

Play with format – table with two sections

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Stuttering

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Stuttering and mental health

• Stuttering is associated with:

• Poorer mental health outcomes

• Social anxiety social phobia

• Children who stutter are more likely to be teased by their peers.

• Older children and adults who stutter often fail to achieve their educational or career potential and may experience significant anxiety in social situations.

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How LCC assists those who stutter?

• Providing a comprehensive and lifespan service encompassing

• Fluency instatement

• Generalisation

• Maintenance (Health Promotion Activity)

• Relapse (Health Promotion Activity)

• Flexible service delivery

• Intensive / Spaced (weekly/fortnightly)

• Individual / Group

• Telehealth

Presenter

Presentation Notes

Play with format – table with two sections

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HealthPromotion

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Our health promotion approach• Improving Mental Health

• Victorian public health and wellbeing plan 2015-2019

• Receive funding from DHHS

• Specific target groups

• Trans and gender diverse individuals who are aligning their voice and communication characteristics with their gender identity

• Those who stutter

• Poorer outcomes if communication issues aren’t addressed and skills aren’t maintained

• Conscious effort to maintain stutter free speech or gender congruent voice

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These specific groups need more than the usual population focussed health promotion approach

Service delivery as prevention (health promoting interventions)

There is a place for targeted interventions for at risk populations

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Health promotion activities at LCC

Fluency services

– Stuttering in adolescents/adults is prone to relapse & thus impacts wellbeing

– Fluency Review Days (4 – 6 annually) for adolescents and adults who have had prior therapy (usually at LCC) and wish to work on maintenance or relapse strategies

– Promotes wellbeing, self management and fluency maintenance: includes opportunities for guided skill practice, transfer, group presentations etc

– Evaluation: pre and post surveys, objective measures

Voice services

– Voice Education Days (2 - 3 annually) to promote overarching knowledge of voice, gender differences, and vocal health

– Voice Review Days (1 - 2 annually) to promote maintenance of voice and the chance to ‘refresh’ and update knowledge and skills with new evidence based changes in training techniques

– Socialisation and education regarding services in the community

– Evaluation: pre and post surveys

Presenter

Presentation Notes

Stuttering Input from a variety of service providers (DET, CEO, private practice) Work with Australian Speak Easy Association Maintenance – coming in to avoid relapse Relapse – are stuttering again

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Our successesParticipants return year after year

Rapid change as a result of review days (stuttering reduces)

Increased confidence in using voice / fluency techniques

Increased confidence when communicating in social activities as a result of their review day attendance

Attendees report reduced anxiety following participation

Presenter

Presentation Notes

We are well known within the trans and gender community and are involved heavily with ANZPATH (aus NZ professional association for trans health) TVQ – transsexual voice questionnaire shows improved outcomes post training Stuttering Input from a variety of service providers (DET, CEO, private practice) Work with Australian Speak Easy Association Maintenance – coming in to avoid relapse Relapse – are stuttering again

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Future directions• Join with local services to continue health promotion work to improve the mental

health of the community

• Trans and gender diverse

• Social support networks / services

• Rainbow Tick Accreditation

• Online module and webinar development to support other Speech Pathologists to work with the community and provide voice training

• Stuttering

• Service development, public information forums, clinician education

• Paediatric populations – focus on literacy, early stuttering

• Other ideas?

Presenter

Presentation Notes

SpeakEasy – support their weekly meetings by rostering students to attend to facilitate feedback and practice Students participate in their booster days (review days) and staff

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