From excitement to self-doubt and insecurity : speech-language pathologists’ perceptions and experiences when treating children with a cleft palate

Background. Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. However, no study has yet investigated how speech-language pathologists (SLPs) perceive and experience this. Aims. The purpose of this study was to explore how SLPs’ perceive and experience the provision of speech intervention to children with a CP±L. Methods & Procedures. Eighteen female community SLPs, aged between 23 and 62 years, were included in this study. Individual semi-structured interviews were conducted. The interviews were analyzed using an inductive thematic approach aiming to identify themes driven by the data. Trustworthiness of the data was achieved by including researcher triangulation (involving three researchers with different research backgrounds) and deviant case analysis of two cases. Outcomes & Results. Initial responses demonstrated that the community SLPs were excited and enthusiastic to treat children with a CP±L. Expanding on these initial reports, however, they revealed that their excitement turned into professional self-doubt and insecurity when confronted with the treatment challenges inherent to this population. To cope with this self-doubt, they outlined several responsibilities for the cleft team SLPs. They expressed a strong desire to receive confirmation and approval on their treatment practices from more experienced SLPs (i.e., the cleft team SLPs). Their perceptions were dominated by a polarized thinking pattern. Treatment approaches were divided into categories as 'right' or 'wrong' and 'good' or 'bad'. Conclusions. The community SLPs lack professional confidence when treating children with a CP±L. They put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready-made answers to problems and questions. This expectation can perhaps be explained by their fear of making mistakes during therapy preventing treatment progress. If they handle in accordance with the experts’ advice, they cannot blame themselves in cases where no treatment progress is seen. Educational programs in speech-language pathology need to pay more attention to gaining professional confidence rather than merely focusing on competency-based learning tools