A study of speech-language pathology services for school-age children within a health region in Alberta

Provision of speech-language services to school-age children residing within a health region in Alberta was investigated as an example of an organizational system responsible for providing these services in Canada. Institutional ethnography was the methodology employed in this study. During stage l, on-site practice observations and interviews were conducted with 14 front-line speech-language pathologists selected to represent urban and rural sites, schools only and schools/preschool practice, and, team and sole practice. A detailed description of their work was developed, including an examination of their perceived ideal and currently practiced roles. Two perspectives on the ideal role emerged: a specific and task-oriented perspective and an overarching and philosophical perspective. Discord between two themes of doing "what was best" for clients and role ambiguity was identified. Participants' currently practiced role was both client- and service-focused. Discord was evident in practice as participants struggled to manage their caseloads within the service time available. Significant role conflict existed because current practice did not reflect the perceived ideal and this conflict jeopardized work satisfaction and ethical practice. At the second stage, health region managers, teachers and education administrators, a regional consulting team, and government employees were interviewed and policy documents were reviewed. The influence of the organizational and governmental context on front-line speech-language pathology practice was explicated. Participants were found to practice in a hybrid work world formed by the health and education contexts. Participant attempts to negotiate this context required significant time and energy, interfered with their work satisfaction, and failed to guarantee any particular level of service.;Implications of the findings included (a) speech-language pathologists require research and administrative guidance to reconcile global service delivery concerns with considerations focused on individual client needs, (b) caseload management and supervisory duties undertaken by speech-language pathologists must be carefully reconsidered and monitored, and (c) conflicts between health and education contexts must be reconciled to remove barriers to the delivery of speech-language services to children. A plan is provided that identifies specific actions that can be taken by key constituents: speech-language pathologists, administrators, training institutions, professional colleges and associations, policy makers, and the research community to re-vision and restructure speech-language services for Canadian schoolchildren.