Current Issues in Voice Assessment and Intervention in Australia

Jennifer Oates, Janet Baker and Anne Vertigan

Introduction

Voice assessment and intervention in Australia share many features with voice practice internationally. However, because of the specific educational, public policy and cultural environment of Australia, it is likely that Australian practice is characterised by several unique features. This chapter describes the context for voice practice in Australia and discusses current practice in relation to speech pathology education, continuing professional development, service delivery and cultural influences.

Because there are limited published data on contemporary voice practice in Australia, the authors developed and implemented three surveys to ensure that the content of this chapter is as current and reflective of actual practice as possible. All three surveys were administered electronically with the target groups all being academics responsible for voice education in Australian universities, convenors of special interest groups in voice, and managers of speech pathology departments in a range of health and community agencies. The survey of academics was followed up with phone calls to explore responses in further depth.

The context of voice practice in Australia

Australia has a population of 22.8 million people spread over 7.6 million square kilometres (just slightly smaller than the USA). Some parts of the country are very remote. Australia is a wealthy country with a GDP in 2011 of US$1.03 trillion (the 13th largest economy in the world), low unemployment (5.3%), and a 99% literacy rate (Australian Bureau of Statistics, 2012). Mean household income is equivalent to US$61,650. Although school education is free, approximately one-third of children attend private schools. Seventy-five per cent of the population have completed 10 or more years of education and 42% of the population have completed 12 or more years. The majority of the population lives in urban areas. Health care in Australia is generally good, and life expectancy averages 81 years.

Australia has a long history of immigration with 24% of the current population having been born outside Australia. The majority of the population is monolingual and there are no recognised Australian dialects. Fifteen million Australians (68%) speak only English. Other common languages include Italian, Greek, Cantonese, Mandarin and Vietnamese. Recently, Australia has also had increased numbers of refugees from African countries, particularly Sudan. Only 2.5% of the population identify themselves as indigenous, that is Aboriginal or Torres Strait Islander. Unfortunately there is an inequitable health gap between indigenous and non-indigenous Australians and a generally low uptake of health and speech pathology services by both of these populations. Average life expectancy for indigenous Australians is approximately 70 years.

Epidemiological data on the prevalence of voice problems in Australia demonstrate that approximately 4% of the general adult population report that they experience voice problems in any one year (Russell et al., 2005). The prevalence rate for occupational voice users is considerably higher than for the general population. The equivalent prevalence rate for Australian school teachers, for example, is 20% (Russell et al., 1998). Few prevalence data are available for Australian children, but early parent-reported data from a large epidemiological study of 4-year-old children in Australia indicate a rate of 1.8% of 4-year-olds with a voice problem and 7% with hoarse voices (J. Skeat, personal communication, 3 August 2009).

Assessment and intervention services for people with voice problems in Australia are provided mainly by speech pathologists and otolaryngologists. Although many speech pathologists and otolaryngologists develop specialist skills in voice practice, it is rare for these health professionals to practice solely in the voice field. There are no phoniatricians in Australia and very few otolaryngologists title themselves as laryngologists. Otolaryngologists are responsible for making the medical diagnosis and for the implementation of medical and surgical intervention for people with voice disorders, but speech pathologists often assume the key coordinating role in the overall management of these clients. Speech pathologists and otolaryngologists often work closely together in client management as well as research and professional development. Other health professionals including neurologists, respiratory physicians and psychologists also contribute to the management of people with voice disorders, although not on a routine basis. In addition, singing and acting voice teachers, speaking voice coaches, physiotherapists, osteopaths and Alexander and Feldenkrais practitioners are sometimes involved in assessment and intervention.

Speech pathology in Australia is a relatively young profession, having been founded by a speech therapist from England in 1931. The first speech pathology training course commenced in 1939 as a hospital-based diploma. In 1967 the first university degree course in speech pathology commenced. As of 2010, there are 10 university degree courses that qualify graduates to practise. These qualifying or entry-level courses are offered as bachelors, bachelors/masters double degrees and...