Neonatal communication intervention in South Africa : training needs and future strategies

Abstract

Advances in neonatal medicine during the past 35 years have led to the survival of more preterm infants than ever before. The focus of the management of preterm infants has consequently shifted from survival to providing for developmental needs, from as early as possible. The increased prevalence of at-risk infants born in South Africa necessitates the appropriate implementation of neonatal communication intervention (NCI) programmes. Since mothers do not always return to health care facilities for follow-up services but are available during the neonatal period, the speech-language therapist should assist them with feeding development, mother-infant attachment and reciprocal communication interaction. The paediatric audiologist should reduce noise levels in the neonatal intensive care unit (NICU) to protect neonatal hearing, conduct a hearing screening test within the first month of life and train parents to create the appropriate auditory environment that will facilitate listening and language development. Audiologists and speech-language therapists need to be fully competent and well-trained in providing NCI, so that their services in the unique multicultural and multilingual South African context can become increasingly effective. The aim of the study was to describe the self-perceived skills and needs of South African audiologists and speech-language therapists regarding NCI. A triangulation mixed model research design, which entails a combination of quantitative and qualitative research techniques, was used. A descriptive survey was employed to describe the self-perceived skills and needs in NCI of 73 participating South African audiologists and/or speech-language therapists. The results of this study indicated that participants experienced the greatest difficulty with and the least confidence in feeding intervention. The participants perceived their skills in communication intervention, neonatal hearing intervention and general collaborative tasks in NCI to be better than their skills in feeding intervention. Some of the participants did not recognise their vital role in kangaroo mother care (KMC), although it is the ideal entry point for the implementation of NCI programmes. The participants identified needs in terms of knowledge and skills regarding feeding intervention, developmental care and KMC. The majority indicated that they perceived their level of practical training as lacking, and that any training in NCI should include practical aspects. It was also found that the participants’ current profession and their professional qualification significantly influenced their reported skills in feeding, communication and neonatal hearing intervention. The more recently qualified participants and those with more clinical experience also reported greater confidence in and less difficulty with feeding and communication intervention, as well as with general neonatal intervention tasks. The findings of this study emphasise the need for audiologists and speech-language therapists to use KMC as the entry point for NCI services. Training in early communication intervention (ECI) and NCI at an undergraduate level should be expanded to include more practical activities, and may need to be standardised across tertiary institutions in South Africa. Professionals working in neonatal settings should also participate in professional development courses that include practical application of learnt skills. Through these activities, NCI services to the paediatric population may reach the necessary standard of best practice.