UNIVERSITY PARK, Pa. — A team of researchers from Penn State’s colleges of Health and Human Development and Education recently completed a pilot program funded by a grant from the Schreyer Institute on Teaching Excellence. This program was the first step of an ambitious plan to train undergraduate students, graduate students, practicing speech-language pathologists, and practicing clinical rehabilitation and mental health counselors about the mental health concerns of individuals with aphasia, a condition that impairs people’s abilities to communicate.
Aphasia occurs when brain injury — most commonly due to a stroke — limits a person’s ability to understand or produce speech or written language. People living with aphasia retain their knowledge and memory, but they lose some or all of their language-processing ability. Mild aphasia symptoms might include the inability to recall words when speaking or the replacement of a certain consonant sound with a different sound. Someone with more significant damage to their brain might lose the ability to speak or understand conversation.
Despite being a little-recognized condition, aphasia affects twice as many people as Parkinson’s disease. The communication deficits resulting from aphasia lead to problems throughout myriad aspects of people’s lives, including mental health.
Training students to see the needs and respond appropriately
People with aphasia often work with speech-language pathologists for rehabilitation, but speech-language pathologists often do not receive any mental health training. Additionally, people with aphasia may not be referred to counseling even when they exhibit mental health issues — like depression or anxiety — that often arise in people with aphasia. Because aphasia can make it difficult for individuals to be understood or to understand speech, counselors may not grasp how individuals with aphasia can participate in talk therapy.
To address this shortcoming in care, Chaleece Sandberg, assistant professor of communication sciences and disorders; Anne Maire Kubat, associate teaching professor of communication sciences and disorders; Liza Conyers, professor of rehabilitation and human services; and Kristen Nadermann, assistant teaching professor of counselor education and Herr Clinic coordinator, developed the training program, “Preparing clinical students to meet the unique counseling needs of individuals with aphasia.”
The researchers worked with students in communication sciences and disorders who are training to become speech-language pathologists and students in counselor education who are training to become counselors. Future speech-language pathologists will learn how to engage patients with mental health concerns and when to refer their patients to a licensed counselor. Undergraduate rehabilitation and human service majors and counselor education graduate students will learn about aphasia and how to communicate with individuals who have difficulty communicating. All students will be introduced to the communication, psychosocial, and mental health needs of people with aphasia.
Piloting the training
Last year, the researchers piloted the clinical aspect of the training program with two doctoral students. This semester, the materials are being introduced in master’s-level courses in both colleges. After completing the eight-hour online training modules, the students collaborate to provide mental health services to an individual with aphasia. Once the training is established at the graduate level, the core content will be incorporated into the undergraduate curriculum for both majors.
In addition to the training, the researchers published a paper summarizing how to support mental health for people with aphasia in "American Journal of Speech Language Pathology." The paper was written to raise awareness beyond Penn State and built upon previous work that Sandberg and Conyers did to apply the client-focused considering work model to people living with aphasia. Conyers said that rehabilitation and mental health counselors can become aware of aphasia and learn basic skills for communicating with individuals with aphasia to be able to better address their mental health needs. Sandberg emphasized that all speech-language pathologists need to know how and when to have conversations about mental health with their patients.
The research team is currently working on a follow-up paper to provide training and tools for speech-language pathology clinical supervisors. Many supervisors have not received training related to counseling needs and could benefit from a framework for applying basic counseling skills to assess clients’ mental health needs and to determine when referrals to a licensed counselor would be advised.
The scope of aphasia’s impact
“Strokes are most common in people over the age of 40,” said Sandberg. “These people have careers, social circles, and fully developed lives. Then, they have a stroke, they get aphasia, and everything crumbles. Usually, they can’t do the same jobs they used to have. They lose their friends. They may not be able to communicate with family members. All the roles in their lives change.
“On the inside, these people retain the same identity they had before their stroke,” Sandberg continued. “But their interactions with the world are completely different, and they lose a lot of personal power which, understandably, is devastating.”
Conyers agreed that aphasia touches far more lives than people understand.
“Aphasia affects millions of Americans, and many of them are not receiving the mental health care they need. Fortunately, through the Schreyer Institute on Teaching Excellence and other programs, Penn State supports the interdisciplinary collaboration necessary to solve these types of problems,” said Conyers. “Hopefully, this training is the first step towards building the awareness and collaboration needed to provide essential mental health care.”