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Introduction

Movies such as “the Kings' Speech” and “Children of a Lesser God” remind us of the speech and hearing problems that may exist in the privileged as well as underprivileged populations. However, stuttering and deafness represent only a small portion of the overall spectrum of communication disorders. Over the past several decades, the field of Communication Sciences and Disorders (CSD) has developed and evolved to meet the needs of clients/patients with an array of communication problems. By definition, CSD is a scientific discipline that encompasses the study, diagnosis, and treatment of speech, language, voice, swallowing, and hearing disorders. Inherently, it is comprised of two related and inseparable fields: speech-language pathology and audiology. The former involves evidence-based diagnosis and treatment of disorders that affect a person's ability to communicate or swallow. The latter focuses on the diagnosis and treatment of human hearing and balance disorders. With the understanding that many of the diagnosed conditions are irreversible, a main goal is to restore and maximize communication function through rehabilitation.

Populations at Risk

With noise-induced hearing loss and hearing problems related to aging, individuals with hearing disorders continue to increase. According to the American Speech-Language and Hearing Association (www.ASHA.org),¹ approximately 28 million Americans have a hearing impairment. For children under the age of 18, approximately 17 in 1,000 are affected by hearing disorders. As people age, the incidence of hearing disorders gradually increases (314 in 1,000 people over age 65). It is estimated that 40% to 50% of the American population over the age 75 are hearing impaired.

While various forms of aphasia, dysarthria, dysphagia, and cognitive-communication impairments occur from stroke and traumatic brain injury in adults, voice disorders are common in both adults and children. Many children with language, articulation, or fluency disorders are also seen in the CSD clinic. Language disorders include any problem that interferes in the expression or comprehension of spoken, written, or other symbolic systems such as gestures and sign language. Articulation disorders affect the way speech sounds are formed and used, and can include sound substitutions, omissions, and distortions. Fluency disorders, commonly known as stuttering, affect the flow, or rhythm, of speech.

On the medical side of the field, swallowing disorders—or dysphagia—include problems affecting the movement of food from mouth to stomach. Such problems have grave consequences including pneumonia, malnutrition, and dehydration. Voice disorders affect the way the voice sounds or feels, and can include inappropriate pitch, volume, resonance, duration, quality, or endurance. In addition, as needed, speech language pathologists work with individuals on accent modification and communication skills improvement. Hearing-related disorders affect a person's ability to hear speech, and monitor one's speech. For all of the aforementioned disorders, individuals require a comprehensive evaluation before initiating treatment.

The Communication Sciences & Disorders (CSD) Department at the University of Hawai‘i

In the past, the program at University of Hawai‘i John A. Burns School of Medicine (UH-JABSOM) trained both speech-language pathology and audiology graduate students at the Masters level.² However, starting January 2012, ASHA, the professional, scientific, and credentialing association for audiologists and speech-language pathologists in the United States, mandates that all future audiologists must have a doctoral degree (PhD or AuD), and complete a minimum of 1,820 hours of supervised clinical practicum sufficient in depth and breadth to achieve the knowledge and skills of becoming an audiologist. To meet this requirement, the department is contacting several model programs on the mainland. Before the collaboration agreement is formalized officially, the CSD department continues to offer a masters (MS) level training program in speech-language pathology. In the interim, faculty at the CSD Department will continue to implement the current curriculum that includes material on comprehensive audiology assessments and hearing aid evaluations.

Students enrolled in the field of speech-language pathology are required to earn a Masters degree as well as a Certificate of Clinical Competence (CCC) following a clinical fellowship year to be licensed to practice in Hawai‘i. Currently, there are 23 speech-language pathology students enrolled in the UH-JABSOM CSD Department. Students are required by ASHA to complete 375 hours of direct client contact in addition to their classroom training.

The University of Hawai‘i Speech and Hearing Clinic (UHSHC)

The UHSHC provides outpatient speech, language, voice, swallowing, and hearing services to enable individuals to communicate effectively in the community. The speech and language services offered at UHSHC include comprehensive evaluations, individual and group therapy, and augmentative and alternative communication (for individuals with limited or no verbalizations).

UHSHC is a clinical training facility at JABSOM that allows graduate students in the Communication Sciences and Disorders (CSD) Program to gain hands-on clinical experience with clients needing speech, language, voice, swallowing, or hearing services. All students providing therapy to clients are supervised by faculty and staff who have their Certificate of Clinical Competence (CCC) and are certified by ASHA. After completing 3 semesters of clinical training at UHSHC, students are placed at externship sites to gain further experience with a variety of disorders. The sites include Tripler Army Medical Center, the Department of Education, Rehabilitation Hospital of the Pacific, Queens Medical Center, Kapi‘olani Medical Center for Women and Children, and Scottish Rite Preschool.

The UHSHC was previously located at the University of Hawai‘i Manoa campus on Lower Campus Road. In March 2012, the CSD Department moved to a new facility, situated in a professional building (677 Ala Moana Blvd, aka Gold Bond Building), adjacent to the John A. Burns School of Medicine to strengthen and improve the clinical and educational services.

The Shortage of Speech-Language Pathologists in the State of Hawai‘i

According to an unpublished study conducted in 2010 by the University of Hawai‘i CSD Department's graduate students (Kwock et al, Distribution and Practice Patterns of Speech-Language Pathologists and Audiologists in the State of Hawai‘i, unpublished)³ the number of working SLPs per capita by island are as follows:

A study by Davies & Enderby (1989)⁴ indicates the speech-language pathologist per population ratio should approach 1:3,846. Accordingly, the ratios found by Kwock and colleagues suggest that the State of Hawai‘i is underserved by speech-language pathologists.

Conclusion

Communication disorders encompass a spectrum of disabling conditions that can be treated by trained professionals.⁵ The CSD Department at the University of Hawai‘i, John A. Burns School of Medicine, which has been newly organized with proactive leadership, faculty, and staff, is the only program in the Asia-Pacific region accredited by the American Speech-Language-Hearing Association (ASHA). The faculty of the CSD Department has established a robust curriculum that provides an active program of both classroom and clinical teaching in speech and hearing disorders. By early 2013, the Department will be adding an active audiology component to its training and service programs. Ultimately, the program's goal is to graduate qualified speech-language pathologists and audiologists to serve Hawai‘i's population and beyond.

Table 1.

Number of Working SLPs Per Capita by Island

Island	Number of Working SLPs per Capita
Kaua‘i	1:4,816.3
O‘ahu	1:5,834.3
Moloka‘i	1:7,402
Hawai‘i	1:10,623.1
Maui	1:6,919.6
Lana‘i	0:3,189

Contact Information

The Communication Sciences & Disorders (CSD) Department 677 Ala Moana Blvd. Suite 625, Honolulu, HI 96813 Ph: (808) 692-1581

University of Hawai‘i Speech And Hearing Clinic (UHSHC) Ph: (808) 692-1580

Website: http://manoa.hawaii.edu/csd/