speech & language therapy in practice, spring 2008

7/28/2019 Speech & Language Therapy in Practice, Spring 2008

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PLUSWinning WaysAssessments assessedHeres one I made earlierspeechmag.com latest and a great reader oer.

Are you gettingenough?Our newsupervisionseries

Health promotionGreater expectations

CaseloadmanagementA dropin clinic

Community learning

QualIT

Service developmentAn aphasia strategy

Research in practiceThe best laid plans

How I meet my

inormation needsDevelopinginormation literacy

www.speechmag.comSpace or reection

Skill mixTime or

communication

Spring 2008

ISSN 1368


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Win Lemon & Lime Library!Do you work with children or adults who would benet rom tailormade articulationworksheets? Then our FREE prize draw is or you. Speechmark Publishing is oeringTHREE lucky readers a copy o the newly released Lemon & Lime Library AnArticulation Screen & Resource Pack, which retails at 45.99 + VAT.Developed by speech and language therapist Rebecca Palmer and researcherAthanassios Protopapas, the interactive CDROM resource proles a clientsarticulation, identies areas or treatment and provides the tools or the therapistto create customised practice worksheets. Theseven levels o practice are: single sounds, CVcombinations, DDK rates, single syllable thenmultisyllabic words, short phrases and longersentences.For your chance to win, email your nameand address to Speech & Language Therapyin Practice editor [email protected] 25th April 2008, putting LLL oer in thesubject line. The winners will be notied by30th April.

For a Speechmark catalogue, tel. 0845 034 4610.Speechmark is now based at 70 Alston Drive,Bradwell Abbey, Milton Keynes MK13 9HG.

Rea

deroffer

Reader Oer WinnersThe three lucky winners o the O We Go! series reader oer in our Autumn 07 issue, courtesy o Speechmark, are SarahChandler, Gill Allen and Jenny Murphy. Meanwhile Plural Publishings book Head and Neck Cancer oered in the Winter 07issue is on its way to Janice Dey. Congratulations to you all.

Spring08speechmag

Our social networking experiment hasended thanks to everyone who participated in this. You now need onlyONE user name and password or themembers area at www.speechmag.com/Members/. For a reminder o yours,email [email protected].

The area includes:Messages rom the editorBack issues rom 20002006A orum speciically or discussion oSpeech & Language Therapy in PracticearticlesOccasional extras rom authors

Only online articles

NEW! Only online articles added Spring 08!

Alison Newton and Linzie Priestndiscuss the process o arriving attheir departments new policy oprioritisation o adult inpatients.Maggie Robinson on makingservices more accessible throughgradual approach to schoolbasespeech and language therapy.


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INSIDE COVER: Reader oerWin Lemon & Lime Library AnArticulation Screen & Resource Pack

2 NEWS AND COMMENT

4 DO DROP INDrop-in clinics are exciting torunas you have to make decisionsquickly as to the possible diagnosisand whether to discharge the child,allowing spontaneous developmentto take place, or ask the parent tocome back in three to six months.Maeve Guly explores how a dropin service can benet children, theirparents and your own proessionaldevelopment.

7 HERES ONE I MADE EARLIER...Alison Roberts suggests Phonbola;Lie o Riley; Havent you changed!

11 A DRIVING FORCERegular in-house sta workshopshave included eedback rom coursesand conerences, article reviews,clinical case discussions, reviewingnew resources and developing anaphasia resource le, all o whichhave led to changes in our practice.Dissatisaction with their aphasiaservice motivated the Portsmouthadult team to take a strategic

approach. Nicola ClarkandSheena Nineham reect on thedierence this is making.

13 WINNING WAYSFollowing Agenda or Change,Melanie eels undervalued. LieCoachJo Middlemissoerspositive suggestions.

Spring08contentsSpring 2008(publication date 29 February 2008)ISSN 13682105

Published by:

Avril Nicoll,33 Kinnear SquareLaurencekirkAB30 1UL

Tel/ax 01561 377415email:[email protected]

Design & Production:Fiona Reid,Fiona Reid DesignStraitbraes Farm,St. Cyrus, MontroseAngus DD10 0DS

Printing:Manor Creative,7 & 8, Edison RoadEastbourne,East Sussex BN23 6PT

Editor:Avril Nicoll,Speech and Language

Therapist

Subscriptions andadvertising:

Tel / ax 01561 377415Avril Nicoll 2008Contents o Speech & Language Therapy in Practice re

ect the views o the individualauthors and not necessarily theviews o the publisher. Publication o advertisements is not anendorsement o the advertiseror product or service oered.Any contributions may alsoappear on the magazinesinternet site.

14 GREATER EXPECTATIONSone o the key actors ininuencing change is alteringthe perception o parents andproessionals that it is normal or

children in deprived areas to presentwith delayed skills.Nicola Brooke looks back on therst three years o a speech andlanguage therapy health promotionpost which oers targeted trainingand multimedia resources.

17 THE BEST LAID PLANSUnderstanding the use o PEG tubesor adults with learning disabilities isan ever more critical concern with thelikely increase in incidence o dementiadue to improved lie expectancy.

Although Paula Leslie, HannahCraword and HeatherWilkinsons research projectinto percutaneous endoscopicgastrostomy tube eeding o adultswith learning disabilities at end olie did not go to plan, there havebeen useul outcomes.

20 REVIEWSDementia, dysuency, groups,early intervention, comprehension,advocacy, autism, rehabilitation,cognitive impairment and phonics.

22 QUAL-ITI believe that my own memorydifculties enable me to have greaterunderstanding o our learners as Itoo need strategies or learning thatcan be employed by some o them.Peter Tester oers tuition ininormation technology tolearners with severe neurologicaldifculties, as part o a project toenhance their quality o lie.

24 ASSESSMENTS ASSESSEDOur indepth reviews consider theCommunication DevelopmentProle and the CommunicationDisability Prole.

26 HOW I MEET MYINFORMATION NEEDSInormation seeking is much morethan solving problems, nding actsor making decisions it can also beabout sense-making and creativity.How do you develop yourinormation literacy and encourageit in your clients and colleagues?Editor Avril Nicoll talks to speechand language therapists KatieCullinan, Rebecca Matthews,Kerry Wreord-Bush and Alison

Hodson.

BACK COVERSUPERVISION (1)supervision is not a static, denedset o skills and roles. It is a uidrelationship encompassing a widerange o skills and techniques.Sam Simpson and Cathy Sparkesbegin our new series or 2008 withan exploration o why supervision isimportant and a practical activity tohelp you make sense o your ownsupervision history.

8 COVER STORY: SKILL MIXone o the big advantages o thecommunication support ofcer role isthat it gives clients the benet o time.This gets them back into the way ohaving conversations and gives peoplewho have an element o institutionali-sation some choice and independence.Mike Harrison with RosanneLyddon, Cathy Harris andYunusHansdot on a three year LeonardCheshire Disability CommunicationProject involving communicationsupport workers, speech andlanguage therapists and aprogramme o sta training.

Cover photo o Cathy Harris andYunus Hansdot courtesy o LeonardCheshire Disability.

IN FUTURE ISSUES: LITERACYSIGNINGAPHASIADOWNS

SYNDROMEINTEGRATED SENSORY ENVIRONMENTSWORKING WITHTEACHERS STORYTELLINGDYSPHAGIA


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NEWS

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 20082

Positive messagesDoncaster Stammering Association has made a CD o music to raiseawareness o stammering and its eects.The songs SSSSStammering is Cool, Dont Finish My Sentence,Avoidance Blues, Look Me in the Eye, time2talk and Exercising the Exorcised were recorded by the Associations selhelp group and 14 chil

dren aged 712 who are clients o speech and language therapist HilaryLiddle. They worked with proessional musicians to develop the lyricsand had access to state o the art recording acilities. British StammeringAssociation Education Ofcer Cherry Hughes says that participants condence increased: Talking and singing openly about their stammeringhelped them to eel less sensitive about it. Projecting positive messagesabout stammering helped to increase their own selesteem.Two downloadable tracks and all the lyrics are at www.stammering.org/time2talk.html, where you can also order the CD or 4.00 (inc. UK p&p).In a separate venture, 12 young people who use AAC made a DVD witha support team including researchers, lm producers and musicians. Listen to Me includes a music track composed by the teenagers, a documentary about their communication with AAC and a section promotingthe 1Voice group. The DVD is 8.00 or a donation.

www.youtube.com/watch?v=w5ZlUnU8Oeo or www.1voice.ino

Interestingly, a childrens charity is also highlighting the positive impacto music on childrens concentration, condence, selesteem and socialinteraction.Coram, whose work supports vulnerable children and their amilies, developed a three year study to test the eectiveness o its music therapyservice as there were no standardised measures available. Unlike the majority o specialist clinical services, Corams music therapy is based withina community centre, engaging directly with children, their amilies andexternal agencies. The communitybased team includes childcare workers, clinical psychologists, child psychotherapists, early years practition

ers, amily support workers, play workers, social workers and teachers.www.coram.org.uk

I ExistA report rom the National Autistic Society concludes that over 60 per cent o adults with autism in England do not have enough supportto meet their needs.Based on the largest ever UK survey o adultswith autism and their amilies, along with localauthorities and health services, the I Existreport

starts a new phase o the charitys think di-erently about autism campaign. The Societyis concerned that 67 per cent o local authorities do not keep a record o how many adultswith autism are in their area and 65 per cent donot know how many adults with autism theysupport. Sixty one per cent o adults with autism included in the survey rely on their amilynancially, 40 per cent live with their parentsand at least 1 in 3 experience mental health diculties so it is not surprising that 92 per cent oparents are worried about their son or daughters uture when they are no longer able tocare or them. Interestingly, 60 per cent o theparents believe that support at an earlier stagewould have prevented problems developing.I Exist also highlights the problem o adultswith Asperger syndrome missing out on support because they dont t neatly into categories such as learning disability or mental healthservices. When surveyed, an adult called Neilsaid the support he would like is speech therapy and music therapy. The Liverpool AspergerTeam, headed up by speech and languagetherapist Chris Austin, is highlighted as an example o good practice.The National Autistic Society says, For too longadults with autism have ound themselves isolated and ignored; they struggle to access sup

port and are oten dependent on their amilies.It does not have to be like this. The charity iscalling on the government to und a UK prevalence study so that services can be plannedand delivered eectively. It also wants to seebetter training or health and social care stawho assess need and an increase in low levelsupport where adults with autism access socialskills training, social groups and beriendingschemes.The report applies to England. Separate reportsare due or Scotland and Wales.DownloadI Existat www.think-dierently.org.uk

ChildhooddementiacallDo you have aninterest in childhooddementia?The DementiaServices

DevelopmentCentre is proposinga conerence onchildhood dementiaor 21 May 2008.They would like tohear rom anyonewho is interestedin attending,participatingor providinginormation.Dementia can beused to describethe conditiono children whohave progressivecognitive declineas a result o raregenetic syndromesor epilepticencephalopathies.Contact JuanitaGreen, tel. 01786467740, [email protected]

Publishing

changesThe speech andlanguage therapypublishing worldhas seen a numbero changes in recentmonths.Speechmark hasbeen sold to ElectricWord which in2007 also acquiredIncentive Plus. Bothbrands are managedby ormer speech

and languagetherapist CatherineMcAllister. MeanwhilenerNelson hasended its ormalrelationship withounding educationalresearch charity NFERand is now knownas GL Assessment,and HarcourtAssessment ormerlythe PsychologicalCorporation has

been taken over byPearson.

Palliative pathwaysThe Association or Childrens Palliative Carehas been awarded unding or three years tohelp lielimited young people prepare or thetransition rom childrens to adults palliativecare services.Advancements in treatment mean that somechildren with conditions such as DuchenneMuscular Dystrophy are living longer than waspreviously expected yet the charity says planning or transition is poor and adult services lackthe specialist knowledge to support them. Theaward will und 12 new transition posts to roll

out a Transition Care Pathway across the UK.www.act.org.uk

time2talk

Listen to Me


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NEWS & COMMENT

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2008 3

Comment:

Space orrefection

In the rst o our new series on supervision

back page, Sam Simpson and Cathy

Sparkes talk about the importance o creating

space or reection. This is also crucial to the

development oSpeech & Language Therapy in

Practice, with reader eedback playing a central

part.

Reecting on recent questionnaire respons

es I am clear that you choose to subscribe

because the magazine is useul, interesting,

readable and above all practical. In spite o time pressures you

would welcome more issues. You like tools such as read this i and

reections but would preer a larger type size and less use o dark

colour. You have not ound the websites social networking experi

ment tempting or userriendly.

I hope thereore that you nd the increased type size and re

duction in dark colour backgrounds helpul, and the revamped

www.speechmag.com/Members/ area straightorward to use. You

can access it with your user name and password or back issues

rom 20002006, extras to complement articles in the magazine,

updates rom me, and a orum or discussion o articles. When pos

sible, I will also include online only articles o the same standard

and design as the print publication.

Whether in print or online, Speech & Language Therapy in Prac-

tice encourages both authors and readers to create space or re

ection. In this issue Maeve Guly audits her dropin clinic p.4,Nicola Brooke looks back on the rst three years o her health

promotion post p.14 and Lynn Dangereld and Sheena Nine-

ham review the impact o their departments aphasia strategy

p.11. All demonstrate the value o pausing to look back on what

you have achieved and learnt and o thinking about how it will

inuence where you go next.

The Leonard Cheshire Disability Communication Project

p.8 and Peter Testers ocus on quality o lie p.22 also give us

the opportunity to reect on the contribution dierent proes

sionals and new technology can make to supporting our clients.

Meanwhile, Paula Leslie, Hannah Craword and Heather Wilkin-

son p.17 help us understand that space or reection can be just

as useul when things dont go to plan as when they do.Ideas or thoughtprovoking eature articles such as How I meet

my inormation needs Katie Cullinan, Rebecca Matthews, Kerry

Wreord-Bush and Alison Hodson, p.26 are oten sparked when

I mull over things you have said or written to me so do keep

those ideas coming!

Holistic approachto ParkinsonsWest Kent speech and language therapist Catherine Jones is one o the contributors to a comprehensive Proessionals Guide to Parkinsons Disease.The ree booklet rom The Parkinsons Disease Society aims to reectthe importance o the multidisciplinary team to eective intervention.

It draws on expertise rom eight dierent proessions general practice,nursing, dietetics, occupational therapy, pharmacy, physiotherapy, social work and speech and language therapy. The nursing contributionincludes communication and swallowing difculties and how nurses canhelp, and the occupational therapy section also covers strategies to support communication. In the social work part, Smales Exchange Model issuggested as a way o empowering someone with communication diculties to participate ully in the assessment process.Catherine commented, I would encourage speech and language therapists to order a ree copy. Having inormation available at your ngertipson a number o disciplines as well as your own will go a long way towardshelping speech and language therapists involved in the management oParkinsons get a holistic view o the condition.www.parkinsons.org.uk/PDF/PubProessionalGuideNov07.pd

Involved inresearchA conerence to promote public involvement in research is giving presenters the opportunity to showcase their work in ways which might beparticularly welcomed by people with communication support needs.While the customary options o posters, poster talks, papers and workshops are available, other ormats suggested include a DVD, a short playor drawing.INVOLVEs 6th national conerence is Public involvement in research Getting it right and making a dierence. The organisation hopes pres

entations will include experiences o what has worked well and whathas not, organisational and cultural barriers, the dierence public involvement has made to the way research is prioritised, commissionedor granted ethics approval and the development o usercontrolled research.The conerence is rom 1112 November 2008 in Nottingham. The closing date or applying to do a presentation is 7 April. INVOLVE providesguidelines on producing accessible presentations and has a conerenceund to help applicants rom local, voluntary and community organisations, selhelp groups and individual members o the public attend.INVOLVE is a national advisory group, unded by the Department oHealth England. Its main task is to promote and support public involvement in NHS, public health and social care research and development. Itsvision is or public perspectives to be integrated into the whole researchcycle as a way o enriching research and enthusing all those who are in

volved in it.www.invo.org.uk/pds/Call4Presd4.pd

Primary TalkAn accreditation system that promotes communication supportive environments or all children in primary schools is being piloted and evaluated with the aim o being rolled out nationally in 2009.I CAN has ormed a partnership with Somerset Total Communication andSomerset Local Authority to develop Primary Talk, a ollow on rom thecharitys Early Talk programme. Primary Talk includes sta training and aweb based resource. Regional Advisors have been appointed in the pilotareas o Somerset, Bradord and Walsall and evaluation is being carried

out by Joy Stackhouse and colleagues at the University o Shefeld.www.ican.org.uk


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these parents would probably have waited andworried or a longer period beore being reerredvia the traditional route.

Te act that the majority o children were agedbetween 2 and 4 years was as I expected. Tereis oten a lot o parental anxiety between 2-2years i children are slow to develop rst wordsand are not linking two words together. At 3 yearsthere is concern as children start preschools thattheir speech will not be understood by unamil-iar listeners. From 4 years ewer children attendthe drop-in clinic and, when they do, it is oten

with speech sound delay; they may still be havingproblems with /s/, //, //, /k/, /g/ sounds.

My primary nding or each child is in gure2. Tere is however overlap, or example somechildren with speech diculties may also haveexpressive language delay and /or comprehen-sion problems.

CASELOAD MANAGEMENT


Do drop inMost o us are amiliar with the pressures o large caseloads, waiting lists,late reerrals and nonattendance at community clinics.Maeve Gulyexplores how a dropin service can help addressall these issues, beneting children, their parents and yourown proessional development.

in one o our standard reerral orms just in case thechild doesnt turn up to the drop-in clinic.

Te drop-in clinic mainly serves a preschool

population but I have made it known to the lo-cal schools that I will see children with phonol-ogy problems who might have allen throughthe net and who may be experiencing literacydiculties as a result. Te ages o those attend-ing are in gure 1. O the 150 children, 97 (65per cent) were male and 53 (35 per cent) wereemale, showing the male predominance in atypical speech and language therapy caseload.

AppropriateIt is unusual to see children under the age o 2years but, in each case where this happened, it

was appropriate that the parents should seek ad-vice. Tose attending included a child who hadhad meningitis the previous year, a child withtongue tie and a mother who had had postna-tal depression and was worried about the eectson her child. A health visitor reerred a am-ily who had an unrealistic expectation o theirchilds language development at 16 months.One mother had a child already on our caseload

with a language disorder and she was very anx-ious about her second child at 23 months. Tesixth child came because there was a history oautism in the amily and the child was showingsigns o not interacting and communicating at22 months. Without access to the drop-in clinic

T

he idea o speech and language drop-inclinics is not new but, as I am unawareo any inormation about them in the

literature, I would like to share myexperience o running one or six years. I willdescribe who comes to the clinic, how I run itand what I do to help the parents and children

who attend. Finally, I will ask the all importantquestion - are they useul?

I work in a community clinic in avistock, asmall country town in Devon surrounded by ninevillages within a seven mile radius. Public transportis poor and it can be dicult or parents withouta car to access our service. In amilies where bothparents are working, knowing the drop-in clinicdates well in advance makes it easier to get time orom work. Drop-in sessions are run twice a monthat the main clinic and approximately twice a termat playgroups in rural settings. For the purpose othis article I am reviewing a consecutive sample o150 children rom the main clinic.

Te drop-in clinic does not provide an in-depth assessment. Rather, it is an inormal op-portunity to gauge what the childs problem is,and to oer advice and reassurance until urthertherapy can be given should this be necessary.

Posters advertise the drop-in clinics at GP surger-ies and preschools but most people who come havebeen recommended to do so by their health visitor.I health visitors are concerned about a child - andthe parent consents to a reerral - we ask them to ll

READ THIS IF YOU

WANT TOIMPROVE

ACCESS TO YOUR

SERVICE

OFFER EARLY

INTERVENTION

REDUCE

WAITING TIMES

AND LISTS

Figure 1 Drop in clinic attendances in age

Number %

Speech impairment 74 49.3

Receptive and Expressive 34 22.7Language problems

Dysuency 12 8

Autistic Spectrum Disorder 3 2

Within normal limits /should resolve spontaneously 27 18

Posters advertise the dropin clinics at GP surgeriesand preschools but mostpeople who come havebeen recommended to doso by their health visitor.

40

35

30

25

20

15

10

5

0

1 - 1.5 1.5 - 2 2 - 2.5 2.5 - 3 3 - 3.5 3.5 - 4 4 - 4.5 4.5 - 5 5 - 5.5 5.5 - 6 6 - 6.5

Number

Age years

Figure 2 Primary ndings


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CASELOAD MANAGEMENT


Te largest group was children with speechdiculties, which accords with Broomeld andDodds (2004) ndings when they looked atcaseload characteristics. Seventy one children (47.3per cent) had delayed speech sound development,8 associated with otitis media and 3 with tonguetie. Tree children (2 per cent) had a phonologicaldisorder. Tirty our children (22.7 per cent) haddelayed language development, 7 (4.7 per cent)

with a primary problem with comprehension.Fiteen amilies had two or more children pre-senting with communication problems, the ma-

jority being phonological diculties.Te challenge o the drop-in clinic is that you can-

not get prepared in advance or individual children.As the health visitor only lls in one o our standardreerral orms i she is particularly concerned abouta child, or the majority the childs age and generalproblem will not be known beorehand.

I have to hand:A box with a cup, two plates (red and yellow),a brick, a key, a spoon and a big and little teddyto see how many key words are understood.

A concept box with toys to check the childs

understanding o big / little, ull / empty, on /under, top / bottom, long / short, behind / inront and colours.Objects such as a brush, bike, car, cup, ba-nana and spoon to see i the child understandsthe unctions o objects eg. what do youeat?(usually understood rom 2 years).Phonological Screening est (Stevens & Isles,2001) or or younger children Everyday Objectspictures (Speechmark, 1999). I put the picturesinto a shing game to get an idea o the childsvocabulary and speech sound development.Te Preschool Language Scale-3(UK) (Bouch-er & Lewis, 1997), as it provides an age related

assessment o a childs auditory comprehen-sion and expressive communication.South yneside Assessment o Syntactic Struc-tures (Armstrong & Ainley, 1999) or check-ing language development.Te Symbolic Play est (Lowe & Costello,1998), which can be useul to gauge the unc-tional play o children up to three years whoare not talking.

A eely bag with objects and toys or youngerchildren to get a sample o their vocabularyand unctional play.

A Playmobil park and arm with animals tohear childrens spontaneous language in playand to observe imaginative play.

Inset puzzles, stacking beakers, cause and eecttoys, puppets and books (eg. Laa Laas Ball anda Spot lit-up-the-aps book) to observe generalplay, development and communication.I usually spend approximately -1 hour with each

amily. As part o the assessment, I take a brie casehistory o birth, milestones, communication, whenhearing was last tested and outcome, eeding andgeneral health. Following the assessment, I prioritisethe child on a low / medium / high scale dependingon the severity o the communication impairmentand its impact on the child and carer. From my sam-ple o 150 children, I gave 38 (25.3 per cent) a highrating, 31 (20.6 per cent) a medium rating, 54 (36

per cent) a low priority and ound 27 (18 per cent)were within normal limits. O the children who

had a low priority rating, 40 were given appoint-ments. When the other 14 parents were contactedby phone they said they no longer had concerns anddid not need urther input.

O the 27 children who were discharged, twowere re-reerred, one because she was still ronting/k/ and /g/ sounds six months later and there was alot o parental anxiety. Te other child had come tothe drop-in aged 15 months because he was a quiet

baby who hadnt babbled very much but he wasstarting to vocalise more and was saying two words.He was discharged with advice and came back tothe drop-in at 2 years because he was slow to de-velop rst words; he went on to have phonologicalproblems.

Helpul or parentsI have ound the Firth & Venkatesh (1999)hand-outs on eye contact, turn-taking, makingchoices and playing together very helpul or par-ents. Te Ann Locke First Words (1985) andthe verb lists and ways o encouraging them arevery useul. I oten give advice rom the Hanen

programme It akes wo o alk to reduce andsimpliy the language used with a child and topause and give the child time to respond.

Leaets about the possible eects o prolongeddummy use and ideas to wean the child o themare also available.

I have ready-made packs that can be loaned toparents or the most requent sounds that need re-mediation - /s/, //, /k/ word initial and nal, withlots o ideas or games. It has been my experiencethat parents are more likely to play games thatare attractively presented and have already beencoloured and laminated. Te advice sheets rom

Elklan (1999) on ways to help the child whosespeech is dicult to understand, and explaininghow to teach basic concepts, are also very useul.We give British Stammering Association ad-

vice leaets to parents and to sta in preschoolsand nurseries on how to help the dysuentchild. Ater the initial contact at the drop-inclinic, only ve o the twelve children with dys-uency needed a ollow-up appointment, whichsuggests that the advice was eective.

I have ound the leaets Making the mosto hearing (2000) and Helping children whohave a mild conductive hearing loss rom theRoyal National Institute or the Dea to be very

helpul or giving parents practical advice andsharing ideas with preschool settings. Tese are

no longer available but Glue ear - a guide orparents (NDCS) is also useul.When I rate children as a low priority it is im-

portant to give the parents clear advice as to myexpectation o progress. So, or example, I mightask them to come back to the drop-in clinic i thechild is not linking two words by 2 years 6 monthsor their speech is still unintelligible at three years.Te handout showing the development o speech

sounds will hopeully reassure parents who worrywhen their children aged three years are usingcommon immature patterns, substituting [t] or/k/ or reducing /s/ clusters.

Saety netTe drop-in clinics appear to be useul in anumber o ways. Te eedback rom health visi-tors is very positive. When they are doing their2 and 4 year checks they can immediately rec-ommend the drop-in clinic i they are worriedabout a childs development. In some areas healthvisitors are regrettably no longer doing 2 yearchecks so a drop-in clinic will provide an essential

saety net to identiy speech and language delay /disorder as early as possible. Drop-in clinics arealso useul or training purposes as trainee healthvisitors and student paediatric nurses can see thediversity o communication needs we encounter.

Early intervention is one o the key benets, andthe drop-in clinic gives an opportunity or parents

with children under the age o 2 years to seek ad-vice. It can be reassuring to a parent to nd theirchilds speech and language development is withinnormal limits, and such children can be dischargedrather than being unnecessarily on a waiting list.Indeed, drop-in clinics reduce waiting lists and canbe a means o picking up high priority cases early.

I, or example, children are showing signs o be-ing on the autistic spectrum we can seek an earlyappointment with a paediatrician to consider a di-agnosis. Reerrals can be made to the Early Years

Advisor and parents can access the EarlyBird Par-ent Support Programme to get strategies to cope

with challenging behaviour.In general, seeing a child earlier should help to

relieve rustration. Parental anxiety can be re-duced through advice on how to encourage theirchild to speak and what to do when they cantunderstand what their child says. In children

with dysuency in particular, early advice mayprevent a more signicant problem developing.

Te clinic can also provide advice to amilies

who may not be able to keep standard appoint-ments, and some parents may just preer thechance to talk to a therapist beore a ormal re-erral is made. Te child is only taken onto thecaseload i a urther appointment is needed, withthe person who recommended the parent to thedrop-in clinic regarded as the reerring agent.

Tere are, o course, some disadvantages. Itcan be rustrating i no-one turns up to a clinic,although I can useully do some paperwork ithis happens. I can be overstretched i more thanthree amilies come to the same clinic and haveto be seen within two hours. In practice thisdoes not happen oten and, when it does, I can

oer some advice and see them again within athree month period.

The clinic can also provideadvice to amilies whomay not be able to keepstandard appointments,

and some parents mayjust preer the chance totalk to a therapist beore aormal reerral is made.


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checked can be made or a reerral made to apaediatrician or Early Years Advisor should thisbe necessary.As a therapist I have oten been cautious, want-

ing to review children to check that spontaneousrecovery has taken place. I am now happier to dis-charge knowing that a parent can easily access thedrop-in i there are urther concerns. Running thedrop-in clinic has improved my prediction skills

CASELOAD MANAGEMENT


Although drop-in clinics are useul or trainingspeech and language therapy students in taking casehistories and making diagnoses, the unpredictabilityo whether anyone will attend can pose a problem.

ExcitingDrop-in clinics are exciting to run as there isalways an element o the unknown: you neverknow who will walk through the door! Teykeep you on your toes as you have to make

decisions quickly as to the possible diagnosisand whether to discharge the child, allowingspontaneous development to take place, or askthe parent to come back in three to six months.

According to Kate Malcomess, a duty o carestarts at the initial consultation i child-specicadvice has been given. Accordingly, a child whois taken onto the main caseload will be oeredan appointment within three months but inthe meantime a request to get a childs hearing

REFLECTIONSDO I HAVE SYSTEMS FOR

PRIORITISATION, FOLLOWUP AND

ONWARD REFERRAL?

DO I REVIEW MY CASELOAD STATISTICS

TO INFORM MY PLANNING?

DO I WELCOME UNPREDICTABILITY

AS A WAY OF HONING MY DECISIONMAKING?

How has this article been helpul to

you? Have you ound dropin clinics a

useul tool? Let us know via the Spring08 orum at www.speechmag.com/

Members/

ReerencesArmstrong, S. & Ainley, M. (1999) South yneside Assessment o Syntactic Structures. Ponteland: SASS.Boucher, J. & Lewis, V. (1997) Preschool Language Scale-3 UK Edition. London: Pearson.

Broomeld, J. & Dodd, B. (2004) Children with speech and language disability: caseloadcharacteristics, International Journal o Language and Communication Disorders38(3), pp.303-324.Elks, E. & McLachlan, H. (1999) Early Language Builders. Cornwall: Elklan.Firth, C. & Venkatesh, K. (1999) Semantic-Pragmatic Language Disorder. Milton Keynes: Speechmark.Locke, A. (1985) Living Language. London: NFER-Nelson.Lowe, M. & Costello, A.J. (1998) Symbolic Play est. London: GL Assessment.Manolson, A. (1992) It akes wo o alk. oronto: Te Hanen Centre.Speechmark (1999) Pocket ColorCards: Early Objects. Milton Keynes: Speechmark.Stevens, N. & Isles, D. (2001) Phonological Screening Assessment. Milton Keynes: Speechmark.

ResourcesBritish Stammering Association leaets see www.stammering.org/pac.htmlEarlyBird Parent Support raining see www.nas.org.uk/earlybirdMalcomess Care Aims Model see www.careaims.comNational Dea Childrens Society - www.ndcs.org.uk

resources

about the improvement a child should make ina given time. Tis involves adapting my knowl-edge o normal development to take into ac-count delay - which may or example have beenassociated with glue ear - and giving the parentan expectation o what the child should be do-ing in a 3-6 month period.Interestingly the drop-in clinic - in terms o theratio o impairment - provides a microcosm o

the whole caseload or the clinic which showsthat it is representative o need. It providesa speedy access to the speech and languagetherapy service. Tis is appreciated by parentsand health visitors, our main reerrers, and myexperience suggests it is an ecient caseloadmanagement tool.

Maeve Guly is a speech and language therapist atavistock Clinic, 70 Plymouth Road, avistock,Devon.

Running the dropinclinic has improved myprediction skills aboutthe improvement achild should make in agiven time.

ilting larynxGet your paper, scissors, glue and paper astenersready Vocal Process oers a ree Build Your Own

Tilting Larynx template atwww.vocalprocess.co.uk/resources/build_your_own_tilting_larynx.pd

Challenging behaviourCommunication and Challenging Behaviour is a 45minute DVD aimed at parent carers. It ocuses on ourindividuals with severe learning disabilities and includes interviews with amily, carers and speech and

language therapist Jill Bradshaw. The DVD is 31.50inc. UK p&p but ree to parent carers.www.challengingbehaviour.org.uk

Tinking toolsThe I Think2 Electronic Toolbox includes 48 thinkingtools which young people can use to solve problems, including Venn diagrams, memory maps, decisionmaking trees and reliability grids.www.alite.co.uk

Fragile XThe Fragile X Society has updated its IntroductoryBooklet to relate to adults as well as children withFragile X. It also has genetic inormation available inGujarati, Punjabi, Urdu and Turkish with translations

in Arabic and Farsi due this year.www.ragilex.org.uk

End o caringWhen caring comes to an end is a short, practical guide to help carers whose responsibilities arechanging, or example when the person they careor moves into a residential home or dies.www.carersuk.org/hub_content/Inormation/Or-derpublications/Factsheetsbooklets/UK9014/Book-letWhencaringcomestoanendOct2007.pd

Communication MattersA new DVD aims to help Asian amilies with deachildren. Communication Matters is available in

Urdu, Punjabi, Sylheti, English, British Sign Language and subtitles. It eatures 13 young peopleand their amilies, and gives a clear message thatdeaness should not be a barrier to learning.Free rom the NDCS (the National Dea ChildrensSociety) Freephone Helpline 0808 800 8880 or e-mail [email protected]

Film choiceThe Diving Bell and The Buttery is a lm depicting the true story o JeanDomnique Bauby,editorinchie o French Elle, who had a massivestroke at the age o 43. Let with lockedin syndrome, the lm shows how an eye blink communication system allowed him to unlock the divingbell that his body had become with the buttery

o his imagination.www.thedivingbellmovie.co.uk

Get it on timeThe Parkinsons Disease Society has a ree Get it ontime washbag o tips and advice to help peoplewith Parkinsons get their medication on time during a hospital stay. The Society also has UK countryspecic leaets to help people report an incident tothe National Patient Saety Agency.Tel. 01473 212115, e-mail [email protected]

Road crash supportBrakeCare oers ree training courses or health proessionals in the North West, North East and South

East o England including London on supportingpeople aected by road crashes.www.brake.org.uk/index.php?p=1112

HCA dementia courseThe Dementia Services Development Centre has introduced a six part selstudy course to help healthcare assistants think about how they respond to theperson with dementia.www.dementia.stir.ac.uk/documents/HCA-CourseFlyer.pdf

Inclusive awardsMencap has introduced a Gateway Award 8 to 13to bring children and young people together in inclusive settings to take part in interesting challenges in our activity zones: active, adventure, people

and the planets, Soundz arty.www.mencap.org.uk/html/gateway/8-13_award.asp

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9/32SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2008 7

HERES ONE I MADE EARLIER

Heres one I made earlier...Alison Roberts with more lowcost, exible therapy suggestionssuitable or a variety o client groups.

Alison Roberts is a speech and language therapist at Ruskin Mill Further Education College in Nailsworth, Gloucestershire.

A series o games ora group o clients toencourage observationo other people. It isalso a good opportunityto practise Makaton orother signs.

Havent youchanged!

MATERIALSBig jar Ive ound that extralarge jars o pickled gherkinsare quite easy to nd. I yourtherapy room has an unorgiving oor you will need to nd aplastic jar instead.PenSmall pieces o thin, oldable card

BRAWNWrite words, phrases etc containing your clients target sound onthe cards. Alternatively, i yourclient is a nonreader draw littlepictures, or, i you have them, youcould use Widgit symbols.

IN PRACTICE I Simply place theolded cards in the jar, put the lidon, and roll it towards your client.They pick out a card and read it /name it.

IN PRACTICE II The client makesa sentence containing the jarword.

MATERIALS

As many battered old toy carsas you can nd, the worse theircondition the betterOr, and more appropriate orolder clients, pictures o realold bangers you can get theserom a specialist magazine onstock car racingAlternatively use other old vehicles / pictures such as buses,trains, and motorbikes

IN PRACTICE Ask clients to make

up a story to explain the currentcondition o the car. You can getthe ball rolling yoursel, or example describing how a vehiclestarted lie as a amily car, andwas stolen and used as a getaway car, or got let in a beach carpark when the tide came in. Itwas later sold to a new driver asa rst car, but kept being badlyparked, bumping into posts etc. Itmight even have been taken to asaari park and reengineered by

a monkey. Finally, you can decide

and describe the ate o the car,perhaps to start a new lie, aterbeing repaired and repainted,or to be crushed and made intosaucepans! Try to end the carslie on a reasonably positivenote.

MATERIALSScarves, hats, glasses, jackets andso on or versions I and II

There are several, progressivelyharder, ways to approach this.

IN PRACTICE I You must have thechange items outside the room. Oneo the clients is scrutinised by the others, goes out, puts on a hat, or a pairo glasses, returns to the room, andthe others say what has changed.

IN PRACTICE II A client goes outo the room while someone letinside changes something aboutthemselves, such as putting on ajacket, with the others in the groupremaining neutral. The other clientreturns and examines those alreadyin the room, selecting the changer.

IN PRACTICE III A client goes outo the room and the others decideon a acial expression, a Makatonsign, or a way o sitting, or example

with arms or legs crossed. They areall doing this action when the clientreturns or a short while to look atthem, but nothing is said. Now theclient goes out again, and the groupadopts a dierent acial expression,Makaton sign, or pose, and whenthe client reenters s/he must statewhat is dierent about the group.

IN PRACTICE IV A still more difcult version is a new take on a parlour game. One person exits, and

the others decide on an overt action and a covert action. The overtaction could be to pass aroundsomething like an open or closedbook, but covertly the action is sitting with the legs either apart or together. When the person reentersthe room s/he sits down with thegroup, and tries to join in with thegroups activity. The rst one in thegroup one who is in on the secretstates I pass on this book open, or, Ipass on this book closed. The bookwill be randomly open or closed;

it is the position o the legs thatgoes with the words. The one whois excluded rom the Secret tries towork out what the covert posture is.Another statement could be I passon these scissors crossed, or I passon these scissors uncrossed; againthat would happen randomly; itwould be the legs that are crossedor uncrossed. You could try I passon this tea towel olded or I passon this tea towel unolded, when itwould actually be the arms that are

olded or not. Passing the towel onwith olded arms is possible to do!Or try I pass on this pencil upright/leaning, but it would really be yourposture that is upright, or inclining slightly to one side. Then therecould be I pass on this pen pointingup/down, and with the other handslightly point up or down. Your ownor your clients imaginations willsuggest more o these; all you haveto remember is that you need astatement which can apply both toan object and a bodily action.

This is a un addition toyour phonological mate-rials. You can use it as aone to one activity, or in agroup.

Phonbola

This is a lateral thinkingactivity or a group o airlyable children or young teen-agers. It also helps to developnarrative skills. The idea is toexplain how the cars couldhave got into such a state.Extra praise should be givenor the unniest or mostoutlandish ideas.

Lie o Riley


10/32

COVER STORY: SKILL MIX


tion by a team rom University College London.It is unded by a grant o 737,000 rom theBig Lottery Fund, with additional unding rom

UniChem (part o Alliance Boots) and LloydsSB Foundation or England and Wales. It hasbeen introduced in Leonard Cheshire Disabilityservices throughout the UK, ollowing a success-ul pilot project in the charitys central region,

which covers Bedordshire, Berkshire, Buck-inghamshire, Gloucestershire, Hertordshire,Northamptonshire, Oxordshire and Warwick-shire. Leonard Cheshire Disability has a und-raiser in each region so, i the NHS and SocialServices will not or cannot und a high techcommunication aid when a need is identied,the charity tries to source unding that includesa commitment to maintain the aid.

Te project started with communication sup-port ocer Rosanne Lyddon. She had been acare assistant or 6 years and was not particularlyexperienced with speech and language therapyissues, so describes the development o theproject as a learning curve. Her work involvesassisting the service users to explore and improvetheir own personal communication system(s)and also look at how other people communicate

with them. Sometimes her role is to raise aware-ness o an individuals communication style andpreerences. Tis might include someone whoindicates yes / no with an eye icker, or agreeing

with a client how many times it is acceptable toask them to repeat something beore they resortto an aid. One lady with a degenerative condi-tion is keen to maintain her speech or as long aspossible. She was anxious that a communicationaid would make her lazy, but is happy with thesupport o a spell board.

Rosanne eels one o the big advantages o thecommunication support ocer role is that it

A

lmost hal o Leonard CheshireDisabilitys residential service users havecommunication impairments associated

with congenital or acquired conditionssuch as cerebral palsy, multiple sclerosis andacquired brain injury. Te nationwide shortage ospeech and language therapists - and the prioritygiven to dysphagia management - means thatsuch clients may not be able to access the helpthey need. An award winning CommunicationProject championed by the charity is working toovercome this through employing communicationsupport ocers and oering training to sta (box1, p.10).

Te charity has recruited a team o ten com-munication support ocers, one or each o theLeonard Cheshire Disability geographic regions.

Te communication support ocers visit serv-ice users, sta and volunteers regularly to assistthem in developing more eective communica-tion methods and to make sure that speech andlanguage therapy recommendations are put intoeect within the service users own environment.

Journey time to clients can be up to 4 hours de-pending on the area covered. On average a com-munication support ocer sees 8-10 clients at atime, spending 60-90 hours with each, althoughthis can be less i there is a simple solution.

On receiving a reerral, the communicationsupport ocer checks i a speech and languagetherapist is already involved, then makes contact

with them. Te majority o clients reerred haveno AAC system in place, and some have old orobsolete equipment which is no longer insured.

Te ethos o the project is to nd a low tech andlow cost solution i possible. Te communicationsupport ocers all have PCS Boardmaker, socan introduce Communication Passports, sym-bol books and spell books i they will be helpul.raining has been provided by the Communica-tion Aid Centre at Frenchay Hospital in Bristol,and the communication support ocers can usethe CAC-Frenchay Screen or AAC.

EvaluationTe Communication Project is being independ-ently evaluated throughout its three year dura-

Time or communWith speech and language therapists in short supply and people with

communication support needs missing out on the benets o AACaugmentative and alternative communication, imaginative solutions arecalled or. Mike Harrison, Rosanne Lyddon, Cathy Harris and Yunus Hansdotare part o a three year Leonard Cheshire Disability CommunicationProject involving communication support workers, speech and languagetherapists and a programme o sta training.

gives clients the benet o time. Tis gets themback into the way o having conversations andgives people who have an element o institution-

alisation some choice and independence. Clientscan also be involved in creating their own Com-munication Passport or Book.

alking Mats has proved useul or nding outabout a clients likes and dislikes. Te communi-cation support ocers encourage clients to be ashonest as possible about where they live / sta /residents / money, but only pass on the comments

with consent. A side eect is that this oers in-ormation about the daily routine which is useul

when it comes to programming a high tech aid.Making sure that the support package is de-

livered to the service user in an accessible andempowering way has the knock-on eect o im-

proving the communication skills o everyoneconnected with the service. Tis has two ben-ets. Te speech and language therapists havesomeone who will ollow up their recommen-dations and work with clients on a regular ba-sis. And, just as important, the communicationsupport ocers become a ready source o sup-port or clients, ensuring that their communi-cation needs are understood and catered or bysta. urnover o sta can be high in residentialservices, but the communication support oc-ers ensure continuity or this particularly vulner-able group o clients.

Reaching peopleOten disabled children and young adults withcommunication impairments are well cateredor at school, but support can all away as theyreach adulthood. Te Communication Projectis reaching people who have not had access tospeech and language therapy as they move intothe community or into residential services, anddo not have appropriate ongoing support in theenvironment in which they live.Yunus Hansdot (37) has cerebral palsy and is a

resident at Leonard Cheshire Disabilitys servicein Cheltenham. Sta supporting Yunus on a dailybasis rst asked Rosanne or advice in October

2005 because they realised that he was upset butdid not know why. He wanted to tell them hed

READ THIS IF

YOU WANT TO

INCREASE

CHOICE AND

INDEPENDENCE

ACCESS TO

APPROPRIATE

TECHNOLOGY

COMMUNICATION

SKILLS IN CARE

ENVIRONMENTS

The ethos o theproject is to nd alow tech and low costsolution i possible.


11/32



like to change his key worker but he was nd-ing it dicult to express himsel. He was visiblyrustrated and everyone thought it was a bigger

problem than it was, remembers Rosanne.Yunus has good auditory comprehension and

recognition o symbols but very limited intelli-gible speech. Te rst thing Rosanne did was re-new his Bliss book - a communication aid basedon symbols which can be used in isolation or insequence to create a message.

When you meet Yunus you can see that hehas a lot to oer, says Rosanne. He has a wick-ed sense o un and likes to crack jokes alsohe has a sense o adventure. Seven years ago,

Yunus undertook a sponsored tandem skydiveto raise unds or a communication aid - thePathnder with Minspeak - which was then

purchased. Tis is an excellent device but it wasnot right or him. Rosanne recognised this anddiscussed the problem with the service managerand sta who had worked with Yunus. It wasagreed that Yunus should be reerred to a speechand language therapist.

Cathy Harris, lead therapist or communicationaids in the adult service at Gloucestershire NHSPrimary Care rust, says that Yunus case highlightsthe need or ongoing specialist assessment and in-put or people who use communication aids, espe-cially ater the transition rom education to adultservices. When I met Yunus, he was nding hiscurrent communication aid very rustrating. He

was adamant he didnt want to try to use it. Yet heis a great total communicator and knew what he

wanted rom a speech output device, especially inrelation to size and accessibility.

Cathy was able to reassess his current needsully, and Yunus has been supplied with a moreappropriate device a Dynamo. I someone isntassessed by a speech and language therapist, mon-ey can be wasted on inappropriate equipment. Itsabout looking at a persons environment, assessingtheir needs and abilities, giving them choice, andnot being araid to try dierent things out over aperiod o time. Te trial period is really importantas it can show whether the device is going to beuseul to them in the longer term, says Cathy.

Te Dynamo is mounted on Yunus wheel-chair on a quick release mount. Te touch screen

is divided into nine sections, or ease o access,and the chosen category headings reect Yunusneeds and interests.

Once Yunus eels condent locating and access-

ing one level, new vocabulary is added onto thenext level. Rosanne has learned to programmethe Dynamo and works with him to make surethat all the inormation is personal and up-to-date. So, or example, hobbies includes motor-bikes. Yunus loves Harley Davidson bikes andgoes to the International Motorcycle & ScooterShow at the NEC in Birmingham each year. In-ormation and comments can be added beoreand ater the event.

In the cold drink section there is Bud pleaseand I I cant have a Bacardi Ill just have a coke.He also has a swearing section but hes careulhow he uses this.

Cathy says the advantage o speech output isthat someone can more easily attract attention

and ask questions, so they are initiating speechand communication rather than just being in re-sponse mode. Te Dynamo is still just one parto Yunuss communication system. He also useshis low tech Bliss book and Rosanne is workingon putting together a Communication Passport,

which will help new sta build a relationship with

Yunus and understand his needs and preerencesmore quickly. Key to all his communication andhaving his needs met are a supportive environ-ment and sta with time and the necessary skills.Ater the initial assessment and input, Cathy

only needs to visit Yunus every ew months, butRosannes ongoing role is crucial. Cathy knowsthat she can rely on Rosanne to put her recom-mendations into practice and to let her know ia problem arises. One o Rosannes priorities isto make sure all sta know that Yunus has hisDynamo when he needs it. Rosanne also meets

Yunus regularly to work on his vocabulary on theDynamo, which they are expanding all the time.

In residential homes, service users benet

rom having a person like Rosanne, especiallyi there are requent changes o care sta, saysCathy. In addition to training sta, Rosannesupports and encourages Yunus to use his com-munication systems. Te role o the speech andlanguage therapist is to assess, plan and deliverintervention and then to enable the communi-cation support ocers to ollow up any recom-mendations, supporting them as necessary.

Interactive and condentNow that Yunus is well supported he is mak-ing ull use o his low tech Bliss book and high

tech Dynamo communication systems. TeDynamo means that he is able to interact much

cation

Making sure that thesupport package isdelivered to the serviceuser in an accessible and

empowering way has theknockon eect oimproving thecommunication skills oeveryone connected withthe service.

L-R Cathy Harris, Rosanne Lyddon, Yunus Hansdot. Courtesy o Leonard Cheshire Disability.


12/32SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 200810


more readily when he goes out and meets people.Rosanne says that members o sta have noticed adierence in Yunus since he started using the Dy-namo. Hes able to be more interactive in groupactivities, more verbal and more condent.

Cathy eels the way Leonard CheshireDisabilitys Communication Project is accessingexpertise is invaluable. Knowing my visits will beollowed up is key. Te communication support

worker can make sure that recommendationsare acted upon, which benets the clients whomay not be able to speak up or themselves.

With constraints on spending in the NHS, Cathyadds it is crucial that resources and equipment arestrategically deployed. Te Communication Projectis an excellent initiative. It utilises a collaborativeapproach to care, with an understanding o theimportance o services being delivered where aperson lives. Individuals eel more supported and areable to make the best use o their communicationsystems in their own environment.

Rosannes enthusiasm also shows no signso diminishing. As a communication supportocer she has access to the membership benets

REFLECTIONSDO I SEE THE INCREASE IN SUPPORTWORKERS AS AN OPPORTUNITY TOSPREAD GOOD COMMUNICATIONPRACTICE?DO I ACCESS RESOURCES FROM THEVOLUNTARY SECTOR?DO I USE PROJECT MANAGEMENTPRINCIPLES WHEN PLANNING A SERVICEDEVELOPMENT?

How has this article been helpul to you?What is your experience o working withthe voluntary sector and support sta? Letus know via the Spring 08 orum at www.speechmag.com/Members/

ResourcesACE Centre Oxord, www.ace-centre.org.ukBliss Symbolics a symbolic graphical language, www.blisssymbolics.usBoardmaker with Picture Communication Symbols, www.mayer-johnson.comCommunication Matters, a UK charity concerned with AAC needs, www.communicationmatters.org.ukCommunication Passport a low tech resource to help with communication o personal inormationrelated to a persons care and preerences, www.callcentrescotland.org.ukDynamo a symbol based communication aid with a dynamic display and digitized speech output, www.dynavox.co.ukFrenchay Hospital Communication Aid Centre and Screening ool, www.cacrenchay.nhs.uk/

Pathnder a powerul communication aid with synthesized speech output using Minspeak languagesystem accessed via a static keyboard, www.prentkeromich.co.ukScope, a UK disability organisation, whose ocus is people with cerebral palsy, www.scope.org.ukalking Mats a low tech communication ramework involving symbol sets, www.talkingmats.comUniversity College London project evaluation, www.ucl.ac.uk/HCS/research/projects/?projectid=45

Box 1 Communication training

An important element o the project is the training course that Leonard Cheshire Disability sta receive,

which ensures they give service users the best possible support or their communication needs. The

course recently received recognition at the Greater London Training Awards, when Leonard Cheshire

Disability was presented with a Highly Commended award. This is part o the National Training Awards

which were set up to celebrate businesses, organisations and individuals that achieve outstanding

success through training and development. The awards are sponsored by City & Guilds.

The charity has so ar trained approximately 250 sta and volunteers, raising awareness o

communication issues and introducing AAC techniques ranging rom simple symbol boards and

Talking Mats to sophisticated voice output aids. The course was collaboratively developed by Tom

Presland and Marianne Scobie o Leonard Cheshire Disabilitys Service User Support Team, with help

rom the charitys Regional Training Manager, Diane Perry.All sta who work with people with communication impairments at Leonard Cheshire Disability will

attend this course over the next three years.

o Communication Matters and to equipmentroadshows, healthcare exhibitions and theexpertise o suppliers such as Possum. Teteam is also extending links with other agenciessuch as the ACE Centre in Oxord, UniversityCollege London and Scope.

So, what keeps her going? Rosanne says, I wantto see it through because I have been involved orso long. I really enjoy doing the job, working with

service users even on the bad days when I wantto throw the laptop out! Starting with someonewho may have nothing and seeing them at theend, just making that bit o dierence.

Rosanne Lyddon can be contacted on 01295713250.

Mike Harrison is the Leonard Cheshire DisabilityCommunication Project Co-ordinator, CentralOce, 30 Millbank, London SW1P 4QD. LeonardCheshire Disability supports over 21,000 disabled

people in the UK and works in 52 countries. Itcampaigns or change and provides innovativeservices that give disabled people the opportunity tolive lie their way. Visit www.LCDisability.org ormore inormation.

news extraSEN outcomes debatedA private Members Bill to require central collection and annual publication o inormation relating to children with a range o Special Educational Needs has passed its second reading in Parliament and is being

supported by the Government.A private Members Bill is a proposal or new legislation that is debated byParliament. Sharon Hodgson MPs motivation or initiating it came rompersonal experience. Her son, diagnosed as severely dyslexic, has hadvariable speech and language therapy input depending on the amilyslocation rather than his needs. She believes that analysing existing dataand gathering new inormation that ocuses on monitoring outcomeswill raise expectations and achievement. The MP said, It will be a step inthe right direction to record whether children with SEN are happy, sae,enjoying school, achieving personal targets, making a positive contribution to society and, where possible, going on to achieve independenteconomic wellbeing. We can then highlight the valuable contributionthat children with SEN can go on to make.The Special Educational Needs Inormation Bill now goes orward to a

Committee or more detailed consideration.www.publications.parliament.uk/pa/pahansard.htm

Anti-social networksAbility Net has drawn attention to the ways that social networking websites, popular with young people, are excluding people with disabilities.The charity reviewed Facebook, MySpace, Bebo, YouTube and Yahoo. It

says, Many o the barriers to accessibility we encountered could be easilyremedied and it was shocking how little response we received when weapproached the sites or advice on these issues.www.abilitynet.org.uk

Changing attitudesLeonard Cheshire Disability has teamed up with the makers o Wallace &Grommit, Chicken Run and Creature Comorts or a media campaign tochallenge and change attitudes towards disability.Creature Discomorts includes plasticine characters using wheelchairs,sticks or crutches, combined with the real voices and experiences o disabled people. Steve HardingHill rom Aardman Animations commented that creating animated stories that are inormative, entertaining and

poignant has been an immense but incredibly satisying challenge.www.creaturecomorts.org

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2. WorkshopsRegular in-house sta workshops are run or ourspeech and language therapists to educate, de-velop and support sta, share best practice andmaintain the prole o aphasia within the de-partment. opics have included eedback romcourses and conerences, article reviews, clinicalcase discussions, reviewing new resources anddeveloping an aphasia resource le, all o whichhave led to changes in our practice. Te speakers

or these workshops have been rom within ourdepartment.

3. GroupsWe have ormalised speech and language thera-py involvement with groups and group therapy,establishing:a) Time to Talk groups for people with aphasiaGroups are held at regular intervals across ourhealth economy. Each group meets or 2hours a week or 6 weeks. Te ime to alkgroups principally aim to provide a orum orgroup members to discuss issues such as theirexperience o therapy and recovery, changes thathave occurred in their lie as a result o aphasia

and ways in which they overcome their dicul-ties. It also aims to help members increase theircondence in their ability to communicate e-ectively with others.b) Carer SupportCarers may attend all or some o the ime toalk groups as observers. All carers completean evaluation sheet at the end which asks themquestions about any changes they may havenoticed in their relative over the period o thegroup. Responses have shown that all respond-ents perceived positive changes in their relativesability to communicate and in their condenceabout communication. Many also noted that

they gained useul insights into what it is like tohave a communication diculty.

SERVICE DEVELOPMENT


Aew years ago, our team was experiencinggrowing dissatisaction regarding thequality, quantity and equity o serviceprovided to people with aphasia, along

with unease over the amiliar emphasis ondysphagia. At the same time we were all aware

o national developments in the eld o aphasia,such as the work o Connect and the British

Aphasiology Society. We resolved to move up agear so that the Portsmouth City eaching PCadult speech and language therapy departmentcould also become a power behind the wheel oaphasia provision.

Te speech and language therapy servicedevelopment plan 2003-2006 identied our

Aphasia Strategy as a priority. In 2003, the de-partment ormed an Aphasia Action Group todevelop and implement our Aphasia Strategyor the local service. Te group comprised o veprincipal speech and language therapists work-

ing within neuro-rehabilitation and stroke, andwas ully supported by our speech and languagetherapy proessional advisor and adult servicesmanager.

Te aims o the strategy were to:create a communication riendly healthcareculturepromote a condent and enthusiastic service

which supports and develops everyone in-volved with aphasiaprovide an equitable service to people withaphasiahave a locally and nationally respected service.Te Aphasia Action Group identied key areas

to ocus on, including establishing a programme

o workshops or sta to promote sta educa-tion, development and support. We also wantedto adapt the British Aphasiology Society CarePathway (Hirst, 2001) to make it more locallyrelevant, and to set up a rolling programme oSupported Conversation training. SupportedConversation was developed by Connect, thecommunication disability network, to oer peo-ple with aphasia opportunities or genuine adultconversation and interaction. It is designed toreduce the psychosocial consequences o apha-sia. Te conversation partner acts as a resourceor the person with aphasia and actively sharesthe communication load; training provides the

conversation partner with the methods and ma-terials or achieving this.

1.

2.

3.

4.

We drew up a timeline to implement these keyareas within the three-year Service Plan and al-located group members to take on lead responsi-bilities. Te implementation o the strategy wasachieved with current stang levels by review-ing service priorities.

Many o the developments have been inspiredby national initiatives and shaped to t ourneeds locally:1. ResourcesTere are now a number o departmentally-createdaphasia-riendly tools (gure 1), such as:

Goal-setting packs

Consent ormsA Medical Inormation File on the acutestroke wardFamily and Social History QuestionnaireDysphagia InormationLie History books.

We have also produced resources and train-ing packs including Aphasia Resource Files,Personalised Communication Folders or cli-ents and Supported Conversation rainingPacks. Tese are now widely available acrossthe clinical bases.

In addition we have invested in laptops, digitalcameras and computer sotware including RE-

AC, Aphasia utor and Speech Sounds on Cueor aphasia therapy.

a)

b)c)

d)e))

A driving orceDissatisaction with their aphasia service led the Portsmouth adult teamto steer a new course. Nicola Clarkand Sheena Nineham take a pit stop toreect on the journey soar and to signal the wayahead.

READ THIS FOR

EXAMPLES OF

HOW TOSHOW

LEADERSHIP

PLAN A

STRATEGY AND

SEE IT THROUGH

MAKE THE MOST

OF EXISTING

EXPERTISE

LR Principal speech andlanguage therapists Lynn

Dangereld, Nicola Clark,Sheena Nineham, GraceWatson and Ruth Sullivan

Many o thedevelopments have

been inspired bynational initiatives andshaped to t our needslocally.


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SERVICE DEVELOPMENT


c) Structured speech and language therapy par-ticipation with the local Dysphasia Support /Communication Support Group

Tis has taken the orm o appointing a LinkTerapist with a remit to:

Work closely with the Communication Sup-port CoordinatorProvide ongoing training to volunteers in sup-porting people with aphasia to have conversa-tionsMeet regularly with group members on an in-dividual basis to discuss the goals they want toachieve and to review these goals

Disseminate these goals to the Communica-tion Support Coordinator and the volunteers,with advice on how to help achieve themProvide a link between the speech and lan-guage therapy service and the group.

4. ConferenceWe have successully hosted a National Multi-Disciplinary Aphasia Conerence in 2005 (Bor-rett, 2006) and will be hosting another one on12 May 2008 (see p. 13).

So, has it worked? Te ongoing evaluationo the service has been central to the AphasiaStrategy because its implementation has in-

volved investment in sta time, not only in at-tending the workshops but also in developingand implementing the changes to our serviceto people with aphasia, and in new equipment

which was nanced by reprioritising our exist-ing budget. It is thereore critical that the successis careully measured and recorded.

Sta views o dierent aspects o the strategyhave been measured throughout the three years.One o these aspects has been the comparison ospeech and language therapists perceptions o theirown competence and condence in working withclients with aphasia. On a sel-rating scale o 0 (notcompetent) to 10 (very competent), pre-strategy

the percentage o sta rating their competence lev-el at 6 and above was 66.7 per cent whereas when

reviewed 2 years later this had increased to 80 percent (see table 1). Tere was a similar shit in staperceptions o their overall condence levels.

Table 1 Competence Rating

Rating Pre-strategy 2 years post-strategy(June 04) (June 06)

0-5 33.3% 13.3%

5.5 0% 6.7%

6-9 66.7% 66.7%

10 0% 13.3%

Average 6.0 7.1

Results such as these, taken together with stacomments gathered rom workshop evaluationsand questionnaires, are encouraging. Tey sug-gest we are taking positive steps towards one othe original aims o the strategy that o havinga condent and enthusiastic aphasia service.

Obviously the main drivers or any changesmade to the speech and language therapy serviceare those that will benet the clients and otherusers o our service such as reerrers, carers andthe wider multidisciplinary team. One o therst areas where we wanted to eect change was

within the department itsel ater all, it wasnot realistic to expect others to do what we our-selves were not consistently demonstrating. By

building the condence and competence levelswithin the department and the development o

aphasia-riendly material and supported conver-sation training to the multidisciplinary team,there have been positive benets or clients ac-cessing our service. For example, supportedconversation ramps are now being used by themultidisciplinary team whereas pre-strategy this

was not as evident.We acknowledge that incorporating user views

o the service is an integral part o any devel-opment o the strategy. Whilst we have begunto seek user views on some aspects o the serv-ice, we will be strengthening the role o thesethrough service user questionnaires and encour-

aging user views / eedback into service planningto take this strategy orward.Our plan is to maintain the momentum o the

Aphasia Strategy bydeveloping and implementing a clear processor users o the service to contribute to servicedevelopmentsorganising another national conerence or2008maintaining and updating our current devel-opmentscontinuing with our sta workshopscarrying on group service delivery.

We hope that our ongoing commitment toimproving our service will enable us to take ur-

ther steps towards being recognised as a drivingorce in the eld o aphasia.

For urther inormation, please contact anyo the Aphasia Action Group Members:Nicola Clark, e-mail [email protected],Lynn Dangereld, e-mail [email protected],Sheena Nineham, e-mail [email protected],Ruth Sullivan, e-mail [email protected] Grace Watson, e-mail Grace.Watson@

ports.nhs.uk.

The ongoing evaluationo the service has beencentral to the AphasiaStrategy because its

implementation hasinvolved investment insta time.

Figure 1 Excerpts rom departmental resources


15/32

WINNING WAYS


ReerencesBorrett, K. (2006) Conerence Calls: Leading By Example, Speech andLanguage Terapy in PracticeSpring, pp. 20-21.Hirst, L. (2001) British Aphasiology Society Newsletter. May.

ResourcesBritish Aphasiology Society, www.bas.org.uk

Computer sotware described all available rom www.propeller.netConnect - the Communication Disability Network, see www.ukconnect.org

REFLECTIONSDO I TAKE STOCK WHEN I AM FEELING DISSATISFIED WITH THE

SERVICE I OFFER?

DO I CONSIDER HOW A SHIFT IN PRIORITIES CAN BE ASEFFECTIVE AS AN INCREASE IN RESOURCES?

DO I HAVE THE AMBITION TO MAKE MY SERVICE A LEADER AS

WELL AS A FOLLOWER?

How has this article been helpul to you? What impact havestrategies had on your department? Let us know via the Spring

08 orum at www.speechmag.com/Members/.

Portsmouth City Teaching PCTSpeech & Language Therapy dept.is hosting its 2nd MultiDisciplinary

Study Day on

Living Independently withAphasia

on Monday 12th May 2008.

Speakers include Pro. Chris Code,Ruth Nieuwenhuis, Dr. Jane Williams &

Service Users.A range o topics relating to the longerterm impact o aphasia and stroke will

be addressed.

Cost: 70For urther inormation and an

application orm,contact Jane Singletontel: 023 92894534 or

[email protected]

As is always the case, the way we see the problem is the

problem. Projection is perception.For a long time I simply could not get my head around

this theory. How can it be that I am actually the cause omy problems when it seems so obvious that another is to blame?Yes, we belong to a blame culture. Someone must be held responsible at all times Where theres blame theres a claim! So Melanie eels undervalued but what is she prepared to do aboutthis situation?

Feeling undervalued starts with selesteem. Melanies job is reviewed and someone else has an opinion about it. I that opinionis valid, and Melanie respects the evaluation process, then shehas choices to make. I on the other hand she does not acceptthe evaluation, then why is she stressing about it? It would be aninteresting exercise or Melanie to turn her thinking around and

ask, I I do not value the job o the evaluators, who then is doingthe undervaluing?Our power to choose our attitude in any circumstance is the

greatest reedom. Melanie can start with a review o her own attitude to her lie and work, and be prepared to accept that nooneand nothing else is actually in charge o her attitude.

Once a decision has been made to change her mind or achange then Melanie would benet rom looking at diet, exercise,mental stimulation and balance in order to regain that old joie devivre! A good starting point might be the Power Morning Questions below.

Write down the answers to these questions rst thing every morning. They will concentrate your mind on the positive side o yourlie, even when things could be better.

What am I happy about today?What am I excited about today?What am I proud o today?What am I grateul or today?What am I committed to today?Who do I love and who loves me?

Lie coach Jo Middlemiss

oers readers positivesuggestions or copingwith common problems.

Following her Agenda or Change job evaluation,Melanie eels undervalued, unappreciated and stuck.She is settled in the area, generally likes her job andhas a reasonable standard o living. So why doesntshe eel more positive about things?

Jo Middlemiss is a qualied Lie Coach with a background in education and relationship counselling, tel. 01356 648329. Jo oers readers a complimentary halhour telephone coaching session or thecost only o your call. While all Jos work inorms Winning Ways,your contact is condential and no personal or identiying details

will be given.

Winning Ways


16/32SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 200814

HEALTH PROMOTION

Greater expectationsNicola Brooke looks back on the rst three years o a health promotion post

which oers targeted training and multimedia resources to try to ensurethat all children, wherever they live, have the opportunity to developcommunication skills to their ull potential.

READ THIS IF YOU

WANT TO

ADDRESS THEATTAINMENT

GAP ASSOCIATED

WITH

DEPRIVATION

SEND OUT

CONSISTENT

MESSAGES

FROM YOUR

DEPARTMENT

EVALUATE OUT

COME AS WELL

AS PROCESS

Statistics on the prevalence o children withspeech, language and communicationneeds vary considerably (Lawet al., 1998)but anecdotal evidence and work carried

out by I CAN (Hartshorne, 2006) seems to indi-cate the number o children experiencing delayedand / or impoverished language skills is on the in-crease. Whether this is due to increased awareness

or an actual increase in incidence is not clear. Whatis clear is that the impact o such delays can be se-vere and long-term. Children entering school withdelayed spoken language skills are unable to accessthe curriculum ully and consequently are at highrisk o developing behavioural diculties and lowsel-esteem. In the long-term they are more likelyto leave school without the necessary qualicationsto gain employment (Letts and Hall, 2003).

o counter this, policies such as Every Child Mat-ters and the National Service Framework (NSF) orchildren strive or preventative input rather thanocusing on remediation o established diculties.Tey call or more collaboration between services

and with amilies. Tis all sounds like a good ideabut - with constraints such as limited budgets andtime - how can NHS speech and language therapydepartments achieve this, and how can we measurethe success o our input?

I have been working as clinical lead speech andlanguage therapist or health promotion or South-ampton City Primary Care rust since the post

was created in 2004. Recent statistics or South-ampton (DH, 2007) show signicantly worse rateso GCSE attainment compared to the average inEngland, alongside signicantly higher rates o in-come deprivation and children living in poverty.Consequently there is a strong need or health pro-motion activities within the city. I have been very

ortunate to get joint unding to implement severalinitiatives targeting awareness o early speech andlanguage acquisition. Each project has ocused onincreasing knowledge amongst practitioners andamilies o how to encourage normal language de-velopment and make onward reerrals in a timelymanner. Tere has been a strong emphasis on col-laborative multi-agency working and inclusion oevaluation measures to assess eectiveness.

1. Training programmeDuring the preschool years children accessmany proessionals rom health, education,social services and voluntary agencies including

health visitors, nursery sta and childminders.In Southampton it is acknowledged that such

practitioners require support to increase theirknowledge o early language development.Using unding rom Sure Start local programmesand a Neighbourhood Renewal Fund, I deviseda programme with colleagues or practitionersrom all these services. Te rationale is that ipractitioners working with preschool children,especially those in deprived areas, can be skilled

in supporting normal language acquisition itwill help reduce the incidence and prevalenceo preschool language delay. Tis in turn shouldimprove academic outcomes or children.We have delivered the annual training pro-

gramme three times and revised it several timesbased upon participant eedback. Whilst the maincontent has remained the same (see box 1) wenow deliver it during a one day workshop ratherthan over 3-4 hal days. We made this change toacilitate attendance, as many practitioners oundit dicult to spare so many sessions rom their

work schedule. Alongside weekday workshops wenow also oer evening workshops or childmind-

ers and others who are unable to attend during theday. Since implementing these changes attendancerates have increased rom 69 to 83 per cent. Each

workshop is delivered by two speech and languagetherapists, and lots o therapists rom our depart-ment have been involved. Tis acilitates city wide

collaborative working and also ensures that all localtherapists are promoting the same messages.We have evaluated the eectiveness o the work-

shops in three ways:Attendance registers allow us to monitoruptake o courses and the range o proessionalstrained. Tis is important as during earlytraining we identied key proessional groups

who had not been invited and also patternso ailure to attend. Tese issues were thenrectied or uture workshops.Immediately prior to and ollowing each

workshop we ask participants to complete

a questionnaire to assess their knowledgeo areas covered. Analysis has allowed us to

I.

II.

quantiy knowledge gained and to identiy andalter teaching o particular areas where mostparticipants ailed to gain knowledge.Several months ater completion we sendparticipants a urther unctional questionnairedesigned to evaluate how they have managedto implement their newly acquired knowledgeinto the workplace. Tis questionnaire alsoaims to identiy any areas o training thatcould have been improved. Te eedback hasled us to oer reresher workshops to providepractical support to practitioners in convertingtheory into workplace practice. Te content or example, clariying reerral criteria and

procedures - is determined by requests romparticipants.Te evaluations have shown positive outcomes

in all instances. Over three years we have trained164 practitioners rom a range o disciplines (box2). Participants have consistently demonstratedincreased knowledge post training. During themost recent workshops participants showed lim-ited baseline knowledge, with the majority achiev-ing scores o between 0 and 25 per cent correct onthe pre-workshop questionnaire. Post-workshop,88 per cent achieved scores between 76 and 100per cent correct (gure 1). Seventy one per cent oparticipants who returned a unctional question-naire rated the workshop as very good or excel-lent and 100 per cent reported that they couldnow identiy children with eeding and commu-nication diculties.

Tere will always be a percentage o childrenwith specic speech and language dicultieswho require specialist help rom a speech andlanguage therapist. However, empowering otherproessionals to acilitate communication de-velopment should help reduce the incidence opreventable speech and language delays result-ing rom impoverished language stimulation.

2. Literatureraining proessionals is just the tip o the ice-

berg when considering how to promote earlycommunication development. Parental involve-

III.

Over three years we havetrained 164 practitioners roma range o disciplines.Participants have consistentlydemonstrated increased

knowledge post training.


17/32

remain or diering reasons. Sta turnover is amajor actor and its vital that new sta enteringsettings can access support. Sta shortages arealso a diculty; in Southampton midwieryshortages mean that we have been unable toprovide training to this cohort o proessionals,despite them being key to the right rom thestart approach to health promotion.c) Level of trainingEducating such eclectic groups o proessionalscertainly has its benets such as sharing oknowledge rom dierent perspectives andnetworking opportunities. However, onediculty is pitching training at the right level

to meet everyones needs. Most participantshave been satised but some have expresseddissatisaction at the level either being too lowor too high. Tis is a diculty experienced byother speech and language therapists providingtraining (Jack, 2004) and consideration isneeded as to how to overcome this.d) Needs assessmentHealth promotion projects are only successul ia needs assessment has ascertained what requirespromoting. One challenge to this is the evolvingroles o early years proessionals. In Southamptonhealth visitors previously assessed childrens needsat 18 months and three years but are implement-ing a new strategy whereby assessments occur attwo years and close liaison is implemented withchildcare settings or children over three years.Tis change in service delivery will allow moretime or domiciliary visiting or hard to reachamilies and those not attending pre-school butmay result in new needs or example, will earlyeducation sta now need urther training on in-ormal assessment? Do health visitors require sup-port regarding assessment o two year olds? Otherneeds may be culturally driven. Southampton isa culturally diverse city where a large number olanguages are used so support is required withidentiying language impairment versus delay inEnglish as a result o bilingualism. Tere is also a

need to train bilingual workers on how to assessbilingual children in their rst language.


HEALTH PROMOTION

ment is central to success; i a parent is given thecondence they will do it or themselves ratherthan being done to

speech & language therapy in practice, spring 2008

Documents