speech & language therapy in practice, winter 2007

7/28/2019 Speech & Language Therapy in Practice, Winter 2007

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ISSN 1368-2

PLUS Winning WaysSotware solutions?...My Top Resources on aphasiamore great reader oersand eaturing multiproessional working.

Sign, SEAL, deliverEmotional literacy

OutcomesMeasuring up

Making an impact

Using NLP

Beyond impairmentUser eedback

How I involve studentsAccessible InormationInterproessional educationLie stories

Assessments assessedHearing impairment,dysphagia, aphasia

www.speechmag.comStriking a balance

Winter 2007

Lcatin,Lcatin,Lcatin


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Win REACT 2 software!

In conjunction with Propeller Multimedia Ltd. we are

oering one lucky reader a FREE single user licensed copy

o the new REACT 2 speech and language therapy program,

worth 475 (plus VAT).

The program has in ecess o 7,000 eercises in 5 modules:Auditory Processing

Visual Processing

Semantics

Memory / Sequencing

LIFE SKILLS the new module to be launched early 2008

Reviewing REACT 2, two Australian Speech Pathologists said:

The sotware contains a broad range o receptive and epressive language processing

activities and, clearly, is based on current theory in Aphasiology. The individual tasks

contain welldeveloped hierarchies, and have clear instructions and pictures. In addition,

REACT 2 was very userriendly, both or the clinician and the client. We believe that REACT

2 will become an invaluable clinical resource or clinicians working with aphasia.

So or your chance to win:

Go to www.propeller.net/magazinecompetition.htm

Fill in your name, address and email detailsAnswer the simple question

Submit the orm beore 28th February 2008.

Entries with the correct answer will be included in the draw. The winner will be notied by

email by 15th March and the program CD dispatched to their address.

React2 is a joint venture between Propeller Multimedia Ltd and NHS Borders, Scotland. Propeller

Multimedia Ltd., P.O. Box 13791, Peebles EH45 9YR, tel. 01896 833528, e-mail enquiries@

propeller.net, www.propeller.net.

See review o REACT 2 on p.22

1.

2.3.

4.

Read

eroffe

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Reader Oer WinnersBlack Sheep Press oered 5 copies o their Key Stage 2 Narrative pack in our Autumn 07 issue. They go to Fiona Fickling, Noreen Marks,Catherine Byrne, Barbara Kendray and Susan Bannatyne.

Plural Publishings pre-school stammering assessment KiddyCAT is meanwhile winging its way to the other side o the world as it was

won by Angelina Rose in New Zealand.

Congratulations to you all and keep the entries coming as next time you could be the lucky one!

www.speechmag.com

Winter 07speechmagNew on speechmag!

Cnerence reprtsAnn French n what she tk away rm the

2007 IALP Cngress in Cpenhagen.

Eitr Aril Nicll reects n British AphasilgySciety, I CAN an Sltin Fcse Brie

Therapy in Ecatin eents.

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SIGN, SEAL, DELIVERIt became apparent to us that the parents would benet rom looking at how giving children

responsibilities can raise sel-worth and condence.

Catherine Williamson and Jenny Maguire discuss the SEAL primary emotional literacy curriculum o

England and a complementary workshop they oer to parents.

INSIDE COVER: Reader Oers, Winter 07 Speechmag

Win REACT 2 sotware and the book Head and Neck Cancer.NEWS &

COMMENT2

Winter07contents

ASSESSMENTS ASSESSED

Our series o indepth review continues with the

Graded Auditory Speech Perception Screen GRASPS

the Assessment o Dysphagia In Adults A Bilingual Manual and th

Verb and Sentence Test VAST.

16

7NLP IN MOTION

The [group] members became active and more conden

as they began to believe they themselves held the solutio

to their communication issues.

Maggie Wallis reects on the dierence NeuroLinguistic

Programming is making to her practice in particular the benetsbrings or people living with aphasia.

MEASURING UP

more tools are needed to assess directly

the impact o therapy at the levels o activity,

participation and well-being.

Dianne Webster reports on a preliminary investigation o

outcome measurement by therapists working with peoplewith aphasia in Shefeld.

4

Winter 2007(publication date 30 November 2007)ISSN 13682105

Published by:

Avril Nicoll,33 Kinnear SquareLaurencekirkAB30 1ULTel/a 01561 377415email:[email protected]

Design & Production:Fiona Reid,Fiona Reid DesignStraitbraes Farm,St. Cyrus, MontroseAngus DD10 0DSPrinting:Manor Creative,7 & 8, Edison Road

Eastbourne,East Susse BN23 6PTEditor:Avril Nicoll,Speech and Language Therapist

Subscriptions and advertising:Tel / a 01561 377415Avril Nicoll 2007Contents o Speech & LanguageTherapy in Practice reect theviews o the individual authorsand not necessarily the viewso the publisher. Publication

o advertisements is not anendorsement o the advertiser orproduct or service oered.Any contributions may also appearon the magazines internet site.

BEYOND IMPAIRMENT

Many o the speech and language therapists described

how, as a result o the study ndings, they would now view

dysarthria as much o a priority as other communication problems

Sylvia Dickson, Marian Brady, Rose Barbour, Alex ClarkandGillia

Paton bring together research participants people with dysarthria,

their carers and speech and language therapists to consider thendings and implications.

18

FEATURE: TEAM TALK

"As communication specialists we are particularly good at

'opening up spaces'; together with what we know clients and

amilies want, this should give us condence to handle whatever challenges

multi-agency working presents."

With big changes ahead in the structure o children's services, editor Avril

Nicoll talks to Helen Daly, Christina Barnes, Judith Delve, Kate Evans,

Karen Bonham, Gerry Walsh, Hayley Dench and Karen Davies about

their eperiences o multiproessional working across a range o client

groups and settings.

13

Cover photo o models Steven

Winters, Craig Scott and Chris

Flanagan by Paul Reid see p.7

8 10

HOW I INVOLVE STUDENTS

Our contributors show how everyone benets when students

are seen as an additional resource rather than a burden on

already stretched services.

(1) ACCESS-ABILITYAlison Matthews, Emma Sims, Katie Cowburn, Amy Erwin, Amy

Sadowski, Nicola Derbyshire, Lizanne Carter and Linda Collier give

managerial, student and university perspectives on a service centred

accessible inormation project or adults with learning disabilities.

(2) A SAFE CONTEXT

Mel Adams, Celia Harding and Andrea Lillystone support students o

speech and language therapy, social work, nursing and medicine to eplore

issues o client assessment with the assistance o carers o people who have

comple communication needs.

(3) EVERYONE CAN COMMUNICATE SOMETHING

Laura Brierley and colleagues introduce rst year students to lie story

work with people with dementia and their carers in a good practice project

that provides a reason to communicate as well as an understanding o the

person behind the dementia.

REVIEWS

Selhelp, syndromes, autism, Asperger Syndrome, parent

child interaction, early language, AAC, Intensive Interaction,

aphasia, signing, eating and drinking, literacy.

20

24

WINNING WAYS

Lie coach Jo Middlemiss on transitions and balance.23BACK COVER:MY TOP RESOURCES

Everyone in our department was encouraged to construct their

own lie story book[which] can be used to start and then model

supported conversation.

Sheena Nineham, Joanna Kerr and Fiona Buckshare the

resources they could not do without in their work with people wit

aphasia.

SOFTWARE SOLUTIONS

With computer sotware becoming ever more

sophisticated and accessible or therapy, our indepth

reviews help you decide whats hot and whats not. Our reviewers

consider REACT 2 and Smart Learnings Interactive Literacy series.

22

IN FUTURE ISSUES: HEALTH PROMOTIONFOOD REFUSA

LITERACYSTORYTELLINGAPHASIA PRIORITISATIO

ITDROP IN CLINICSAAC


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NEWS

SPEECH & LANGUAGE THERAPY IN PRACTICE Winter 20072

Lets Go toLanguageland on CDThe Lets Go to Languageland adventures will shortly be

available on CDROM rom Black Sheep Press.

Staordshire speech and language therapist Angela

Wright developed the package or use by therapists

and class teachers with children aged 37 years. She is

pictured with David Gleaves o MidTECH, the NHS Inno

vations Intellectual Property Hub or the West Midlands,

which supported Angela through the publication proc

ess. NHS Innovation Hubs aim to ensure that a share o

prots o commercialised ideas goes to the inventor and

their employing Trust.

www.midtech.org.uk

www.blacksheeppress.co.uk

Plea fromPakistanThe rst BSc in Speech

Language Therapy has

started in Pakistan. The

organisers are keen tohave any spare books,

periodicals or resources

that might be o use. I you

can help, contact the Co

ordinator Amina Siddiqui,

email [email protected].

www.zmu.edu.pk/

speech.html

Are youUp forReading?Up or Reading is a sponsored event that promotes

the benets o reading

and literacy or all children,

including those with

Down syndrome.

Celebrity supporters in

clude Maisy Mouses crea

tor Lucy Cousins and artist

Quentin Blake. Schools,

nurseries and individual

children can take part at

any time beore 31 March

2008. Money raised ben

ets the Down Syndrome

Educational Trust.

www.up-or-reading.

org/

No Voice, No ChoiceService users interviewed by Scope believe many speech and language therapists do

not have the epertise necessary to assess peoples communication needs accurately

or recommend appropriate equipment.

Scopes No Voice, No Choice research consulted over 160 communication aid users and

their amilies to nd out the eperience o people with communication impairmentswho use or could benet rom AAC. The report highlights a severe shortage o support

and equipment.

Scope is calling or the Government to initiate better data collection and unding

arrangements and to secure the uture o specialist services. It also makes a specic

recommendation that speech and language therapists, occupational therapists and

GPs should have minimum training standards on AAC use and access to a specialist

resource and inormation portal.

www.scope.org.uk/disablism/downloads/noVOICEnoCHOICE.pd

Communicationaccess training caseA major study into the needs o people with aphasia in Scotland concludes there is a case or

communication access training to be compulsory or all sta working in public services.

The Aphasia in Scotland Project report says moving and handling and child protec

tion are eamples o how such an approach can be implemented. It adds this could

have widespread interagency benets because it would also be relevant to people

with sensory impairments, learning disabilities, mental health problems and those

who are not able to communicate readily in English.

The report suggests that speech and language therapists are moving towards a social

model o working with people with aphasia. There is a need or more provision in the

community at a time and place o most use to the client. In particular, services should

reduce isolation by helping people with aphasia to restore, develop and maintain so

cial networks. The report is clear, however, that this cannot be at the epense o one

to one therapy, and that the number o speech and language therapists working with

people with aphasia needs to increase.

The researchers ound a dearth o statistical inormation, with only three o the our

teen NHS boards able to provide data on age, gender and severity o aphasia. They see

prospective data collection specic to aphasia as essential or understanding demands

on service providers and eective workorce planning. This includes people under 65

who have particular needs around employment and caring or a amily.

The research, carried out by the Centre or Integrated Healthcare Research, included

groups o service users, speech and language therapists and other proessionals. A

communication accessible summary o the ndings is to be produced.

www.nhshealthquality.org/nhsqis/3800.html

Happy aces ater the 2007 proessional honours ceremony o the Royal College o Speech & Lan-

guage Therapists. Recipients included speech and language therapists Deirdre Dyer, Jane Kerr, Eryl

Evans, Kaye Radord, Sara Harris and Susan Edwards.

ToolkittrainingConnect has introduced

a new style o training

scheme so it can reach as

many people as possible.

The communication

disability networks

courses in Running a

Conversation Partner

Scheme and Making

Communication Access

a Reality are already

popular. The new Toolkit

style includes two days

o learning, practice and

discussion at Connect in

London and a take home

resource package so

those attending can oer

the training to others in

their own area.

www.ukconnect.org/

connectcourses.aspx

Grief Mattersfor ChildrenThe Childhood Bereavement Network is gathering sup

port or its campaign to ensure that all bereaved children,

young people and their amilies have access to support

wherever they live and however theyve been bereaved.

The Network says the majority o young people will

have been bereaved o someone close to them by the

time they are siteen. It is calling or better training and

inormation to be available to teachers and or a greater

duty on authorities to make provision and collect data.

Its website includes advice and resources or proession

als, amilies and young people themselves.

www.childhoodbereavementnetwork.org.uk/news_

November2007.htm

Working goalsThe Government says there is growing evidence that

being in work is good or health and wellbeing and

it wants health proessionals to help clients remain in

work or return switly to it.

The Health Work Wellbeing website includes inorma

tion and resources or health proessionals and the

opportunity to submit case studies.

www.workingorhealth.gov.uk


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Deaf role modelsThe National Dea Childrens Society has etended its Dea Role Model Project or dea

children aged 018 years living in large parts o England, Wales and Northern Ireland.

The project recruits and trains a variety o dea adults who are successul in all walks

o lie to visit people in their homes, at local groups, schools, colleges and youth clubs

and talk about their eperiences. They do not advocate any one type o communica

tion, education, technology or medical intervention. Sally Reynolds, the charitys FamilyCommunication Services Manager, said, This project will help dea children eel less

isolated, and help the whole amily have higher epectations o what their dea child

can achieve with the right support and encouragement.

The project is supported by the Big Lottery Fund. Posters, yers and urther inormation rom

Valerie Copenhagen, [email protected].

Contributions recognisedProessor Jane Marshall has been awarded the 2007 Robin Tavistock Award in recogni

tion o her signicant contribution in the eld o aphasia.

Qualiying in 1987, Jane is now joint head o Language and Communication Science

at City University London and a member oAphasiologys Editorial Board. The award

recognises the inuence her groundbreaking research has had on aphasia therapy

practice. Colleague Tim Pring commented, Janes research is both creative and practical reecting her curiosity about the nature o the language o people with aphasia and

her concern to help them through therapy.

Meanwhile Proessor Bill Hardcastle has been made an Honorary Doctor o Science at

Edinburghs Napier University.

Formerly a Proessor o Speech Science at Reading University, he is currently Dean o

Health Sciences and Dean o Research at Queen Margaret University, Edinburgh.

Special trainingTeachers, support sta and early years practitioners in England are to receive a

programme o training to help them develop their teaching strategies or children with

special educational needs.

Schools Minister Andrew Adonis announced the Inclusion Development Programme, which

has been developed by the Department or Children, Schools and Families in partnership withcharities I CAN and Dysleia Action. The training materials will initially ocus on speech,

language and communication needs and dysleia. Training on autistic spectrum disorders,

behaviour and moderate learning difculties will ollow over the net our years.

The Training Development Agency is also piloting specialist material or undergraduate

teachers ocused on giving them a good skills base or working with children with special

educational needs.

NEWS AND COMMENT

SPEECH & LANGUAGE THERAPY IN PRACTICE Winter 2007 3

Comment:

Striking abalance

Jo Middlemiss p.23 used to like the phrase work/

lie balance but has concluded the work/lie part is

unnecessary and we just need balance. This can be

more difcult to achieve than we think but at least we

can draw on eternal help, rom the support o riends,

amily and colleagues to ormal supervision or lie

coaching.

In her new role as a lie coach Catherine Williamson

p.4 nds her speech and language therapy background

invaluable. While the strategies discussed in emotional literacy groups or

parents are very similar to those suggested in parentchild interaction groups,

there is more emphasis on parents and carers nding balance in their own lives.When we ask, we nd that clients and carers are also looking or more balanced

provision rom services. Research participants told Sylvia Dickson and

colleagues p.18 that the emphasis on the acute stage should not be at the

epense o longer term support, oered when and where it is needed most.

They also said this applies to the whole team, not just speech and language

therapists.

As our eature on multiproessional working p.13 shows, getting new teams

unctioning in new ways is a challenge. The balance o structural change,

leadership and shared vision is nely tuned and absolutely dependent on

eective communication. Mel Adams, Celia Harding and Andrea Lillystone

p.26 look at the advantages o starting these interproessional conversations at

an undergraduate level.

When individuals have a communication difculty it is important to provide

balanced input that addresses Impairment, Activity, Participation and Well

being. Although our outcome measurement tools are still weighted in avour

o impairment Dee Webster, p.8, we are making real strides. Maggie Wallis

p.10 talks about the person beyond the label, while Laura Brierley p.27

understands the person behind the dementia.

The tools we choose can help clients bring a balance back to their identity. In

Maggies case NLP rameworks are enabling clients to nd their own solutions

to living with communication impairment while Laura is giving students

eperience o constructing real lie story books. Interestingly, speech and

language therapists in Portsmouth back page ound making their own lie

story books reduced the power imbalance o therapy sessions as they could

echange inormation with clients.

As a team manager, Alison Matthews p.24 tries to strike a balance between a

service centred and a person centred approach. She is also interested in nding

ways o balancing the needs o the service with our responsibility to provide

quality placements or students.It is a privilege as editor oSpeech & Language Therapy in Practice to learn about

the many inspired directions speech and language therapists are taking. When

you are acing major changes and challenges at work, a ick through the pages

will remind you why you chose this proession and why we keep striving or

balance.

Education Show brought forwardThe Education Show 2008 has been brought orward rom its usual date to take ac

count o earlier Easter school holidays.

The UKs biggest ehibition o educational products and resources, this ree event also

includes seminars and workshops. The Special Needs Zone will have nearly a hundred

ehibitors, including Speechmark, I CAN, 2Simple Sotware, Badger Publishing, Crick

Sotware, Three Bears Playthings, The Sensory Company and TetHelp Systems.

The 2008 Show is at the NEC Birmingham rom Thursday 28 February to Sunday 1 March.

www.education-show.com


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EMOTIONAL LITERACY


Sign, SEAL,elierI Social and Emotional

Aspects o Learning are

crucial to a happy lie,we need to consider this

when planning therapy.

Speech and language

therapist turned lie coach

Catherine Williamson

and lie coachJenny

Maguire discuss the SEAL

primary emotional literacycurriculum or England and

a complementary workshop

they oer to parents.

Te Special Educational Needs and Disability Division's

ambition is or every child with special educational needs to

reach their ull potential in school, and to make a successul

transition to adulthood and the world o urther education

training or work (www.teachernet.gov.uk/wholeschool/

sen/). As both a speech and language therapist and Lie

Coach, I am particularly interested in the potential oSEAL to benet the estimated 7.4 per cent o children (2-3

per class) who have language diculties o varying severity

(I CAN, 2001). It is recognised in the Joint Proessional

Development Framework (I CAN, 2001, p.6) that, In the

classroom, SLCN (Speech, Language and Communication

Needs) can have a major impact on childrens ability to

think and learn, and can aect their behaviour and social

and emotional development.

A ellow Lie Coach, Jenny Maguire, has a son at St

Josephs Primary School in Wrightington. She noticed new

school work seemed similar to some o the goal setting

techniques she uses with clients. She approached the

head teacher to nd out i we could support this excellent

practice in improving the Social & Emotional Aspects o

Learning o the children by working with their parents. Weshared ideas, identied common themes and got the go-

ahead to see i parents would be interested.

We sent parents an initial letter. Tis included a

questionnaire about responsibility or ensuring these social

and emotional aspects o their childs learning are met:

religious input in their lie

eelings o sel worth

a high standard o reading or writing

a good circle o riends

the ability to voice their opinions

an active role in the community

a healthy liestyle.

We asked the parents to consider the responsibility they

believe the child, parent or teacher has or the childsdevelopment in each area on a scale o 1-10. Te response led

to the rst parent workshops going ahead in January 2007.

Responsibility is one o the key SEAL areas. Millman

(1999) says sel-worth reers to your overall sense o

value, worth, goodness and deservedness. O parents who

responded, 63 per cent rated their childs responsibility

or their sel-worth as less than 5, and 64 per cent said

they would like to give their children more condence. It

became apparent to us that the parents would benet rom

looking at how giving children responsibilities can raise

sel-worth and condence.

One parent who attended agreed to discuss getting her

8 year old a pet. Te parent and child entered negotiations

and agreed that i the child could show she had looked

into and researched what having a pet would involve andhow this would be maintained then she could have one.

Tis parent was amazed at how much eort her child put

into this and how thoroughly she thought through the

implications (requency o eeding, cage cleaning, health

care). Te child identied the responsibilities she needed

to take and those she would need help with (buying ood,

bedding).

Children can learn to take responsibility by using thinking

skills and eelings together to guide their behaviour. aught

calming-down, problem-solving and confict management

techniques use language to empower children to make

sense o their world and what is happening to them.

eachers, therapists and parents working collaboratively

and creatively can give the child with speech and languageneeds access to the SEAL curriculum through supporting

Students who are anxious, angry or depressed

dont learn; people who are in these states do not

take in inormation eciently or deal with it

well when emotions overwhelm concentra-

tion, what is being swamped is the mental capacity cog-

nitive scientists call working memory, the ability to hold

in mind all inormation relevant to the task at hand.

(Goleman, 1995)

In a report commissioned by the Department or

Education and Skills, Weare & Gray (2003) say there is

sound evidence, mainly rom the United States, that work

on emotional and social competence and wellbeing has a

wide range o educational and social benets. Tis includes

greater educational and work success, improved behaviour,

increased inclusion, improved learning and greater social

cohesion.

Te Government set up Social and Emotional Aspects

o Learning (SEAL) in 2005 as a way o helping children

in England to:Be eective and successul learners

Make and sustain riendships

Deal with and resolve confict eectively and airly

Solve problems with others or by themselves

Manage strong eelings such as rustration, anger and

anxiety

Be able to promote calm and optimistic states that

promote the achievement o goals

Recover rom setbacks and persist in the ace o

diculties

Work and play cooperatively

Compete airly and win and lose with dignity and

respect or competitors

Recognise and stand up or their rights and the rights

o others

Understand and value the dierences and commonalities

between people, respecting the right o others to have

belies and values dierent rom their own.

Lie skillsLie Coaching is a dynamic approach to help people o

all abilities make the most o what they are good at and is

thereore an excellent complement to the SEAL initiative.

Coaching is about helping children or adults understand

what they nd dicult and what they want to change and

then to identiy the steps to get there. Tese truly are lie

skills, the tools we need to become resourceul and success-

ul in our adult lives.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

READ THIS IF YOU WANT TO

FORGE INTER-PROFESSIONAL COLLABORATION

RAISE SELF-WORTH AND CONFIDENCE

HAVE A LONG-TERM IMPACT

Catherine Williamson Jenny Maguire


7/32

EMOTIONAL LITERACY


the spoken word with tools such as sign and symbols.

I ound my speech and language therapy background

invaluable in running the parent workshops, both in

conveying the importance o language and or helpul

resources. Our work on praise drew on tools I used

previously with children who stammer. It aims to build

sel-esteem by ensuring a ratio o 5 positive comments toevery 1 negative (Grantham, 2000). Another workshop

involved exploring how the word dont eatures heavily in

our language and has implications or our ability to ocus

on what we should be doing instead.

Goal settingInterestingly, in the pre-SEAL workshop question-naire, 33 per cent o parents who responded said it

was not their childs responsibility to learn thatwas up to the teachers and parents to do! Yet oneo the key outcomes o successul work to developsocial and emotional skills is independent and au-tonomous children who are able to take ownershipo their learning and behaviour. Speech and lan-

guage therapists routinely involve children in goalsetting and measuring perormance using toolsthat are not dependent on language such as thesmiley rating scale (gure 1). Tis experience canbe helpul when exploring ways that teachers canconstantly encourage children to take ownership.Ideas might include:

involving children ully in the decision toimplement the SEAL curricular approach, andmaking sure they, as well as adults, understand thepurpose o the work and the hoped-or outcomesinvolving the children in the identication ocriteria that demonstrate successinvolving children in the evaluation o their

learningallowing children to determine their ownquestions or enquiry and debateusing behaviour management techniques that

a.

b.

c.

d.

e.

encourage children to make a choice abouttheir behaviour (such as golden time wherethe children are able to choose their own rewardor good behaviour)providing opportunities or children todetermine class and playground rules androutines, and ground rules or the activities todevelop their social, emotional and behaviouralskills. St Josephs has a school council wherebythe children help sanction poor behaviour.Our Coaching Workshops or parents play

an important role because skills learnt in schoolare not meant to stay in school; children need

to develop these skills in all aspects o theirlives, and parents are the teachers who do thisat home. But what i parents themselves dontknow how to develop these skills? What i theydont eel empowered to teach their children thevaluable skills o negotiation, compromise andresponsibility?

As listening proessionals, speech and languagetherapists oten nd themselves supportingparents. Our workshops give a wider range oparents a rare opportunity to press pause, look at

where they are now and learn how to:Get their children to take responsibility ortheir role within the amily. See Doughnut

in gure 2.alk so children will listen and cooperate stoptelling them what they dont want them to doand start saying what behaviour they want to see.

.

1.

2.

Eectively reward children to keep themmotivated and keen to develop themselves.It is essential that children are involved indetermining their reward. As Brophy (2004)showed, children learn more rom intrinsicmotivation - when they are doing a task to

please themselves - rather than when they aretold to do it with a reward in place.Manage their time more eectively so theycan spend quality time with the children. Tisincludes leading by example. In our Goal Setting

workshop, parents realised they had stoppedsetting themselves goals and instead ocusedtheir energy on the children. When we askedthe question What do you want or your child a lie ull o new possibilities until they are 40or a lie ull o new opportunities until they are80? well, you could have heard a pin drop asrealisation dawned.Build their own sel-condence so thatthey provide a positive role model or their

children.Te eedback rom the parents has been very

positive:I elt that it has been one o the best presentationsI have ever been to, everything was so poignant,and we just thought thats me, I do that!Te dierence is unbelievable.I have noticed that the children respond morepositively and we are now showing them thatas parents we trust them and have condencein them.

Essential actorsTe Primary National Strategy says, Social, emotional

and behavioural skills underlie almost every aspect oschool, home and community lie, including eec-tive learning and getting on with other people. Teyare undamental to school improvement (DES, p7,

3.

4.

5.

Figure 2 Doughnut o responsibility

Whatd

oyoug

ainfromgivingyourchildren

respon

sib

ilit

ies?

Whatresponsibilitiesdoes yourchild have?

I Would like Mollyto become more

responsible or one o the

ollowing chores:

Saving some money

Doing the dishes

Looking ater the pets

Watering the plants

Folding the washing

Preparing the meals

Helping with the hoovering

Keeping her room tidy

This will allow me to:

Spend more time doing

what .......................... wants

me to do

See how responsible my

child can be

Remain calmer with my

children as my workload

lightens

See their condence grow

In return I will rewardMolly in one o the

ollowing ways:

Financially

Spend agreed time

together

Allow a riend over to play

Present

Figure 1 Smiley rating scale


8/32

Catherine Williamson (www.meettherealu.co.uk) has a

BSc Speech Therapy & Pathology and a Diploma in Lie

Coaching. Jenny Maguire (www.noguiltzone.co.uk) has a

Diploma in Lie Coaching. For urther inormation, e-mail

[email protected].

AcknowledgementWith many thanks to Mrs Keating, Head eacher,parents and sta at St Josephs Primary School,

Wrightington, West Lancashire.

EMOTIONAL LITERACY


SLTP

2005). Identied essential actors to successul imple-mentation o SEAL include:

Senior management commitment to the principlesand understanding o the implications. St Josephssta are all committed to the SEAL initiative and itis carried on throughout the school.

A school which makes sure all individuals eel valuedand listened to where childrens achievements arecelebrated.eacher insight and knowledge into the emotionalactors that aect learning. Tis has also developedvia the parent participation in the workshops, assta elt they understood the views and aspirationso parents more.Te active involvement o children themselves. StJosephs have noticed the children respond well tobeing talked to positively. Te Year 6 children hada new cloakroom and their teacher would regularlycomment on how tidy it was or that certain areaswere really tidy, which made the children motivatedto keep it this way.

Proactive work with parents. At St Josephs this is anon-going area o work as it is becoming more evidentthat the negative attitudes o some o the childrenare infuenced by parents. Weare & Gray (2003,p.24) quote Cumbria LEA: Childrens behaviouris a consequence o their social and emotionaldevelopment and their mental health; it is learned.

a.

b.

c.

d.

e.

St Josephs wants to get parents on board so that thevaluable work done in school can be reinorced athome.A Special Educational Needs Coordinator in apoorer area o Stockport said that, although heagreed with our workshop plan, he elt his parents

would not be able to access this level o learning. Hisschool is using SEAL to teach parents the basicsrst. Many parents can eel overwhelmed with thethought o going back into the school environmentand their own experiences o education can make ithard or them to access new inormation. In thesecases just getting them to come into school is anachievement.

We have nished the project pilot and are evaluatingthe results. We plan to seek accreditation or thecourse and roll it out to other schools. We are alsomaking links with the Qualications and CurriculumAuthority approved PEARL (Personal, Employability,Achievement and Refection or Learning) Programme.Tis ramework aims to be a cohesive mechanism that

allows competencies in key areas such as willingness tolearn, sel-motivation and team work to be accuratelyassessed and accredited. Tis is the rst perormancebased system or measuring and awarding learnerssocial, emotional and behavioural skills.

Our plans may be ambitious but we are buoyed bythe schools enthusiasm and excited about the uture.

Catherine and Jenny are running The Amazing Wom-

ens Day on 27th February, 2008 at Maxwell Hall, Sal-

ord University, Manchester rom 10am-4pm. The cost

is 50 and the aim is or participants to Appreciate all

that you are and all that you can be. Further details

will be available on www.growingdreams.co.uk.

REFLECTIONS

DO I HELP CLIENTS FIND WAYS TOCOPE IN SPITE OF THEIRCOMMUNICATION DIFFICULTY?DO I UNDERSTAND THAT SOMECARERS NEED TO DEVELOP THEIROWN EMOTIONAL LITERACY BEFORE THEY CAN HELP THE CLIENT?DO I MODEL PERSONAL GOALSETTING BEHAVIOUR?

How has this article been helpul to you?

What are you doing to address socialand emotional aspects o learning? Letus know via the Winter 07 orum on thewww.speechmag.com members area.

ReerencesBrophy, J. (2004)Motivating Students to Learn. 2nd edn. NJ: Lawrence Erlbaum Associates.DES (2006) Primary National Strategy - Excellence and Enjoyment: social and emotional aspects o learning. Crown copy-right. Available online at: www.standards.des.gov.uk/primary/publications/banda/seal/pns_seal137805_guidance.pd(Accessed 20 October 2007).Goleman, D. (1995) Emotional Intelligence. New York: Bantam Books. (aken rom Primary National Strategy, p8, 2005).

Grantham, P. (2000) How o Build Clients Sel Esteem workshop. Harrogate: Skills Development Service. (Further detailsat www.skillsdevelopment.co.uk/seminars.php?courseid=1.)I CAN (2001)Joint Proessional Development Framework. London: I CAN.Millman, D. (1999) Everyday Enlightenment: Te welve Gateways to Personal Growth. Warner Books.Weare, K. & Gray, G. (2003) What Works in Developing Childrens Emotional and Social Competence and Wellbeing. Universityo Southampton. Available online at: www.des.gov.uk/research/data/uploadles/RR456.pd (Accessed 20 October 2007).

resourcesCommunity TerapistsThe Community Rehabilitation Team Network has been

rebranded as the Community Therapists Network. It is

or therapists providing care and support in the com

munity or people living with longterm conditions.

www.communitytherapy.org.uk

elehealthTinyEye technology has been developed or speech

and language therapists to oer remote consultation

and therapy services using a head set and web camera.

www.tinyeye.com

ransitionThe Transition Inormation Network is an alliance o

organisations and individuals who want to improve

the eperience o disabled young peoples transition to

adulthood.

www.transitioninonetwork.org.uk

PoliticsThe Disability Rights Commission has produced a

downloadable booklet Getting involved in a political

party Inormation or people with learning disabilities.

The DRC is now part o the Equality and Human Rights

Commission.www.equalityhumanrights.com(search Publications)

Crime talkCrimestoppers has a new website aimed at getting

young people aged 1116+ involved in discussions

about crime.

www.shadowcs.co.uk/

Palliative careThe International Childrens Palliative Care Network

advocates or and raises awareness o the needs o

lielimited children and their amilies.

www.icpcn.org.uk

React 2The lie skills module o the React 2 rehabilitation

sotware will be ready early in 2008.

Trial versions o all programs can now be downloaded

rom Propeller Sotwares website.

www.propeller.net

alking Mats and dementiaA study has ound the lowtech communication tool

Talking Mats eective as a way o helping people at

dierent stages o dementia to epress their views,

compared to their usual communication methods. It

also reduced repetitive behaviour and helped to keep

participants engaged in conversation.

Download the report ree atwww.jr.org.uk/bookshop/

eBooks/2128-talking-mats-dementia.pd

Thanks to Contact a Family www.cafamily.org.uk,

the source or several o these resources.


9/32SPEECH & LANGUAGE THERAPY IN PRACTICE Winter 2007 7

COVER STORY: HERES ONE I MADE EARLIER...

SLTP

Tere is a huge resource o ree and high qualityletover material lurking in the ling cabinets oEstate Agents. Yes, I did say Estate Agents!It occurred to me that house leafets providean ideal resource or working on inerence andlogical thinking, not to mention discussion andteam building skills. We all love to look at detailso other peoples houses and these leafets givedetails o price, house type, size - all you have todo is write a selection o client details to match up

with the houses you have details o.When I rst went to an Estate Agent I was givena whole range o details on houses rom 100,000to 500,000. Tey were also happy to give me sixor more copies o each leafet so I didnt have tocopy them. I then wrote short sketches o myclients, or example:

Mr and Mrs Black have a budget o no more than250,000. Tey have no children but 2 dogs. Teylove walking and would like to live in an older style

property in the country but not too ar rom shops.Te group then had to consider all the clientsand decide which houses would be most suitableor them. Tis included lots o vocabulary workstarting with what is a semi-detached house?,progressing to what is meant by no more thanor an older style property. Tey also had to inerinormation rom the client prole such as thatthey would need a garden i they had dogs.Te young people aged 13 to 18 who have usedthis activity have really enjoyed it, and we haveturned it around so that they can begin to writeclient proles or another group to match withhouses. It is an innite resource, easily added toand great un.

Alison Roberts regularly contributes reallypractical and imaginative ideas to this page. Shehas used this idea and extended it to matchingholiday wish lists to travel brochures, again a

wonderul ree resource. So even though Summerholidays are over we can still dream o that perectgetaway while we work!

Sheina Stockton is anindependent speech andlanguage therapist inUpton upon Severn.

Heres one I made earlier

Lcatin,Lcatin,Lcatin

Sheina Stockton with alow-cost, fexible therapysuggestion suitable or avariety o client groups.

PictureofmodelsSteven,

CraigandChrisbyPaulReid


10/32

OUTCOMES


Over recent years we have become in-creasingly aware o the need to measureoutcomes, so that we know our inter-vention is having an impact on clients

lives. As a recently qualied therapist I was keen toget to grips with the outcome measurement toolsused in my team and the wider service. I wanted tond out whether or not therapists were measuringoutcome, what they were measuring, the main ac-tors aecting outcome measurement and perceivedbarriers. With the support o colleagues I under-took this as a project, carrying out a literature re-view ollowed by a baseline audit and a preliminaryinvestigation o local practices to assess the impactand outcomes o clinical service (RCSL, 2006) atan individual therapist level.Te literature review in April 2005 revealed ew arti-cles that had investigated the use o outcome meas-ures in everyday practice. O these, studies such asthose by Simmons-Mackie et al. (2005) and Hesketh& Hopcutt (1997) revealed diversity in the rangeo outcome measurement tools used by clinicians.ools were ormal and inormal; unctional and im-pairment based.

Account for variability

Attempts to dene outcome measurement refect thewide range o variables involved. Simmons-Mackieet al. (2005, p.2) aim to account or this variabilityrather than trying to pin down a denition:

What rehabilitation proessionals measure in out-come assessment, as well as when or how outcomesare measured, depends on a range o variables suchas the philosophical and experiential orientationo the person doing the assessment, the intendedaudience, the time and resources available, and thespecic purpose o the assessment.

Tis is certainly a helpul approach when we areconsidering outcome measurement in a real worldsetting. Aphasia therapy in Sheeld takes place in avariety o settings at dierent points along the stroke

pathway; rom the acute phase right through to sev-

eral months and years ater. Terapists dier in theirexperience and there is also variation in available re-sources, both materials and stang.Speech and language therapists in Sheeld have anumber o tools which could be used to measureoutcome. Tese include:

ormal, standardised assessments (such as ROG,Boston Naming est, PALPA, Comprehensive

Aphasia est) or inormal checklists which areused where therapy has targeted a specic elemento language processing in an impairment-basedapproach.measures o mood and sel-esteem (or exampleVASES, SAD-Q or DISCS (urner-Stokes et al.,2005)) or inormal rating scales i therapy has tar-geted psychosocial issues.OMS or inormal observational checklists, meas-uring therapy outcomes that have targeted access tocommunity activities and participation in society.

For the project audit I used criteria based on guid-ance specic to the proession, including RCSLClinical Guidelines (2005). I ormulated standards(table 1) based on my own clinical experience andinormal discussion with colleagues.o nd out i these standards were being met I senta questionnaire (based on Simmons-Mackie et al.,

Measring pGiven the many reasons in avour o outcomemeasurement it is important we know whatwe need to measure and how we are going todo it. Dianne Websterreports on the questionsarising rom her preliminary investigation ooutcome measurement by therapists working

with people with aphasia in Shefeld.

2005) to a group o Sheeld speech and languagetherapists working primarily with adults with apha-sia ollowing stroke. Te questionnaire (available inull via the Extras group on the members area at

www.speechmag.com) gathers inormation aboutthe setting(s) the respondent works in and the gen-eral stage they see clients at ollowing a stroke, along

with their level o experience and continuing proes-sional development. It also asks how much time theycan oer a client with aphasia and whether compu-ter based interventions are included in their service.Respondents are invited to dene outcome measure-ment and explain the theoretical or philosophicalmodels or rameworks that currently infuence yourapproach to outcome measurement in aphasia.Tey then answer questions about whether, when andhow they measure change beore moving on to sectionsabout what infuences decision-making (or exampleaphasia severity / evidence o spontaneous recovery /motivation o client) and whether there are signicantbarriers to conducting outcome assessment in your set-ting / with individual clients. Finally, respondents aregiven a list o 26 outcome tools suitable or use withpeople with aphasia and asked to indicate whether theyuse them and, i so, why (or example to determine

what to do in therapy / track client progress).

READ THIS IF YOU

WANT TO

COMPARE AND

CONTRAST WHAT

COLLEAGUES ARE

DOING

IDENTIFY GAPS IN

RESOURCES

DEMONSTRATE

YOU ARE MAKING A

DIFFERENCE

Results

89% respondentsmeasure therapy outcome

100% o those who usetools do so in 2 or moreareas

89% reportedinvolvement in a specicaphasia-related activity

Criterion

Outcomes o therapy should be routinelymeasured (RCSLT, 2005, p.17)

Measurement will refect the range ointerventions delivered and the aims agreedor therapy (RCSLT, 2005, p.17)

Speech and language therapists musthave available a wide variety o potentialapproaches to therapy, including awarenesso the latest techniques, and be inormed odevelopments in the theory and practice oaphasia therapy (RCSLT, 1996, p.164). This willthen inorm outcome measurement in aphasia.

Standard

All therapists will measure outcomeso therapy

80% o therapists will use tools in2 or more o the ollowing areas:impairment, activity, participation,well-being (WHO, 2002)

80% o therapists will be inormed odevelopments in theory / practice oaphasia therapy

Table 1 Standards


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OUTCOMES


Nine o the ten questionnaires were returned. I wasinterested to note that:

Eight o the nine responding therapists reportedthat they measured outcomes. (Te other thera-pist worked in the acute setting and our denitiono outcome measurement did not include meas-

urement o communication to sta and amily orcommunication acilitation.)ime constraints were reported most requentlyas a barrier to outcome measurement. Reportedtime taken to measure outcome ranged rom 30minutes to 3 hours and related to time availableor therapy. Terapy intensity diers accordingto setting and resources (such as assistants), withmore typically available in intermediate care andinpatient rehabilitation settings.

All 8 therapists reported using tools that involveda range o the our categories: body unctions andstructures (impairment), activity, participation andcontextual actors (well-being). As this mirroredthe therapists reported infuences to outcome

measurement, with all respondents mentioning arange o philosophies / models, this suggests thattherapists are attempting to address and targetclinical areas at a range o levels.Despite therapists working at a range o levels, themajority o outcome tools used were at an impair-ment level (such as the Comprehensive Aphasiaest, Pyramids and Palm rees), with only 26 percent at an activity / participation level (or exampleinormal unctional checklists, observation check-lists) and a mere 9 per cent or well-being (such asVASES). As all therapists included well-being intheir denitions and use o tools, this suggests tome that more tools are needed to assess directly the

impact o therapy at the levels o activity, participa-tion and well-being.Enderby & Emerson (1995)comment that most studies investigating aphasiatherapy use standardised tests to measure aphasiaoutcome, yet these tests may be measuring littleor nothing that has been targeted in therapy. Tedevelopment and availability o valid tools thatmeasure the impact o intervention at the levels oactivity, participation and well-being would allowclinicians to capture the breadth o interventionand subsequent impact on the individual. Tis

1.

2.

3.

4.

can then provide inormation to service providersand commissioners on the ull range and value ospeech and language therapy and its relevance toservice users.Respondents denitions o outcome assessmentvaried, with disagreement about whether this

should be broad or linked to a specic area otreatment. More consensus is needed on how in-tervention is measured. I clarity is gained on theactors that should be considered when deningmeasurement, tools can then be careully chosento capture these parameters.Many therapists reported involvement in an apha-sia-specic activity. We can assume that, in addi-tion to a specic interest in aphasia therapy, thesetherapists have access to research and best practicendings, and that this should inorm outcome as-sessment and enhance good practice.

Questions raisedOne o the main outcomes o this project was the

many questions it raised:How is outcome measurement viewed? Is it seen asan integral part o a therapy block or viewed as anadditional activity? How can more time be madeavailable to measure outcome?How is outcome measurement dened and whatinfuences this decision?Can we gather more examples o therapy currentlyprovided at the levels o Impairment, Activity, Par-ticipation and Well-being? How can the impact oour therapy on the individual be measured appro-priately, across the breadth o our input?

What limitations / barriers do the care pathwayand particular models o service delivery place on

individual accessibility to therapy services, subse-quent therapy and outcome assessment?How is the client and carers perceived impact otherapy being measured? How is this being used toinorm service planning and therapy ocus at di-erent stages o the care pathway?

Outcome measurement or aphasia was reportedby Sheeld speech and language therapists to takeplace routinely. Tis is reassuring as it is widely ac-cepted that measuring outcome o therapy is goodpractice (RCSL, 2005; RCP, 2004). Within the

5.

6.

NHS, the Payment by Results system (DoH, 2002)encourages eciency, and so measuring outcome isimperative. Commissioners also want to know thatservices oer value or money and meet the needso a given population. Given the importance o thissubject, urther discussion and refection on the re-

maining questions is needed and will orm the basiso uture developments on outcome measurementwithin speech and language therapy in Sheeld.

Dianne Webster is a Specialist Speech and LanguageTerapist with Sheeld Primary Care rust, [email protected], telephone 0114 2264034.

AcknowledgementsI am grateul or the time, advice and support pro-vided by my colleagues and managers within theSheeld Speech & Language Terapy Service. Withparticular thanks to Caroline Haw, Clinical Supervi-sor and Dr Caroline Pickstone, Research Lead.

Reerences

Department o Health (2002) Reorming NHS Financial Flows. Introducing Payment by Results.Crown Copyright.Enderby, P. & Emerson, J. (1995) Does Speech and Language Terapy Work?: A Review o the Litera-ture. London: Whurr Publishers Ltd.Hesketh, A., & Hopcutt, B. (1997) Outcome measures or aphasia therapy: Its not what you do,its the way you measure it, European Journal o Disorders o Communication 32 (3), pp.198-203.Royal College o Speech and Language Terapists (2005) Clinical Guidelines. Bicester: Speechmark.Royal College o Physicians (2004) National clinical guidelines or stroke. 2nd edn.. London: RCP.Royal College o Speech and Language Terapists (2006) Communicating Quality3.London: RCSL.Royal College o Speech and Language Terapists (1996) Communicating Quality2. London:RCSL.Simmons-Mackie,N., Treats, .. and Kagan, A. (2005) Outcome assessment in aphasia: a sur-vey,Journal o Communication Disorders38, pp.1-27.urner-Stokes, L. Kalamus, M., Hirani, D. & Clegg, F. (2005) Te depression intensity scalecircles (DISCs): a rst evaluation o a simple assessment tool or depression in the context o braininjury,Journal o Neurology, Neurosurgery and Psychiatry76, pp. 1273-1278.World Health Organisation (2002) owards a Common Language or Functioning, Disability and

Health. Geneva: WHO.

Resources availability

Armstrong Naming est Whurr Publishers - out o printBoston Naming est http://www3.parinc.comComprehensive Aphasia est www.languagedisordersarena.comTe Pyramids and Palm rees est www.harcourtassessment.comPsycholinguistic Assessments o Language Processing in Aphasia (PALPA) www.languagedisordersarena.comSAD-Q (Stroke Aphasic Depression Questionnaire) reely available onwww.nottingham.ac.uk/iwho/general/links.phpOMS (Terapy Outcome Measures or Rehabilitation Proessionals) www.wiley.comrog-2 (est or Reception o Grammar) www.harcourt-uk.comVASES (Visual Analogue Sel-Esteem Scale) www.speechmark.net

REFLECTIONSWHEN I WANT TO FINDSOMETHING OUT, DO I STARTWITH BASIC TOOLS SUCH AS ALITERATURE REVIEW AND AUDIT?DO I GET INVOLVED IN GROUPSWHERE I CAN DEVELOP MYKNOWLEDGE AND SKILLS?ARE THE OUTCOMES TOOLS I USEAPPROPRIATE TO THE CHANGES IWANT TO CAPTURE?

How has this article been helpul toyou? What are you doing to measurethe outcome o your intervention? Letus know via the Winter 07 orum on thewww.speechmag.com members area.

SLTP


12/32SPEECH & LANGUAGE THERAPY IN PRACTICE Winter 200710

GROUPS

ent aspects o their communication, resulting in amodel which others could then pattern. From thesebeginnings NLP has been applied to various elds,again with the aim o providing a model rom whichothers could draw to acilitate their own success.

NLP has developed what it calls its presuppositions.Tis is an acknowledgement that, in anything wedo, the assumptions we bring to bear on a task havean eect on the end result. NLP proposes that weconsciously assent to particular assumptions - notbecause they have to be true but because they areeective in generating change. Te mental posture

we adopt is crucial to the response we elicit.NLP presuppositions:Everyone has their own unique model o theworld dependent on their experience, beliesystems, and way o ltering inormationBehind every behaviour is a positive inten-tion or that personTe meaning o your communication is theresponse it getsPresent behaviour is the best choice avail-able at the timeTere is only eedback; each situation providesuseul inormation, revealing whether or not you

have drawn nearer to your intended goalResistance is a sign o lack o rapport and isthereore useul eedbackMind and body are one unied systemEveryone has - or can acquire - all the re-sources they need.In addition there are ve guidelines as to how

we operate in a given situation:Determining our state o mind and bodyandaligning this to what is called or in the currentsituation. An unresourceul state is one that isnot producing desirable results. Breaking stateis an NLP term describing the capacity to pullyoursel out o an emotional state, with the in-tent o moving into a state that is more condu-cive to bringing about your desired outcome.Developing rapportwith whoever we need tocommunicate, paying particular attention tovoice quality, the words we use and physiology.(NLP has developed a useul system to inter-pret messages we can receive through observa-tion o body language and acial expression.)Establishing outcomes so that resources re-quired can be clearly identied.Developing sensory acuityso we can useully cali-brate our eectiveness towards a given outcome.Learning fexibilityso we are able to recognisethere are numerous ways o achieving the sameoutcome, and nd the one that best suits our

set o circumstances.

1.

2.

3.

4.

5.

6.

7.8.

1.

2.

3.

4.

5.

THE MOVING STREAMOver the years there have been continuous and dra-matic changes in the ways we view our role as speechand language therapists, yet we have always beendealing with the same commodity: communica-tion. Te reason or the fuctuation lies in the natureo the commodity. In many ways communicationbehaves like water. What we see o it is only what isrefected back to us. We observe only the eects oit, not the thing itsel. Even these eects cannot be

adequately measured or dened - they pass throughthe receptors o the brain, aecting thoughts andemotions, infuencing acial expression, body lan-guage and responses in a constant fow. Commu-nication must be in motion or it is simply words.Oten our assessments measure something whichis static, yet these results may have little bearing oncommunication behaviour.

Ater a Lee Silverman Voice reatment course,I returned idealistic that I now had the key tochange or all my clients with Parkinsons disease.Te therapy achieved what it said it would do - theclient could speak with a loud voice. Even withthe emphasis on carryover, what did not change soreadily were the dynamics between spouses ollowingtherapy, or contexts in which the loud voice mightbe useully engaged. In other words, the water mayhave developed a dierent quality but it still met thesame conditions and restraints. Tese barriers needalso to be addressed i communication is to improvein a lie enhancing way.

In the past we have bought into the medicalmodel, looking at ways o mending what hasbecome broken. We have been less ocused indeveloping our skills o recognising and enhancinggood communication. But over the past ew years,

with Connect blazoning the way, the psychosocialmodel o aphasia has begun to take precedence.Its emphasis is on looking at the environment and

context in which communication occurs and makingthis amenable to the person who is struggling tocommunicate. As one manages water, so we help toimprove the fow, remove barriers and redirect.

THE NLP WELLo communicate eectively is a desire common toeveryone whether or not their speech or language isimpaired. One area o study that has paid particularattention to eective communication is Neuro-Lin-guistic Programming. NLP began as a ascination oa linguist, Richard Bandler, and a mathematician,

John Grinder. Tey wanted to encapsulate the suc-cess o various psychotherapists who had excelled in

their eld. Tey did this by looking closely at dier-

NLP in mtinAs speech and language

therapists we want therapy

to impact on a clientslie not just specic skills.

Maggie Wallis reects on the

dierence NeuroLinguistic

Programming is makingto her practice, including a

timelimited monthly groupacilitated with a palliative

care pharmacist or peopleliving with aphasia.

READ THIS IF YOU WONDER

WHY

OUR PROFESSIONAL ROLE

IS IN CONSTANT FLUX

PEOPLE CAN BEHAVE IN AN

UNPRODUCTIVE WAY

YOU SEE CHANGE

WITHOUT CARRYOVER


13/32

GROUPS


Good intentionOne o the NLP presuppositions suggests that,

when dealing with people, we recognise thegood intention behind any behaviour, howeverunproductive we measure the behaviour itsel.It suggests by so doing that the person will view

themselves in a more positive light and that ourdealings immediately become solution ratherthan problem ocused.

A woman who had experienced a stroke withaphasia in her thirties returned to our departmenttwo years later. Her lie had begun to settle and she

wished to take in hand the enormous dicultiesshe was experiencing in reading. She came withher ex-husband who had provided her with alaptop and sotware which highlighted words on apage to aid the reading process. Te program wasinappropriate and drew attention to her incapacityto do the task. However, useul pointers arose:the womans desire to work on her reading ability,

to work independently and to use the computertowards this end. Once supplied with a suitableprogram to match her current ability level, thebenets o the computer became evident withoutany need to question her original intentions.

NLP suggests that, when dealing with peoplesbehaviour, we encourage ourselves and others toregard any outcome as useul eedback and never asailure. It asks us to adopt a curious rather than criticalattitude to our own behaviour and that o others.

Following the experience o stroke, people mayeel let down by their own body and mind. NLPoers guidelines to re-establishing control overour situation, rst o all by gaining insight intothe lie o the land, then nding how to move

through it eectively.NLP employs various rameworks to better

understand our human condition.

Figure 1 The Logical Levels

Te ramework in gure 1 has been developedby Robert Dilts rom the work o Gregory Bateson.o begin to embrace change, it is necessary tomake sense o the change that has occurred.Following dramatic change the initial experienceis oten o chaos. Frameworks make it possibleto organise the story so that important elementscan be located and retrieved, recognising the levelor levels where change has impacted. Tis maypromote some sense o order and understanding

o the situation.

Figure 2 An NLP model of communication

Te model in gure 2 is commonly seenin NLP workbooks (without reerence to aparticular source). It can be a useul rameworkor understanding our own and otherscommunication. Most people have a preerred wayo expressing themselves and storing inormation,usually in an auditory, visual or kinaesthetic orm.It is possible to adapt our language to match thepreerred system o the person with whom we arecommunicating. Tis can help them eel more at

ease with us. We can also be more certain theyreceive inormation in the way we intended. It isoten possible to identiy peoples preerence inretrieving or generating inormation by attendingto such details as their eye movements and choiceo language. I once asked a voice client how heelt about his louder voice. He looked blankly atme until I changed the question to ask how hisnew voice sounded to him. He then respondedenthusiastically.

CHANNELLING / IRRIGATIONAttending an NLP course on eective commu-nication or NHS workers in the Highlands, it

interested me that such a diverse group o peoplecould be enticed to communicate, cooperate andbecome ascinated in each others behaviour whenthe ocus was diverted away rom our proessionalstatus and onto our communication skills. I waskeen to experiment with running a post-strokegroup using some o the techniques I had seenin action.

Te people I wished to target are regardedas low priority in terms o risk management.

While impairment therapy is perhaps no longerappropriate, they are discontented because theyperceive their communicative abilities havediminished ollowing stroke. I decided to oera monthly session or six months, catering orpeople rom a broad geographical area as theHighlands is populated in a dispersed way. I ranthe group with a pharmacist in palliative care whoalready had signicant experience using NLP.

Te group members had to be coping with somedegree o aphasia but able to communicate withrelative independence. Teir comprehension hadto be adequate or them to participate and benetand to understand that the intention o the group

was not to help their speech but to assist them indealing with their stroke and aphasia.

Te three males and three emales identiedwere aged rom 43 to 82 and time since the strokewas rom under 1 year to 9 years. wo lived alone

and additional physical actors included deaness

and limited mobility. Word nding dicultieswere the most obvious language impairment.

Te members brought a wide range o hobbiesincluding cooking, knitting, gardening,gol, socialising and hill walking. Some hadound their particular interests reading,

riding, writing signicantly aected bythe stroke.A specic activity launched discussion

at each session, oten with a lm snippetto demonstrate a particular issue relating to

communication, or skills that might benetcommunication. A clip rom Entrapmenteectively demonstrated how non-verbalcommunication carries more import than verbal.

As acilitators we didnt need to make this explicitand group members discussed it rom their ownperspectives. We were alert to issues arisingpertinent to the rameworks o NLP, and refectedthese back as appropriate, on occasion drawingdiagrams to demonstrate their point.

Lively discussionTe ensuing discussion was lively and containedtheories about communication in general whilstalso refecting on individual experiences beoreand ater stroke.

Group members spent a great deal o timediscussing issues between themselves, but reerredto the acilitators or specic inormation relatingto their particular knowledge base. Each memberhad skills and knowledge rom their own lieexperience which they brought to bear. Onehad been involved in adult literacy work, whilstanother had been a photographic journalist.

Another had driven ghter planes and lecturedin the RAF.

Members were willing to discuss more personalissues as the months progressed. Tey becameinterested in and observant o their own and othersabilities and behaviour. During the second sessionone member arrived having had a signicant losso temper whilst being unable to tackle a simpletask at home. His wie had temporarily movedout as a result. He observed during the sessionthe skill o another member to break state whilstdealing with similar rustration. As a result o thismodelling he was able to tackle urther instanceso rustration in a more productive way.

A healthy ascination and curiosity developed,as well as a strong bond between various members,

which motivated some to maintain contact aterthe group had completed its six month duration.

Te members became active and morecondent as they began to believe they themselvesheld the solutions to their communication issues.Tey listened eagerly to each other, and armedthe useul contributions that others made. Teacilitators did not have to take responsibility orstoking the momentum. Te members began toassert themselves as individuals beyond the labelo stroke, some even becoming aware that aspectso their stroke previously considered shameul

were now dening eatures within the new

identity they were beginning to embrace.

IdentityBeyondidentity

Beliesand values

Environment

CapabilitiesBehaviours

Experience

SeeHearFeelSmellTaste

Filters

BeliesValuesMemoriesPast experiences

DeletionDistortionGeneralisation

Internalrepresentations

ImagesSoundsFeelings

SmellsTaste

Sel Talk


14/32

GROUPS


Issues covered over the six sessions were:Signicance o non-verbal communication

Why the telephone adds stress tocommunicationPreerred ways o ltering and storinginormation or individuals

Possible eect o stroke on our preerredsystemsHow others perceive us and what we can do toalter their perceptionHow to deal with unresourceul statesTe use o humour in dispersing a xed stateHow to move rom 1st person to 3rd person tosee things more in perspectiveCommunication issues that exist or everyone,

with or without aphasiaHow our view o the world colours the issues

we regard as signicant at any one timeTe value o relating to others who share ourexperienceHow ease o communication is dependent on

whom we are communicating with and the topicVarying experiences in ability to read and

write, and the progress that can be madeEstablishing o skills and mental rehearsalprior to activity.

a)b)

c)

d)

e)

)g)h)

i)

j)

k)

l)

m)

n)

Tere were also useul discussions unrelated tocommunication. Te presence o the pharmacistenabled the members to tap into her expertise:

Te eect o stress on our body and whetherthis relates to the possibility o strokeHow the sense o sel resides with capabilities

prior to stroke and sense o lossTe useulness o particular medicationsResponding to change, as described by theKubler-Ross model (2005).We enlisted the Clinical Eectiveness eam or

NHS Highland to help evaluate the group. Teyconducted a group interview to elicit the views oall members at a specially convened session. Teirndings are in gure 3.

We attempted to measure the eects moreobjectively using the Disability Questionnairerom the Comprehensive Aphasia est (Swinburnet al., 2004) pre and post group. Tough manyresponses were interesting and revealed useulinormation about individual participants, it did

not eectively measure the parameters we wereinterested in because:

Te group had a solution ocus whereas theDisability Questionnaire is problem basedTe questions did not cater or the subtleties ochange in constructs that had appeared to takeplaceQuestions were purely about communication

whereas the groups issues extended beyondthese connes.We have continued to run these monthly groups

to good eect and hope to establish an alternativemeasure that better refects changes that mighthave occurred or individuals. Te structure o

the Communication Disability Prole (Swinburn& Byng, 2006) has the potential to refect someo the changes in attitude evident in participantscomments. As this measure looks at changes inconstructs relevant to the client at a given time itshould be possible to ascertain whether someone

rates anger, rustration or determination as mostrepresentative o their general state.

AmbienceTis group diers rom others because:

Te ambience was largely determined

by the acilitators adherence to the NLPpresuppositions.Tere was no dened structure.Group members were not actively taught or ledby the acilitators. Trough skilul questioningand responses the participants were encouragedto explore and discover their own resources and toexamine their own experience o lie using variousrameworks oered by NLP.Te skill base o each group participant (whetherclient or acilitator) was considered o equal value.Te length o time between sessions encouragedparticipants to integrate their learning andexperience into daily lie. Tey did not becomereliant on the group. Participants who lived a airdistance away could attend and, where possible,

were let to organise transport themselves topromote urther independence rom the group.Pound (2004, p.41) suggests, Allow your

therapist expertise to interact with but notoverpower the expertise o the person living withaphasia. Oer experiences and insights but donot make assumptions that they t this particularindividual. For all o us it is important tounderstand how we operate, and what we can doto improve our unctioning in any given situation.NLP ocuses on discovering as individuals where

we nd ourselves now - and our available resources- to realistically choose our destination and how to

get there. It oers the potential to consciously accessthe resources we have available in communication,to be eective in our contact with others.

Maggie Wallis is a speech and language therapist withNHS Highland in Inverness, e-mail [email protected].

1.

2.3.

4.

5.

SLTP

ReerencesPound, C. (2004) Dare to be Dierent: Te Person and thePractice, in Duchan, J.F. & Byng, S. (eds.) Challenging AphasiaTerapies. London: Psychology Press.Kubler-Ross, E. (2005) On Grie and Grieving: Finding the Mean-ing o Grie Trough the Five Stages o Loss. New York: Simon &Schuster Ltd.Swinburn, K., Porter, G. & Howard, D. (2004) Comprehensive

Aphasia est. London: Psychology Press.Swinburn, K. & Byng, S. (2006) Communication Disability Pro-fle. London: Connect Press.

Resources* Connect www.ukconnect.org* Entrapment - www.oxmovies.com/entrapment/* Lee Silverman Voice reatment - www.lsvt.org/* Robert Dilts - www.nlpu.com/

Recommended readingBurns, K. (2005) Focus on Solutions. London: Whurr.Felson, J. & Byng, S. (2004) Challenging Aphasia Terapies. Lon-don: Psychology Press.McDermott, I. & Jago, W. (2001) Brie NLP Terapy. London: Sage.OConnor, J. (2001) NLP Workbook. London: Harper TorsonsElement.

Walker, L. (2002) Consulting with NLP. Oxord: Radclie.

Figure 3 Clinical Eectiveness Team ndings

TimingAll members would have preerred meetings to bemore requent

AttendanceTransport issues were manageable, though gettingout during the winter months proved more eortulAll attended regularly unless they were prevented orgood reason

PurposeTo meet others in the same situationTo nd out how varied the eperience o stroke can beTo share and gain understanding rom otherseperiences

Benetopennesssupportat an opportune time in their livesencouraged to discuss things they would notnormally discussacceptance o each others difcultiestime available or all members to participate as theywished

Contentinitial eercise was a trigger to get them talkingmembers set the agenda themselves

eercises and discussion elt natural; more likeconversation than a training session

Facilitatorsteachers guiding with suggestionssupportivecoordinating groupnot interering or dictating the contentsumming up conversationssometimes giving a push

Outcomesimproved communication abilitiesincreased condence in dealing with strangers and insocial situationsless rustrationimprovement in dealing with eelings in relation to strokedierent understanding o how stroke had aected themdesire to continue meeting.

REFLECTIONSDO I STRIVE FOR A CURIOUSRATHER THAN CRITICAL ATTITUDETO MYSELF AND OTHERS?

DO I ACCEPT MY MENTALATTITUDE IS CRUCIAL TO THERESPONSE I RECEIVE?DO I HELP PEOPLE ACCESS THEIROWN RESOURCES?

How has this article been helpul to you? Whatare you doing to help clients nd their own

resources? Let us know via the Winter 07 orum

on the www.speechmag.com members area.


15/32

FEATURE: MULTI-PROFESSIONAL APPROACHES


Team talkS

peech and language therapists are very skilledmulti-disciplinary workers. In addition to be-ing natural communicators, the nature o the

job brings us into contact with a number odierent teams and settings. Many o us unction

within teams built around a clients medical needs orplace o education; these can be multi-disciplinary(within health) or multi-agency (health and edu-cation). Others particularly in the adult learningdisability eld are an integral part o multi-agencyteams that cross health and social care. Most recently

we have been involved in the transition to Childrensrusts in England. Tis is seeing the removal ostructural barriers between education, care, amilysupport and health to enable ormalised, ully inte-grated services or children.

It is clear that the goal o redesigning the structureo childrens services is to improve lie outcomes. AsPugh (2007, p.viii) says, Young children and theiramilies do not see their needs or early education,health care, job or housing advice in separate silos,

and neither should the proessionals working with

them. Multi-agency working was to be encouragedas the most eective way o responding to the needso service users. But the practicalities and challengeso managing such transitions cannot be underesti-mated. How do we build in proessional leadershipand support so that the quality and standard o ourindividual contribution to a multi-agency service isassured? o nd out how we might move orward,I asked eight speech and language therapists to sharetheir experience o working with other proessionals.

Coming rom a Language & CommunicationResource, Helen Dalywas used to working witheducation colleagues and parents. She eels ortunateto have been able to use that experience at a strate-gic level as principal speech and language therapistor paediatrics in Wakeeld over a period o excit-ing change. Tree years ago dissatisaction amongparents with the way speech and language therapy

was provided to schools led health and educationauthorities to organise a multi-agency conerenceand strategy group along with parents and voluntary

services. Helen says Research shows that barriers o

The advent o childrens centres in Englandheralds a massive change or public services,with all the ensuing hopes and ears. Whilespeech and language therapists are alreadyskilled multidisciplinary operators, multi

agency and ully integrated working requirea urther shit in attitude. Editor Avril Nicolltalks to Helen Daly, Christina Barnes, JudithDelve, Kate Evans, Karen Bonham, GerryWalsh, Hayley Dench and Karen Daviesabout their eperiences.

READ THIS IF YOU WANT TO

MOVE CONFIDENTLY TO MULTIAGENCY WORKING

BREAK OUT OF TRADITIONAL WAYS OF WORKING

INFLUENCE BUDGET HOLDERS AND COMMISSIONERS


16/32SPEECH & LANGUAGE THERAPY IN PRACTICE Winter 200714

terminology, training and practice need to be over-come. We have gone rom a airly ragmented to avery collaborative service, with people really workingtogether to benet all children. Parents seem happierand as a clinician I eel more condent in my role.A raining Plan or teachers, outreach teams, the

diversity service and educational psychology nowcovers speech / language and social communication/ interaction. Trough I CANs audit tool Schoolalk, (www.ican.org.uk) schools identiy their train-ing needs, while Bradords alking Partnersproject(www.bradordschools.net) orms the basis o jointtraining to schools rom speech and language thera-py, educational psychology and the advisory service.

An outreach advisory teacher in language and com-munication works alongside speech and languagetherapists. A Post Graduate Certicate o Educationin collaborative practice or teachers and speech andlanguage therapists has started at the University oCumbria in Wakeeld and Helen hopes this willspawn outcome evaluations.

With strong leadership, training and a sharedphilosophy, expectations and responsibilities in

Wakeeld are shiting. Down in Wiltshire, Chris-tina Barnes also works with education services. As amember o the South Wales and West Special InterestGroup in deaness she took a lead role in developingcare pathways or assessment and intervention withchildren who have a hearing impairment (Barnes,2004). Tese continue to be amended to suit localcircumstances such as availability o specialists. Par-ents and other proessionals eel happier because theyare clear about the levels o service delivery when,

who, what to expect. Tis has been particularly help-ul in relation to working with teachers o the dea.

Christina nds care pathways help parents and otherproessionals adjust to the realisation that once aweek therapy with a specialist may not be the mostappropriate input or the child. Instead, the specialisttherapist is seen as one contributor to the creationo a 24/7 enabling environment. Te care pathwayshave training built in, and the training oered toteaching assistants includes a piece o refective writ-ing about the impact o their learning on how theyare able to support their named pupil.

Christinas vision is or needs centred care pathwayswritten alongside specialist teachers which wouldhelp identiy the lead / responsible person at dier-ent times. She muses, Perhaps education could getmanagement support and time to write their own

care pathways rst, then we could work on bringingthem together?

Care pathways have also been transormative orJudith Delves stroke team and consistency o pro-vision across district general hospitals in Shropshire;although this is largely a multi-disciplinary ratherthan multi-agency service, the results suggest carepathways could be equally useul in a multi-agencycontext. Judith emphasises the value o ace to acediscussion to eective multi-disciplinary working, butadds that care pathway paperwork lends itsel to auditto ensure standards are being met. Te Royal Collegeo Physicians Guidelines on Stroke and the NationalSentinel Stroke Audit Programme (www.rcplondon.

ac.uk) have been a really positive driving orce. As

well as highlighting the need or improved clarity onote keeping, audit results have provided evidence ora bid to train nurses to screen or dysphagia within24 hours o admission. Although team members atthe coal ace were already working well together, carepathways have raised the prole o the proessions

contribution with nurse managers and consultants.

Think positivelyJudith reckons that, Local guidelines oten refectavailable stang. Te only way in the modern NHSto keep standards up is through a national organisa-tion with a lot o power saying what we are expectedto deliver. While targets may seem unattainable,you can think positively about the rationale behindthem and how you can go some way towards meet-ing them perhaps through oering training or de-veloping inormation leafets.A settled sta with good leadership helps create

a fexible approach to joint working. Judith ndsjoint assessments particularly useul, noticing cli-

ents can communicate dierently or exampleduring a physiotherapy session in the gym. InGloucestershire, Kate Evans also shadows clientsin dierent environments, and a calming sensorysession with an occupational therapist can carryover to a communication session.

Kate works in two 8 bedded in-patient unitsor adults with learning disabilities who have ad-ditional mental health, autism or challenging be-haviour needs. Not only is multi-disciplinary andmulti-agency working an aspiration, Its the only

way we can work! Care pathways are again seenas crucial, to the extent that the rust has a care

pathway co-ordinator. Kate says, Care pathwaysput the client at the centre and stop us being in ourlittle ivory towers.

Te team uses the East Kent Outcomes Systemmodel and the ocus rom the start is on agreeing acore aim enabling the person to be discharged. Eachproessional says what they will do to enable this tohappen. Within the team the communication assess-ment is recognised as a priority so other proession-als know how to communicate eectively with theperson in terms o levels o understanding, expres-sive ability and whether additional strategies such asvisual material are needed.

More radically, a New Ways o Working coner-

ence has turned a nursing recruitment problem into

an opportunity or newly qualied proessionalsrom other disciplines. Nursing money is unding aband 5 newly qualied speech and language thera-pist or two years to work a ull shit system. Tegoal is to get eective communication at all timesthrough modelling. Initially the nursing team elt

threatened but they now eel more positive, and seeit in terms o supporting clients. Kate is supervi

speech & language therapy in practice, winter 2007

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