Consulation as a model for SLT

The Bercow Report (DCSF 2008) states that in the UK more commonly than not in Mainstream Primary school teams a consultative model of management is used. This sees SLTs writing a programme of therapy and providing the school with the relevant resources to engage in the therapy activities, thereby reducing the level of SLT direct input.

I am currently writing an essay that is based on a child that is on my hypothetical caseload. He is 5;06, attends a mainstream, and has a diagnosis of limb dyspraxia, severe verbal dyspraxia, and moderate learning disabilities. Though he is able to communicate via Makaton and can express 2-3 word phrases and understands Makaton supported 3-4 word phrases, his speech is unintelligible.   We have been given information regarding our job, in that we work for 1 and a half days per week, and currently have a caseload of 45 children in a 50x50 mile geographical span.   Now, we are given 3 options of management strategies to select ONE from. They include: regular direct therapy, SLT programme and review or parent and teaching staff training including a programme and review.

My gut instinct is indirect therapy of some kind.  He is able to communicate his needs through the mean of Makaton, and is able to understand WHEN supported with Makaton. So my thinking is that we need to promote the use of Makaton within the school and support the teachers with curriculum alterations and Makaton integration.

This means I have just fallen into the very same scenario that the Bercow Report refers to. The trap of the consultative model.

Now I also happen to be currently working on a presentation based on the McCartney et al. (2011) paper that researches the benefits between direct and indirect therapy. There I have come to unearth that expressive language improvements have been significant when direct therapy with a SLT occurs.  When indirect therapy is used, the interventions are rarely followed  and complied with as the SLT suggests that should be, and intervention is often subjected to issues of time available in a school day, finance of relevant teaching support and the issue of child and staff absences.

I find it intriguing that the Evidence Base suggests how strongly results can be seen when working directly with an SLT and yet the common practice, and even my own judgements are to work consultatively.

One thing that the McCartney et al. (2011) paper suggests is that IF the common practice in the UK is that of the consultative model, then a newly developed and improved model of consultative practice is required to be developed in order to produce similiar (if not the same) results as SLT direct therapy. So I think 2012 is the time to start working toward better consultative practice! We need to reduce risk factors and put in better scaffolding for working together - the gap between Health and Education is closing, but we need to continually work to ensure that the best duty of care is given to both the children and the teaching staff we work with!

References

McCartney, E. , Boyle, J., Ellis, S., Bannatyne, S. and Turnbull, M. (2011) Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention International Journal of Language and Communication Disorders 46 (1) 74-82

Department for Children, Schools and Families (DCSF) 2008, The Bercow Report: A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Needs (London DCSF) <available at: http://www.dcsf.gov.uk/bercowreview> [accessed on 17^th June 2012]