SLT Jokes: A Humorous Photo for the Day

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]

Dysphagia, AAC and Autism (The Autism Show!)

Yesterday, both myself and some fellow MScSLT peers attended The Autism Show in London's Excel.  It was both inspiring and eye-opening! I was able to attend several talks from a range of professionals, parents and individuals with autism and was exposed to new insights into communication and sensory issues as related to autism. I also saw 2 SLTs from the Hesley Group talk on the topic "Dysphagia and Autism" - As we have yet to cover dysphagia or anatomy in the course (yes, I bet you are shocked that 10 months in we have yet to cover this!) I found this a wonderful insight into the "normal" swallow and also some red flag indicators that are commonly seen in individuals with autism at eating and feeding times.  The sensory issues that accompany foods are essential to take note of - many individuals with autism have heightened or reduced sensory impacts compared with "typical" individuals and as such new tastes and textures will be unpleasant to them.  This can cause negative associations with mealtimes and can lead to poor nutrition.  Another factor that may be cause for concern that is often common in autism is Pica.  This is the eating of non-food substances and can affect both nutrition and diet but can have an impact on internal systems such as the oesophagous and stomach.  So, a very interesting talk to attend and fascinating to meet new SLTs and discuss ASD with them. 

The highlight of my day has to be the wide variety of AAC devices available to both experience hands-on but also to purchase.  Both low and high tech devices were on show and a range of different companies promoting both symbol, written and picture based devices.  As I have seen a range both working in playschemes with children with autism, but also as an SLT Student in placement it was fascinating to talk to the creators and directors of these companies to get their view on AAC.  One sales rep (for the AAC company Dynavox) even remarked that he was not there as a sales rep and was not concerned with how many sales he made, his goal was to make sure people had the opportunity to experience different AAC types hands on.  He stated that it is more important to be aware and familiar with the AAC devices that we may one day be recommending.  He even offered to do a one day talk at University! So I look forward to him demonstrating and allowing us to experience a range of low and high tec devices that his company recommends.

I was then able to get my hands (or should I say eyes?!) on trialing a piece of eye gaze software.  Now, before this opportunity I had heard of eye gaze AAC devices and seen pictures of these, but never had I seen a service user with one nor attempted to use one myself.  So straight away I burst up to an unsuspecting rep and said "please can I try it?" whilst trying to explain I was a SLT student currently with a BIG interest in ASD.  He agreed and set me up with a programme that made pretty dots dance around the screen as a result of where your eyes pointed.  Now I strongly recommend that anyone who is from an SLT, to an OT to a health care professional, to a carer, anyone working with a client with an AAC device, should try out the device and experience it for themselves.  There is no better way to learn how another person copes with life than by stepping into their shoes. So this is what I did. And my gosh was it hard! We may take for granted sometimes that if a client has access to a AAC device that that must mean its working for them.  This may not be true at all! I found that using the eye gaze softward took a lot of concentration, a lot of patience and a lot of staring very still for a long time. And I'd be as bold as to say I have good eye co-ordination! So you can imagine for many AAC users out there that a co-morbity of diagnosis' may occur and eye co-ordination may not be a strength of theirs, or even those with fantastic eye co-ordination but have un-patient personalities. 

So what this really taught me was that AAC devices can talk the talk and claim to be the best, but the only way a particular device can be the best is individually and unless a certain individual works well with an AAC device and states a preference for one over another, the companies cannot claim that one is more beneficial than another! We, as SLTs, need to ensure that the AAC device that is given to a client is one that is well suited to both their speech, language and communication needs, but also their personalities!

 

Though it is stated frequently that Autism is a spectrum, therefore the nature of each diagnosis is individual and just like snowflakes no two people with autism will present the same - it takes a day like this to prove just how true that statement is!

The Autism Show was definitely a thoroughly interesting and eye opening (and eye gazing!) day out that I recommend to anyone with an interest in the field of Autism! I am only disappointed that I could only attend one day out of the two days that this show was held for!

Feeling Inspired

Recently on Placement I have been engaging in Intensive Interaction and Attention Bucket. So I felt it best to go read up on both of these, find a solid evidence base and have a complete holistic view of both of these approaches.

So I was quickly led to a therapyideas blog all about Gina Davies' speech at a conference detailing how you use the Attention Bucket.  Well it sounded inspiring so I went in search of a similar video on youtube and ended up at a brilliant website "Attention Autism".  On that page was some information about Gina Davies' most recent speech, of which is 5 minutes talking about how to inspire attention in children, and it utterly completely inspired me!

My current placement is 4 days per week for 5 weeks and each day I have a different setting - so Monday is Early Years, Tuesday is Mainstream, Wednesday is a SLCN unit, Thursday is a SEN school.  And this has really got me in a muddle as to where I want to go and what I want to do as an SLT.  Its been a brilliant experience and I feel I've had my eyes open to so many wonderful different experiences, but finally I feel inspired - and it's come from a 5 minute video! I just wish I had more time to spend in the SLCN unit and the SEN school to really dig my hands deep and get a complete feel. I have 2 more weeks to go, so 4 more days within the SLCN and SEN settings and then it'll be a long wait till I am qualified - but that means getting my head down and completely whole-heartily researching about working with children with Autism and MLD/PMLD children. 

Though my head feels it may explode after today, and this week (what is a very short week for me thanks to the bank holiday!) - I feel inspired to keep on learning! I believe I've come such a long way since September '11, and will continue to grow and learn!

And for any other SLT students out there that may occasionally feel less than inspired to continue with the hard work and the long hours - watch Gina Davies; I can guarantee you will be inspired.

ACE Centre + Theraplay: What they have in common.

In a time of such political change, and the current campaigns such as the Giving Voice - it surprises me to read of all these centres that are about to close!

Talk to any parent that has a child with a Speech Language or Communication need and they will tell you how invaluable SLTs are to their life's and to their children's. 

Talk to any educational staff member, they will also vouch for the lack of SLTs and how necessary it is for more to be put in place.

Yet here we are, with many centres that offer support and a sense of community closing down! 

I am devastated and somewhat saddened that places which give so much to the community, are being closed and the effect that has on these children is huge.  Recently the case of the ACE centre in Oxford, where many have petitioned and raised awareness of this amazing centre and its soon-to-end future, but now we hear that in West Sussex another SLT centre is to close! Its just appalling - talk to people and they will tell you that they are in high demand and need for SLT support, but yet the funding, the jobs and the centres are non-existent! I think its about time we start fighting for not only our jobs, but our children!

It's necessary to be constantly aware of how changes like this are occurring and how they effect the perception of the therapy role - so lets get out there and raise our voices to promote the Giving Voice Campaign. Where would you be without your voice?


Links
BBC News - Theraplay to close

ACE Centre Closing

Thinking before Speaking

So, today's hurdle was one that I suspect many, if not most, SLTs go through on a daily basis.  The tactical way to approach parents.

This week I've sat in on many Annual Reviews of which the parents have all been in attendance (hooray no DNA's!) and have written a couple of end of year SLT Reports.  My biggest hurdle has been altering my communication - and I'm sure non-SLTs that may have stumbled across my blog are thinking - "but aren't you an expert in communication?" - well it still proves difficult from time to time, that's the honest answer!

I've had to adapt my writing style to be able to discuss the child's difficulties in a positive light, whilst still being realistic about the child's progress over the year and where the child's problems lie so that relevant support stays in place - and this sounds easier said than done! All technical lingo goes out the window and everything you could say face to face is too informal. 

But then in face to face scenarios you have to tread even lighter! At least if you write something in a report that you think doesn't sound positive enough, or you need to rephrase a sentence detailing the child's progress to still provide motivation to continue with the therapy, you can just delete and re-write! However, in a face to face meeting you really have to be wary of thinking before speaking - something that I don't tend to do in my day to day life! And each set of parents is different - the up-front and honest approach might work for some, but for others a different approach may be necessary - so tread lightly!

But both the annual reviews and the reports were a success - in relative terms mind you!

So its definitely my thought of the day: how we as SLTs need to learn to adapt our communication for the audience (in this case the parents!!) - something that many of our children and young adults with Speech, Language and Communication needs struggle to do.  It's eye-opening to even spend a second in their shoes - not being 100% sure that what you say is going to be taken in the right way and worrying if you will be able to make your point understood, and having to have that pause to really think before you speak, something that these children are challenged with every time they want to communicate!

Communication is a powerful tool so we all need to think before we speak!

SLT & Social Networking

I began my MSc in September 2011, and one of the initial thoughts was - set up a Twitter account.  This thought occurred to me as I realised that with the lack of evidence base that the job role has there was an ever changing policy and practice based on new research and contemporary clinical reasoning - So I really needed a fast way to access this and began adding everyone and anyone with "slt" or "slp" (speech language pathology!) and any notable names in the research field of speech, language and communication.

Having found a wealth of information, and a fantastic way to brainstorm, problem solve and the ability to communicate with SLTs from UK, Ireland, America, Canada and even as far as Australia, I can safely say that Twitter has me hooked! Ok sure, I have the odd band or stand up comedian on my list - but the moment I sign on, I scroll through the latest updates - then proceed to search for my favourite hashtags! And for any of you SLT's to be (or just those new to Twitter), I recommend a look at the following hashtags:

#SLPeeps

#SLP2B (or in lower case #slp2b)

I've been able to discuss a range of things with my followers (and fellow SLT's) from speech interventions that work best to different types of formal and informal speech assessments and have even received help and support about my upcoming essay titles!  I feel like I have a SLT family to support and guide me when needed and am even beginning to offer my own suggestions and views based on clinical practice within placement.  With the development of modern technology, both networking with other professionals and the promotion of the profession to others is now accessible to everyone and anyone!

Ok so the downside might be that I tend to spend a portion of my "study" time ever-so slightly distracted by twitter, my blog, facebook etc.  But the benefits in this case, definitely outweigh the cons!

So for all you modern day SLTs, whether you are a student or not - get on to twitter! And when you do, follow me - you can guarantee I'll follow you back!