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ISSN 1368-2105

ISSN 1368-2105 Summer 2006 www.speechmag.com EXPLORING SPACES Partnership in profile Working with teachers and parents

Summer 2006

ISSN 1368-2105 Summer 2006 www.speechmag.com EXPLORING SPACES Partnership in profile Working with teachers and parents
ISSN 1368-2105 Summer 2006 www.speechmag.com EXPLORING SPACES Partnership in profile Working with teachers and parents
ISSN 1368-2105 Summer 2006 www.speechmag.com EXPLORING SPACES Partnership in profile Working with teachers and parents

www.speechmag.com

ISSN 1368-2105 Summer 2006 www.speechmag.com EXPLORING SPACES Partnership in profile Working with teachers and parents

EXPLORING SPACES

Partnership in profile

Working with

teachers

and parents

ShowandTell

- making

information

accessible

PLUS

The

The space between:

Addressing speech issues

HowI used a systematic approach for

• Aphasia

• Phonology

And featuring ‘Male’communication

Application key…Here’s one I made earlier…Recommended reading…

and My Top Resources – from people with Parkinson’s Disease…

Reader offers

WIN TALKING MATS® BOOKS WIN NDP3 (2004) The Nuffield Centre Dyspraxia Programme has been completely
WIN TALKING MATS®
BOOKS
WIN NDP3 (2004)
The Nuffield Centre Dyspraxia Programme has been completely
updated and revised – and we have TWO copies to give away FREE to
lucky readers or departments.
This 3rd edition includes a detailed therapy manual, an oro-motor and
speech assessment procedure, photocopiable therapy
worksheets and therapy picture cards.
NDP3 with NDP Therapy Cards usually retails at £228 + shipping. For
your chance to win a copy, e-mail your name and address to Speech
& Language Therapy in Practice editor Avril Nicoll (avrilnicoll@speechmag.com) or
post to her at: 33 Kinnear Square, Laurencekirk, Aberdeenshire AB30 1UL.
The closing date for receipt of entries is 25th July 2006 and the winners will be
notified by 1st August.
For details about NDP3, see www.ndp2004.org.
Talking Mats® is a research-based low tech communication tool designed to help
anyone with communication difficulties think about issues and express their
opinions effectively. Talking Mats® developers Joan Murphy and Lois Cameron have
written a book to explain its uses, incorporating the knowledge and ideas they have
gathered from clinical research, practice and training courses.
Talking Mats® - A Resource to
Enhance Communication usually
retails at £14.99 but you can win
one of THREE copies – FREE!
To take part, simply send your
name and address to: Linda
Tierney, AAC Research Unit,
University of Stirling, Stirling
FK9 4LA, or e-mail linda.
tierney@stir.ac.uk.
The closing date for
receipt of entries is 25th
July 2006 and the
winners will be
notified by 1st August.
For more details about
this and other Talking
Mats® resources, see www.
talkingmats.com.
The lucky winners of Barbara Prashnig’s ‘Learning Styles in Action’, offered in our Summer 06 issue courtesy of Network Continuum Education, are Kim Williams (Salford),
Jane Baker (Kingsteignton), Liz Fairweather (Cupar), Janice Maughan (Guiseley) and Julie Phillips (Manchester). Congratulations to you all!

Summer06speechmag

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Practice, e-mail avrilnicoll@speechmag.com.
Your details will not be passed to any third
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Westaway, A. (2005) ‘Signing up to inclusion’, Speech & Language Therapy in Practice Autumn, pp.7-9. Online at www.
speechmag.com/archives/annawestaway.pdf
Heneker, S. & MacLaren Page, L. (2003) ‘Functional communication: the impact of PECS’, Speech & Language Therapy in
Practice Autumn, pp. 12-14. Online at www.speechmag.com/archives/impactofpecs.pdf
If you want to find out more about some of the topics in this magazine, you may be interested in the following articles
from earlier issues. Remember, if you don’t have access to them, check out the abstracts on www.speechmag.com and
take advantage of our article ordering service.
Partnership
(305) Child, C. (2005) Getting the message. Spring: 4-6.
Aphasia
(050) Armstrong, L. & MacDonald, A. (1998) Augmentation or extra effort? Using computers
with people who have aphasia. Winter: 15-17.
(194) Wade, J. & Woodward, S. (2002) This is IT. Summer: 13-16.
Phonology
(221) Bowen, C. (2002) My Top Resources. Winter: back page. Online version available
FREE at http://members.tripod.com/Caroline_Bowen/topten.htm.
(020) Ogilvie, M. (Emphasising communication); Stanbury, R. (Maintaining motivation);
Williams, P., Corrin, J., Colebourne, S.J., Burrows, S. & Friel, S. (A specialist opinion). All in
(1997) How I manage speech sound difficulties. Winter: 24-28.
Gender
(226) Earle, S. (2003) Barbie & Ken: an unequal relationship. Spring: 21-22.
Accessible information
(308) Nicoll, A. (2005) The write stuff? Spring: 14-16.
IMPROVED CUMULATIVE
INDEX FACILITY
Our cumulative index facilitywill soon be database-driven! This means you
will be able to search for articles from the Spring 2004 issue by author, title
or text, and we are also grouping articles under new categories. (The index
of abstracts from Summer 1997-Winter 2003 is still available online. You can
search it by author, category or through using the speechmag site’s search
facility.) When you find an abstract that inspires you, you can order a copy
of the full article for a small charge via our secure server.

www.speechmag.com Pay us a visit soon.

contentssummer06

Cover photo: Paul Reid. Posed by models.

SUMMER 06 (publication date 27/05/06)

ISSN 1368-2105

Published by:

Avril Nicoll 33 Kinnear Square Laurencekirk AB30 1UL Tel/fax 01561 377415 e-mail:

avrilnicoll@speechmag.com

1UL Tel/fax 01561 377415 e-mail: avrilnicoll@speechmag.com Design & Production: Fiona Reid Fiona Reid Design

Design & Production:

Fiona Reid Fiona Reid Design Straitbraes Farm St. Cyrus Montrose Angus

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Editor:

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Tel / fax 01561 377415

©Avril Nicoll 2006 Contents of Speech & Language Therapy in Practice reflect the views of the individual authors and not necessarily the views of the publisher. Publication of advertisements is not an endorsement of the advertiser or product or service offered. Any contributions may also appear on the magazine’s internet site.

4 COVER STORY:

THE SPACE BETWEEN

“I reasoned that the difference(s) between what Jason

could and couldn’t say would provide a basis for treat-

ment. So I took a word Jason couldn’t say, and changed

it to something he could say. We continued this process,

gradually moving closer to the target, until he could say

it correctly. Each change produced a nonsense word, but

a possible one nonetheless.”

Aubrey Nunes explains ‘feature prosodic therapy’, where a child with a speech disorder and their thera- pist explore the space between what the child can say

and what they can’t.

INSIDE COVER

SUMMER 06 SPEECHMAG

Win the Nuffield Dyspraxia Programme (NDP3) and Talking Mats® – a Resource to Enhance Communication Also see reader offer for the new Communication Development Profile on p. 10

READER OFFERS,

2

NEWS / COMMENT

8

PARTNERSHIP IN PROFILE

“Right from the initial transition meetings, parents are clear about what their child needs and recognise the value of interaction approaches, and teachers are clear about their role and responsibility and how the child will be supported by the speech and language therapy service when in school.” Charlotte Child reflects on the inspiration, theory and life experienceunderpinningher newly-publishedCommunication Development Profile - and explains how it has led her to a genuineandrewardingpartnershipwithteachersandparents.

11 HERE’S ONE I MADE EARLIER…

Alison Roberts with more low-cost therapy activities:

Binocular game; Wedding cake game.

12 REVIEWS

Collaboration, group work (adults; literacy; learning), speech disorder, literacy, software, stammering, signing, adolescents, autistic spectrum disorder.

14 FEATURE

FROGS AND SNAILS AND PUPPY

DOGS’TAILS?

“In researching this topic it quickly became clear that, even where boys and men do not have a communication impairment, there are general ‘male’ communication issues that impact on many areas of life – learning, interacting with others, even health.” Could we improve therapy outcomes if we had a better understanding of why and how male communication can be different? Editor Avril Nicoll finds out what little (and not so little) boys are really made of.

17 RECOMMENDED READING

Dysphagia; collaboration with educational psychologists.

18 KEYS TO WINNING WAYS SERIES (7)

THE APPLICATION KEY

“I observed the non-stop asking of questions by curious well wishers and loving friends and relatives and learned not to ask. “How are you?” “Are you in pain?” Are you being sick”? “Are you sleeping?” “Have you lost weight?” - all un- derstandable, but so wearing if answered twenty times a day.” Life coach Jo Middlemiss did not choose the sad circumstances surrounding this article. But it felt an appropriate time to explore the toughest challenge of all – the application of her keys at a time of loss.

20 CONFERENCE CALLS

SHOW AND TELL

“All participants were invited into small groups to discuss fun- damental questions posed by the conference working group:

1. What information is being made accessible?

2. Why is information being made accessible?

3. What are the risks / pitfalls of making information accessible?

4. What is being done to reduce these risks / pitfalls?”

As demand for accessible information grows, Alison Matthews and Rachel Samuels report on a multi-agency event that kick-started a north west of England forum for sharing good practice.

24 HOW I USED A SYSTEMATIC

APPROACH

Our authors explain their choice of a systematic and finely graded therapy programme for their clients and highlight the importance of timing when making management decisions.

(1) THE RIGHT TIME TO ACT

“Mr McDonald expressed through his wife that he now wished to explore new possible communicative means as an alterna- tive to his impaired speech production…[and] we agreed that his written language expression would be the focus of the next block of therapy.” Ideals of client-centred goal negotiation, outcomes that really make a difference and effective use of limited therapy time can be challenged when we are working with clients with chronic severe aphasia. Linda Armstrong and Jaclyn Dallas discuss the benefits and limitations of introducing a client to Beeson’s Anagram and Copy Treatment and Copy and Recall Treatment protocols.

(2) NEVER TOO SOON TO START

“Caelan took to the programme like the proverbial duck to water. Although features of social communication disorder were less obvious than previously, Caelan still liked routine and predictability. The routines of practice and therapy there- fore worked well for him.” Heather Saunders on why she believes the third edition of the Nuffield Dyspraxia Programme was the key to improvement made by Caelan, a preschool child with autism and verbal dyspraxia.

BACK COVER MY TOP RESOURCES

“Parkinson’s is a very individual condition, and many people living with it tell us they feel that health professionals do not know enough about it.” The Parkinson’s Disease Society ask people with Parkinson’s disease to think about the resources they value most in a speech and language therapist…

IN FUTURE ISSUES…DYSARTHRIA

APHASIA

SOUND THERAPY

USER

INVOLVEMENT

STAMMERING

NEWS

Return to practice process

Following consultation, the Health Professions Council has published its process for returners to practice. Under legislation the Council cannot carry out indi- vidual assessments of returners’ requirements, but in- stead must provide information in a way that enables a returner to identify what is required of them. From July 2006, for people with 0-2 years out of practice there are no requirements, while 2-5 years needs 30 days of up- dating and 5 or more needs 60 days. The updating pe- riod should be structured to include supervised practice, formal study and private study, and must be completed within 12 months immediately preceding the date on which they apply to be readmitted to the register. Policy Manager Rachel Tripp explained, “Health pro- fessionals may take a break in their practice for many reasons. It is vital that we set up a system which allows these people to return to the Register, and to update their knowledge and skills in a personal way which combines flexibility and public protection, so that they can then re- turn to the workplace as safe and effective practitioners.” www.hpc-uk.org

Wanted: autism advocates

The National Autistic Society Advocacy for Education Service is compiling a database of speech and language therapists with an interest in and experience of working with children on the autistic spectrum. Information on this database will be made available to people with au- tistic spectrum disorder and their families. The service provides advice, information and support to enable parents who have children on the autistic spectrum to get the most appropriate educational provision for their child. It aims to empower parents to make informed choic- es and decisions about their child’s education. To be included email advocacy@nas.org.uk with the sub- ject ‘Speech and Language Therapist’, write to Advocacy for Education Service, 393 City Road, Islington, London, EC1V 1NG, or call 0207 903 3664.

Media message

The Health Professions Council is looking for people to take part in its ongoing media campaign which asks members of the public to make sure they are using reg- istered health professionals.

If you would be happy to talk about the importance of

being a registered health professional, or if you have treated someone who previously received unsatisfactory

treatment from an unqualified practitioner, the Council would like to hear from you (e-mail casestudies@hpc- uk.org with your name, profession, contact details and

a summary of your experience). Public information leaf-

lets, car stickers and posters are also available. All registrants with the Health Professions Council will be recording their continuing professional development from 1 July 2006. www.hpc-uk.org

Call for more MS specialists

‘Therapists in MS’ are calling for an increase in specialist therapy provision to improve quality of life and reduce hospi- tal admissions in people with multiple sclerosis.

A project group, which includes Aberdeen based speech and language therapist Clare Laing, says there are only

around 100 suitably qualified therapists in the UK, and that specialist therapists will have to take on a greater role if National Institute of Clinical Excellence guidelines on MS are to be successfully implemented.

In

a report issued by the MS Trust, the group lists‘a passion for MS management’ among the key competencies of special-

ist

therapists. They recommend that assessments should take place in the home environment and that therapy services

should be holistic, covering work, leisure and personal care, and showing good knowledge of available local resources. They say that speech and language therapy services in particular should be available early enough to prevent a crisis and that there should be timely provision and review of assistive technology and equipment. Treatment should be goal orientated and specialist therapists should have training so they can discuss the impact and management of loss. Shortly after this report was released, the MS Trust drew attention to the financial threat to over a quarter of existing MS Specialist Nurse posts. Spokesperson Nicola Russell said, “We are worried that MS may be seen as a soft target for cost-cutting because it has a lower profile than some other diseases. It is outrageous that people with MS, who are already vulnerable, are being penalised for shortfalls within the NHS.” www.mstrust.org.uk/downloads/therapists_in_ms.pdf

Therapists in MS launch their report. (Clare Laing is in the centre at the back.)
Therapists in MS launch their report. (Clare Laing is in the centre at the back.)

Nuffield consultation ends soon

Speech and language therapy views are being sought on the future of the Nuffield Speech and Language Unit in Ealing. While the Royal Free Hampstead NHS Trust is undertaking a public consultation on the future of the specialist unit, it favours the option of closure, citing changes in referral patterns and funding disputes as a result of the political drive for local provision and inclusion. The unit provides intensive, specialist speech and language therapy and teaching to up to 14 children aged from four

to seven years who experience such severe difficulties that their needs cannot be met by local services. The typical

length of stay is two years, when over 40 per cent of the children go on to mainstream education. The issue has been debated in Parliament, where questions were raised about the integrity of the consultation proc- ess and responsibility for specialist, national services. John Bercow MP also pointed out that “the unit is inextricably bound up with the Nuffield hearing and speech centre, which receives some 40 requests each week—from parents and professionals, by telephone, e-mail and post—seeking advice on speech therapy”. Concern has been expressed that, should the facility close, it would be impossible to retain the level of expertise and experience it offers. The consultation period closes on 30th June and the decision will be made at the end of July. www.royalfree.nhs.uk/ealingconsultation/Nuffield_consultation.pdf

Speaking and listening from the start

The independent review of the teaching of reading in early years settings and primary schools has called for more attention to be given right from the start to promoting speaking and listening skills. While general media interest in the Rose report has centred on its support for synthetic phonics, the children’s communication charity I CAN has welcomed its emphasis on language and communication as key components of literacy development. They said that, while they recognise the importance of synthetic phonics as an approach to de- veloping literacy, the emphasis on the need for a range of interventions to meet the needs of all children is “of particular importance to children with communication dis-

ability who have specific difficulties with learning to read and for whom the interaction between different routes to literacy through language is often unusual and complex.” From September 2006, I CAN in partnership with service company SERCO will offer a range of online learning tools and training to support the assessment and develop- ment of speaking and listening skills of pupils in key stages one and two. I CAN’s existing programmes include Early Talk, which focuses on supporting the de- velopment of all children’s communication in preschool settings and provides a model

of excellent practice to meet the needs of the one in ten children with a communica-

tion disability. By 2008 I CAN will be working in partnership with 56 local health and education authorities to reach 60 000 children through Early Talk, providing advisory support, service standards, staff training and information for staff and parents. www.ican.org.uk Note from the Editor: Interestingly, the Rose report calls for“greater technical skill from the teacher in enunciating phonemes, as well as an understanding of why this is so important.”While the meaning behind the example given will be welcomed by speech and language therapists, it may also leave them scratching their heads wondering where the /r/ appeared from: “When sounding out (segmenting) words such as ‘cat’ and ‘bat’, the teacher frequently stretched the consonants, for example by adding the sound‘ur’. What the children heard was‘cur-a-tur’and‘bur-a-tur’thus they found blend- ing (synthesising) the sounds (phonemes) for‘cat’ and‘bat’ unnecessarily difficult.” www.standards.dfes.gov.uk/rosereview/report.pdf)

Aphasia award

Speech and language therapist Anne Whitworth has received a Health Foundation Leading Practice Through Research award.

A Senior Lecturer and Director of Clinical Education at the University of Newcastle

upon Tyne, Anne receives personal development training to enhance her leadership skills and over £130,000 to develop a range of effective therapies for people with apha- sia. The project will focus on 20 clients who experience difficulties with comprehension

or combining words into sentences and evaluate the ability of different strategies to

produce improvements in language processing skills.

Anne said, “This award will allow me to test out hypotheses concerning how language

is impaired in the event of neurological damage. It will show whether different un-

derlying deficits respond differentially to specific therapies.” She added, “The project aims to provide evidence for developing effective integrated aphasia therapies which will fully consider people’s competence, confidence and ability to function in everyday situations. I believe it will make a major contribution to aphasia research and empower other professionals to improve the service they provide to their patients.” www.health.org.uk

Cheers?

A research report from the Mental Health Foundation suggests many adults in the UK

are using alcohol to deal with feelings of stress, anxiety and depression - and that ex- cessive drinking increases vulnerability to a range of mental health problems.

The researchers report that there is a significant relationship between job stress and alcohol consumption, and that people drink more when they experience moderate to high levels of shyness or fear. The Mental Health Foundation believes that the public has a right to information about the hazardous effects that alcohol misuse can have on their mental as well as physical health. www.mhf.org.uk

comment

NEWS AND COMMENT

Exploring

spaces

www.mhf.org.uk comment NEWS AND COMMENT Exploring spaces When Jo Middlemiss (p.18) arrived at a natural hiatus

When Jo Middlemiss (p.18) arrived at a natural hiatus in her work commitments she assumed she should immediately set about closing it. However, experience has reinforced for her that we all need to ‘mind the gap’ and ask ourselves what it might be for. On the other hand, when we realise something needs done, we may have to create the space. For Alison Matthews and Rachel Samuels

(p.20) this took the form of a forum for sharing ideas and good practice in the production of accessible information. Challenged by older children with speech issues, Aubrey Nunes (p.4) reasoned that the space between what they could say and what they couldn’t say would provide the answers. Therapist and child explored a large number of possible words together and what had been impossible became possible. Our feature on male communication (p.14) finds that such ‘no failure’ approaches may be particularly appealing to boys. At one point it seemed impossible to Charlotte Child (p.8) that the space between speech and language therapy, education professionals and parents was anything other than a black hole. But several defining moments – and a lot of hard work – later, her Communication Development Profile is shedding light so that everyone can understand each other and work together. Charlotte mentions that exhilarating feeling when you know you’re onto something, which Heather Saunders (p.27) also clearly understands. With verbal dyspraxia occupying the space where expressive language should be, she explains why she believes the new Nuffield Dyspraxia Programme was the launching pad her client Caelan needed. An equally structured approach helped Linda Armstrong and Jaclyn Dallas (p.24) negotiate a client and his family towards discharge so that the space left would not feel like a void. In addition to creating such space for joint planning, we need to give ourselves room to reflect on what clients tell us about our service, and use this information to make it even better. With this in mind, our top resources (back page) are from people with Parkinson’s disease telling us what they most value in a speech and language therapist. As our designer tells me, for the magazine to make sense and be read, its spaces are as important as its copy. So whatever your circumstances, go boldly – and mind that gap.

your circumstances, go boldly – and mind that gap. Avril Nicoll, Editor 33 Kinnear Square, Laurencekirk

Avril Nicoll,

Editor

33 Kinnear Square, Laurencekirk AB30 1UL

tel/ansa/fax 01561 377415

e-mail avrilnicoll@speechmag.com

COVER STORY: DIRECT THERAPY

The space

READ THIS IF YOU WANT TO EX- PLORETHE SPACES BETWEEN

WHAT A CLIENT CAN DO ANDWHAT THEY CAN’T

THERAPY‘DEMAND’AND ‘SUPPLY’

LINGUISTICS AND SPEECH AND LANGUAGE THERAPY

Words like‘Geronimo’ and ‘cardigan’ might not appear in standard articulation or phonology assessments, but for linguist and one- time speech and language therapist, Aubrey Nunes, they are key to the search for more effective and efficient therapy for children with speech disorders. Here, he explains the development and unexpected pedigree of ‘feature prosodic therapy’, where the child and therapist explore the space between what children can say and what they can’t.

space between what children can say and what they can’t. B ack in 1983 a father

B ack in 1983 a father referred his son to me. Jason, then aged seven, had had speech and language therapy and been discharged with the parents getting the idea that any remain- ing problems should resolve on their own.

There were no problems with Jason’s school work, but his father felt there were still issues with his speech. On assessment, Jason had a complete phonemic inventory, with no obvious problem in casual conversation, but he could say few words of four syllables or more (for in- stance, Geronimo became . At this level of word-complexity, Jason’s speech sounded immature. I remember the heady scent of elder in full bloom as

I decided to accept Jason for treatment. It seems fitting

now, given that we were embarking on a journey that would change my understanding of therapy and on the way pay tribute to the profession’s own unsung elders. So, what treatment? What caused which errors? I reasoned that the difference(s) between what Jason could and couldn’t say would provide a basis for treat- ment. So I took a word Jason couldn’t say, and changed it to something he could say. We continued this process, gradually moving closer to the target, until he could say

it correctly. Each change produced a nonsense word, but

a possible one nonetheless. This article describes what happened next. It is rel- evant to speech and language therapy for children with speech-specific issues – mostly in mainstream. My aim is to enable therapists working with such children to:

• Sharpen diagnosis and focus treatment

• Raise clinical goals

• Ensure that the most severely affected children are treated accordingly

• Effect economies. Returning to Jason, starting from a variation of the tar- get word that he could manage, I found I could ask him to say around 100 nonsense words in a session. I gave no correction, just praised his efforts regardless. My pur- pose was to define the point(s) at which the breakdown occurred and to find a way of working up to that point that would facilitate success. At the end of the first ses- sion I again asked Jason to say the original word, and he said it correctly. With no consultation and presumably

he said it correctly. With no consultation and presumably no rehearsal, a week later Jason again

no rehearsal, a week later Jason again said it correctly. The therapy implication was obvious. I decided to try it out with more children.

Focusing treatment

At 4;6, Kelvin was mostly incomprehensible. As an example, using a large character in pointed brackets to show a weak articulation, cardigan went to – with laterality in the final onset and dorsality in the nasal. By 5;3, when we started therapy, he was more un- derstandable but still had issues. He could now say cardi- gan, except that the /g/ was . In one session I focused on the stop quality of the /g/. First I opened the final syllable, devoiced the onset, and changed the stress pat-

syllable, devoiced the onset, and changed the stress pat- , tern – to . Kelvin said
syllable, devoiced the onset, and changed the stress pat- , tern – to . Kelvin said
syllable, devoiced the onset, and changed the stress pat- , tern – to . Kelvin said
,
,

tern – to . Kelvin said this as so I then tried a sonorant in the stressed onset, which Kelvin could say. After ten trials varying the two sonorants /n/ and /l/ in this position, Kelvin could say forms like with all three syllables begin- ning with an oral stop. If all the stops were voiceless

ning with an oral stop. If all the stops were voiceless became , so voicing had
ning with an oral stop. If all the stops were voiceless became , so voicing had
ning with an oral stop. If all the stops were voiceless became , so voicing had

became , so voicing had to be part of the issue. After two successful trials with a voicing contrast, I tried more dactylls, starting with

a voicing contrast, I tried more dactylls, starting with , but varying the voicing and the

, but varying the voicing and the length of the stressed vowel. After nine more successful trials, I closed the final syllable with /n/ as . This was correct. After was also correct, I returned to cardigan. This was now correct – with three proper stops, two articulators and contrastive voicing in the middle. By 5;6, after just 14 half-hour sessions, with each session consisting of work around one or more dif- ferent words, and with this as the sole therapy, Kelvin’s speech was age appropriate. Leo at 6;0 had the speech of a 4 year old. After 11 half- hour sessions over 3 months, following the same ap- proach, with Leo saying around 1,000 nonsense words in all, bearing on a wide variety of relations between the stress pattern and the sound-structure, his speech was age-appropriate. This therapy starts from what the child can do, and builds on this, working towards what the child can’t do. All responses get equal praise. The immediate goals are nonsense words, most said just once. The intention is for the child to experience non-stop success and to discover how features and prosody interact. I developed ‘Feature Prosodic Therapy’ from 1983 to 1989 in NHS clinics with children with specifically phonetic / phonological disor- ders who were not responding to therapy on the basis of missing or defective ‘sounds’, or for whom there was no obvious therapy. It is still rudimentary and open to improvement.

Pedigree

What I didn’t know then was that such therapy has a ped- igree. William Holder was a 17th century teacher of the deaf, John Thelwall treated children’s speech disorders in

deaf, John Thelwall treated children’s speech disorders in 4 SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER

COVER STORY: DIRECT THERAPY

between

Cover photo by Paul Reid. Posed by models
Cover photo by Paul Reid. Posed by models

the early 19th century, and Alexander Melville Bell treat- ed communication issues in children and adults later in the 19th century. Holder (1669) proposed the essence of what is now known as ‘distinctive feature theory’– with phonemes as the surface expression of combinations of universal features. Thelwall (1814) used an early version of what is now known as the ‘metrical theory’ of word stress to describe the characteristic English alternation between stressed and unstressed syllables. Making distinctive feature theory more complete, Bell (1849) showed that English vowels could be defined by height and frontness / backness. As a Scot, Bell was interested in the difference between his trilled /r/ and the English untrilled /r/, and he proposed a feature for this. All three describe their work in terms which make it

easily recognisable as speech and language therapy. From Holder to Bell there is a growing understanding of the significance of linguistics. Significantly, these therapy pioneers all asked children to repeat structured sequences of minimally-different nonsense words. This fits in with the modern idea of ‘possible words’ from gen- erative phonology. The pioneers don’t talk about possi- ble words, as this term only came in during the 1960s, but it is only on the basis of this idea that their practice makes sense. The pioneers’legacy was buried in the early 1900s and then lost until Rockey (1977) rediscovered some of it. Duchan and Nunes (forthcoming) find more. The legacy has been greatly advanced by studies of both prosody and distinctive features since Chomsky and Halle (1968),

where the English stress rule is first fully spelt out. The one way in which Feature Prosodic Therapy may improve on the practice of the pioneers is that it involves an on-line adjustment by the therapist to the way the child is managing – or not – so as to ensure the child can copy whatever is being modelled by the therapist. Every therapy should be tested rigourously. I ran the first test of Feature Prosodic Therapy with otherwise nor- mally-developing children, and then developed the the- oretical rationale - see Nunes (2002). A clinically based pilot test is now in process and I welcome contact from any therapist who would like further information.

Process of learning

This approach is about therapy in relation to the process of learning. It is obvious that children are expected to learn in about 10 years what makes one language differ-

ent from others. What is less obvious is that such differ- ences are not random and that, despite the variety, there are universals. The first person to see this was Holder, with his early version of distinctive feature theory. An- other universal concerns word-stress. If a language has

a stress-system – like about half the world’s languages

do – either it is just on the ‘edge’ of the word or it is by an alternation between heavy and light ‘beats’ in succeed- ing syllables. In the French hippopotame, the only stress

is on the /a/. In English, as in French, the stress is com-

puted from the right, and some final rimes are ignored, but there is an alternation of beats. So in hippopotamus, there is a light stress on the first syllable and main stress

on the third. Because in English stress often falls on the initial syllable, there is an easy inference that scansion is from left to right. Such an inference happens to be cor- rect in Scottish Gaelic but not in English, where stress is defined on three interacting principles: scansion from the right, alternating beats, and a skipping of some final syl- lables. This of course has to be learned. And it is not easy. There are many other ways in which stress could be or- ganised - but isn’t. It could peak in the middle of a word,

or words could vary randomly according to whether they

have stress or not. But no language like this has been found. Rather, stress is computed from left or right, with alternation or not, and so on. So the learner only needs to consider a particular sub-set of the logically possible options. Because this sub-set is finite, acquisition can be finite too. But in order for this to work, the learner must have a way of telling what counts as evidence and what does not. The simplest way of explaining this ‘learnabil- ity’ is by a Speech and Language Acquisition Module (SLAM), interpreting for the child what they happen to hear. A defect in this module leads directly to a disorder

of speech and / or language. This learnability-driven approach:

• Explains the (otherwise hard to explain) co-morbidities, involving lisps, multiple ‘processes’, the loss of vowel distinctions, and syntactic issues.

• Suggests that what speech and language therapy

issues. • Suggests that what speech and language therapy SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER

COVER STORY: DIRECT THERAPY

COVER STORY: DIRECT THERAPY DOES in such cases is to help a natural process in the

DOES in such cases is to help a natural process in the child’s mind of getting to‘know’ what counts as a possible sentence / word.

• Informs answers to questions like: Is my child brain- damaged? Have we as parents done something wrong? If there is a Speech and Language Acquisition Module, the answer to both questions can be a firm “no”.

The implications are both positive and negative.

A) POSITIVE IMPLICATIONS:

i) By Feature Prosodic Therapy a small but permanent gain can be made in 75% of children with speech specific issues saying between 20 and 100 nonsense words

- In this first test of Feature Prosodic Therapy parents were not directly involved. The sole variable was the children’s experience of saying the selected nonsense

words. For the sake of replicability, in a way that I would not do in the clinic, the sequence was standardised.

- Because gains are by the interaction between ele-

ments, these are exponentially greater than by the sum of the sessions, and thus cost-effective.

- Parents like to see session-by-session gains which are both permanent and exponential.

ii) Diagnosis is sharpened

- The diagnosis is defined in terms of the relation between

normal competence and the child’s speech. So in both

and Geronimo as

, there are limits on which features can be realised outside the foot (underlined). Both of these forms could be described by combinations of processes

- in

the-tongue gesture getting wrongly made in the final consonant, sonorance in the final consonant getting wrongly copied into the consonant before, but with a change from nasal to lateral, and so on. But this is mak-

, by a dorsal or back-of-

cardigan as
cardigan as
on. But this is mak- , by a dorsal or back-of- cardigan as Alexander Melville Bell
on. But this is mak- , by a dorsal or back-of- cardigan as Alexander Melville Bell

Alexander Melville Bell (Parks Canada / Alexander Graham Bell Historic Site of Canada)

ing the child’s speech more complex than competent speech, so it doesn’t explain anything. By diagnosing in terms of limits, it is possible to refer to both issues and achievements. This can be nicely and accurately put to parents, for example “He / she can only say that back of the tongue bit of the sound at the end of the word”. The key word is only.

- A positive and non-pressurising speech and language

therapy approach is underpinned.

- There is a better chance of catching the most severely

affected children. iii) If therapy goals are defined in relation to possible words, the long-term goal is likely to be normal

speech

- None of our elders suggests anything else. This is ob- viously a much higher goal than one defined on mere improvement or communicative need.

Auditory Integration Training or by oral-motor therapy with its associated materials (approaches that have been

marketed before being fully tested), there is a loss of di- agnostic focus.

iv) Allocate scarce resources by giving priority to

younger children This risks diverting resources to minor issues which may resolve naturally, and may deny resources to children with greater issues. Phonetic / phonological develop- ment has an irreducible linguistic aspect, is develop- mentally vulnerable, and is still normally in process at 8;6. Since it is impossible to determine future needs

in relation to a process before it is naturally complete, therapy resources should remain available to children of 8;6 and older.

v) Expect to treat speech issues by anything other

than face-to-face, expert therapy (or think that therapy is ever ‘routine’) Law et al. (1998) found that what they call ‘indirect ther- apy’ does not work in the case of speech delays. By my claim, it cannot work. This is not to disparage the role of parents, assistants, teachers, volunteers, and others, as observers, helpers, and so on. But they cannot replace therapists. Some speech and language issues are unlikely to re- solve spontaneously. Given the space between publicly- funded therapy demand and supply, such issues deserve to be ring-fenced.

B) NEGATIVE IMPLICATIONS

There is no reason to:

i) Assume that child-directed speech makes all the difference If it did, ‘finite learnability’ would be impossible – as ex- plained earlier, this is contrary to fact. In particular cases, the style of parent-child interaction may be non-optimal and this may impair the process of acquisition. But it does not follow that such an effect is general. You may feel - for this and the other negative implica- tions listed - there is proof-of-the-pudding evidence to the contrary from therapists’ experience. The problem, though, is telling what is causing what. For example, when parents are coached in the use of child-directed speech and improvement follows, was the child-direct- ed speech the cause, or was it the change in the parents’ thinking and feelings about talking?

ii) Characterise speech issues only by ‘processes’

(stopping, fronting, initial consonant deletion, assimilation, and so on) The effect is that therapy goals are seen in terms of what is ‘wrong’ / most difficult for the child. Common pronun- ciations like little as and soldier as are hard to describe. Complex, subtle and unfamiliar interactions between consonants and vowels can be underestimated and the most serious disorders overlooked or misread. The children concerned can fall through the net.

iii) Expect sensori-motor treatments to have a

general effect ‘Shopping–list’ definitions of speech-specific, or verbal, a/dyspraxia, have multiple (and contentious) second- ary characteristics. Without excluding the possibility of

a/dyspraxia in exceptional cases, the general treatment of mixed disorders in this way makes it hard to under- stand what they truly are. By working on sensori-mo- tor issues in isolation, by certain software packages, by

Dr Aubrey Nunes is a linguist and director of Pigeon Post- Box Ltd, which supplies computer-based educational toys (http://pigeonpostbox.co.uk), e-mail aubrey@pigeonpost- box.co.uk.

References

Bell, A. M (1849) A New Elucidation of the Principles of Speech and Elocution. Edinburgh: The author. Chomsky, N. & Halle, M. (1968) The Sound Pattern of Eng- lish. New York: Harper Row. Duchan, J. & Nunes, A. (forthcoming) The Awesome Four- some. Holder, W. (1669) The Elements of Speech. London: Schol- ar Press. Law, J., Boyle, J., Harris, F., Harkness, A. & Nye, C. (1998) ‘Screening for Speech and Language Delay: a Systematic Review of the Literature’, Health Technological Assess- ment 2(9). Nunes, A. (2002) The Price of a Perfect System: Learnabil- ity and the Distribution of Errors in the Speech of Children Learning English as a First Language. PhD thesis Univer- sity of Durham. Rockey, D. (1977) ‘The logopaedic thought of John Thel- wall, 1764-1834: First British speech therapist’, British Journal of Disorders of Speech 12, pp. 83-95. Thelwall, J. (1814) Results of Experience in the Treatment of

Cases of Defective Utterance London: J. McCreery.

of Cases of Defective Utterance London: J. McCreery. SLTP REFLECTIONS • DO I MAKE THE MOST
of Cases of Defective Utterance London: J. McCreery. SLTP REFLECTIONS • DO I MAKE THE MOST
SLTP
SLTP

REFLECTIONS

• DO I MAKE THE MOST OF MY LINGUISTIC KNOWLEDGE WHEN PLANNING THERAPY?

• DO I REGULARLY RE-VISIT ASSUMPTIONS OF HOW SERVICES SHOULD BE PROVIDED TO CHECK THEY HOLD GOOD?

• DO I SET CLINICAL GOALS TO SUIT THE CLIENT OR THE SERVICE?

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ADVERTISEMENT SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2006 7

EARLY COMMUNICATION

Partnership in Profile

Finding the route to true partnership with teachers and parents full of obstacles, Charlotte Child looked for a way through, and the result is her newly-published Communication Development Profile. Here, she reflects on the inspiration, theory and life experience underpinning the profile - and explains why genuine partnership feels so great.

READ THIS IF YOU WANT TO

• USE DIRECT AND INDIRECTTHERAPY APPROPRIATELY

• SHARE THE RISKS AND THE REWARDS OF YOUR WORK

• ENSURE OTHER PEOPLE UNDERSTAND WHERE YOU ARE COMING FROM

versus education. It’s a simple fact that teachers observe and assess a child’s performance and we observe and as- sess a child’s competence.

2. ‘He can do that at home’

Secondly, through our observations and assessments we make judgements about a child’s skills and the level they are at. But our opinions, however well evidenced, may not match the parents’ views. Think about that all- too-familiar sinking feeling as you’re told the child can understand everything whilst you’re watching them struggle to respond to a one word level command. The resulting way that you explain and deal with this can set the tone for the rest of your sessions. Parents can feel that their child hasn’t been seen in the best light or been seen too briefly – and that they have been left with ‘but he can do that at home’ as their only way to contribute. I often wonder what the parents report back to other family members and friends after their initial sessions; how they were made to feel, whether or not they agreed with what was said, whether or not they felt listened to, whether or not they’ll come back…

3. Expectations

Third is the most difficult area regarding the level and type of speech and language therapy provision. Parents rightly want what is best for their child, and speech and language therapy seems to be widely viewed - in spite of enormous changes in policy and provision - as a direct intervention best provided through some sort of face-

T he term‘partnership’ is heav- ily used in many local and government directives. But what does it actually mean? How many times do we

come away from a situation feeling we have failed to achieve it? How can we work in a true and useful partnership with the families and staff we support? In preparation for a workshop at a recent National Portage Conference I looked up what ‘partnership’ actually meant. A simple definition is ‘sharing’, so on the face of it we all do that rather well. The National Health Service and the Education Service seem to be awash

with shared paperwork (of varying use- fulness), and we put a huge effort into sharing our skills and ideas. However, for that sharing to be effective, what we share needs to be understandable and accessible to others. In addition, the definition also refers to the sharing of risks and rewards. I smiled when I read this because it is a key shift in the way my practice has developed over the last sixteen years as I have tried to move towards a bet- ter working relationship with parents and teaching staff. When I came out fresh from Leeds Polytechnic (now Leeds Metropolitan University), I took on the whole responsibility for a child’s assessment, therapy, and ul- timately any successes and failures. However, once you begin to share those roles, you also begin to share the outcomes. As a result your role changes from being in charge to being a resource when things go wrong, through helping to problem solve and encouraging everyone to have another go, and to quietly stepping back when things go right. So what are the key problems within many partner- ships between speech and language therapists, families and other professionals?

to-face contact. Any mismatch between the parents’expectations of the service and what their child needs can cause huge difficulties, and in some cases lead to a tribunal.

Defining moment

There was an incredibly defining moment 12 years ago when the concept of the Commu- nication Development Profile (Child, 2006) hit me. I returned to the medical room in the special school I covered, from yet another one of those teacher liaisons where every- thing had gone wrong, and I just sobbed. However, as strong as the urge was to run down the street never to return, I also real-

ised that I needed to make changes to my practice that would begin to tackle these problems. I had to find a way to explain where I was coming from - to have a framework that I could share with the teach- ers and use to jointly discuss and plan for a child. In ad- dition, I needed a way to explain the type of speech and language therapy intervention that would best support the child’s communication skills. Before I left that day, the first version was scribbled down. With all great ideas come support and a lot of cake and tea. I had that in abundance from my colleague Sue Stronge whose office was within walking distance of a rather nice bakery. The first version (1994) worked well and was used across each of the special schools in South Devon. It began to address some of the problems I was experiencing in being an effective and useful resource to teachers and schools. The second most defining moment came with becom- ing a mum and being forced to live my work. I realised how wonderful it was to tell people your child’s latest achievement, to talk about what they do well and how awful it was to be on the end of assessments not under- standing or necessarily agreeing with the other person’s opinion - and knowing that they did indeed do that at home! I began to write down a great deal of how my children were communicating. It started out as a way of me really making sense of what I was experiencing, and reflecting on what I offered as a therapist. However, it has ended up as the core of the 2006 version of the profile. I learnt that my own children could show very clear single word understanding and use, but when I sat them down with the Derbyshire Language Assessment (yeah, right, I’m the only one who’s done that!) their attention

1. Talking different languages

Firstly, joint liaison and planning sessions can be incred- ibly frustrating leaving you at best needing to bang your head on the wall and at worst imagining the wine chilling in the fridge for a mid-week tipple. This for me generally occurs when the other person and I are talking different languages - particularly speech and language therapy

EARLY COMMUNICATION

Figure 1 Summary of phases (based on Child, 2006) Phase 1: Early Communicators Children are learning how to be communicators, that they can influence the world around them and that they can interact with and influence other people. Behaviours include crying, facial movements and expressions to reaching, looking and making noises. Children progress from using their behaviours in response to things going on around them, to using them in a planned and deliberate manner to achieve a specific goal.

Phase 2: Developing Communicators Children are gaining language-based skills without realising it through the process of closely matched adult - child interactions. This phase is a largely unconscious learning process for children and adults.

Phase 3: Established Communicators Because children now understand what language is all about and how it works (sometimes described as ‘meta-linguistic skills’) they are able to make direct changes to their language skills, through adding new words or structures and amending others. The whole language learning process has become deliberate and conscious, and children developing within this stage can learn language through language.

and listening was still naturally so single chan- nelled that they couldn’t complete it. I then be-

gan to look at the Communication Development Profile in a new light and to write it in a way that I could use not only with teachers but also with parents, so they could tell me what their child was doing at home and be directly involved in their child’s assessment and planning. To make the framework even more useful and relevant in school, I linked each stage of de- velopment to the appropriate P-Level. P–Levels are the performance descriptions set out in the Qualification Curriculum Authority (QCA) Cur- riculum Guidelines (2005), which outline the eight levels of early learning and attainment leading up to Level 1 of the National Curricu- lum. P-Levels can also be used in conjunction with the Foundation Curriculum (DfEE / QCA, 2003). However, it is important to realise that both the Foundation Curriculum and the P- Levels have been written for different purposes and constructed in different ways. For children with significant special needs, P-Levels provide

a more detailed and specific framework for as-

sessment and planning. Unfortunately the basic Qualification Curricu- lum Authority descriptions are not easy to work within as they comprise of a few lines with some disjointed examples. However, the P-Levels them- selves are very relevant to the same framework of development that we use. P-Levels P1 (i) to P3 (ii) relate to the five stages in the development of intentional communication (Coupe O’Kane and Goldbart 1998), and P-Levels P4 to P8 to the Der-

byshirewordlevels(KnowlesandMasidlover, 1982). There are still some difficult areas within the interpretation and descriptions, most notably the use of ‘key words’ to describe both comprehension and expression. In addition, the division between P7 and P8 is rather ambiguous and not one that we as speech and language therapists would

make - well, certainly not in the way the document presents

it! However, as again this is all about the process of the joint

discussions with the teaching team, these can easily be over- come through discussion and referring to examples. I have recently been meeting a team of mainstream and special school teachers and local authority advisors

in Devon who are just completing a moderation exercise

for the Speaking and Listening P-Levels. This will give

Charlotte Child with her own and friends’ daughters who contributed to the Profile
Charlotte Child with her own and friends’ daughters who contributed to
the Profile
own and friends’ daughters who contributed to the Profile Figure 2 A profi le screen in

Figure 2 A profile screen in progress (Picture courtesy of Speechmark)

teachers more extended descriptions and real examples of the P-Levels through videos in order to help them, particularly teachers in mainstream schools who are now expected to use the P-Levels to plan targets and write re- ports. It struck me not only how hard it is for mainstream teachers to take on this level of assessment but, more significantly, how important it is that we make sure we fully understand and use the P-Levels ourselves.

Inspiration

The final piece of inspiration for the new version came initially from the Checklist of Communicative Compe-

tence (Gerard, 1987). In it, Kathryn Gerard summarises three levels of communication development: pre-intentional, intentional and linguistic. She makes the point that the first two levels are all about the development of communicative competence with the sub- sequent development of linguistic skills be- ing mapped onto - and their use dependant

upon - these core skills. This made a great deal more sense as a mum with young chil- dren who had a great line in communicating ‘I’m a toddler, get me out of here’ without a word being spoken, and it led to my interest in ‘messages’ (Child, 2005). I then found this theme expanded in Anderson-Wood and Rae Smith (1997), with the levels linked to the learning style with which the child developed their communicative competence. Ander- son-Wood and Rae Smith pointed out the importance of recognising not only the differ- ing levels of development but their differing needs for intervention. This made tremen- dous sense and provides what I believe to be

a core framework to help define what we do

and why we do it (see figures 1 and 2). Direct ‘table-top’ speech and language therapy is easily identifiable as us ‘doing some- thing’, and many parents understandably want

a ‘specialist’ working directly with their child to

help them develop their communication skills. Indirect intervention, where we work with teaching teams and parents to change the style of interaction or environmental demands to support the child’s development of skills and competence, has got very muddled with a lack of speech and language therapy provision. Indirect forms of intervention should not be seen either as a Cin- derella service or an add-on, but recognised as the most appropriate and clinically effective form of intervention for a child at that stage. We know that trying to sit a child down (who is around a single word level of comprehen- sion) and do some sort of direct teaching of language skills isn’t going to work, but what alternative style of service do we provide and, more importantly, how do we present it? Little wonder that parents and teachers think they are being fobbed off when we tell them their child won’t benefit from weekly one-to-one speech and language therapy intervention.

weekly one-to-one speech and language therapy intervention. SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2006 9

EARLY COMMUNICATION

news extra

Autism excluded

The National Autistic Society is concerned that the government’s Education Bill does not take children with autism into consideration. In particular the Society says that the proposals for school discipline will have a disproportionate impact on children with autism and their families. It says that 27 per cent of children with autism are excluded from school - most commonly because the school can’t cope with their needs. As parents will have to take complete responsibility for their children for the first five days of an exclusion, the Society is concerned this will be detrimental to families who already struggle to balance employment with caring for their child. It wants schools to review a child’s support needs be- fore taking disciplinary action. The Society also believes the bill may disadvantage chil- dren with special educational needs including autism throughtheproposedadmissionspolicyfortrustschools. Spokesperson Amanda Batten said, “So long as schools can reject children with autism either before or after they have been admitted, we will not address the long tail of under achievement that exists. Getting it right for pupils with autism can mean better outcomes for all children, as all will benefit fromimproved provision.” The National Autistic Society is to launch an Education Campaign to raise awareness of the issues that face chil- dren with autism and their families and to call for change. www.nas.org.uk Information about the Education and Inspections Bill 2006 is on www.dfes.gov.uk

Parkinson’s priorities

The Parkinson’s Disease Society says the five key priorities outlined in the second draft of NICE Guide- lines would bring much-needed and comprehensive improvements in care – but it wants to see greater emphasis on implementation in the final document (expected June 2006). The draft guidelines‘Diagnosis and Management of Par- kinson’s Disease in Primary and Secondary Care’ state that patients should have access to a range of therapies from the beginning of the condition onwards and regu- lar access to a health professional such as a Parkinson’s Disease Nurse Specialist. When Parkinson’s is suspected, and before any treatment is started, a patient should be referred within six weeks to a specialist, and thereafter have regular clinical reviews once or twice a year. Con- sideration of palliative care requirements in all phases of the condition is also a key priority. The Society is concerned that there is insufficient empha- sis on the implementation of the Guidelines, including the need for development of multidisciplinary working across primary and secondary care. It also hopes to see clear recommendations on drug treatment for people with Parkinson’s with dementia, and the recommenda- tion for further applied research focused on alleviation of symptoms and maximising quality of life in addition to cost effectiveness of treatments. The Parkinson’s Disease Society is running a national cam- paign to ensure that people with Parkinson’s in hospital or a care home get their medication on time – every time. www.parkinsons.org.uk www.nice.org.uk

10

– every time. www.parkinsons.org.uk www.nice.org.uk 1 0 Clear about needs However, this Profile’s structure shows

Clear about needs

However, this Profile’s structure shows people where the child’s overall communication development is falling and links this to the best form of speech and language therapy intervention for their child. Using it has been one of the most positive changes I have made to my practice. Right from the initial transition meetings, parents are clear about what their child needs and recognise the value of interac- tionapproaches, andteachers areclear about their roleand responsibility and how the child will be supported by the speech and language therapy service when in school. Of course we all have a different way of looking at things but this journey of developing a resource has been fascinat- ing (as I’ve learnt so much), exhausting (I had no idea what I was letting myself in for, in spite of tremendous support from Speechmark publishers) exhilarating (that feeling when you know you’re onto something) and incredibly satisfying. Al- though I still get involved in many a heated discussion, I now have a way to show people what I mean, to include them meaningfully in the decision making and to provide a frame- work for them to make informed choices about what they would like for their child - and it has made a huge difference to the outcomes. I am finally able to provide a genuine part- nership with those I work with, and it feels great!

References

Anderson-Wood, L. & Rae Smith, B. (1997) Working with Pragmatics; A Practical Guide to Promoting Communica- tive Confidence. Bicester: Speechmark. Child, C. (2005) ‘Getting the message’, Speech and Lan- guage Therapy in Practice Spring, pp. 4-6. Child, C. (2006) Communication Development Profile. Bicester: Speechmark. Coupe O’Kane, J. & Goldbart, J. (1998) Communication before Speech. London: David Fulton. DfEE / QCA (2003) The Foundation Stage Profile Hand- book - Access to the Foundation Curriculum for Children with a range of Special Needs. London: Qualification and Curriculum Authority. Gerard, K. (1987) Checklist of Communicative Compe- tence. Unpublished. Knowles, W. & Masidlover, M. (1982) The Derbyshire Lan- guage Scheme. Derbyshire County Council, www.derbyshire-language-scheme.co.uk. QCA (2001) Planning, teaching and assessing the curricu- lum for pupils with learning disability. London: Qualifica- tion and Curriculum Authority. QCA (2005) Using the P-Scales. London: Qualification and

Curriculum Authority.

SLTP
SLTP

Charlotte Child is a speech and language therapist with South Devon Healthcare NHS Trust. For further details about the Communication Development Profile or to arrange workshops about this, ‘Choices Changes and Challenges’ or ‘First Messages’, please contact Charlotte on chaos@hgf.eclipse.co.uk

REFLECTIONS

• DO I CHANNEL THE ENERGY OF EXTREME FRUSTRATION INTO POSITIVE ACTION?

• DO I PROVIDE SUPPORT AND A SOUNDING BOARD TO COLLEAGUES WHO ARE DEVELOPING NEW IDEAS?

• DO I RECOGNISE AND REFLECT ON KEY SHIFTS IN MY PRACTICE?

Reader offer

WINTHE COMMUNICATION DEVELOPMENT PROFILE Are you looking for a simple shared framework to help you
WINTHE COMMUNICATION DEVELOPMENT PROFILE
Are you looking for a simple shared framework to help you work in a more effective partnership with the families,
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As author Charlotte Child explains, the Communication Develop-
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ance in the child’s overall communication development and can
be linked with the most appropriate style of intervention. Most
importantly it helps all involved understand each other and set
targets.
The Communication Development Profile normally costs £39.95
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The Communication Development Profile is published by
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published by Speechmark. For a free catalogue, tel. 01869 244644. SPEECH & LANGUAGE THERAPY IN PRACTICE

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2006

HERE’S ONE I MADE EARLIER

HERE’S ONE I MADE EARLIER “Hereʼs one I made earlier ” ALISON ROBERTS WITH MORE LOW-COST,

“Hereʼs one I made earlier

ALISON ROBERTS WITH MORE LOW-COST, FLEXIBLE THERAPY SUGGESTIONS SUITABLE FOR A VARIETY OF CLIENT GROUPS.
ALISON ROBERTS WITH MORE LOW-COST, FLEXIBLE THERAPY SUGGESTIONS
SUITABLE FOR A VARIETY OF CLIENT GROUPS.

I. BINOCULAR GAME

“This is a group activity that promotes aware- ness of other people, and of social context. It also encourages appropriateness of conversa- tional topic choice.”

MATERIALS

• Large piece of firm cardboard for the base of your game

• 2 cardboard tubes – loo roll tubes will do

• Ribbon

• Plenty of magazine pictures of different types of people

• Paste

BRAWN

You may need to cut out the pictures your- self, or your clients can, depending on their dexterity. Stick the pictures all over the cardboard base. You don’t need to leave any gaps, and it doesn’t matter if they overlap a little. You should create the effect of a crowd of peo- ple, or a party. Link the cardboard tubes with the ribbon, but leave about 10 cms between the two tubes. The idea is not to look through both ‘lenses’ at the same time, but to select two separate people on the board. For a supe- rior effect paint the tubes black. You may feel the need to cut them down a bit – to around 6 cms.

IN PRACTICE

Place one ‘lens’ over one person and the other over someone else. Ask your clients a series of questions such as :

• What does each person look like?

• Do their clothes suggest any particular interests?

• How might they introduce themselves to each other?

• What might they go on to talk about?

• Will they become friends?

II. WEDDING CAKE GAME

“This group activity is particularly liked by teenage girls, but can equally well be used by boys. It promotes good dating skills by encouraging appropriateness of conversational topic choice. It sets out to be light-hearted; it does not intend to recommend marriage as a necessary or desirable goal! The game is related to the ‘Binocular Game’, reinforcing some of the same skills, but presenting them in a new way. (Be warned that, if many cakes have been awarded and mouths are watering, you might need to provide a cake, or at least a biscuit, at the end of the session!)”

MATERIALS

• Large piece of firm cardboard or hardboard for the base of your game. This needs to be really good and flat as you are going to use it as a sort of ‘Shove ha’penny’ board. It also needs to be a bit bigger than your table, or if that’s not possible you will need to move it so that one side of the board can hang slightly over the table edge, and then turn it so that the other side can hang over.

• Plenty of magazine pictures of men and women as dating candidates. (Pictures of just the head and torso are fine, or you can use whole bodies if you can find good photos.) You can use photos of celebrities, and of unknown people. Have some really unlikely-looking candidates too.

• Pictures of wedding cakes (wedding magazines often contain lots of these or you can draw your own cakes of different types)

• Pictures of cups of tea / coffee (again, draw your own if you can)

• Labels saying“Never mind. Try again”

• Paste

• 2p coins

• Question document - see below

BRAWN

You may need to cut out the pictures yourself, or your clients can, depending on their dexterity. If you are having home- drawn cakes and cups of tea let everyone design one. The same with the “Never mind, try again” sticky labels – everyone can write one. Stick the pictures of the men along one side of the board, and the ladies along the opposite side. Have the tops of the heads towards the outer edge. You don’t need to leave any gaps along the edges, and it doesn’t matter if they overlap a little. You now have a large piece of board, with a line of ladies on one side, one of men on the other, and a gap between them.

Stick the wedding cake pictures in a line

right along the middle, dividing the ladies and gentlemen. So there are now three

lines of pictures. In the intervening gaps on either side of the cakes, stick a few

pictures of cups of tea, and some “Never

mind, try again” labels.

IN PRACTICE

Taking turns as ‘Matchmaker’, choose either a man or a woman, and place a coin on that person, with a portion of the coin hanging over the edge of the board. With the flat of your hand, give the coin a sharp shove, so that it travels across the board to a person on the other side. Now your clients need to answer a series of questions:

• What does she say to him?

• What does he say to her?

• What do they go on to talk about?

• What do they agree about, and where do they disagree?

• Do you think they will go on a date? If yes, where might they go for this date? Now the group must discuss whether, given the facts, the couple are likely to make good life partners. If they think the ‘Matchmaker’ has made out a good case for a lifelong commitment between their candi- dates then the ‘Matchmaker’ can choose and describe one of the cake pictures. If more information is needed then the group will vote for the ‘cup of tea’ option, and can go on to discuss what else the potential couple might need to talk about. If it’s a definite “no” for that couple, then the “Never mind, try again” labels are pointed at. (But the matchmaker can’t have another go until it is their next turn). Now it’s the turn of another potential ‘Matchmaker’

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

REVIEWS

reviews

COLLABORATION

Collaborating for Communication (How to run language groups linked to topics in the National Curriculum - A Manual for Schools and Speech and Language Therapists) Karen Heins Taskmaster Ltd ISBN 1872294 12 X £14.95

Practical answers

This book has practical answers to the questions that many speech and lan- guage therapists and schools have re- garding the best use of speech and lan- guage therapy time, training issues and relating programmes to the curriculum. Time saving session plans, sample letters and forms provide a good starting point for delivering this style of intervention and training. The sessions (Understand- ing Stories, Building Vocabulary, Listen- ing and Following Instructions and Tell- ing Stories) can easily be adapted to the current class topic, although school staff will need time for preparation. Collabo- ration is the key with information about training for parents as well as school staff. Frustratingly, some areas are not covered in as much detail – for example, speech sound groups - but it definitely has some useful ideas and is great value for money. Nicola Waddington is a speech and lan- guage therapist working in community and education for Leeds speech and language therapy service.

GROUP WORK (1) ADULTS

Communication Activities with Adults Jayne Comins, Felicity Llewellyn & Judith Offiler Speechmark Publishing Ltd

ISBN 0 86388 343 5

£14.95

Activities require little preparation

This revised and updated version of the Activities and Ideas book published by the same authors in 1983 is a useful therapy resource for those working with groups of adult clients with aphasia, the elderly and in day centres. It contains activities incorporating cued responses, short answers, longer answers, non-verbal activities, reading and writing. It has been updated to make it more contem- poraneous with 100 plus graded activities - many needing only a flip chart and a pen. Very good value for money, this book is to be recommended to health profession- als and activity providers working with groups of adult clients seeking activi-

ties that require little or no preparation. Some of the activities could be used with individuals to support work on target ori- entated goals. Carole Smith is a senior speech and lan- guage therapist at the Acorn Unit, St Ann’s Hospital, London.

GROUP WORK (2) LITERACY

Group Games: Playing With Words Rosemarie Portmann & Elisabeth Schneider Speechmark

ISBN 0 86388 545 4

£14.95

Quick reference

This book provides more than 100 games for use with groups. Aimed at develop-

ing literacy skills, the games are simple to organise and need few resources. The introduction gives some useful general advice on selecting and setting up group activities. Most games focus on spelling and require reading and writing skills but this may not always relate to speech and language therapy targets. Some games using word knowledge will be familiar to therapists, many others could be adapted to develop specific skills at word, phrase or sentence level. The games are listed by title only – I would find grouping by type of activity more helpful. This resource is aimed at teachers, thera- pists and youth club leaders and could be

a useful quick reference for those working

with groups of 8-16 year olds. Sue Brown is a specialist speech and lan- guage therapist, working in mainstream schools in West & South Hertfordshire.

GROUP WORK (3) LEARNING

Toon Cards Toolkit Chris Terrell Network Educational Press ISBN 1-85539-145-7

£39.95 (inc. VAT)

Really useful

In schools, we are encouraged to engage young people in reviewing their own learn- ing and developing awareness of their

learning needs. This really useful resource

primarilyprovidespracticalandfuntoolsfor

encouraging active learning review. It has potential for developing self-expression, self-esteem, language and communication

skills and enjoyment of group interaction in

a variety of client groups.

The kit includes a manual, 120 A5 cards and a CD-ROM. The 28 session plans have very clear guidance as to aims and poten- tial benefits as well as helpful practical

tips. The author clearly has a lot of experi- ence in activity-based learning. Primarily

a practical resource, there are strong links to the psychology of individual learning styles and group interaction.

Card graphics are cartoon-style, clear and unfussy. The black and white images are easy to reproduce, attractive and easy to understand. The four sets increase rough-

ly in developmental level. The cards cover

in words and pictures a huge range of feelings (eg. grumpy), behaviours (eg. lis- tens carefully to others) and qualities (eg. trustworthy), and the author provides guidance on their selection. The language might make the cards less useful for very young or less able youngsters. However, the CD provides ‘silent’ cards for which more suitable text may be developed to suit different needs. Invaluable for therapists, teachers and oth- ers working with groups of children and

young people, such as anyone organising activity-based outings or holidays, and the cards appear tough enough to cope with a bit of mud and grubby fingers! Jennifer Reid is a speech and language therapist working with school-aged chil- dren with specific language impairment, NHS Fife.

LITERACY

Foundations of Literacy – A balanced approach to language, listening and

literacy skills in the early years Ros Bayley & Sue Palmer Network Educational Press

ISBN 1 85539 093 0

£17.95

Does exactly what it says

This book ‘does exactly what it says on the tin’. The authors present an early years curriculum (3-6 years) that emphasises language development as an essential precursor to literacy development. Seven strands to this curriculum are detailed with examples of relevant activities or adult support strategies. Additional infor- mation is given relating to implementa- tion and monitoring of this curriculum. The book is aimed primarily at early years education providers but would be very helpful to speech and language therapists working with young language delayed children in mainstream settings who can make good use of the information given

on supporting oral language develop- ment. The presentation is clear and attrac- tive, and will support therapists wanting to ensure advice on language development fits with a child’s overall curriculum.

Flying start with literacy: activities for par- ents and children

Ros Bayley and Lynn Broadbent Network Educational Press ISBN 1 85539 194 9 £8.95

Use judiciously

This sister publication to ‘Foundations of Literacy’ is intended to provide parents

with the same framework for promoting literacy skills, with an emphasis on the bal- ance of skills that need developing, includ- ing talk. The information regarding ‘Sup- porting and extending talk’ is a delight to speech and language therapy ears:‘Follow your child’s lead’, ‘Expand conversations’, ’Avoid correcting what they say’, ‘Avoid asking too many questions’. Each chapter has a section on parents’ frequently asked questions which is also useful. However, the tone of the book is sometimes un- fortunate, and almost alarmist, as in the opening line “Everyone worries about literacy” (are parents meant to infer that they won’t need to worry now that they have bought this book?) And there are some statements about English phonol- ogy which are just wrong. There is useful information here but use judiciously with parents. Sue Greensmith is a community speech and language therapist working in Deeside, Aberdeenshire, with an interest in early years development including literacy.

SPEECH DISORDER

Differential Diagnosis & Treatment of Children with Speech Disorder Barbara Dodd (Ed.) Whurr

ISBN 1-86156-482-1

£24.99

Very good value

Thorough - a comprehensive text for stu- dents, but with plenty to stimulate experi- enced clinicians. Logically and clearly print- ed and set out with 17 chapters in three sections, Barbara Dodd features in 16 of the chapters (with 14 other authors), so some views may not be universally accepted. Style and content varies - some chapters report detailed research findings and some are more easily readable. A number of relevant case studies are included along with a detailed progression from assessment to diagnosis to therapy. While this high quality paperback can be ‘dipped’ into it remains a cohesive whole ranging over 50 years of theory and prac- tice. Very good value. Fran Neale is a speech and language thera- pist with Norwich Primary Care Trust.

SOFTWARE

Team Up With Timo Stories (CD Rom) Animated Speech Corporation

ISBN 0 9767299 2 X www.animatedspeech.com

$99

A fun alternative

This software can be used with late pre- school to primary school aged children. It provides activities through an ani- mated tutor targeting story comprehen- sion, sequencing, vocabulary, categories, descriptions and problem solving, using

non-complex language.

It is easy for clinicians or assistants to install and use and can be tailored to individuals. The graphics are appealing and good for maintaining attention, and feedback is clear and pleasant. Children can carry out the tasks independently, using the mouse (although eager clickers may have to be slowed down!) The disadvantages are the use of Ameri- can vocabulary (such as closet, baseball), the synthesized voice (unclear at times) and that only one user’s details / progress can be stored at a time.

A fairly expensive product, but a fun alter- native to table-top therapy. Gayle Jamieson is a paediatric speech and

language therapist, Exeter PCT.

STAMMERING

The Treatment of Stuttering in the Young School-Aged Child. Roberta Lees & Cameron Stark (Eds) Whurr ISBN 1 861 564864 £21.99

Full of ideas

This book should be on clinic bookshelves everywhere. A useful tool to dip into for inspiration, or to read in its entirety to recap basic principles and see reviews of intervention programmes in America, Australia and Europe. The eleven chapters detail a holistic ap-

proach to assessment and treatment, both with stuttering in isolation and co- existing with other difficulties. The focus

is on children between 7 and 12 years, al-

though reference is made to adults, other children and adolescents. The editors present a valuable critique of widelyacceptedprinciplesandmethodsand consolidate a lot of the theory around stut-

tering intervention today. They also include

in detail the methodology and outcomes of

research surrounding intervention. An excellent resource full of practical ide- as for students and clinic therapists alike. Laura Baker works as part of the paediatric team at Portsmouth City PCT.

SIGNING

Sign and Do – Nursery Rhymes Book 2 (with CD) Kay Meinertzhagen & Gill Kennard The Signalong Group

ISBN 1 902317 52 1

£29.00

Accessible, convenient and fun

This fun, busy pack can be used in dif- ferent environments - nurseries, schools, individual families, signing groups. The book is divided into three comprehen- sive sections: nursery rhymes with signs

drawn, activities corresponding to the rhymes, and a signing appendix. There is a good range of less familiar nursery rhymes and the signs are well drawn and easy to follow, even if you have very little signing experience. The activities are not particularly innovative but they are acces- sible and it is useful to have them as ideas and templates to hand. Invaluably, all the activities are provided on an accom- panying CD and can be printed out as many times as desired. The introduction to the book gives helpful guidelines. It is

possible for any child to join in with the signing activities which extends the use of the resource. I would recommend this as a convenient resource for speech and language therapists, other professionals and families. Caroline Clifford was until recently a Sure Start speech and language therapist in Hemsworth, Kinsley and Fitzwilliam and is currently a stay-at-home mum.

ADOLESCENTS

Helping Adolescents and Adults to Build Self-Esteem Deborah Plummer Jessica Kingsley Publishers ISBN 1 84310 185 8 £18.95

A good, photocopiable introduction

This book provides a good introduction to self-esteem and offers basic advice

on setting up groups, as well as ideas for activities supported by worksheets. Some of the suggested activities are likely to be too challenging for the client group I work with (adolescents with autistic spectrum disorder) because of their abstract nature, but there are others which address many

of the issues around self-awareness and awareness of others. The book is not spe- cifically for clients with autistic spectrum disorder, however, and may be better suited to professionals who are working with adolescents with a range of present-

ing difficulties, the result of which is low self-esteem. It is easy to read, with relevant worksheets at the back identified in the course of the text. The price is reasonable given that it is both informative and contains a sub- stantial number of photocopiable sheets. Lorraine McCoull is a speech and language therapist in Lanarkshire working with adolescents in a communication disorder unit attached to a mainstream secondary school.

AUTISTIC SPECTRUM DISORDER

Understanding the Nature of Autism and Asperger’s Disorder Edward R. Ritvo MD Jessica Kingsley Publishers ISBN 1 84310 814 3 £13.99

A borrow rather than a buy

This is easy to read with useful informa- tion for those with little prior knowledge.

REVIEWS

Chapter 4 provides interesting insights into the development of research on au- tism and Asperger’s syndrome, and neu- rological characteristics linked to these conditions. Written in clear language, explaining terminology in a user friend- ly way, the tone is warm and personal with anecdotal information based on the author’s extensive work in the field. Throughout, the attempt is to provide a positive outlook and overview. However the book often lacks a balance of informa- tion and objectivity about the very real challenges that those with these condi- tions and their families can face. The book offers a brief overview of some therapeutic options which would provide limited functional use for a professional working in this area. The author aims to offer an introduction to this subject, how- ever I feel other books have achieved this in a more successful and comprehensive way. Overall, I recommend a borrow rath- er than a buy. Sam Wickins is a speech and language ther- apist with East Kent Coastal Teaching PCT.

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FEATURE

Frogs and snails and puppy dogs’tails?

Speech and language therapists are mainly female and their clients are mainly male. Could we improve therapy outcomes if we had a better understanding of why and how male communication can be different? To find out, editor Avril Nicoll asks what little (and not so little) boys are really made of…

Speech and language thera- pists strive to offer an individu- alised service based on clinical need and to avoid unhelpful or limiting stereotyping. Whether we are working with boys or girls, men or women, fathers or mothers should therefore be ir- relevant. On the other hand, if we can understand more about why and how male communication may be differ- ent, we can potentially find a ‘way in’ to engaging them in more meaningful and effective therapy. The fact is that, overall, the profession works with more males than females. Caseloads attest to the greater propor- tion of boys affected by developmental communication disorder. Boys are for example four times more likely to de- velop autism than girls (www.nas.org.uk). In the under fives, twice as many boys stammer as girls (www.stammering.org). And, in 16 months of monitoring referrals to a paedi- atric speech and language therapy service, Broomfield & Dodd (2004) found that seventy per cent were boys, with the proportion higher for language diagnostic cat- egories than for the speech category. Males are two to three times more likely to have a head injury than females, rising to a ratio of 5:1 in the age group 15-29 years (www.headway.org.uk). There are 3.5-4 men for every woman who stammers (www.stam- mering.org). Males represent 94 per cent of the prison population (www.statistics.gov.uk). Bryan (2004) confirmed high levels of speech, language and communication difficul- ties among a young offender population and suggested this meant, “around 40 % of young offenders might have difficulty in benefiting from verbally mediated interven- tions such as anger management and drug-rehabilitation courses”. She continued, “This would imply they might be more likely to leave prison with unresolved problems known to contribute to re-offending” (p.399). In researching this topic it quickly became clear that, even where boys and men do not have a communica- tion impairment, there are general ‘male’ communica- tion issues that impact on many areas of life – learning, interacting with others, even health. According to Adam

interacting with others, even health. According to Adam Cox (2006), the roots of this may lie

Cox (2006), the roots of this may lie in childhood, given male stereotypes and our expectations of our sons: “On the time line of human development, our circumstances have changed more quickly than our genes. Genetically, our sons may still be better programmed to defend against predators than to foster co-operation in a town or an office” (p.63). Cox argues that the key is teaching boys social communication skills to counteract the in- sidious effect of the social reinforcement they get for withholding signs of emotion. One of the ways this can be done is through encour- aging their fathers to model vulnerability (holding up their hands to mistakes, saying sorry, expressing sadness), asking for help, compromising, learning from others and persevering. Cox explains how vulnerability is a terrify- ing prospect for many males, and efforts to hide it can result in a mask of indifference, withdrawal or anger. They need to feel they are good at things or they lose interest, confidence and self-esteem. As a result, they have even less opportunity to develop the emotional vocabulary and social skills they need to experience a healthy life.

Compounding the problem with communication is the reported reluctance of men to ask for help from health service providers.

Interestingly, the initial inspiration for this feature was a conference presentation on the importance of fathers, and their changing role as a result of an ever-moving po- litical and social context. Brid Featherstone (2005) said research evidence confirms it is good for men, women and children if men are involved in family life for reasons as diverse as better mental health, less criminality and better exam results. As a result, information groups such as Fathers Direct (www.fathersdirect.com) and docu- ments such as the National Service Framework for Chil- dren, Young People and Maternity Services (DH, 2004)

are driving a cultural change in service provision so that we support parenting in general, not just mothers. In speech and language therapy this is put into prac- tice through programmes such as Hanen and Parent- Child Interaction Therapy or via Sure Start projects, or through individual therapists involving both parents where possible. Burgess (2006) says it is essential to rec- ognise that a different approach is needed to engage fathers: “even when you are seeking to foster the same kind of behaviour from fathers and mothers towards their children, you need to remember that fathers ‘come from a different place’”(p.5). However, Brid Featherstone says we need to be aware that the involvement of a fa- ther is not per se good for a child; the crucial factor is the relationship between the child’s parents, and this ap- plies whether or not the parents are ‘together’. She suggests we bear in mind that, while many men subscribe to the involved father model, the ‘economic provider role’ is still important in men’s construction of what it is to be a good father, perhaps because it fits with being ‘protective’. Working fathers may therefore find it difficult to balance their desire for involvement with their need to put in the hours needed to protect and provide. We also need to be aware of the particular challenges of working with young men as parents. While they have often had bad parenting themselves and ex- press a desire to be a better parent and to be involved, Brid says they struggle with how to do this, especially when it comes to communication issues. Some men who are not used to being interdependent can be threatened by the emergence of this being to whom they feel con- nected. Some find after the birth that it is far harder than they expected to be an involved father and in their anxi- ety retreat into gender stereotypes with thoughts such as “I’m useless”, “She knows best”, “I’d better keep out of the way”. Reactions can be exacerbated by alcohol or when a man finds it difficult to express himself in a non- threatening way. Compounding the problem with communication is the reported reluctance of men to ask for help from health service providers. Smith et al. (2006) say while the reasons for this are poorly understood, we need to be sensitive to the fact that men tend to view partners and

Illustration by Graeme Howard
Illustration by Graeme Howard

friends as a primary resource for help, so their approach to us may be indirect. In addition, men may be less able to boost their resilience and wellbeing (‘salutogenesis’) through personal social net- works, particularly if they are in the lowest household income group or if they belong to certain minority ethnic groups, for example Chinese and Asian men (Matheson &Summerfield, 2001). The sad outcome of this is that suicide is now the sin- gle largest cause of death of men aged under 35 in England (www.menshealthforum.org.uk), while older men have the highest suicide rates in the UK, and this is strongly associated with depression, physical pain or illness, living alone, and feelings of hopelessness or guilt (www.samaritans.org.uk/ know/pdf/InfoResourcePack2004web.pdf). We may also be

less likely to recognise the impact of these factors; while depression may occur as often in men as in women, doc- tors are less likely to diagnose it in men (www.mind.org. uk/Information/Factsheets/Men/). In fact, the average man lives a shorter life than the average woman – and for fifteen of those years can ex- pect to be seriously or chronically ill (www.menshealth. co.uk). Ed Garrett, a community health worker in Aber- deenshire, is actively seeking ways to empower men to improve their health through the Mearns Healthy Living Network. Much of his work involves supporting the de- velopment of community social and activity groups to counteract isolation and depression in older people. For men specifically, there is a need to provide socially ac-

FEATURE

Boys have a natural competitive instinct and it is very important to them to appear confident and knowledgeable. They appreciate opportunities for leadership, risk-taking, role modelling and action, and enjoy cracking‘codes’ and finding practical solutions.

ceptable alternatives to the pub but, with low numbers and a vulnerable membership, the older men’s group is struggling to be viable. This is unfortunate because Ed observes that the men clearly feel comfortable, have a laugh and are not having to play a role. Conversation includes lots of male-orien- tated banter and discussion of health issues. He says, “My feeling is that the group provides a valuable social space which can act as a springboard to involvement in other activities. One member, for example, hadn’t been out of his house on his own for three years but the boost to his confidence has allowed him to join other activities too.” This older men’s group includes men who have dif- ficulty with mobility and self-care. Resources for Re- habilitation (1997, p.17) suggest that “Accepting the limitations of a disability or chronic condition is not only psychologically liberating, but also makes daily liv- ing easier.” Importantly, they warn professionals that, as men may have their masculinity threatened by accept- ing help, getting to this stage may be difficult and take time. However, “The acceptance of realistic limitations and abilities may result in the restoration of self-esteem, the sense of control over life, and pride in achievements for men in all stages of life.” Adam Cox’s (2006) hooks for ‘Raising Our Sons to Com- municate and Connect’ might give us clues about com- municating and connecting with males in general. Boys have a natural competitive instinct and it is very important to them to appear confident and knowledgeable. They like specific direction and explanation. They may have a kinaesthetic learning style which means they get more out of exploring through physical contact, handling and touching things, and moving through space and new territory, than they do out of just listening. They appreci- ate opportunities for leadership, risk-taking, role model- ling and action, and enjoy cracking ‘codes’ and finding practical solutions. While goal-directed solution making is a good therapy tool, Cox cautions that it “tends to inhibit awareness of the more subtle information that enriches social percep- tion and communication” (p.23). It is therefore an idea to help boys define and articulate specific goals about things that matter to them and plan actions to achieve

things that matter to them and plan actions to achieve SPEECH & LANGUAGE THERAPY IN PRACTICE

FEATURE

news extra

Low incidence SEN provision under scrutiny

An audit of how local authorities meet the needs of children with ‘low incidence’ severe special educa- tional needs flags up the need for the department of health to continue to address recruitment issues in speech and language therapy. Carried out by the Special Needs Consultancy, the national audit considered provision for children with severe autistic spectrum disorders, severe sensory im- pairment and severe behavioural, emotional and social difficulties. It looked for examples of good practice, ex- plored gaps and made recommendations which would allow more children to have their needs met locally. In addition to addressing recruitment issues, the au- dit says that therapy services “are looking to develop more cost-effective ways of service delivery that will enable their support to be better targeted”. It men- tions Harrow speech and language therapy services where direct therapy is targeted on children with more complex and long-term needs and other groups are reached indirectly through teachers and teaching assistants. The audit report suggest that there have been “significant benefits where different services have come together for multi-agency training, so that there are better common understandings and a com- mon language / repertoire of approaches available”. The authors call for priority to be given to develop- ment in support and provision for older children as they move towards adulthood. In addition to the need for better support in mainstream secondary schools and local Further Education College provi- sion, gaps relate to broader areas of family support / respite care and support for mental health issues. The National Audit of Support Services and Provision for Children with Low Incidence Needs report is at www.

dfes.gov.uk/research/data/uploadfiles/RR729.pdf

Better communication cuts reoffending

Courses in oral communication and thinking skills not only improve prisoners’ quality of life in custody, but can significantly reduce their likelihood of reoffending, ac- cording to research from the Learning and Skills Devel- opment Agency (now the Learning and Skills Network). The researchers found that oral communication cours- es proved particularly beneficial for certain groups, particularly repeat offenders, those with shorter sentences and those with a high risk of reconviction. Prisoners found the training helped them to commu- nicate more effectively with fellow inmates and prison staff. A scale completed by prison officers produced high ratings for ‘control of temper’ and ‘thinking be- fore acting or speaking’ as positive benefits. Speech and language therapists were not involved in this research which looked at the effect of the English Speaking Board’s education courses in oral communica- tion, run in HM Prisons since 1999. The researchers rec- ommend that oral communication skills should be given greater prominence and that the courses should be more widely available in prison and in the community. Developing oral communication and productive think- ing skills in HM prisons by David Moseley and Kay Liv- ingston – see www.lsneducation.org.uk.

and Kay Liv- ingston – see www.lsneducation.org.uk. them. In addition, it is important to build an

them. In addition, it is important to build an ‘emotional dictionary’ (p.43) by modelling lots of synonyms of emo- tions, providing opportunities for boys to observe and notice emotional responses and change in others, and reassuring boys that feeling confusion over emotion is normal. Interestingly, Cox adds that“expressive depth is at least as important as having expressive breadth” (p.234). However, if parents or therapists try to take on full responsibility for changing a boy, Cox says their efforts will fail. Self-esteem is boosted by the hard work that is needed for meaningful change – even if the boys don’t want to talk about the fact that they have changed! We need to capitalise on boys’ hunger for parental approval by encouraging adults to notice and thank them when they use social communication skills, and to convey con- fidence in their ability. The environment is significant too - males struggle to communicate in a one-to-one com- pared with less personal settings, and a ‘safe’ place such as home can be a good place to start building bridges.

boys are particularly sensitive to individual teachers and effective teaching, whatever the sex of the teacher.

Amidst a wealth of possible clues about the way in to boys’ minds, Cox includes:

• Don’t force eye contact

• Avoid sarcasm and criticism

• Respond positively when a boy takes the initiative to talk

• Minimise the possibility of failure

• Avoid‘overquestioning’

• Use expressive tools from e-mail to the arts

• Be task / activity orientated to encourage talk

• Ask more about interests and opinions and pay particular attention to the music / lyrics he likes

• Distinguish thoughts from feelings

• Understand that resistance to communication may mean a boy needs more time to understand himself how he is feeling. Many of Cox’s strategies resonate with Jon Pickering’s

(1997) ideas for raising boys’ educational achievement. Pickering argues that, contrary to media spin, boys care as much about their learning as girls – they just show it in a different way. To feel OK about doing well at school, they also need to have balance, with a life outside school and other interests. Rather than blaming outside factors for boys’educational shortcomings, Pickering asks teach- ers to look for answers within their own classrooms, and from their own boys. This may include planning plenty of “contrast and change” (p.36), formal presentation / public speaking tasks, and having a system that allows for a speculative, risk taking and experimental approach, ending with an exam. Other suggestions include giv- ing praise – and punishment – in private, capitalising on boys’ interest in non-fiction, and using project work which includes recording of responses. Pickering stress- es that boys learn best when:

• work is matched to ability

• there is clear explanation of the task and learning stages with visual reinforcement and opportunity to ask for clarification

• the teaching of speaking and listening skills is prioritised and practised. None of this is surprising, but reinforces the value of speech and language therapists supporting change in the classroom. Pickering also supports individualised action planning like individual education plans, argu- ing that through this a boy learns how to learn by tak- ing greater responsibility for his learning, setting clear objectives and getting regular feedback.

Sensitive to individuals

Pickering stresses that boys are particularly sensitive to individual teachers and effective teaching, whatever the sex of the teacher. This is important as only 7 per cent of educational assistants, 13 per cent of primary and nurs- ery teachers, 12 per cent of nurses and 12 per cent of care assistants and home carers are men (2004 figures). This isn’t going to change anytime soon. In higher edu- cation, just 19 per cent of those studying education and subjects allied to medicine are males (2002/3 figures) (all EOC, 2005). And analysis of the membership of the Royal College of Speech & Language Therapists (Cobb, 2003) found that a mere 1.6 per cent of assistants, 2 per cent of full members and 2.8 per cent of students were male. So frogs and snails meet sugar and spice. But to end up with all things nice, it is clear we need to take an indi- vidualised approach that avoids stereotyping but draws appropriately on our understanding of what boys and men might really be made of.

Acknowledgement

Thanks to Ed Garrett for his time.

References

Broomfield, J. & Dodd, B. (2004) ‘Children with speech and lan- guagedisability: caseloadcharacteristics’, InternationalJournal of Language & Communication Disorders 39(3), pp. 303-324. Bryan, K. (2004) ‘Prevalence of speech and language dif- ficulties in young offenders’, International Journal of Lan- guage & Communication Disorders 39(3), pp. 391-400. Burgess, A. (2006) Engaging Fathers in their Children’s Learning: tips for practitioners. Available at: www.fathers- direct.com (Accessed 3 May 2006). Cobb, J. (2003) Sex count. Unpublished: Royal College of Speech & Language Therapists. Cox, A.J. (2006) Boys of Few Words. NewYork: The Guilford Press. Department of Health (2004) National Service Framework for children, young people and maternity services. Crown copy- right. Equal Opportunities Commission (2005) Facts About Women & Men in Great Britain. Available at: www.eoc.org. uk/pdf/facts_about_GB_2005.pdf (Accessed 3 May 2006). Featherstone, B. (2005) ‘Antenatal education for men:

Why we should engage fathers in antenatal classes’, 3rd Annual Preparing for Parenthood Conference. Edinburgh 5 May. London: The National Childbirth Trust. Matheson & Summerfield (eds) (2001) Social Focus on Men. London: The Stationery Office. Pickering, J. (1997) Raising Boys’ Achievement. Stafford:

Network Educational Press. Resources for Rehabilitation (1997) A Man’s Guide to Coping withDisability. Massachusetts: Resources for Rehabilitation. Smith, J.A., Braunack-Mayer, A. & Wittert, G. (2006) ‘What do we know about men’s help-seeking and health service

use?’, Medical Journal of Australia 184(2), pp. 81-83.

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RECOMMENDED READING

resources

Recommended Reading

Given the overwhelming amount of information available, we need to be selective in what we read. Even then we find that papers do not always include an explicit link between the theory / experiment and its direct or indirect implications for practice. Articles in journals have gone through a painstaking process of peer review but it is ultimately for you, the reader, to judge whether the stated result is a) valid and b) clinically important – in other words, why and how the article will change your practice. In this section, readers explain why they would recommend a particular article from a peer reviewed jour- nal to their colleagues. While this is a personal response that focuses on clinical importance and practi- calities, the author may also wish to comment on factors such as study design / validity and statistics / statistical significance. If you are interested in contributing to this section, please contact the editor, avrilnicoll@speechmag.com. We are also happy to feature policy documents and other important papers.

DYSPHAGIA

Paula says:

Leopold, N.A. & Kagel, M.C. (1997) ‘Dysphagia -

ingestion or deglutition?:

a proposed paradigm’, Dysphagia 12(4), pp. 202-

206.

Paula Leslie is based in the Faculty of Medicine, University of Newcastle and holds specialist NHS speech and language therapy posts in adult swallowing and fluency. She is an RCSLT dysphagia advisor.

“Despite my base in clinical, often quantitative swallowology research, this paper is one that made me think when it first came out and con- tinues to be there in my mind eight years later! This is a review not a scientific study. Review papers allow us to ac- cess a number of papers on a subject quickly but they only offer the interpretation of the authors. To use such a paper I would always ad- vise checking the primary sources to see if the interpretation matches your own. Leopold and Kagel suggest that a “paradigm shift” is required in the way we think about swallowing, from deglutition to ingestion. I sus- pect that when you read it, you will think it’s common sense, but we need more than just common sense to justify our intervention and to direct future research. This paper provides references to back up our common sense hunches. The paper puts together a case for considering what happens before the food or drink gets to the lips. And that this pre oral stage might affect subsequent oral and pharyngeal physiology. As with good research it raises more questions than it answers. Per- haps showing us directions that clinical research should take rather than timing of infinitesimally small movements, or rates of aspiration divorced from long-term outcomes?”

EDITOR’SCHOICE

Editor Avril Nicoll says:

EDUCATIONAL

PSYCHOLOGY

Dunsmuir, S., Clifford, V. & Took, S. (2006) ‘Collabora- tion Between Educational Psychologists and Speech and Language Therapists:

Barriers and opportunities’, Educational Psychology in Practice 22(2), pp. 125-140.

“I was drawn to this paper because, with one wonderful exception, my most challenging professional relationships have been with edu- cational psychologists. Although this study only involved practition- ers from two local authority areas, the results suggest I am not alone – and that the feeling is mutual. An open-ended questionnaire asked both professions what informa- tion they request from each other, how psychological assessments are used and interpreted and what issues are faced in working col- laboratively and sharing information with each other. The main tension grew out of the speech and language therapy need to understand more about a child’s cognitive development, and the reasons why the educational psychologist might be unable or unwill- ing to provide such information. My interpretation is that this acted almost as an impasse, as the speech and language therapists also wanted much wider and better communication. Tellingly,“comments from some educational psychologists suggested that restricting op- portunities for communication could be used as a tactic to avoid dis- cussion of contentious issues” (p.136). The paper reviews the drivers for collaboration, and emphasises the imperative of a strategic approach to change. It recommends joint training and suggests that individuals could be more positive about the potential value of collaborative work.”

Alzheimerʼs

diagnosis

The Alzheimer’s Society can provide a research-based train- ing and diagnostic package in text and electronic format free of charge to GPs. Carers and people with dementia tell the Society that bet- ter care and understanding of dementia at GP level and early diagnosis would make a big difference by enabling them to plan and ask for support. www.alzheimers.org.uk

Older people

Research into Ageing, the biomedical research arm of Help the Aged, is celebrating 30 years of funding research to lead to better health and independence for older people. Evidence-based resources include free leaflets such as ‘Healthy Bones’, ‘Staying Steady’ and ‘Bladder and Bowel Weak- ness’ on www.helptheaged.org.uk/AdviceInfo/InfoPoint/, and the video ‘Be Strong, Be Steady’ and book ‘How To Thrive Past 55’ for sale at http://www.helptheaged.org.uk/acatalog/.

Wall of Words

I CAN’s Wall of Words was designed to highlight the impor-

tance of language in our lives – but the result may also pro- vide a useful therapy tool. Older children with phonology and / or language problems might be intrigued by the wide choice of favourite words and the reasons given. www.wallofwords.co.uk/index.asp

Endoscopy ebook

The voice training company Vocal Process has released a 2½ minute video ebook of a healthy voice from the inside using Endoscopy film. The ebook includes a voiceover explaining exactly what the viewer is looking at, and film of a healthy larynx speaking and singing five vowels. Future releases will contain various different vocal tasks. Available at an introductory rate of £5 (10% goes to the British Voice Association and the British Association for Performing Arts Medicine) from www.vocalprocess.co.uk.

Conditions

explained

The 2006 edition of Contact a Family’s Directory of Specific Conditions, Rare Disorders, and Support Groups is out now. Focused especially on conditions affecting children it aims to provide clear and concise medical information, useful to lay

people and professionals. www.cafamily.org.uk/dirworks.html The charity for families with disabled children has also added

a new factsheet for gay and lesbian parents caring for a disa- bled child to its website. www.cafamily.org.uk/FactsheetGayAndLesbianParents.pdf

KEYS TO WINNIING WAYS (7) The application key The sad circumstances surrounding this article were

KEYS TO WINNIING WAYS (7)

The application key

The sad circumstances surrounding this article were not of life coach Jo Middlemiss’s choosing. But, having previously advocated keys of awareness, appreciation, abundance, affirmation and authenticity to encourage reflection and personal growth, it felt an appropriate time to explore the toughest challenge of all – their application at a time of loss.

 

READ THIS IF YOU

I

read in a child’s book once that a black dog was like a hole in the world. I couldn’t really imagine it until I saw my own black lab standing against a snowy background. He did look exactly like a hole in the world. It is an image that has come often to

• DEAL WITH LOSS

• FIND BUSYNESS MASKING YOUR PURPOSE

 

• WANT TO STEP INTO NOT ONTO ANOTHER’S LIFE

me since my sister Mary died on March 30th after a very rapid eight week encounter with cancer. There is a hole in the world where she was and I miss her for many different reasons. Mary is my big sister. We are separated by four years and two brothers, enough to grow up without really getting to know one another. Our love and friendship was one that grew only after the shared experience of motherhood, marriages, separa- tion and maturity. We lost another sister over 20 years ago to another type of cancer and Mary’s illness, although very differ- ent, presented an overlay of déjà vu. Mary had gone to Canada and nursed my younger sister almost to the end of her young life at a time when I was not in a position to help at all.

I could have saved myself time and space if I had used the old adage‘Mind the Gap’.

I have experienced many of life’s adversities but have developed my work and philosophy to a deeper level in recent years. The speed of Mary’s illness was a bless- ing and a wound, and the certain knowledge of where I would be and what we would be for each other at this most challenging time of our lives was to be the big- gest test of my ‘keys’. Would the keys open the doors to deeper knowledge and understanding? Would they be helpful in dealing with this loss?

What is this for?

Over Christmas and New Year a very natural gap ap- peared in my work pattern. Long-term clients finished working with me at absolutely the right time for them and me. However the diary wasn’t filling up as I would have liked. Previously this gap would have filled me with a spot of panic, but this time I thought “What is this for?” Unfortunately I didn’t trust my intuition quite enough and immediately set about networking for new clients, taking on speaking engagements and organising cours- es. Busy busy busy. No sooner had I done this than the phone call came in. What I could unpick I did, but it was

complicated and annoying, although all the people who were inconvenienced were very supportive. In retrospect I could have saved myself time and space if I had used the old adage ‘Mind the Gap’. I will in the future. I do now. I will keep myself available for the real tasks of life rather than the endless busyness which can mask our purpose. The next step was to go to Ireland where my sister was and step into her life without stepping onto her life and the lives of her close family. Her husband was absent. After a wearying struggle Mary had really come into her own in her early sixties and was truly joyous for the first time in a long time, so her illness was a confusing irony. There was a great high when she was first diagnosed but when I arrived that had turned to sadness and in- trospection. Where she had wanted phone calls, letters, presents and flowers, she lost interest in all of those things. She wanted to be silent, she wanted to be safe and she wanted to stay in hospital.

Living in the moment

A course of chemotherapy was prescribed and she was

more anxious about that than I had ever seen her. Al- though we were sisters, I thought that I would have be-

haved very differently in this circumstance. But I learned not to judge anything that was happening. The truth is, I don’t know how I would be, and just know how she was – and that is where I had to be, in the moment with her. Living in the moment in a hospital is a challenge for

a fresh air loving, active person like me. My sis was on

large doses of morphine. She was sleeping a lot. I was sitting a lot. I observed the non-stop asking of questions by curious well wishers and loving friends and relatives and learned not to ask. “How are you?”“Are you in pain?” Are you be- ing sick”? “Are you sleeping?” “Have you lost weight?” - all understandable, but so wearing if answered twenty times a day. We developed a strategy where I became the phone fielder and the initiator of a weekly text mes- sage which answered the standard questions without being too obvious: “Hi there, Mary here. Thank you for your kind message. My pain is under control, my nau- sea is being well managed. I am sleeping very well al-

though food is not of much interest. I’ll keep you posted

or you can contact my daughter on [tel. no.].” This way

people felt considered but the replies tended to be texts and therefore could be read anytime. A system proved to be essential. Loving interest can be very exhausting and at this stage we were all in the business of building strength not wearing it out. There is so much fear surrounding cancer and its

treatment and yet the professionals involved were, for the most part, expert, knowledgeable, skilful and loving. They were adept at pain relief, nausea control and symp- tom management. As the chemo approached Mary’s anxiety built and I realised the power of being there. Not talking, just be- ing. It’s hard to convey the power of a knowing look, re- specting the feelings of fear but not joining in. Although my sister was very ill, not a single one of the fears she fretted about proved to be anything other than a paper tiger. The chemo was manageable (but too late). She was never sick. Her pain was controlled. She was able to go home, meet family members and enjoy a birthday party. Each time, when the storm had passed, she agreed she had been able to come through all the challenges her

I learned not to judge anything that was happening. The truth is, I don’t know how I would be

illness and treatment presented. In my reflections I reaf- firmed to myself that worry really doesn’t do any good. As it became obvious that Mary’s liver was in failure the consultant pulled me to one side and used the words “rapid decline” more often than I cared to hear. The last week of her life was spent observing how she almost imperceptibly detached herself from all the things and people she was most attached to. This was not callous - this was vital. I don’t even know if Mary was aware that she was doing it.

Time and distance are illusions

My time was spent masterminding family visits and farewells; screening phone calls but making sure that the people who needed a final word got it. I will never forget the last conversation of a mother to her eldest son. He was in Australia with no chance of getting back in time: “Neither time nor distance can make any differ-

ence to our love for each other.” After the call she said “It is really true, time and distance are illusions, I never believed it before.” She wanted no more treatment and none was offered. From that momentous decision her fear disappeared. Palliative care was the route for the last twenty four hours. Two of my brothers, two of her children and I accom- panied her to her death. We promised we would never leave her and we didn’t. It was a bit like being in the de- parture lounge at an airport except that she was going on a journey from which there was no return. Normally I’m hopeless at airports and can cry just watching other people saying good bye to each other! This was very dif- ferent for there was laughter as well as tears. There were moments of farce and nonsense and there were mo- ments of love so powerful that you realised it was a force stronger than anything else on earth. The precise moment of passing was when she was alone with her children. (My brothers and I had withdrawn to the chapel for an early morning prayer.) Nothing has ever felt so right. The next few days are a bit of a blur. The Irish way of death is nothing if not funny and I felt as if I was on the set of Father Ted and Ballykissangel. The undertaker really did work out of a pub and he lured my brothers into a business deal with a huge pint of Guiness and a pile of white bread sandwiches - just the job after the all night vigil (you can go off brothers pretty quickly!) But there was no point in stressing and it all worked beautifully. Mary’s body returned to the house. I stayed with her remains although I knew she wasn’t there. There was something incredibly comforting about seeing the task through to the end. The funeral was joyous. I did not want to cry my way through, which is my usual style. I wanted to sing, read a lesson and speak to people who had taken the trouble to travel long distances. The crea- tive key came into practice as we all swallowed copious quantities of ‘Virtual Valium’. (I had read that if you ask for tranquillity and calm, the body will produce a kind of natural valium for you. On an early morning walk with tears streaming down my face I cried out to the heav- ens for tranquillity and the idea popped into my head. I put out my hand and imagined taking a pill. I could take a couple of these. I could overdose on these with no harm done. The tears turned to laughter. I couldn’t wait to tell my nieces and it had the same effect.) We floated through the next few hours gaining strength from each other and all the supporters who came from far and wide. It was a real traditional Irish wake.

Travelled together

When it’s over it’s over, and one is left with the most ex- traordinary lethargy and exhaustion. All the things that have been written about the process of grief are true, to different degrees depending on the situation. My every waking moment was not concerned with my sister as we lived separate and different lives - but for six precious weeks we travelled together. We were supposed to be going to Canada in the summer for the trip of a lifetime. Although the journey we took was very different alto- gether, I will always remember it as one of the most im- portant I have ever undertaken. Only in retrospect did I realise that it was almost exactly the period of Lent. On Easter Sunday I thought for the first time that I under- stood exactly what it meant to be “living Lent” rather than doing something for Lent.

All of us experience loss throughout our lives and it is important that we acknowledge its impact and award ourselves the time and space it requires. In applying my keys in a time of great loss, the Appreciation Key stands out; gratitude for the life of my sister, gratitude for the joy and wisdom and love of my sister and most sincere gratitude for the opportunity to share her final days with her without the need for any kind of excess. I long to see her again but what I gained from our shared Lent has far outweighed the hole in my world. To give you some idea of my sister I leave you with the appreciation paid to her by her daughter Eileen:

Mum

If we know what Love is, it’s because of Mum. It was in her eyes every time we walked through the door. It was shown in the way she protected us, but let us go our own path.

If we know what Joy is, it’s because of Mum. Her never ending enthusiasm towards every part of life, from her grandchildren to a chocolate biscuit! Mum overflowed with life.

If we know what Strength is, it’s because of Mum. Mum had the courage and strength to overcome the difficulties that faced her, and to blossom in her independence.

If we know what Compassion is, it’s because of Mum. Mum gave herself to everyone. Her time, her skills and her acceptance helped so many people, not only through her St Vincent De Paul work, but also through her everyday life.

If we know what Happiness is, it’s because of Mum. The laughs, the fun, the sharing cocktails and champagne at every given opportunity!

If we know what Family is, it’s because of Mum. Mum fostered in us the importance of brothers and sisters and children. She created an unbreakable bond between all of us, making the future look bright and full of hope.

She was our beautiful, fun and loving Mum. We are so privileged And thankful that we got to call her “Mum”.

SLTP
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Jo Middlemiss is a qualified Life Coach with a background in education and relationship counselling,

Jo Middlemiss is a

qualified Life Coach with

a background in

education and relationship counselling, tel. 01356 648329, www.dreamzwork.co.uk.

Jo offers readers a complimentary half-

hour telephone coaching session (for the cost only

of your call).

KEYS TO WINNIING WAYS (7)

resources

Special Source

The charity BDF Newlife has introduced ‘Special Source’, a free online web resource designed to com- plement its Nurse service. It provides answers to the commonest questions asked by parents, patients and support professionals about inborn conditions. The child health and research charity seeks to im- prove the lives of people affected by inborn condi- tions and to reduce the chance of children being affected. It says around 45,000 babies are born each year with an inborn condition in the UK and 20 per cent do not live to see their 7th birthday. www.specialsource.org www.bdfcharity.co.uk

Insight magazine

The Royal National Institute for the Blind has a new magazine for children and young people with sight problems. www.rnib.org.uk/insightmagazine

SEN

The May / June issue of SEN magazine includes a fea- ture on speech and language development. www.senmagazine.co.uk

Oral health

National Smile month (ending 13 June) encourages everyone to consider how they can improve their oral health. Information, puzzles and games are available on www.nationalsmileweek.org.

Eating and drinking

Exhibitors at CareExpo 2006 included Medoris who make the Catchkin which is designed to look and drape like a napkin but perform the functions of a bib. www.medoris.co.uk

CASP on the web

The second edition of the Communication Assess- ment Profile (CASP) and inserts are now available on the web, or from Speech Profiles, The Old Post Office, 4 The Street, Slinfold, Sussex RH13 0RP. The CASP costs £85.00 plus p&p. www.speechprofiles.co.uk

Reminiscence and Recall

This revised and updated guide includes intergener- ation work, and working with minority ethnic elders and people with sensory and learning disabilities or with dementia. Reminiscence and Recall: 3 rd edition – A practical guide

to reminiscence work by Faith Gibson is available from Age Concern Books on 0870 44 22 120.

ACCESSIBILITY

Conference

As demand for accessible information grows, Alison Matthews and Rachel Samuels report on a multi-agency event that kick-started a north west of England forum for sharing good practice.

THE ‘SHOW AND TELL – PERSON CENTRED INFORMATION IN PRACTICE’ CONFERENCE ON 1 MARCH 2005
THE ‘SHOW AND TELL – PERSON
CENTRED INFORMATION IN
PRACTICE’ CONFERENCE ON 1
MARCH 2005 WAS ORGANISED BY
THE ROYAL COLLEGE OF SPEECH
& LANGUAGE THERAPISTS NORTH
WESTADULTLEARNINGDISABILITY
FORUM. A ‘NOT FOR PROFIT’
EVENT SUBSIDISED BY AN RCSLT BT
BURSARY, ALL SPEAKERS GAVE
THEIR TIME FREE.
Alison and Rachel

ALISON MATTHEWS IS SPEECH AND LANGUAGE THERAPY TEAM LEADER WITH THE OLDHAM COMMUNICATION THERAPY TEAM, E-MAIL ALISON.MATTHEWS@ OLDHAM.GOV.UK. RACHEL SAMUELS IS A SPEECH AND LANGUAGE THERAPIST WITH CITY CARE IN MANCHES- TER E-MAIL RACHEL@CITYCARE. ORG. OR RACHEL.SAMUELS@ MANCHESTER.GOV.UK.

1. The need

Discussions within the Royal College of Speech & Lan- guage Therapists’ North West Adult Learning Disability Forum highlighted a need to share good practice in the production of accessible information. As a result we set up a sub-group of speech and language therapists, assistants and an information worker from a variety of agencies to organise an event to kick-start the process.

2. The context

Over the years, many documents have emphasised the need for accessible information. Core NHS principles in- clude“The NHS will … provide open access to information about services, treatment and performance”(http://www. nhs.uk/England/AboutTheNhs/CorePrinciples.cmsx). Given that a large percentage of people with learning dis- abilities have difficulty in accessing written information, this presents its own unique challenge to services. ‘Valuing People’, the White Paper launched in April 2001, identifies that there is‘Not enough effort to communicate with people with learning disabilities in accessible ways’ (4.1, p.44). It adds that the challenge for public services is to begin ‘Improving information and communication with people with learning disabilities’(4.2, p.45). Signposts for Success (1998) indicated that people with learning disabilities and their families have the following information needs:

• Appropriate language in terms of gender and cultural awareness.

• Text in short clear sentences without jargon.

• Clear, life-like pictures that are presented in a simple and enjoyable way.

• Pictures, writing and the spoken word used together.

• Video tapes and audio tapes.

• Materials appropriate for people with impairments of hearing and vision.

• Computer programmes, models, large simple print, pictures, photographs, slides, posters, symbols, sign and Braille.

• Opportunities for practice and rehearsal.

• Involvement of carers, relatives and advocates to reinforce important messages.

• Allowing plenty of time. The risk in not addressing the need for accessible in- formation is that we go on producing written informa- tion for people who are unable to read, denying them access to information about health and social activities and ultimately excluding them. As a service we have a responsibility to alter our communication to enable people to participate in planning and implementing changes and developments to their lives, health, and aspirations, whether that is their review, person centred plan, proposed house move or advice about diet. We need to remember that ‘user led’ means user said and

calls:

signed, or symbolled, or drawn, or photographed, or gestured, or videoed. However, we have a decision to make in how we meet the demands for person-centred and service-centred ac- cessible information as there is a tension here. Information can be required by a person for an event in his or her life. In producing person centred informa-

tion, best practice involves individualised assessment by

a speech and language therapist of a person’s informa-

tion needs, taking into account the person’s symbolic understanding, then producing information in a format which enables them to understand. It may not necessar- ily involve pictures. Although it is time and personnel

intensive, information can only be considered accessible

and be easily measured in terms of its success - when

it

is person centred.

we have a decision to make in how we meet the demands for person- centred and service- centred accessible information as there is a tension

More recently political pressure has been placed on

services to produce accessible information to wider groups of people with learning disability. The initial push began as early as 1995, with the Disability Discrimination Act. Under this, from October 1999 service providers have had a statutory obligation to ensure their services are ac- cessible to everyone. More recently, ‘Valuing People’ (DH, 2001) highlights the need for services to produce acces- sible information so people can make choices. This need

is raised in sections on housing, mental health services,

and people from ethnic minority communities. Informa- tion needs to be improved for carers (5.2, p.53), direct payment schemes must be accessible and there needs to be accessible sex education. Producing good service centred information is resource intensive. It needs to be produced in a variety of formats – leaflets, tapes, video, and possibly in different languages, including sign. It is not simply a matter of illustrating a document with some pictures from the computer. Analysis of the language content and structure is necessary to maintain the mean- ing of the original document or source. It is important to remember that service centred information will always be an attempt to reach a middle ground and is therefore not truly accessible information.

ACCESSIBILITY

Show and tell

Both requirements have inevitably led to a real in- crease in the demands on therapists’ time. One solution of the Adult Learning Disability Team in Oldham was to second Chris Marsland, a support worker from the local day centre, into the role of information worker. A sec- ondary benefit was that Chris undertook a great deal of the organisation of the conference.

3. The state of play

Workshops and presentations ran throughout the day. However, the opportunity to gather the thoughts of such a broad range of people working with people with

Table 1. What information are we making accessible?

Area identified

Number

a) Service required materials for an individual:

 

• Person centred plans

5

• Tenancies

4

• Personal reviews

3

• Health action plans

3

• Staff interviews and selection

2

Employment: contracts, conditions, application forms

1

b)

Bespoke information

• Timetables

6

• Staff rotas

4

• Choices

4

• Accessible environment eg. using objects

4

• Reports

2

• Menu choices

2

• Medication information

2

• Personal diaries and calendars

1

• Shopping lists

1

• Feelings barometers

1

• Consequences of actions

1

• How to do information

1

• Consent

1

• About me books

1

Moving house books

1

c) Service level information not personalised

• Minutes

6

• Leaflets about services

4

Health information, eg. videofluoroscopy, epilepsy, diabetes

4

Policies

3

• Service reports

3

• Agendas

3

Complaints and compliments

3

Newsletters

2

Information leaflets eg. sexuality, money

2

Rights

2

Consultation documents

1

• Referral forms

1

• Appointment letters

1

• Care plans

1

• Statement of purpose

1

• Consent

1

• Anti bullying

1

 

Information outside of learning disability services

d)

• Police information

1

• Hospital information booklets

1

learning disabilities was not to be missed. All participants were invited into small groups to discuss fundamental questions posed by the conference working group:

1. What information is being made accessible? (Table 1)

2. Why is information being made accessible? (Table 2)

3. What are the risks / pitfalls of making information ac-

cessible? (Table 3)

4. What is being done to reduce these risks / pitfalls?

(Table 4) The collated group responses showed a high level of consensus, with a plethora of accessible information in production, and more and more being shared via adult learning disability networks. There was an almost equal split in the information that was being produced for individuals and for services. Common types of person centred information included person centred plans, timetables and staff rotas. The

most frequently produced service information included

agendas / minutes and leaflets around health and other

community services.

The drive to make information accessible functions at

three levels: society, policy and individual. Within these categories the human right to information, legal require- ments and enhancing quality of life for the individual

Table 2. Why are we making information accessible? Area highlighted Number a) Society level •
Table 2. Why are we making information accessible?
Area highlighted
Number
a)
Society level
Inclusion
7
Human rights
6
Increase participation
5
Gain access to services
2
Citizenship
1
Respect
1
“Because it’s about time!!”
1
Equity
1
b)
Political / policy level
The law
6
Valuing People say so
5
To comply with local policies
4
Political agenda
3
Because we are told to
3
To meet demands
2
For person centred planning
2
Enable user involvement
2
Multidisciplinary team requests
1
Increase health and safety
1
c)
Individual level
Increase understanding
8
Promote choice
7
Give power / control and empower
6
Quality of life
3
Maximise communication
3
Increase independence
3
Increase self esteem
2
To increase knowledge
1
Central to support
1
“It’s good fun”
1
1
To explain change

were the most frequently cited drivers. “Because it is about time”and“it’s good fun”also struck a chord. Risks and pitfalls divided into those identified at a service level (such as lack of coordination, ownership issues and time), issues around the purpose of making the information accessible (overloading people with in-

the information accessible (overloading people with in- Table 3. What are the risks of making information

Table 3. What are the risks of making information accessible?

Highlighted area

a) Service

Number

• Lack of support, eg. funding

8

• Who’s in charge

5

 

• Time

4

• Reluctance to sign up / passing the buck

3

• Lack of review

2

• Lack of coordination

1

• Lack of collaboration

1

• Lack of discussion

1

b)

Common pitfalls

Who is the target audience / risk of one size fits all. Not a translation service

9

Overuse of symbols / ignoring the written content

8

Risk of lip service

8

Overload of information

7

Lack of “how to” knowledge

6

Fails to make information more understandable

3

Lack of training

2

Cause offence

1

Preaching to the converted

1

c)

Individual

Accessible to the producer and not the person / pretty not accessible / style over content

7

Over / under estimation of receptive language

levels

6

Confidentiality issues

3

Table 4. What are we doing to reduce the risks of making

information accessible?

Highlighted area

a) National

Number

• Sharing practice

4

• Multi agency working / partnership

4

• Speech and language therapists don’t hold all

2

 

the knowledge of how to produce accessible

information