TRAINING / IN BRIEF

It was great to meet other people who were going through similar problems. I cannot over emphasise how welcome it has been to hear discussion on practical and pragmatic things that are clearly relevant and which will help us. I think the course gave us time to take time out of our normal situation and focus on our daughter and things we could do to support her in her daily life. [In the past] We were given the diagnosis and told to read Tony Attwoods book [Attwood, 2006]. That is all the information we were given. This programme has been invaluable in helping us understand our child and his difficulties. I wish his teacher had the same level of knowledge and understanding. We have both recently left the NHS but offer training workshops to enable other staff and professionals to deliver the PALS programme. We have also had a book published (Crow & Finley, 2009) which provides detailed session plans and teaching materials to enable others to present the programme. We would like to follow up future programmes with more detailed assessment and evaluation of benefits to children, families and service providers. We would be interested to hear from others who would like SLTP to contribute to this. Judy Crow (email jacrowslt@yahoo.co.uk) and Diana Finley (email diana.finley@virginmedia. com) are consultant speech and language therapists who developed the PALS programme while working for Northumberland NHS Care Trust. Both are now in the independent sector.
References Attwood, T. (2006) The Complete Guide to Aspergers Syndrome. London: Jessica Kingsley. Crow, J. & Finley, D. (2009) PALS. Parents Aspergers/ Autism, Language and Social Skills. Chesterfield: SHU (Sheffield Hallam University) / Winslow Press. Gray, C. & White, A.L. (2001) My Social Stories Book. London: Jessica Kingsley. Lieb, S. (1991) Principles of adult Learning. VISION. Available at: http://honolulu.hawaii.edu/intranet/ committees/FacDevCom/guidebk/teachtip/ adults-2.htm. (Accessed 6 October, 2010). Sussman, F. (1999) More than Words: Helping Parents Promote Communication and Social Skills in Children with Autism Spectrum Disorder. Toronto: The Hanen Centre.

In Brief...
Easier self-referral for people who stammer
Pat Brookes on how a speech and language therapy department is working with service users to become more stammer-friendly by developing web-based information and referral. have been working with adults who stammer since 2000. Sometimes clients would tell me about their experiences of difficulties in getting a referral for therapy. Most assumed that they needed to be referred by their GP. The process of phoning for an appointment or talking to the receptionist in a crowded waiting room and then explaining their difficulty to the doctor felt very daunting to many of them. Those who braved this process did not all find their GP very helpful. Some were given incorrect information, even that there was no provision, so we wondered how many potential clients are lost at this point. Although we offer open referral for fluency problems, potential clients had few ways of knowing this and, if they did, the normal option of making a phone call to a complete stranger, or answering machine, was far from stammer-friendly. The process was putting unnecessary barriers in the way of people who needed help and advice and failing to fulfil the Royal College of Speech & Language Therapists requirement: Referral procedures will ensure that all individuals have access to the service, irrespective of age, language, gender, race, presenting communication difficulty or location (RCSLT, 2006, p.190). In 2008 Anna Shepherd, a student speech and language therapist, undertook a serviceuser consultation about access to and value of speech and language therapy for adults who stammer. She interviewed nine people who had received speech and language therapy. The participants in her study valued the speech and language therapy that they had received, but thought that the speech and language therapy service did not inform the public about the help that was available, and that referral was difficult. Anna reported, All participants believed that the SLT department should advertise their services better including alternative ways to access SLT, such as an email service and a direct telephone number for the SLT department. We decided to put information about the fluency service on the PCT website, including alternative means of referral. The communications and IT department were enthusiastic about the idea. We linked up with Katie Pringle, Communications special project officer, who implemented our ideas.

supported by

We decided that the website needed to include information about the whole service for people who stammer from preschool to adult. The design consisted of a short introductory page with quotes from service users and four options aimed at the different age groups. On each page there is a brief description of the difficulties that stammering can cause for that age group, a description of what the speech and language therapy service can provide, and ways to self-refer. There are also links to other helpful organisations such as the British Stammering Association and the Michael Palin Centre. Two service users reviewed and agreed the wording and layout. The information package was approved by speech and language therapy managers, IT and information governance. We produced leaflets for adults and for teenagers with the same information as on the website to encourage self-referral. The website went live in the autumn of 2008. Adults on my current caseload who stammer looked at the website and confirmed that it was easy to access (by searching for North Tyneside stammering) and included the information that they thought was necessary. Comments included: Really liked the matter of fact approach... delighted to see it up and running and so easy to access, too has all the details for each age group. The leaflets for teenagers were sent to high schools and colleges in North Tyneside. The information about self-referral was publicised in an article in our local paper, the Newcastle Evening Chronicle, in March 2009. Its content was largely based on ideas from the adults who stammer who attended an evening therapy group.

REFLECTIONS ON GROUPS DO I OFFER A MIX OF DIRECT TEACHING, DISCUSSION OF STRATEGIES AND OPPORTUNITIES TO SHARE PERSONAL EXPERIENCES? DO I STAY ALERT, NOT JUST TO WHAT PEOPLE ARE SAYING, BUT THE UNDERLYING ANXIETIES THEY MAY BE EXPRESSING? DO I HAVE THE FLEXIBILITY TO DEAL WITH EACH GROUP DYNAMIC AND ENSURE EVERYONE HAS THE CHANCE TO CONTRIBUTE?
To comment on the impact this article has had on you, see guidance for Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends.

Unexpected bonus

I normally receive about 12 referrals a year for adults who stammer. This year 4 of the initial enquiries that I received were via email and text. An unexpected bonus for service users was that adults on my caseload have found it very useful to use text and email for arranging or changing appointments, sharing news about issues relating to stammering and discussing ideas. I plan to inform GPs about the website so that, if people come to them asking about speech and language therapy for stammering, they have easy access to accurate information for their patients. Pat Brookes is a speech and language therapist and specialist in stammering with NHS Newcastle and North Tyneside Community Health.

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2010

IN BRIEF

Email In Brief entries to avrilnicoll@speechmag.com. One lucky contributor in each issue receives 50 in vouchers from Speechmark (www.speechmark.net), a company which publishes a wide range of practical resources for health and education professionals.
Resource You can access the website at: http://www.northtynesidepct.nhs.uk/services/ community-services/speech-and-languagetherapy/stammering Acknowledgements I am very grateful to the following people who have helped me in developing the service to adults who stammer in this area and in writing this article: adult clients; Rose Hilton, Speech and Language Therapy Lead, North Tyneside PCT; Katie Pringle, Communications special project officer NHS North of Tyne; Anna Shepherd, Speech and Language Therapist, Rotherham PCT. References Royal College of Speech & Language Therapists (2006) Communicating Quality 3. London: RCSLT. Shepherd, A. (2008) The Views of Service Users and Potential Service Users of Speech and Language Therapy for Adults that Stammer. Unpublished student project.

Communication Therapy International - whats that?

Amy Jensen explains why she is an enthusiastic member of the networking organisation Communication Therapy International.

any low and middle income countries have limited services for people with communication disabilities. Often services are provided by people with very little training in the area and, where specialists exist, they are likely to be working in the main cities with the most affluent people. Large numbers of people with a communication disability receive no specialist support. Communication Therapy International does what it says on the tin: its an international network of people with an interest in communication therapy. It was set up in 1990 by a group of British speech and language therapists who had experience of working in developing countries. They recognised that speech and language therapists were not the only people who might help those with communication disabilities; in many places this work is carried out by interested and motivated teachers, doctors, nurses, community disability workers and others. Often they do a great job, with very limited resources and few opportunities to gain extra information and ideas about practical ways to help. Although many techniques and approaches used by speech and language therapists in well-resourced countries can be

applied effectively elsewhere, it often takes a bit of imagination and adaptability to be helpful in a different cultural context. So, Communication Therapy International acts as an information and support network. It serves as a forum for sharing knowledge, experience, resources and the low-tech, practical know-how which can make a difference to peoples lives. Particular emphasis is placed on countries where there is a shortage of resources for people with communication disabilities. We are keen not to restrict our membership to qualified specialists, and have a diverse list which includes speech and language therapists, doctors, teachers, community development workers, and people with a communication disability along with their parents and carers. Many of our members fall into one of two categories. Over half are people working in their own countries either for nongovernmental organisations (NGOs) or for government health or education services, providing services for disabled adults or children. They may have had related specialist training or learning on the job. For them it is useful to have contact with people in other regions who face similar challenges, and to receive information about new and useful approaches and resources. The other big membership group is people from well-resourced regions such as the UK, USA and Australia who are interested in helping to develop services outside their own country. Communication Therapy International can help them to think about how their specialist knowledge can best be used in other settings. Transferring skills and knowledge from one place to another is often more difficult and complicated than people first imagine! Sharing ideas and experiences is useful and saves people from repeating mistakes or reinventing the wheel.

Challenges and benefits

Most of the information exchange happens via individuals making links by email or letter. Communication Therapy International meets once a year in the UK. Members attend a study day and annual general meeting, and have the opportunity to network in person. Our 2009 study day focused on overseas projects, their inherent challenges and benefits, and how to address some of the issues that arise from shorter term projects. Melanie Adams examined the advantages and disadvantages of different models of project work, and these were explored in more detail by a number of speakers with experience of different overseas projects. Debbie Sell introduced the Sri Lankan multidisciplinary Cleft Lip and Palate Project,

set up to provide treatment, teaching and research. She explored some of the challenges of transferring skills to a team with no speech and language therapist, expanding speech and language therapy services in the context of a developing health field, and promoting self-sufficiency. Bethan Hope and Peter Smith from the Jack Tizard Special School reported on their visit to two special schools in Uganda, which offered them an understanding of how best to develop useful and rewarding links between the schools. The audience was also introduced to City Universitys ongoing project in Cambodia, which is visited annually for three months by a group of newly qualified speech and language therapists. The challenges of measuring effectiveness and increasing sustainability in the context of such short visits was discussed. This interesting and informative study day was rounded off with a lively debate for and against the motion, Short-term projects are no more than a glorified holiday. Our annual study days take place every November and are open to non-members, with members paying a reduced price. As Communication Therapy International is a non-profit making organisation, all membership fees are used to cover overheads, run study days and produce resources. If you are interested in joining, benefits include: access to the membership directory, and the ability to interact and collaborate with other members and share knowledge and experiences the opportunity to make a positive impact by letting other members profit from the challenges youve faced, the experience youve gained and the lessons youve learned the ability to support the publication of our newsletter and development of our website by writing an article about your work participation in our networking ideas such as the Buddy system information about international jobs or volunteer opportunities information about upcoming events and activities. We welcome contact from anyone interested in finding out more about Communication Therapy International, email ctimembership@yahoo.co.uk. Speech and language therapist Amy Jensen has volunteered and worked overseas and is currently a research assistant at Strathclyde University. Resource The Communication Therapy International website is at www.commtherapyint.com.

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2010