Tuesday, 8 August 2017

Short-term gain vs quality outcomes

The Royal College of speech and language therapists commissioned a cost-saving matrix to help services demonstrate the value of SLTs to national and local decision makers, while at the same time showing evidence of efficiency and value for money. All public services, and the professionals who deliver them, are under increased financial scrutiny and the pressure which ensues. As you no doubt know, there is more pressure than ever before to show how taxpayer funded services are cost-effective and how they meet local and national priorities.

The language unit at Flash Ley in Stafford has been a great example of specialist provision for children who are bright but have disordered speech and/or language skills. Specialist teachers and speech and language therapists have worked together to maximise the child's potential and they then return to mainstream school to be with their peers when they are more able to cope. I know several who have been. I met them when they were in nursery and knew they'd find it hard to cope in mainstream schools but they had normal learning ability so a generic special school would not be the answer.

Flash Ley had teachers who were more qualified and experienced in SLCN plus enhanced input from specialist SLTs. Working together gives the best way forwards.

Having worked for 30 years, I witnessed the first language units and the fights to have more. We knew then, as we know now, they are the answer for many children with disordered speech and language.

When I first worked, my NHS head of department was a lady whose views were never questioned. Partly because counsellors or managers daren't but also because she was the professional so she knew best. That's a long-gone scenario and, I for one, would never have managed a typical Judith Waterman peer over her glasses, half as well as she did. It said 'stupid man' without need for words!

There are 2 reasons why closing language units are not a good idea:

1. It's not good for the long term outcome of the children. These children have great potential.

2. The savings are only short term. For every £1 invested in enhanced speech and language therapy for children with SLI generates £6.43 through increased lifetime earnings.

This is in comparison to routine speech and language therapy, where enhanced therapy results in an additional 5,500 students achieving five or more GCSEs A* - C (or equivalent).

The resulting benefit of providing enhanced therapy for all children aged six to 10 who currently have SLI exceeds the cost of the speech and language therapy by £741.8 million.

Further analysis shows the estimated annual net benefit is £623.4m in England, £58m in Scotland, £36.1m in Wales and £24.2m in Northern Ireland.

 PLUS: parents will fight to take up specialist school places out of county (it's one of the few clinical areas where there is an evidence base to say they need enhanced!) so the LEA will have to pay thousands in legal fees to fight this. If and when parents win, these are the figures they might need the LEA to cough up:

Alderwasley  From £57,689.00  
Bladen House £82,223
Dawn House 25k (2013 figures)
 (figures from google so may not be up to date)

What will the provision look like for the children who should go to a language unit? It maybe a half-termly visit from  a SLT to school with extra TA support. This is not what the evidence say works best: the children who require the most specialist teaching are in the charge of the least qualified members of staff (absolutely no disrespect to the TAs but that's the fact).

As an independent SLT, whose team can offer weekly or more regularly, I'm not complaining as we can offer what they need BUT it's short sighted. Let's hope the other language unit in Staffs is more successful at fighting it.

Wednesday, 2 August 2017

Second common scenario

Last time, I talked about a common scenario for secondary school, this time I will share a common primary school one.

Picture the scene: playtime in small primary school:

Boy, L, aged 9 is knocked over by another boy who was playing football, 'Sorry!' he shouts as he runs off. L is very angry as he had bumped into someone last week and had been told off and had to stand by the teacher. He had been messing about and had been 'an accident waiting to happen' according to the teacher. So he duly reports the other boy to the teacher on duty. 'I saw L, it was an accident, don't worry about it,' she responds.

L has quite a black and white view of life and doesn't really see the difference. His vocabulary isn't great so the term 'accident' had been used last week and again today so what is different?

He's irritated so argues with the teacher, 'But he did it, it wasn't an accident'. The teacher is calm for a short while but then equally irritated (she's probably got so much to do, she'd rather not be doing a duty anyway).

He's angry now so shouts at the teacher as he would his mum (he doesn't know those pragmatic rules where he should be modifying his language to his teacher). The teacher is now furious and sends him to the headteacher.

L still doesn't see that he should not argue/be respectful so yells at the headteacher. He is now so upset by the sheer injustice of the situation and can't hear any reason whatsoever,

L is excluded for the rest of the week!

If they could understand that he has:

  • poor auditory memory
  • difficulty remembering and learning new vocabulary
  • rigid thinking
  • lack of pragmatic awareness
They might handle him differently.

If the school set up was communication friendly and staff knew about these difficulties it would make their life and poor L's life so much easier.

Speech and language therapists have a valuable role to play in assessing child with behaviour difficulties. All behavior is communication, it's telling us something. There's no point in working on the symptoms i.e. rudeness, shouting at teacher etc, we need to understand the cause because then we can address it.

Unfortunately, there are may Ls out there but it upsets me every time!

Monday, 17 July 2017

Secondary schools don't need speech and language therapists.... or do they?

I have a few common scenarios which show how speech, language and communication issues can be the predominant cause of behaviour problems. These scenarios are very common so could be about anyone of 6 or 7 clients currently known to me. This is the first one:

Teenage girl, second year of secondary school. No issues noted in primary apart from maybe a few 'fallings out' with other girls. No previous behaviour issues at home or at school. Perhaps she's even been a model student. 

Since starting secondary school, however  everything has started to fall apart: at home she's sulky, rude even abusive to parents, shuts herself away, won't go anywhere, friendships may have broken down, parents describe 'melt-downs' when she comes in. At school they didn't notice anything in particular and were quite surprised to hear of the behaviour at home in year 7 but this year, she is falling behind and they are constantly reporting her behaviour which is usually similar to this scenario with E aged 13 years:

Teacher presenting a  power-point which needs to be copied down
E. hasn't finished when teacher moves it on
E 'Excuse me sir can you just leave that a bit longer as I haven't finished?'
Teacher 'No E you'll have to stay at the end as everyone else has finished' E looks round and sees that 3 others haven't either
E 'No sir that's not true x, y and z haven't either'
Teacher 'E you're trying my patience, we've discussed your behaviour!'
E 'But Sir I'm not being naughty, I'm trying to do my work, I just need 2 more minutes please?'
Teacher 'That's it, you have a detention'
E 'For god's sake how stupid? I just want 2 minutes'
Teacher: That's 2 detentions young lady'
E 'I cant believe you're doing this I just want to do my work and you're treating me like this'

Sometimes it escalates further and sometimes EVEN further.

Sometimes the child is excluded.

The child may have 14 detentions in a 2 week period as in one case or 101 since xmas in another. 

Why should a child behave this way?

In the cases I have been dealing with:

1. slower processing skills
2. poor auditory memory
3. both of the above lead to difficulty understanding longer and more complex questions
4. literal understanding of language
5. lack of social skills/pragmatic ability means they don't modify their language for teachers so yell as they would to their parents
6. Rigid thinking means they cant 'let it go' because their sense of justice is so well developed they aren't wrong so the teacher must be
7. Can't see another's point of view 
7. An awareness of their difficulties but a desire to mask them means their anxiety levels are already heightened so it doesn't take much to 'set them off'

It has become a dreadful, seemingly untenable situation. School will have tried all their usual strategies for behaviour problems but nothing works. Yet the answers are simple strategies and an understanding of the problems. It amazing how we can make a HUGE difference by explaining to teachers why the child is doing what they're doing, if we now see them as struggling rather than defiant, abusive etc, we can avoid getting into many of the situations which have previously been a nightmare.

Some of these children may have undetected ASD but some will have language and communication difficulties which are not part of the spectrum. Hormones and personalities play their part too!

  • A one page profile needs to explain what the child finds difficult. Just the process of completing one of these may make the child feel respected and understood which is an important start.
  • Making sure all the child's staff have read and acknowledged the profile
  • Everything as visual as possible including  a print out of the power-point, gestures, notes. These can all be used to make aspects of the day clearer including the timetable, what a pupil will be learning in that lesson, expected behaviour, key vocabulary and information, the sequence of steps within an activity, names of equipment and where it is stored, etc.
  • Make sure the child is happy where they are sitting. I like them at the front so they can see the teacher and the teacher can see them but the child may well be uncomfortable at the front and want to be at the back. Sitting with a friend can be really helpful
  • Encourage an ethos where all pupils are encouraged to ask questions and seek clarification.
  • Have a code so they can let you know when thy haven't understood that no-one else will notice e.g. bag on desk, pencil case moved 
  • Agree how you can check they have understood
  • Expected behaviour is clearly described e.g. School ‘rules’ and ‘charters’, etc are written in simple, symbol or visual photos form so that pupils can understand them.
  • Quiet space is available for time-out or individual study.
  • A reflections log or journal where the child can write about what went well as well as what went wrong. Even better have  a mentor who can meet with the child regularly to discuss this
SLCN is just as big a problem in secondary school as in primary. In the secondary classroom, language is the foundation for participation in, and access to, most aspects of the school curriculum. Many aspects of written language, such as narrative or understanding what you're reading, can be limited by delayed language skills; 'by secondary age there is an increasing amount of figurative language in text books. The same is also true of ‘teacher talk’: 37% of teacher instructions in secondary schools contain multiple meanings, 20% with at least one idiom. As learning becomes more reliant on independent study, language enables pupils to make contact with others; to organise, manage and evaluate experiences; to influence and inform' (ICAN)

Last week I visited 6 secondary schools and was delighted with their positive responses. We all want whats best for the young person but we need to understand what this is to be able to do that. You may think that they don't need a speech and language therapy assessment as they speak fluently but if the usual strategies don't work, we can probably help fill in the missing links. Behaviour IS communication, we just have to work out what it's telling us.

Saturday, 8 July 2017

Selective mutism training in Staffordshire

Time goes so fast so we're planning what we're going to do for October's selective mutism (SM) awareness month already.

We aim to blitz the local radio shows again with the lovely Natasha Dale who has become a brilliant ambassador for children and young people with SM, we'll have a local press campaign and a training day for parents and professionals.

If you know anyone who would benefit from the training, please let them know, places are limited.

The aims of the day are:
  • To recognise and diagnose SM
  • To fully understand the causes and maintaining factors
  • To relate the above to an appropriate prevention or management plan:

     - educating all key people involved with the child
     - creating the right environment at home and at school
     - talking to the children and their peers about SM
     - considering the need for a formal programme

     - formulating treatment targets

Friday 13th October 9.30am -3.00pm
Uttoxeter Fire Station, Cheadle Rd, Uttoxeter ST14 7BX

£85 to include lunch and refreshments

We'd love to see you!

Thursday, 6 July 2017

My friend Daniel doesn't talk: book review

Image result for my friend daniel doesnt talkMy Friend Daniel Doesn’t Talk is a helpful children’s book about selective mutism, written by Sharon L. Longo and illustrated by Jane Bottomley. This book is very easy to read and understand and the illustrations add more of an insight in to what it is like to have SM. Although this book is very short and simple, it really focuses on the key points of stereotypical selective mutism. We’re first faced with a paragraph about some of the behavioural characteristics and signs of SM and anxiety, “He played with his shirt collar while his mother talked to our teacher, and his face was frozen”. Immediately we are let into the world of a child with selective mutism and are encouraged to almost feel the difficulty these children must experience. 

The main aim and purpose of this book is explained to be, to help others who don’t have SM, but know someone who does, understand the condition. 

Having had selective mutism myself, throughout childhood and adolescence, I felt this book was somewhat relateable and insightful. I particularly liked that it focused on Daniel himself, his behaviour, his anxiety and how others perceive him, as well as Daniel’s friend. I was really warmed by reading how SM can affect the other children in the class. I think it’s important and useful to take the time to read this book, especially if you yourself have SM, and especially if you’re a child, because it allows you to see that people want to understand, they want to help and they will accept and befriend you. Talking is not a necessity in gaining and maintaining friendships and the people who matter, the people who care about you (your friends) will remain patient and understanding as long as needed.

Daniel’s friend was full of curiosity and asked his mother many questions about Daniel and his SM. When curiosity about Daniel was the topic of the school playground, Daniel’s friend explained, “My Mom said some kids are so scared to talk that their words can’t come out”. Daniel’s friend was incredibly interested in learning about how he could help and be a good friend to Daniel, as were other children in Daniel’s class.

The only concern I have with this book is that it is very much based and focused on stereotypes. Nonetheless, this book still allows us some degree of insight into the condition from a child’s perspective. However, there is one part of the story that I don’t feel too comfortable with, “I’m going to be extra nice to him so he’ll talk to me one day”, as much as this can be read in a completely positive light, and indeed there is much positivity behind it, it also holds some concerns as it is potentially suggesting that there is a pressure to talk if a person is being nice to you, as well as giving the impression that a child with SM is to be treated as special with added attention. Although, of course, these comments and acts of apparent kindness do happen in schools, so I think it does hold some importance in being included in the book. It is important to remember that most children with SM want to be included, they want to be treated fairly and given the support and understanding they need, however they do not want to be singled out. A little further into the book, this is pointed out and rightly so, “we shouldn’t make a big deal when Daniel speaks. That would just make him feel more upset” which I think is an incredibly important key point.

Most of all, I thought the guide for parents and teachers, at the back of the book, is extremely useful. This guide explains that this book carries the theme of acceptance, diversity and equality, which is reassuring. I would agree, this book definitely not only helps children who have SM themselves, but it could be very helpful to children who do not have SM themselves, but know someone who does. It answers many questions and solves the confusion felt by many children trying to understand someone who doesn’t speak. Just as importantly, this guide also gives very brief but very accurate points and information on how teachers and parents can help and support their pupil, or child, with SM.

Overall, I would say that this book’s main purpose includes, to reassure children with SM that they are not going to be forced to speak, people will be patient and understanding and true friends will be supportive. At the same time it helps children without SM to understand children with selective mutism, or perhaps even it encourages other children to embrace and accept difference more broadly. My Friend Daniel Doesn’t Talk is a beneficial read and I would recommend anyone affected by SM to read it, whether that be first or second hand; children with SM, children without SM, teachers and parents.

Natasha Dale

Monday, 3 July 2017

Research: Autism and the sisterly bond

As the youngest of three siblings, with two older brothers I have been fascinated with how siblings interact. Playing with dolls and making up stories was my rest from running around the garden covered in mud with my brothers. During these hours I often wondered what it would be like to have a sister. Would we argue over toys and clothes, or would we share everything and get along perfectly? If our personalities were fundamentally different, would that make things easier or add another difficulty to the relationship?
This is what I have been investigating in my current research. Previous research has stated that sisters- when one has autism- have a more positive bond than a brother-sister or brother-brother pairs.  In my project ‘Understanding the experiences of sisters when one has Autism Spectrum Disorder’ I aim to hear the stories of sisters who have been effected by autism in one way or another, to gain an understanding of what may influence their relationship. Ultimately, I hope that this will add to the understanding of autism and sibling relationships and perhaps one day be used to improve the bond between siblings when one has autism.

Much of the current research focuses on the parent-child bond or the parent’s experiences. But the sibling relationship is often the longest relationship we will have in our lifetime, and it is so often overlooked in research and life in general. Furthermore, I would like to understand this research question from the perspective of the autistic sister to learn both sides of this fascinating bond.
I have already interviewed a number of neurotypical women who have an autistic sister. And I am now looking for autistic females who have a sister! Participants must be female, over the age of 16, have a diagnosis of ASD and have at least one sister.  If you, or anyone you know, are eligible and interested in being a part of this novel research, please get in touch with me at fhd1g14@soton.ac.uk
Participation will include one interview which will last no more than an hour- this can be done over the phone, skype or in person. Interviews will be recorded, transcribed and anonymised. Although some quotes may be used in the write up of the report, there will be no way of linking them back to you.  

I am hoping to have this research published in an academic journal and I would greatly appreciate any help in achieving this. Whether it is taking part or passing this on to anyone who may be interested.

Thanks for reading!

Ffion Davies

University of Southampton

Friday, 16 June 2017

Would you like your child to be ready for school and attend a quality holiday activity?

We have some summer group sessions running at our clinic base on the Staffordshire/Derbyshire border to help children be ready to start school. The sessions will look at:
  • Confidence to communicate
  • Attention
  • Listening
  • Memory
  • Vocabulary
  • Verbal reasoning

via games, activities and stories. We'll have fun while we learn! These sessions will be run by a fully qualified and experienced speech and language therapist.

Monday 14th August  to Thursday 17th August 9.30-11.30am

Cost: £200 per child. Spaces are limited so please apply early.

To book https://v1.bookwhen.com/smalltalk