Tuesday, 14 August 2018

Independent speech and language therapists do tribunal work too


The Association of Speech and Language therapists in independent practise (ASLTIP) has a website where you can seek out Speech and language therapists who carry out medico-legal work. This is based upon their guidance. They may cover the following situations:
  • SENDIST (special educational needs and disability tribunal) – cases where a child’s education is affected by a communication problem and extra specialist assistance is being sought.
  • Medical negligence (such as birth injury affecting a child’s development), or trauma (such as a road traffic accident resulting in head injury and communication problems) – cases where the aim is to determine costs for therapy when seeking compensation.
  • Occasionally an assessment is necessary to assess whether or not a problem exists.
Recognised characteristics of medico-legal work:
  • We will review medical notes and other important documents.
  • Assess  the client’s speech and language skills to determine whether a problem exists and, if it does, how severe it is.
  • Writing a detailed report of findings, diagnosis, prognosis and recommendations for further therapy. In SENDIST cases there is a need for very specific recommendations quantifying the amount of ongoing therapy considered necessary.
  • Appearance at Tribunal/Court as an expert witness if applicable.
Some points you may wish to discuss with any therapist you contact:
  • The therapist’s specialist credentials and experience in the area of medico-legal work e.g. writing expert witness reports and giving evidence at SENDIST/Court.
  • As a detailed communication assessment must be made, the therapist needs a background of experience with the relevant population (i.e. adults or children), and with any specific conditions in the case (e.g. autism in children).
  • The timescale for when the report is needed and the reports/information the therapist will need prior to the assessment; how liaison with other professionals (e.g. a solicitor if one is involved) can be maintained; who else can provide qualitative information about how the client functions in everyday communication situations.
  • How much experience the therapist has with similar medico-legal work.
  • Where the therapist will see the client for assessment. Sometimes the therapist will wish to see the client in more than one situation.
  • How much the therapist charges. The therapist may have a fixed charge for the assessment and subsequent report. However, it may be that the therapist charges an hourly rate and guidance on average overall charges can be requested. Because each case will be different, it is important to discuss specific details which are relevant, so you are aware what the therapist will provide and what the likely fee will be.
We do medico-legal work at Small Talk and are prepared to travel so please let us know if we can help or look on ASLTIP's website www.helpwithtalking.com



Sunday, 12 August 2018

Therapy is about Engagement, not Compliance!

I’ve been using the Attention Autism programme (Gina Davies) pretty much every day for the past two years and I can honestly say I don’t know how I did speech and language therapy without it. The basic principles of Attention Autism such as; the activities needing to be motivating, visual, appealing etc are our bread and butter skills as therapists but ensuring that everything I deliver is an irresistible invitation to learning is a completely new challenge.

Attention and listening are pre-requisite skills to language development and the time and effort we need to invest in supporting children both with and without Autism with this cannot be underestimated. After all, we need to ensure that our activities are indeed worth communicating about!

The Attention Autism programme consists of four stages:

-          Stage 1: ‘the Bucket’ – Focus

-          Stage 2: ‘the Attention Builder’ – Sustain

-          Stage 3: ‘the Interactive Game’ – Shift

-          Stage 4: ‘the Table activity’ – Transition
 


“I’ve got something in my bucket, in my bucket, in my bucket, I’ve got something in my bucket whatever can it be?”

 
Stage 1 is all about ‘the Bucket’! A bucket filled with simple, motivating and appealing toys that will capture the child’s attention. The main aim at this stage is to teach the child to independently focus on the adult-led agenda and to take the risk of trying something new.
As a ‘speech’ therapist the trickiest thing I found when I started was to try and not talk. Many children with speech and language difficulties find too much verbal information overloading which can result in ‘tuning out’. When delivering Attention Autism, I am now more confident to rely on the activities to bring the child’s engagement, not the language.

Now of course at the beginning, things went terribly wrong. Children kept getting up from their seats, others found it hard to transition to the activity and however prepared you are, you need to trust that it is ok for mistakes to happen. We cannot take the child’s cooperation, for, however short a time, for granted. The supporting adults need to resist trying to herd the children back to their chair as Attention Autism is about working on engagement not compliance. Remember: ‘if it’s Fun, they’ll come!’. Make your targets realistic, at Stage 1 aim for your children to attend for 1 minute initially and then build up slowly each day. If you deliver a fun and appealing session the children will learn to naturally and spontaneously self-regulate to the adult-led learning.

If we are expecting the child to tune in and attend straight away, then we need to ensure we are ‘selling the bucket heart and soul’.

Fun doesn’t mean Unstructured. Follow the rules.

1.       ‘It’s Tish’s bucket, it’s Tish’s toys’.

It may seem mean but only the leading adult is allowed to touch the toys. Many children have single challenged attention (Cooper, Moodley and Reynell 1997), so if they are playing with the toys, they are not focusing on you. Keep your distance so little hands don’t feel tempted to pick up the toys.

2.      Show first, add words later.

If you’re like me this part may be tricky to begin with. We may instinctively want to start adding in language, but it is important to stay quiet and allow for thinking time. Then gradually increase the language.

      3.      Everyone one is joining in – no exceptions!

Supporting adults need to keep modelling expected behaviours. If we begin talking amongst ourselves or getting up to ‘do a job’ we are only modelling to the children that it is acceptable to get up and leave the activity if you feel like it. Our children attend to the most dominate stimulus in the room – make sure it’s ‘the Bucket’.

     4.      Keep Calm it’s only a bucket.

However prepared you are, you’ll never be prepared enough for the unpredictability of working with children, which I tend to love about this job. Don’t get distracted by louder children, you’re the adult you dictate the start and finish of the session. Don’t let children getting up and wondering off fluster you, trust your supporting adults to bring them back silently. Rushing adds anxiety, so keep calm and enjoy the shared experience.

5.      Focusing leads to sustaining.

Aim to carry out the session 4/5 times a week, start at 1 minute and build up slowly. When 80% of your group can attend for 5 minutes, you’re ready for Stage 2 and remember

“if it’s fun, they’ll come!”

 

 



 

Saturday, 11 August 2018

assessing a demand avoidant child...... yes you may look stupid but who cares?

I've just handed over a new case to one of my colleagues and as I was telling her about him, I also discussed that I'd had a new student with me when I met him. Having someone else observing made me reflect on how we interact with  children who are harder to engage but there's not much written about it as a guide for school aged, especially, if they are demand avoidant. I saw myself through her eyes and realised I definitely did look stupid and it probably wasn't how she was expecting a 50-something professional to behave! However, it was exactly what the situation demanded. If I can use the dog, it really helps but on this occasion, he was scared of dogs so Ralph wasn't there.

Many of the pre-school Hanen tips still work well:

1. Observe, wait, listen: ask parents what they're interested in and watch and listen closely. He used sound bites and little scripts acting out situations, as the main part of his expressive language. These included zombies, teleporting and fighting. We hadn't finished what I needed to cover when he'd thrown me out of the play room as he hated me and 'couldnt stand' me any more, I crept out out of a second door and burst in telling him I'd teleported. He forgot he was cross with me and asked me to 'Do it again!'. Of course, I  can only do it once a day, so maybe next time.  A little while later, he ran outside and wouldn't come back when we asked, so I pretended to be a horse, crying 'Jump on I'll save you from the zombies!' He did and we piggy-backed back into the playroom.

2. Get down on their level: you can see their facial expressions so much better if you're on the floor with them but they're level, so you are seen as more equal. This is far less stressful for them and you're more likely to get them talking if they feel equal. Sitting at a desk would have been impossible anyway! We did an expressive language sample while we were both colouring our pictures in.

3. Follow their lead, follow their interests: I didn't direct him very much really, I used books, toys and games he wanted to use. I asked him to choose each time. I had the Dewart and Summers pragmatic checklist his mother had completed and was able to interview her at length so it didn't matter that I couldn't do anything formal. I got a really good measure of his abilities and what he needs help with

4. Use a low-arousal approach. This Approach emphasises a range of 'strategies that focus on the reduction of stress, fear and frustration and seeks to prevent aggression and crisis situations'. The low arousal approach seeks to understand the role of the ‘situation’ by identifying triggers and using low intensity strategies and solutions to avoid punitive consequences. I keep calm whatever the situation throws at me (physically and verbally). His mother uses humour as part of this approach, brilliantly to deflect, move him on and get him on-side.

5. Never take things personally. Demand avoidant children may call you names (I know I'm 'old, fat and ugly' so nothing new there), may try to shock you verbally or physically or threaten you. We need to see it for what it is, an attempt to get out of a stressful situation.

6. Have the confidence not to mind what other people think: just as with pre-school ones you can burst into song, do unexpected silly things, pretend not to know.... As long as you can justify it....do it if the situation demands! Fortunately the student turned out to be brilliant and she didn't see me as some crazy old woman. She understands we have to do what it takes!

I was able to report on his attention, listening, understanding, vocabulary, expressive language and social thinking skills. The real hard SLT work will be done by my colleague as she sees him for therapy. The real hero? His mother.
Hanen www.hanen.org
Low arousal http://www.lowarousal.com/

Tuesday, 7 August 2018


PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding. See more at https://www.promptinstitute.com

Therapists begin by helping patients produce certain phonemes. A phoneme is the smallest increment of sound in speech. For example, the “d” sound in the word dog is one phoneme, the “o” is another and the “g” is yet another. Each phoneme requires different muscle contractions/retractions and placement/movement of the jaw, lips, tongue, neck and chest to produce. All of these things have to happen with the proper timing and sequence to produce one phoneme correctly.  The therapist attempts to “teach” the patient’s muscles to produce a phoneme correctly by stimulating all of these through touch. With the timing and movement of more than 100 muscles involved, you can see why the training needs to be very thorough.
PROMPT therapy is appropriate for a wide range of patients with communication disorders. The most common patients have motor speech disorders, articulation problems or are non-verbal children. Many patients with aphasia, apraxia/dyspraxia, dysarthria, pervasive development disorders, cerebral palsy, acquired brain injuries and autism spectrum disorders have benefitted from PROMPT therapy. An evaluation by a PROMPT-trained speech therapist is the only way to find out if a patient is appropriate for the therapy. 
We are delighted that Sophie Harding, speech and language therapist has completed her 3 day training. This means she  has been trained how to make the “touch cues” to the articulators to help patient’s produce a phoneme. She can also properly evaluate a patient (from a motor perspective) to identify if PROMPT therapy will be beneficial.
If you feel that our child needs an assessment please get in touch office@smalltalk-ltd.co.uk
  

Saturday, 4 August 2018

Welcome Alison to the Small Talk team



We are delighted to have a new addition to our team: welcome Alison Phipps, speech and language therapist. She has recently qualified from Birmingham City University with a first class degree. However, we have known Alison for many years as she used to work part-time as a speech and language assistant for us running groups in the Tamworth area. She was actually a graphic designer but wanted a change!

Alison is working across the staffordshire area. She has a particular passion for working with children and families with ASD and has already been on the Attention Autism course and is confident with SCERTS, Intensive Interaction, PECS and using visual support. She helped to run Hanen's More Than Words and Elklan's verbal children with ASD.   

She will be contributing to the blog soon!

Thursday, 2 August 2018

Is it just delayed talking or is it more?



As speech and language therapists we need to look at a toddler who isn't talking to determine whether we think it is delayed or disordered language or whether we need to refer on for further assessment. Remember, it doesn't have to be ASD, as there are so many more children with speech, language and communication difficulties than children with ASD. 


What are the red flags we are concerned about?......
  • Eye Contact and Eye Gaze – difficulty paying attention to faces and following your point after 12 months
  • Responding to their Name – inconsistent responding to own name most of the time by 12 months
  • Pointing to or Showing Objects of Interest – does not point or show objects to others by 15 months
  • Pretend Play – does not demonstrate how familiar objects are used by 15 months and doesn’t show true “pretending” in play such as feeding a baby doll or using one object to represent another object by 24 months
  • Imitation – does not watch other people to copy their actions and body movements such as waving; does not imitate sounds and words by 16 to 18 months
  • Nonverbal Communication – does not understand and use a variety gestures by 16 months; displays “flat” affect or limited facial expressions or body language
  • Language Development – exhibits delays and differences in both language comprehension and expression as compared to same age peers; may talk but not communicate with others. Expressive skills may be at a higher developmental level 
  • than receptive skills in autism. 
If you are concerned about your child, please see a speech and language therapist, as early intervention is really important!

www.private-speech-therapy.co.uk     To book an appointment at our clinic click here