Speechmag

Family Action praise preventative Home Talk intervention for children at risk of language delay

Family Action have been in touch to let me know about some promising targeted work they are doing with late talking 2 year olds. 

The charity provides over 100 community based services to disadvantaged and socially isolated families across England. This includes managing Children's Centres in Mansfield where they work closely with local health visitors and speech and language therapists. As part of Nottinghamshire's multi-agency Language for Life Strategy a Play and Learning Worker delivers the Home Talk intervention to parents of children at risk of language delay. 

Children are identified by health visitors using a traffic light screening system devised by the children's centres speech and language therapy service. While children with significant needs are offered referral to speech and language therapy, there are a range of other preventative options including Home Talk for those who may benefit from some targeted support. The Family Action Play and Learning Worker in West Mansfield has been going into homes of each identified child once a week for 6 weeks to work with parents to encourage communication around routines, play and the children's interests. Over the past two years she has seen 30 children, and only 4 have needed further referral to speech and language therapy.

There has been increasing interest in primary prevention, and a number of areas with multi-agency strategies including Nottinghamshire (Language for Life), Sheffield (ESCAL) and Stoke on Trent (Stoke Speaks Out) were commended by Communication Champion Jean Gross in her final report, but such initiatives are under-represented in the research literature. An exception is the Babytalk Home Visiting service, a collaborative primary preventative intervention in Portsmouth. This has been written up in Child Language Teaching & Therapy and, following an encouraging evaluation, is due to have a controlled comparative study. 

Prime and Predigest revisited: techniques to improve writing for publication

Having offered a number of workshops over the years on writing for publication (one written up as ‘Prime and Predigest’), it was a real treat for me to be on the receiving end of a 2 day course on academic writing. John Paley’s main goal was to raise our awareness of the techniques we use subconsciously to make sense of what we read so we can make a conscious effort to apply them when writing. 

None of the participants were novices with the written word. As editor of Speech & Language Therapy in Practice, I supported therapists who were writing articles for the first time. I also encouraged academics to use an accessible style that included explicit implications for practice. The collaborative nature of the editing process helped me improve my own writing as I played with paragraphs and sentence construction in an effort to make life easier for the reader. While books and articles about writing for publication also helped, feedback from readers about what worked for them was particularly instructive. 

John’s course, however, has introduced me to a new level of “staying in control” of written work. As someone who is easily distracted when one thought sparks another, I particularly appreciated his strategies for staying focused. His suggested four stage framework is recursive, meaning that each level is embedded within the next:

1. There is a central claim
2. This claim is justified and elaborated by supporting material
3. This material is given a particular structure
4. This structure is illuminated by the use of cohesive devices.

I was especially intrigued by this attention to cohesive devices - such as paragraphs, repetition and signposting – which prime the reader to see how ideas connect and separate. I have learnt that subtlety with signposting is not helpful when a complex argument is being developed; words such as ‘first’, ‘next’ and ‘finally’ indicate to and remind the reader “where they are on the map”. 

John developed this idea of structure further by drawing on Swales and Feak’s model for Creating A Research Space. ‘CARS’ assists writers to narrow arguments progressively at every stage (paragraph, section, chapter, whole) by setting out the territory, establishing a niche within it and then occupying the niche. This process helps the writer to be single-minded in setting the boundaries for their project, while letting go of other important and interesting angles, or leaving them for another day.  

With that in mind, I will sign off with a final thought. When people find communication difficult, speech and language therapists spend time demonstrating how it can be made more accessible. In a similar way, practising therapists do not always find academic writing accessible. Yet John Paley’s course demonstrates that writers can help, not by reducing the complexity of the argument, but by paying closer attention to the way it is scaffolded. 

Speech & Language Therapy in Practice editor Avril Nicoll attended John Paley’s 2 day course as part of her studies on the MRes (Health) at the University of Stirling.

 

The communication and interaction skills of speech and language therapists applied more widely to healthcare

As speech and language therapists we are highly attuned to interaction. We recognise the link between communication competence and how people feel about themselves. Many of our interventions encourage ‘significant others’ to make changes to their communication. This gives our client (the spouse with aphasia, the child with language delay, the parent with dementia or the young person with a stammer) the chance to express themselves more effectively and be a more equal partner in the exchange.

Much of healthcare is relational and ‘poor communication’ is recognised as an ongoing problem. The experience of speech and language therapists and their clients therefore has wider relevance for interactions between healthcare staff and users of services.

Video Interaction Guidance, Non-Directive Therapy and Solution Focused Brief Therapy approaches have found favour in speech and language therapy and across the helping professions, while Talking Mats and Parent-Child Interaction Therapy originated in speech and language therapy and have been widely applied. Now Ray Wilkinson, a speech and language therapy researcher behind the hugely influential SPPARC (Supporting Partners of People with Aphasia in Relationships and Conversation), is looking to extend his conversation analysis expertise to the broader training of healthcare workers.

Ray was invited to present last week at a multidisciplinary symposium on ‘Communication and Interaction: Applications for Healthcare’. The common bond between most of those attending was an interest in using conversation analysis as a research tool. The diverse backgrounds – such as sports, sociolinguistics, management and health – made for lively and thought-provoking discussion. For some, Ray’s before-and-after video examples were the first time they had really thought about what it might be like to live with – and to live with someone with – a communication impairment such as aphasia or dysarthria. It was also an opportunity for them to see how transformative speech and language therapy intervention can be. 

Ray is clear that we don’t get a true picture of everyday talk from what we see in a clinic. Analysis of more natural interaction shows that, in their effort to adapt to and cope with a communication disability, families can get stuck in a particular interaction style such as a pedagogic (teacher/pupil) pattern. Importantly, he stressed that intervention is not so much a result of judging how ‘good’ or ‘bad’ the interaction is, as raising awareness that there are other options. These may produce different benefits such as greater participation in spite of a persisting impairment.

Although Ray says there has been a lot of work done on improving the communication skills of healthcare workers, this tends to concentrate only on the professional. In contrast, his Interaction-Focused Analysis and Intervention recognises that communication depends on at least two people. What matters is what happens in the space between them, and how they experience it. As much of the way we communicate is below our level of consciousness, video and natural settings provide an effective and generally acceptable way of raising awareness of interaction and the potential impact of adjusting it. 

Later during the symposium we split into groups to discuss a transcript of an interaction between a community nurse and a client. This was a stark reminder for me that, however 'good' or 'bad' anyone judges the particular interaction to be, we should be mindful of the context in which the communication is occurring. Health professionals and the system they are constrained by hold a great deal of power. As with communication much of this is below the level of consciousness but, in raising awareness, we should find there are other options. 

Speech & Language Therapy in Practice editor Avril Nicoll attended the University of Stirling sponsored 'Communication and Interaction: Applications for Healthcare' event on 27 January 2012 as a student on the MRes (Health). 

Communication Champion's final report shows communication is everyone's business

Despite her two year term as Communication Champion officially ending in December, Jean Gross was up with the lark this morning for a 5 minute slot on the Daybreak sofa to talk about ‘testing’ of 2 years olds. 

Having read her carefully considered and detailed final report, I knew that what Jean had actually asked for was inclusion of “a measure of children’s communication and language development at age two” (p.10) in the Department of Health’s Public Health outcomes framework. On the report's release a week ago, the press furore was around its supposed call that parents should receive texts to remind them to talk to their children. What Jean actually recommended was that the Department for Education should “provide parents with interesting, accessible information on how to enjoy and support their child’s communication and language development from birth onwards, using…the full range of technologies – phone apps with free film and text content, social media, texting, daytime television and so on – in order to ensure reach” (p.11). 

Early identification, workforce capacity building, skill mix and team work, joint commissioning, user and voluntary sector involvement and the need to measure impact are all among the report’s recommendations. There is a focus on specialist services including AAC, speech and language therapy provision in different settings, and hard to reach populations. A strong theme is the need for greater recognition of speech, language and communication difficulties in children with behaviour problems. There is plenty of food for thought for speech and language therapists when Jean highlights the continuation of ineffective models of intervention where therapists are expected “to ‘fix’ children through face-to-face work” (p.25) and urges us to question our practice in relation to people who do not attend.

In using examples from a number of places which have really embraced the idea that communication is everyone’s business, Jean shows that transformation is a realistic prospect even when budgets are under enormous pressure. This contrasts with her frustration at the loss of services in other areas and concerns about the long-term impact.

I have often reflected on the strength of character, strategic nous, inveterate networking and chameleon-like adaptability that a ‘champion’ position requires. Presenting complex arguments in soundbites to answer TV presenters' questions such as “Do you think children as young as 2 should be tested for how well they speak?” is just another prerequisite of the job. Admittedly “Do you think it is better to spot a communication problem early and help a child and their family rather than letting them struggle?”, “Do you think good quality information should be available to parents who want to know more about child language development?” and “Do you think people working with young children should know how to get them listening and talking well?” don’t invite quite the same controversy. 

On the positive side, every media opportunity raises awareness of communication and gets people talking about talking, and the Communication Champion’s role has been to make this happen at every level. Media coverage is aimed at the general public but, for those with a real interest in supporting children's communication, the report offers a more complete picture of where we are at and where we should aspire to be going. 

 

Animation Therapy videos to improve narrative in older children with language impairment

Readers of Speech & Language Therapy in Practice will be interested to see these short videos accompanying an article about Animation Therapy in the Winter 11 issue. 

Animation Therapy is a hybrid of skill based and naturalistic activities aimed at improving narrative in older children with language impairment. Speech and language therapist Ravit Cohen-Mimran developed the approach over the past two years. In the Winter 11 issue she describes the rationale, stages, and its use with 11 year old 'Ben'.

The first video shows Ben's traffic jam animation, while the second is by another child. Ravit plans to submit a research proposal to get funding for a larger study with more participants.

 

 

 

 

 

 

'New dimensions' online report from the Child Language Seminar 2011

The final issue of Speech & Language Therapy in Practice has been signed off for printing, so will be mailed out to subscribers the week beginning 5 December. 

Meantime, you can access a new, free, online-only article written to accompany the Winter 11 issue. 'New Dimensions' is a report by Speech & Language Therapy in Practice editor Avril Nicoll from the Child Language Seminar (CLS 2011). This was held in June 2011 in Newcastle, and the organisers made a conscious decision to give it a more clinical focus than usual and encourage more participation by therapists as well as researchers and academics. Speakers included James Law, Liz Pena, Sheena Reilly, Sue Roulstone, Maggie Snowling and Helen Stringer. 

As Avril says in her report, "Over the two packed days, I wondered just how a speech and language therapist could synthesise and translate the swirling mass of evidence, ideas, research methods and theories put before them. Now, with the benefit of distance, it is easier to make sense of it all and to recognise what Maggie Snowling described as the 'take home messages' for therapists in clinical practice."

The photograph shows Helen Stringer and Christina McKean who arranged the seminar along with James Law.

In Giving Voice we are proud to be speech and language therapists

I have watched with admiration as the Giving Voice campaign has spread the message across the UK that speech and language therapy transforms lives.  

Having been active in both Speak Weeks (circa 1987 and 1990) and the rather oddly named SpeakWatch (1994), it is fascinating to see how tools for raising awareness and ways of measuring success have changed, while the passion and many of the issues have not.

The Royal College of Speech & Language Therapists now has a Policy and Public Affairs Team which has provided the advice, coordination and resources to inspire and enable therapists at a local level to get active. One of the most useful of these is the report from Matrix Evidence into the cost benefits of speech and language therapy. (College members can calculate the savings for local services to people with dysphagia, aphasia, specific language impairment and autism here.)

Although the hard statistics following Tuesday's mass mobilisation event and awards ceremony are encouraging enough in themselves (255 turned out for the Giving Voice rally, over 100 MPs were met, and over 400 tweets including #givingvoiceuk were published), the softer ripple effects count even more in the longer term. This includes the increased camaraderie among teams and the success of shared projects and a common purpose with service users.

For Jennie Marshall - who cycled 180 miles to the event using a Lightwriter to communicate - it has provided a great deal of insight and opportunity for reflection. As she said at the Giving Voice rally, "The cycling is child's play compared to using a communication aid...I can't imagine how life would be if I didn't have a voice." A number of younger members of the profession including Sophie Jankel (Social Media Campaigner of the Year award) and Julie Carr (Outstanding Contribution award), have found their campaigning voice and I have no doubt we will all benefit from this in the years to come. 

As veteran campaigner Pam Enderby said, we want to do something about the fact that speech, language and communication difficulties affect relationships, education and employment, and we need to do it "in the context of an ever-moving NHS." Compared with times of previous campaigns we have more evidence, our therapy is more effective we will not be driven into losing our care. "It's not just a job, it's a part of our lives...I am very proud to be a speech and language therapist."

The photos show Ele Buckley, RCSLT National Coordinator for Local Campaigns, with the rally on Westminster Bridge, and Sophie Jankel receiving her award at Church House from Rt Hon John Bercow MP.  

 

Aphasia charity needs online votes to Speakeasy

It is sad that, in spite of top level commitment to user involvement and community engagement, funding cuts mean charities including Speakeasy are having to seek income through routes such as the NatWest CommunityForce, where entrants are in competition for public online votes to win £6000.

Speakeasy was established in Bury almost 30 years ago with support from both social services and the NHS. Over the years the social services support was gradually withdrawn, but the primary care trust financed core services to which Speakeasy added a range of project work such as developing employment opportunities, computer therapy and piloting new approaches for people with aphasia.

Gill Pearl, Chief Executive of Speakeasy, wrote an article for the Winter 10 issue of Speech & Language Therapy in Practice with Gill Jackson of Dyscover, a specialist aphasia charity in Surrey. They described a pilot study of the Personal Development Programme, which promotes volunteering and increased activity among people with aphasia, bringing wide-ranging benefits to the participating individuals and their communities.

Gill explains, "Speakeasy has developed a justifiable reputation as a centre of excellence where people with aphasia from across the North West grow the skills to better navigate their lives with aphasia. In summer 2011, Speakeasy received the devastating news that the PCT had decided to withdraw 100 per cent of its financial support. This loss of funding may close Speakeasy. Although every effort is being made to seek alternative funds, the current financial climate and changes in the health and social care sectors are compounding the difficulties."

I have registered and cast a vote to support Speakeasy's attempts to win £6000 of stop-gap funding and hope other people who have an interest in aphasia will do so too before the closing date of 23 October. This doesn't have to mean that I like the recent trend among big companies to use social media to advertise their products. Such methods certainly will not provide a sustainable approach to funding of charities who provide important services that complement and enhance those offered by health and social care.

Penultimate issue of Speech & Language Therapy in Practice now out

The Autumn 11 issue of Speech & Language Therapy in Practice has been mailed today, so subscribers can expect it through their door very soon!

Cover star Dan sustained a severe head injury in 2007, and Lindsay King describes how revisiting Melodic Intonation Therapy has helped his recovery. Our second 'How I manage acquired brain injury' contribution comes from Laura Flynn in Jersey and is written in memory of another inspiring client, Suzannah Pemberton.

The client-centred theme continues with Karen Leadbitter's reflection on empowering Rhys, a man in his thirties with Down's syndrome, to participate in training his own staff. Lynsey Paterson also concentrates on training, using a literature review to develop parent training following an autism diagnosis.

In the well received Journal Club, Jennifer Reid tackles critical appraisal of observational studies, and subscribers can download two associated frameworks from the members' area of www.speechmag.com. Sam Simpson & Cathy Sparkes continue their goal negotiation series, and include discussion of the thought-provoking Model of Change by Prochaska and DiClemente (1986).

In 2009, Louise Greenstock wrote an interim report on her PhD research into the use of graphic symbols in schools, and here she shares her final findings. These include a theoretical framework which looks as if it would be very helpful in practice.

Alison Roberts is back with 'Here's one I made earlier'. Her low cost and fun therapy suggestions for groups have proved so popular that Speechmark has released a book of them! Cynthia Pelman tells us about one of her top resources, Stern Structural Arithmetic, and Jan Broomfield explores the ethical issues raised when your new referral is the son of your Trust's Chief Executive Officer... 

As well as reviews and editor's choice from the journals, we have brief contributions from Diana James about Paget Gorman Signed Speech, and a delightful snapshot of Nicola Grove's granddaughters talking about talking. As always there are great reader offers, including a Grow Words resource set, books from Plural Publishing and the recently released New Reynell Developmental Language Scales (NRDLS).

You can sign up for all 4 issues in the final year of Speech & Language Therapy in Practice. You will also receive the Winter 10 issue free, and get access to the members' area of www.speechmag.com until 29 February 2012.

Voice banking to preserve the freedom of speech

More on voice banking, a subject I posted on a year ago when Laurence Brewer was interviewed for Radio 4’s Word of Mouth. This time there was a Scottish flavour to another Radio 4 programme ‘Giving the Critic Back His Voice’, presented by Deacon Blue’s Ricky Ross.

Mike Arnott - who is originally from Belfast but now lives in Aberdeen – is 45 and has motor neurone disease. He was referred to speech and language therapist Karen Yuill at a time when he had no speech difficulties to explore possibilities for voice banking. Like Laurence, his goal was primarily to ensure his children would still be able to hear him as him in the event of him losing his speech and voice as the disease progressed. As he says, “How you sound is so much of who you are.”

Karen explains that she had to go away and do a bit of reading and, “We kind of explored the whole thing together really”. Initially this was via ModelTalker, which was straightforward but left Mike a little disappointed.

The next port of call was Edinburgh based company CereProc. They specialise in characterful speech synthesis, and created a text-to-speech voice for film critic Roger Ebert from his recorded documentaries when he was diagnosed with thyroid cancer. The process adopted for Mike involves software recording thousands of phrases and sentences based on phonetic coverage so that all speech sounds can be captured in a way that will make the synthesis sound as natural as possible.

The programme explores the difficulty for synthetic voices in conveying emotions and feelings adequately, including humour, boldness, fear, anger, excitement and joy. Joanna Courtney from CALL Scotland is interviewed about CereProc’s female Scottish voice ‘Heather’, as is Louise Smith whose 19 year old daughter Leanna has Worster-Drought Syndrome. She has been excited to get the Heather voice for her communication aid as it sounds “so normal”.

Michael Arnott says that after the months of recording there was “a hesitation pressing the play button just in case I’d be disappointed – but I certainly wasn’t.” Most importantly, his 8 year old immediately said, “'That’s you daddy!' And I was so pleased because all of that’s been part of the goal...they still hear me as me.”

You can download Scottish voices from the CereProc website. The programme is available for a limited period on BBC iPlayer.