Speechmag

Ralli round to raise awareness of specific language impairment

"Ralli likes computer games, playing with her friends in the park, and smoky bacon flavoured crisps - BUT Ralli also sometimes finds talking difficult, and she doesn't always understand the words people say. Ralli wants to tell you what this is like and explain what happens."

If you haven't met Ralli yet, have a look at the Raising Awareness of Language Learning Impairments You Tube channel, and subscribe to receive new video updates. This campaign was launched in May by Dorothy Bishop, Gina Conti-Ramsden, Maggie Snowling, Courtenay Norbury and Becky Clark as a resource about specific language impairment for children, families and educators.

As is often the case, it is the young people themselves who provide the most compelling viewing as they explain what it is like to have a specific language impairment. The use of video also tells you a lot about context - for example the bookshelves behind the practitioners in the 'Signs of SLI' video hold an eclectic mix of material from joke books to textbooks on vocabulary and language development, to professional standards - a reminder of the everyday but complex process required to put theory into real world practice. 

 

Life and times of a speaking wifie

Catherine Hollingworth may have been a visionary and steely pioneer of the speech and language therapy profession, but in the small Scottish town where she was born she was known straightforwardly as 'the speaking wifie'.

As part of a drive to recognise and celebrate the achievements of 'weel kent Brechiners', Steve Nicoll of the Friends of Brechin Town House gave a fascinating talk on Catherine's life, work and family history last week. Born in 1904, Catherine came from a family with a culture of high achievement and entrepreneurship, with one of her ancestors credited for taking a stand against the practice of body snatching for medical education in the 1800s.

Catherine's independent income meant she was able to pursue her interest in drama through studying at RADA. She may have simply developed her drama teaching, but a road traffic accident in Kirriemuir in 1933 led her to use her learning to address the injury to her own speech. This ignited an interest in speech therapy at a time when speech therapists were self-taught and very thin on the ground.

In 1940, while another pioneer of the profession Lionel Logue was supporting King George VI in London, Catherine was appointed as the first Superintendent of Speech and Drama and Speech Therapy in Aberdeen. According to Steve Nicoll, who has spoken to a number of Catherine's students, her attitude to teaching was disciplined, structured, hard but fair - and she was always right. However, the core values she sought to develop through drama teaching would not be out of place with educational thinking of today: confidence, communication, citizenship, civility, language, personal discipline and personal development. Significantly, Catherine was a great believer in the importance of peer learning, and kept the number of adults involved to a minimum.

In her later years, Catherine came out of retirement to do voluntary work in Dundee with people who had had a stroke. Although some of the specific methods were clearly of their time, it is telling that Catherine recognised the void when people with aphasia were 'left' at the end of speech therapy with no help, and she sought in a variety of ways to help re-build their confidence, self-esteem and social contact.

The profession has come a long way, but being aware of where we have come from can be as inspiring for the 'speaking wifies' of today as recognising where we are now and where we are going.

 

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). 

'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.

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.

Article on speech sound disorders course posted as Caroline Bowen receives special award

By happy coincidence, I completed a new article reflecting on two days immersed in speech sound disorders with international expert Caroline Bowen just as Caroline was awarded life membership of Speech Pathology Australia at its National Conference in Darwin. She is pictured here being congratulated by Ros Neilson, Councillor for New South Wales.

Having known Caroline 'virtually' for many years, it was a pleasure to meet her at last at her two day 'Speech Sound Disorders - the Basics and Beyond II' course hosted by the Association of Speech & Language Therapists in Independent Practice (ASLTIP) in the beautiful city of York. Reading my article will give you a sense of the contribution Caroline has made to promoting evidence based practice around the world, and of why she thoroughly deserves the highest honour of her own professional body.

Caroline is returning to the UK shortly to run three one day courses in London (18, 20, 22 July). She will then deliver two complementary one day courses (28, 29 July) in Durham, 'Spoiled for Choice - Therapy approaches for speech sound disorders in children' and 'Sound Reasoning: Therapy targets and techniques for children with speech sound disorders'. If you are interested in attending, there is more information here.

Communicating with young people about mental health and wellbeing



This afternoon I went to a twilight seminar for a range of professionals. We heard about the findings of a critical review of the literature on children and young people’s views on the factors that influence their mental health. One of the authors, Jenny Spratt, summarised the findings of the review’s 137 pages and we were then encouraged to reflect on how they relate to and can inform practice with young people, whether at school or in the wider community. The four most important influences for young people emerging from the review are all familiar territory for speech and language therapists:
- Social relationships
- A need to feel normal and fit in
- Transitions
- Control over choices.

One of the attendees talked about the challenges of finding the right language to use with young people to discuss their mental health and wellbeing. Jenny has found simple concepts such as ‘good’ / ‘bad’ can be the most effective.

By coincidence, earlier on today I had an order for a 2010 article by Yvonne Macleman. It examines how speech and language therapists can work with Child & Adolescent Mental Health Services using Talking Mats to facilitate accurate mental state assessments in young people with speech, language and communication difficulties.

Talking Mats is a low technology communication framework involving sets of symbols designed to help people with communication difficulties think about issues and express their opinion. Yvonne’s article included an example of their use with Greg, a young man with Asperger’s syndrome. She says his mother “spontaneously commented on two separate occasions that she felt the Talking Mat was an easier way for her son to express his thoughts and feelings around a difficult area.” A family therapy colleague also commented that he “thought the Talking mat could actually be ‘emotionally containing’ for both the young person and their family” (p.9).

Jenny Spratt talked about the irony that  children who are generally happy find it difficult to express the positive factors impacting on their wellbeing while, in contrast, the review says that “some of the most insightful thinking about ‘normal’ states of mental health in young people comes from those who feel they have somehow been tipped beyond this” (p.62). In a similar way, we know that work done with people with speech, language and communication difficulties gives lots of clues about the kind of language and supported conversation that is equally useful with young people who do not have such specific needs.

References
Macleman, Y. (2010) 'Talking Matters', Speech & Language Therapy in Practice Spring, pp.8-10.
Shucksmith, J., Spratt, J., Philip, K. & McNaughton, R. (2009) A critical review of the literature on children and young people's views of the factors that influence their mental health. Edinburgh: NHS Scotland.

Acknowledgement
Thank you to Sue Briggs, Senior Community Learning & Development Worker in Laurencekirk for inviting me to the seminar.

Summer 11 Speech & Language Therapy in Practice out now!

The Summer 11 issue  of Speech & Language Therapy in Practice magazine was mailed to subscribers on Friday and Saturday, so should be with you very soon.

As well as the second instalment in the new goal negotiation series and an 'In Brief' contribution that puts the accent on aphasia, we have an uplifting story of the evolution and impact of a total communication project across Devon. In 'Journal Club', Jen Reid provides a framework for critical appraisal of intervention studies, while 'Boundary Issues' looks at the ethics of new professional roles.

We hear about a collaborative project with a children's centre and library service in an area of deprivation, which seems to highlight the benefits of targeting training on selected individuals. We also get a glimpse into the speech, language and communication needs of prisoners completing community sentences.

The cover feature is on using the evidence in dysphagia management. Hannah Crawford and Julie Bake explain why they have moved away from previous practice and introduced oral taster programmes with people with learning disabilities who gain their nutrition via PEG, while Celia Harding and colleagues use a problem solving framework to support appropriate intervention for infants and children with early feeding, eating and drinking difficulties.

We have reader offers for Photosymbols 4, I CAN Secondary Talk narrative and a Grow Words resource set, as well as Editor's Choice, three pages of reviews and 'Here's one I made earlier' on encouraging clients to make their own books. As always it is good to the very last page, where Kate Balzer shares some of the ideas for working with people with dementia from a SIGDOM therapy swapshop.

Enjoy!

Shine a light to recognise good practice in children's communication and inspire others

I know from all the articles I receive that speech and language therapists put a great deal of thought, imagination and effort into providing the best possible service to clients in challenging circumstances, and that sharing their experience really inspires others. So I'm delighted that the Hello campaign is going to 'Shine a Light' on good practice for children and young people's communication with an extensive awards scheme.

The Royal College of Speech & Language Therapists is sponsoring Team of the Year for speech and language therapists, and there are other categories for outstanding achievement, communication friendly establishments, other types of team, communication strategy, commissing and employee support. You might also want to have a think about potential candidates for the Hello Young Person of the Year Award, open to children and young people up to 19 years with speech, language and communication needs.

Sponsor Pearson Assessment says, "We encourage you to apply no matter what size and scale you are working at. If you think your work is special and making a tangible difference that you can evidence, we want to hear from you."

Hello is the national year of communication, a campaign to increase understanding of how important it is for children and young people to develop good communication skills. Wendy Lee, Professional Director for The Communication Trust, says the awards are intended to recognise inspiring work and "enthuse and spur on others who, through the national year of communication, are starting to tackle this subject head on in a range of ways - from small grassroots projects through to larger area-wide initiatives."

To enter, visit the Shine a Light 2011 Hello campaign awards site. Entries close on 15 July 2011.