Speechmag

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.

Picture menu launched to help people with communication difficulties in hospital

No-one would choose to be in hospital but, if we have to be, the majority of us can at least read the hospital menu and choose our preferred dishes. Unfortunately people who have difficulty communicating - including those who have aphasia, or English as an additional language, or who find reading hard - don't have that luxury. As a result, they miss out on making choices for themselves, and may also miss out on nutrition.

Recognising the problem, speech and language therapist Karen Rodger started to explore the possibility of making an aphasia-friendly hospital menu around 10 years ago. In 2006 she wrote the article 'Some hae meat' about her project for Speech & Language Therapy in Practice. Today I was delighted to catch up with Karen as the Nutrition Standards Service Improvement Programme rolled out the finished product to the main hospital in her NHS area.  

High quality photographs of food choices on the hospital menu are presented in a large, durable ring binder. Copies are available in certain wards and through speech and language therapy and dietetics. Karen has worked with colleagues from dietetics and catering as well as with patients and carers to develop the resource. She is now hoping that the publicity surrounding the launch will make nursing staff aware of the availability of this simple but effective tool, and of the difference it can make to the lives of a variety of patients.

Identifying and supporting 'Other ways of speaking' to ensure everyone can have a voice

Gesure, signing, symbols, boards and books, adapted computers and Voice Output Communication Aids -  in the words of the Hello campaign, 'Other Ways of Speaking' that ensure everyone can have a voice.

My final year project 23 years ago was on 'Using computers with people with aphasia'. Technology has moved on unimaginably since then, and people with communication difficulties are benefiting as AAC (Alternative & Augmentative Communication) becomes ever more adaptable, portable and affordable.

Speech and language therapists have a crucial role in ensuring the 'other ways' are appropriate to the individual's needs and functional in real life situations. The difference matters between aphasia and dysarthria, a physical disability and intellectual disability, or a language impairment that may or may not involve comprehension, as does the age, personality and interests of the client. The right choice of 'other ways of speaking' and support to establish their use in everyday communication is vital.

Manufacturers of voice output communication aids are taking their role seriously. Euan Robertson is Clinical Application Specialist at DynaVox Mayer-Johnson. He says, "I strongly believe a manufacturer's job is not over when a device is sold. Implementation is the difficult part, and AAC manufacturers have a responsibility to help this process. As such, DynaVox have created the Implementation Toolkit and run free workshops across the country. Although DynaVox InterAACt software is demonstrated, the strategies can be used with any form of high or low tech AAC system."

The recently launched MyChoicePad is making impressive use of its website and social media to spread the word about appropriate and functional use through short videos. Developed with the full support and collaboration of the Makaton charity, 'chief juggler' Zoe Peden says, "The angle we've taken is not just that of a low cost AAC device, but more about building the skills for communication using symbols and signs."  

The Makaton charity has also been involved in the production of the free 'Other Ways of Speaking' resource, along with 1Voice, ACE Centre, ACE Centre North, Scope and Signalong, as member organisations of Communication Matters. Anna Reeves from ACE Centre North says, "It is imperative that the needs of children and young people who have difficulties speaking are identified at an early age. Finding the right method of communication can have a dramatic impact on a child or young person's life - helping them to express themselves, participate in decisions, and improve their self esteem, which will ultimately impact on their contribution to society at large."

For proof of this, you only need to watch this video, produced by the ACE Centre for Hello, as part of the National Year of Communication:

 

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.

 

Access to journals for speech and language therapists

Throughout April, Routledge is having an Education Free for All, which means you can get online access to the most recent issues of all the publisher's education research journals.

You can print off any article which is of interest, as long as it is for your own use in research, teaching or private study.

Having browsed through the titles, I have added the journal 'Emotional and Behavioural Difficulties' to my email alert list. This means I will be sent a table of contents with access to abstracts every time a new issue is released.

Many speech and language therapists working for the NHS can get a certain level of online access to journals. For me, the National Information Centre for Speech-language Therapy (NICeST) provides a great service. When I see an article I am interested in, I send in a photocopy request form and am invoiced for £3-£6 per article. It's a great way of getting your inspiration from a variety of sources.

To find out more about this and other services that NICeST provides to members of the Royal College of Speech & Language Therapists, contact the librarian Breege Whiten.   

Why it's worth attending major exhibitions like Naidex and Talk Shop

The needs of people with communication difficulties will be well represented at the Naidex exhibition, which starts tomorrow at the NEC in Birmingham.

It’s a shame I’ve never managed to get to this annual showcase for products to aid independent living, as I’ve found other exhibitions such as BETT, the Communication Matters roadshows and Talk Shop inspiring and informative. As Louise Scrivener of Talk Shop says, such events give you “the space and time to re-discover your passion for your work...discover new ideas and products...and most importantly to network and update your CPD.”

Naidex runs from 5-7 April 2011. Wordswell speech and language therapist Janet O’Keefe will be speaking on inclusive practice in special educational needs, and the Association of Speech & Language Therapists in Independent Practice (ASLTIP) will be exhibiting for the first time. The ‘Communication Village’ area features well-known names in alternative and augmentative communication.

If this is too short notice, TES Education North is from 8-9 April at Manchester Central. Or you can keep Friday 30 September in mind for the third Talk Shop. In a development from previous years, this will now be the National Speech & Language and Occupational Therapy Fair and will include Communication Champion Jean Gross as the keynote speaker.

Comic Relief, stammering, and the real irony

Humour can be difficult to get right - but last night Lenny Henry and the BBC got it very wrong.

My children have been very moved by the various TV programmes leading up to Comic Relief, in particular one involving Lenny Henry in Kenya. On their own initiative they set themselves challenges and got sponsorship. Their questions have led us to discuss politics, culture and the use of humour to highlight inequalities, injustice and our own inconsistencies.

It beggars belief that Comic Relief would open with a spoof of The King's Speech which involved absolutely no irony, hidden message or clever humour. All it said was - it's OK to roll your eyes and laugh at people who stammer, to interrupt them, to hurry them, to make fun of them and to finish their sentences. What sort of signal does that send out to young people who stammer and to their peers who are so crucial to their self-esteem and acceptance?

In a strongly worded complaint Leys Geddes, chair of the British Stammering Association, said, "Thousands of children are teased and bullied every day simply because they stammer. By doing stuff like this, you give other children permission to continue this foul treatment and encourage adults to snigger and turn a blind eye...In your drive for audiences and edge, you trample on the very vulnerabilities you claim to dispel."

The BBC recently showed an excellent programme about young people attending a course at the Michael Palin Centre for Stammering Children. Comic Relief spends considerable sums on anti-bullying projects. It's a pity that no-one involved in the production or showing of the opening sketch seems to have spotted this real irony.

Shopping habits, risky decisions and getting to grips with statistics

I’m sure Jen Reid didn’t intend to improve my shopping habits when she conceived the ‘Journal Club’ series on critical appraisal for Speech & Language Therapy in Practice – but that has been one outcome.

I picked up a pack of four leeks yesterday emblazoned with ‘Special offer! Only £1.70!’ But I paused as a little voice in my head said, “Check the figures and think about it. It’s up to you, not the shop, to decide if this is the best deal.” The loose leeks had a tiny little sign saying ‘£2.75 a kilo’. The four nicely packaged leeks weighed 500g. I did the maths - and swapped them over.

A new Cochrane Systematic Review concludes that people – whether health professionals or consumers – may make different decisions depending on the way risk statistics are presented. There are the usual caveats about more research being needed (and I won’t claim to have studied the whole review), but check out how the example given in the plain language summary (p.2) changes your own perceptions:
“You read that a study found that an osteoporosis drug cuts the risk of having a hip fracture in the next three years by 50% [relative risk reduction]. Specifically, 10% of the untreated people had a hip fracture at three years, compared with 5% of the people who took the osteoporosis drug every day for three years. Thus 5% (10% minus 5%) less people would suffer a hip fracture if they take the drug for 3 years [absolute risk reduction]. In other words, 20 patients need to take the osteoporosis drug over 3 years for an additional patient to avoid a hip fracture [number needed to treat].”

The authors conclude their findings suggest that “the formal education and training of health professionals apparently has no effect on their handling of statistical information” (p.26). It certainly doesn’t come easily to me but, as a teacher said at my older son’s parents’ evening, “He is used to being able to do things so, when they don’t come naturally, he just thinks he can’t do it. I tell him to take his time and to think it through, because he can. And then he does.”

I will keep trying to understand statistics because, when we are asking people to trust us to give them appropriate, evidence based information, an ability to look behind the headlines matters.

Jennifer Reid’s Journal Club series in Speech & Language Therapy in Practice has so far taken the mystery out of appraising expert opinion articles (Autumn 2010), qualitative research (Winter 2010) and systematic reviews (Spring 11). In Summer 11 she will tackle intervention.

Reference
Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schünemann H. Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD006776. DOI: 10.1002/14651858.CD006776.pub2.