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. 

 

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.

 

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.

 

 

 

 

 

 

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!

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.   

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.