The life of a fully qualified SLT

The life of a fully qualified SLT

Sunday 17 June 2012

Consulation as a model for SLT

The Bercow Report (DCSF 2008) states that in the UK more commonly than not in Mainstream Primary school teams a consultative model of management is used. This sees SLTs writing a programme of therapy and providing the school with the relevant resources to engage in the therapy activities, thereby reducing the level of SLT direct input.
I am currently writing an essay that is based on a child that is on my hypothetical caseload. He is 5;06, attends a mainstream, and has a diagnosis of limb dyspraxia, severe verbal dyspraxia, and moderate learning disabilities. Though he is able to communicate via Makaton and can express 2-3 word phrases and understands Makaton supported 3-4 word phrases, his speech is unintelligible.   We have been given information regarding our job, in that we work for 1 and a half days per week, and currently have a caseload of 45 children in a 50x50 mile geographical span.   Now, we are given 3 options of management strategies to select ONE from. They include: regular direct therapy, SLT programme and review or parent and teaching staff training including a programme and review.
My gut instinct is indirect therapy of some kind.  He is able to communicate his needs through the mean of Makaton, and is able to understand WHEN supported with Makaton. So my thinking is that we need to promote the use of Makaton within the school and support the teachers with curriculum alterations and Makaton integration.
This means I have just fallen into the very same scenario that the Bercow Report refers to. The trap of the consultative model.
Now I also happen to be currently working on a presentation based on the McCartney et al. (2011) paper that researches the benefits between direct and indirect therapy. There I have come to unearth that expressive language improvements have been significant when direct therapy with a SLT occurs.  When indirect therapy is used, the interventions are rarely followed  and complied with as the SLT suggests that should be, and intervention is often subjected to issues of time available in a school day, finance of relevant teaching support and the issue of child and staff absences.
I find it intriguing that the Evidence Base suggests how strongly results can be seen when working directly with an SLT and yet the common practice, and even my own judgements are to work consultatively.
One thing that the McCartney et al. (2011) paper suggests is that IF the common practice in the UK is that of the consultative model, then a newly developed and improved model of consultative practice is required to be developed in order to produce similiar (if not the same) results as SLT direct therapy. So I think 2012 is the time to start working toward better consultative practice! We need to reduce risk factors and put in better scaffolding for working together - the gap between Health and Education is closing, but we need to continually work to ensure that the best duty of care is given to both the children and the teaching staff we work with!
References
McCartney, E. , Boyle, J., Ellis, S., Bannatyne, S. and Turnbull, M. (2011) Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention International Journal of Language and Communication Disorders 46 (1) 74-82
Department for Children, Schools and Families (DCSF) 2008, The Bercow Report: A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Needs (London DCSF) <available at: http://www.dcsf.gov.uk/bercowreview> [accessed on 17th June 2012]

Dysphagia, AAC and Autism (The Autism Show!)

Yesterday, both myself and some fellow MScSLT peers attended The Autism Show in London's Excel.  It was both inspiring and eye-opening! I was able to attend several talks from a range of professionals, parents and individuals with autism and was exposed to new insights into communication and sensory issues as related to autism. I also saw 2 SLTs from the Hesley Group talk on the topic "Dysphagia and Autism" - As we have yet to cover dysphagia or anatomy in the course (yes, I bet you are shocked that 10 months in we have yet to cover this!) I found this a wonderful insight into the "normal" swallow and also some red flag indicators that are commonly seen in individuals with autism at eating and feeding times.  The sensory issues that accompany foods are essential to take note of - many individuals with autism have heightened or reduced sensory impacts compared with "typical" individuals and as such new tastes and textures will be unpleasant to them.  This can cause negative associations with mealtimes and can lead to poor nutrition.  Another factor that may be cause for concern that is often common in autism is Pica.  This is the eating of non-food substances and can affect both nutrition and diet but can have an impact on internal systems such as the oesophagous and stomach.  So, a very interesting talk to attend and fascinating to meet new SLTs and discuss ASD with them. 


The highlight of my day has to be the wide variety of AAC devices available to both experience hands-on but also to purchase.  Both low and high tech devices were on show and a range of different companies promoting both symbol, written and picture based devices.  As I have seen a range both working in playschemes with children with autism, but also as an SLT Student in placement it was fascinating to talk to the creators and directors of these companies to get their view on AAC.  One sales rep (for the AAC company Dynavox) even remarked that he was not there as a sales rep and was not concerned with how many sales he made, his goal was to make sure people had the opportunity to experience different AAC types hands on.  He stated that it is more important to be aware and familiar with the AAC devices that we may one day be recommending.  He even offered to do a one day talk at University! So I look forward to him demonstrating and allowing us to experience a range of low and high tec devices that his company recommends.



I was then able to get my hands (or should I say eyes?!) on trialing a piece of eye gaze software.  Now, before this opportunity I had heard of eye gaze AAC devices and seen pictures of these, but never had I seen a service user with one nor attempted to use one myself.  So straight away I burst up to an unsuspecting rep and said "please can I try it?" whilst trying to explain I was a SLT student currently with a BIG interest in ASD.  He agreed and set me up with a programme that made pretty dots dance around the screen as a result of where your eyes pointed.  Now I strongly recommend that anyone who is from an SLT, to an OT to a health care professional, to a carer, anyone working with a client with an AAC device, should try out the device and experience it for themselves.  There is no better way to learn how another person copes with life than by stepping into their shoes. So this is what I did. And my gosh was it hard! We may take for granted sometimes that if a client has access to a AAC device that that must mean its working for them.  This may not be true at all! I found that using the eye gaze softward took a lot of concentration, a lot of patience and a lot of staring very still for a long time. And I'd be as bold as to say I have good eye co-ordination! So you can imagine for many AAC users out there that a co-morbity of diagnosis' may occur and eye co-ordination may not be a strength of theirs, or even those with fantastic eye co-ordination but have un-patient personalities. 

So what this really taught me was that AAC devices can talk the talk and claim to be the best, but the only way a particular device can be the best is individually and unless a certain individual works well with an AAC device and states a preference for one over another, the companies cannot claim that one is more beneficial than another! We, as SLTs, need to ensure that the AAC device that is given to a client is one that is well suited to both their speech, language and communication needs, but also their personalities!
 
Though it is stated frequently that Autism is a spectrum, therefore the nature of each diagnosis is individual and just like snowflakes no two people with autism will present the same - it takes a day like this to prove just how true that statement is!



The Autism Show was definitely a thoroughly interesting and eye opening (and eye gazing!) day out that I recommend to anyone with an interest in the field of Autism! I am only disappointed that I could only attend one day out of the two days that this show was held for!