Speech & Language Therapy in Practice, Winter 2009

ISSN 1368-2105
Winter 2009
In the Wendy House

Do you have what it takes?
Targeting training The Elklan way Student education Role emerging placements Walking with Dobermanns Project work in the community Creating creativity Read all about it! Developing narrative Defining who I am Autism diets What does this house believe?
PLUS...winning ways...heres one I made earlier...reviews...editors choice... resources...and in brief www.speechmag.com
Winter 2009 (publication date 30 November 2009) ISSN 1368-2105
Winter09contents
15 COVER STORY: COFFEE BREAK QUIZ Whether youre thinking of a career in speech and language therapy or are already qualified, Julie Leavetts light hearted questionnaire has a serious message about the positive qualities that show we have what it takes.
Published by: Avril Nicoll, 33 Kinnear Square Laurencekirk AB30 1UL Tel/fax 01561 377415 e-mail: avrilnicoll@speechmag.com
Thanks to Julie Leavett , and our young model for the cover photo by Allan Wilson, www.allanwilsonphotography.co.uk
Design & Production: Fiona Reid, Fiona Reid Design Straitbraes Farm, St. Cyrus, Montrose Angus DD10 0DS Printing: Manor Creative, 7 & 8, Edison Road Eastbourne, East Sussex BN23 6PT Editor: Avril Nicoll, Speech and Language Therapist
4 TRAINING We endeavour to listen to the needs of both our tutors and learners, and take the feedback we receive very seriously. Our courses are not static but have evolved over time and continue to do so. Elklan founders Liz Elks and Henrietta McLachlan reflect on the success of the training brand and offer tips for learners and trainers. 6 EDITORS CHOICE 7 HERES ONE I MADE EARLIER Alison Roberts with two low cost therapy suggestions - The name game and Sound effects. 8 STUDENT EDUCATION I now have a greater understanding of the occupational therapists role, particularly the overlap between the speech and language and occupational therapy professions. Leona Cook, Jeannette Head, Harriet Easter and Stefanie Roberts consider the benefits of an occupational therapy roleemerging placement in a primary speech and language provision. 11 WINNING WAYS It is a wondrous thing when science and goodness meet and agree. Life coach Jo Middlemiss suggests ways to help us cope with pressure.
12 PARTICIPATION My role as project facilitator involved maintaining the fine balance between the autonomy of the group and ensuring that the group maintained direction. In the second of two articles inspired by the late Mark Ylvisaker, Sam Simpson, Emma Gale and Ashleigh Denman focus on group and individual project work with people with brain injury in community settings. 16 DOES THIS HOUSE BELIEVE IN AUTISM DIETS? ...our duty as professionals is to back rationale with evidence and be mindful of our professional boundaries...We need to be careful of commenting on areas managed by nutritionists and psychologists, and to be aware of the evidence and its quality. Rachel Harkawik and Paula Leslie examine the case for gluten and casein elimination diets for children with autism in relation to the impact on speech and language therapy - and find the evidence wanting. 20 REVIEWS Career, dementia, narrative, speech sound disorders, mind, body & spirit, Aspergers syndrome, autism, social communication, voice, child language.
23 HOW I CREATE CREATIVITY (1) READ ALL ABOUT IT! ...when we perform Bible Stories in Cockney Rhyming Slang at Westminster Abbey, the class teacher may describe the activity as Religious Education, the speech and language therapist as Language and Communication, the head of the English department as Drama or Poetry or even, as a visiting drama therapist once said, Applied Theatre. Keith Park on the genesis of an approach which, as it becomes embedded in the culture of schools or day centres, creates the conditions for ongoing development. (2) DEFINING WHO I AM The stories we chose towards the end of the project were designed to encourage the telling of personal stories around the themes of choice making, change, and experiences of fear, sadness and happiness. A story from one lady about the happiness of her nieces wedding and the wistfulness of I wished it was me proved quite poignant. Lesley Johnson with an inspiring tale of a collaborative approach to developing narrative in people with learning disabilities. 30 IN BRIEF Two readers consider what, with the benefit of experience, they wish they had known before. Non Thwaite has learned to organise her time more effectively, while Gwenan Roberts has found that Mindfulness training means things are now just as they should be.
Subscriptions and advertising: Tel / fax 01561 377415 Avril Nicoll 2009 Contents of Speech & Language Therapy in Practice reflect the views of the individual authors and not necessarily the views of the publisher. Publication of advertisements is not an endorsement of the advertiser or product or service offered. Any contributions may also appear on the magazines internet site. Speech & Language Therapy in Practice can be found on EBSCOhost research databases
IN FUTURE ISSUES: EAST KENT OUTCOMES SYSTEM...VOICE...MENTAL HEALTH... ETHICS...ASSESSMENT...ATTENTION AND LISTENING...ADULT ACQUIRED... LEARNING DISABILITY
news
The Neville Childhood Epilepsy Centre which opened on 6th November 2009. www.nycpe.org.uk
Logans voice
Neuro-imaging plea
Researchers at the Wellcome Trust Centre for Neuro-imaging, UCL are looking for clients with or without aphasia to take part in a project which they hope will provide encouraging information on the recovery of language following stroke. Led by Professor Cathy Price, the project aims to establish links between types and locations of brain damage and functional performance on standardised language tests. In the long term this should provide information on typical patterns of language recovery following certain types of stroke. Professor Price says the project will take into account the hundreds of brain regions involved in language rather than simply Brocas versus Wernickes lesions, and co-existing factors such as age and therapy input, so many people will be able to be given more information on their likely pattern of recovery than has previously been possible. Although it may not be possible to predict the consequences of some lesions, it is possible to make very accurate predictions about other lesions and therefore give patients hope that, like others before them, their language skills will improve. Any therapists working with people at any stage post stroke, with or without aphasia, who may be happy to take part should contact Research Assistants Louise Ambridge or Matthew Lawrence on 07984 111 584 or 585 or e-mail stroke@fil.ion.ucl.ac.uk for further information or to request patient leaflets. Participants must be happy to travel to London, and transport costs are refunded on the day by the Institute. Participants will be offered a CD of their brain images and can request feedback on language assessment results. Further information is at www.fil.ion.ucl.ac.uk. A communication aid developed by a father to help his non-verbal son who has autism is now available in the UK. Glen Dobbs says of his son, now 12,Logan was a great user of PECS, but he had no speech and I wanted him to be able to order his own burger when we went out at the weekend. There was nothing on the market that was easy enough for Logan to use or robust enough to withstand the rough handling he would give it. In line with the purpose of PECS, the Logan ProxTalker enables children to exchange pictures for real words. The symbolised tags retrieve spoken words from the device, thus giving the user a voice. To participate in user trials or for further information, contract Sandra Hartley, e-mail Sandra@logan-technologies.com or visit www.logan-technologies.co.uk.
Better Communication Research Programme

The programme of research commissioned to support the development of actions following the Bercow Review will run from 2009-2012 in the first instance, with a potential extension to 2014. The Bercow Review of services for children and young people (0-19) with speech, language and communication needs made a number of recommendations which were incorporated into the government in Englands Action Plan. A Communication Champion, Jean Gross, will take up her post in January 2010, the Communication Council has had its first meeting, and the sixteen commissioning pathfinders have been selected. The supporting research programme has been awarded to a team of four researchers who have longstanding experience in the field. Professor Geoff Lindsay, University of Warwick, Professor Julie Dockrell, Institute of Education, Professor James Law, Newcastle University and Professor Sue Roulstone, University of the West of England will be assisted by two economists and two psychologists. They hope to respond flexibly and involve a wide range of practitioners and service providers as the programme develops. In its first year the Better Communication Research Programme will have five strands. The researchers will review and disseminate best practice and analyse prevalence and outcomes for pupils with speech, language and communication needs, as well as comparing change in children with specific language impairment and autistic spectrum disorder between ages 5 to 14. A further strand will investigate the views of service users, service providers and those supporting provision through professional bodies and the voluntary sector. Interestingly, the researchers will also identify economic criteria for judging the value of intervention. http://www2.warwick.ac.uk/fac/soc/cedar/ projects/current/slcn
Aphasia award
For the first time since its inception four years ago, the Robin Tavistock Award has gone to a person with aphasia. The award, named after the founder of the Tavistock Trust for Aphasia, was presented to Dr Jenny Dautlich in recognition of the way she has dealt with her own aphasia and helped improve the lives of others with the condition. Following a stroke in 1998, the trainee specialist registrar accessed a number of courses to improve her communication skills and confidence. In 2001 she went on to co-found Glos-Speak, a self-help group which offers long-term support to people with aphasia and their families. In 2005 Jenny saw a wider vision come to fruition with the launch of the aphasia-friendly website AphasiaNow, which has become a wellknown and supportive virtual community. www.aphasiatavistocktrust.org www.aphasianow.org
The vision and drive of a year old online business selling sensory toys for children with special needs was recognised when it was runner-up for the Morgan Foundation Entrepreneur Awards 2009. Liz Howard says she set up the Novelty Warehouse because she was alarmed at the ridiculous markups on special needs toys. She now stocks over 900 toys and says they all have two things in common theyre fun and theyre good value. To celebrate its success, The Novelty Warehouse is offering a lucky Speech & Language Therapy in Practice reader a 25 virtual voucher to spend on resources such as a fidget bin for use as rewards and motivators and to promote communication. To enter, answer the question, What is the name of The Novelty Warehouses dinosaur logo? (A visit to www.thenoveltywarehouse.com will help!) E-mail your answer with your name and address to info@thenoveltywarehouse.com, with SLTiP offer in the subject line. Entries must be received by 25th January and the winner will be notified by 1st February 2010.
Reader offer to celebrate success
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2009
NEWS & COMMENT
Artificial larynx for Kenya?
Emma Shah, a speech and language therapist in Kenya, has sent out a plea for spare or second hand artificial larynges. Emma explains that, as trache-oesophageal puncture operations are not done in Kenya, clients get a traditional laryngectomy with little surgical follow-up. Every artificial larynx received will be used to support a client who cannot achieve oesophageal voice. If you can help, e-mail Emma on shah.emma@gmail.com. See the speechmag blog (http://speechmag.typepad.com/ speechmag/) for information on a residential course in Nairobi run by the Kenya Association of Laryngectomees, supported by Emma and other professionals. If you wish to add to the relatively modest sums needed to run this course, e-mail the Associations fundraiser Bishop Mbogo on mbogowanjigi@yahoo.com for advice.
Comment:
Creating
creativity
Visualising sounds
A phonetics and phonology lecturer and a professor specialising in holography have produced a student teaching resource which could become a useful tool for speech and language therapists. Pip Cornelius is working with Professor Martin Richardson on the project to improve how students at De Montfort University are trained in phonetics. The hologram captures and illustrates the exact mouth and tongue shapes involved in producing different sounds. Because it is 3D, it can be played back from a number of angles, enabling visualisation of what cannot usually be seen. (See videos at http://speechmag.typepad.com/speechmag/.) The De Montfort students have to identify and transcribe over 100 speech sound variations, but Pip hopes the applications will be much wider, including demonstrating speech techniques to clients. She says, I hope to use this resource to assemble an entire phonetic library of speech sound configurations and, as well as being used as a teaching tool, it would be great to extend it into clinical environments as a visual support for practising therapists. Further information from Pip Cornelius, e-mail pcornelius@dmu.ac.uk.
Countering cures
New chair of the British Stammering Association Leys Geddes is urging people to take action against videos on You Tube which make misleading claims about cures for stammering. Leys suggests that readers click the Flag link below the relevant video and choose the appropriate option which may be spam scams/ frauds or hateful or abusive content. www.stammering.org/adverts.html
Sign up for 999 texts
Hal Bailey, who was featured in our Autumn 09 issue and has motor neurone disease, wants to draw readers attention to a pilot of a national emergency SMS text service. This service is for anyone who cant make a voice call because of a communication difficulty. As the trial is only for genuine 999 emergency messages to police, fire, ambulance or coastguard services, it is important that as many people as possible sign up. If the trial is a success the service will be launched in 2010. Clients who want to register their mobile phone and find out more about the trial should go to www.emergencysms.org.uk/.
After more than 12 years designing Speech & Language Therapy in Practice, Fiona Reid is moving on. As feedback from readers shows, the clean, bright and readable look she has created is one of the reasons behind the magazines popularity. She is what Jo Middlemiss (p.11) calls a drop of golden sun. On a personal level I am grateful for Fionas common sense, professionalism and good humour (in the face of constantly being asked to squeeze in just a few more things...) I have learned a lot from her over the years and now, through teaching me how to do the magazine layout, she is unlocking a whole new world where I can enjoy discovering endless possibilities of colour, shape and pattern. Keith Park (p.23) coins the phrase creating creativity to describe his work as an advisory teacher. His client, PJ, who has autism, is a prime example of what can happen when we give people the opportunity to discover and develop talents. Like Keith, Lesley Johnson (p.26) and Sam Simpson, Emma Gale and Ashleigh Denman (p.12) find that activities in community settings are key to engaging clients, whether they are adults with learning disabilities telling stories or young people with a head injury organising the Tour de Putney. The word creative invokes a sense of using your imagination, taking opportunities and letting things unfold without being overcome by anxiety, fear of failure and a need to control the outcome. The Elklan training brand (p.4) continues to evolve in this way, while two occupational therapy students supervised by speech and language therapist Leona Cook (p.8) believe their role emerging placement gave them more freedom to be creative. Meanwhile Rachel Harkawik and Paula Leslie (p.16) understand why parents need to find creative ways of helping their children but emphasise this must not prevent us from an objective appraisal of alternative approaches. I hope you are amused by Julie Leavetts creative way of looking at the qualities different people bring to our profession (p.15), inspired by Non Thwaites approach to time management (p.30) and that, like Gwenan Roberts with her mindfulness training (p.30), this issue helps you to let go and accept the possibilities of opportunity.
Unlimited arts
PS Do check out my blog it includes the kind of news, resources and events that you enjoy in the magazine. You can sign up as a follower if you want to receive notification when it is updated. I havent ventured into Twitter - or Wordr - territory, but I have set up a Facebook page for the magazine. If you are a Facebook member, you can sign up as a fan of the magazine to receive first notification of upcoming articles via your feeds.
Unlimited, a disability arts programme launched as part of the London 2012 Cultural Olympiad, has opened for artists entries. The programme has a budget of 3 million, half for new creative work and half to support artists to develop their talent and present work in the UK and abroad. www.london2012.com/unlimited
professional development
Targeting training
The tenth anniversary of Elklan inspired founders Liz Elks and Henrietta McLachlan to reflect on the evolution of the training brand, consider the reasons for its success, and pass on top tips for learners and trainers.
n the current climate speech and language therapy departments are increasingly being asked to meet many varied targets. Indeed, sometimes it seems that there are so many targets to shoot at we dont know where to start. There is frequently a tension between providing the best care for a child - which could involve a variety of aspects such as training, home visits, collaboration with others - and the constant demands to meet waiting list targets and maintain a high number of face-to-face contacts. We are also facing the pressure of auditing the work we do to ensure it is cost effective and fit for purpose. We should however be heartened by the Bercow Review of Services for Children and Young People with Speech, Language and Communication Needs in England (Bercow, 2008), and the Speech and Language Therapy Task Force report for Northern Ireland (DHSSPS, 2008). Both identify the broader role we have to play in equipping the wider workforce in health and education, as well as parents and carers, to enable them to support children with speech, language and communication needs more effectively. Both highlight areas of good practice and, as a profession, we need to extend this current work rather than re-inventing the wheel. Ten years ago, we were both, and still are, community speech and language therapists with an interest in spreading good practice through training others. We couldnt have envisaged at the time that this would lead us to oversee a business offering 10 different courses via a network of 798 Elklan tutors throughout the UK and Ireland as well as Australia, Pakistan, Germany and Singapore! This network has between them trained over 7000 learners, the majority in the UK. In reflecting on our experience we hope to achieve two things. Firstly, to keep training of others as a priority for speech and language therapists and, secondly, to provide an example of the unexpected but rewarding directions your career can go in when you have a good idea and opportunities to take it forward. As speech and language therapists we know it is a good thing to train others who are involved with the child. It makes sense that those who are with the children more than we are - teachers, assistants, support workers and parents - know what and why we are doing the things we do and how they can
READ THIS IF YOU ARE A LEARNER A TRAINER AN ENTREPRENEUR
help. With budgets being stretched, training has to be effective and give staff the information they need. For children with identified speech, language and communication needs, who are supported by the speech and language therapist through collaboration with assistants and teachers, training education staff enables our service delivery to be more appropriate, costeffective and efficient. Other children with less significant speech, language and communication needs can have these met within their school or pre-school setting without specific speech and language therapy support as long as staff can identify the need in the first place and are aware of the practical strategies which can be used to enhance the childs learning within the educational context. Training does not replace 1:1 therapy, but it does mean that education and early years staff can give the appropriate, additional support that many of these children need to progress. The first step in the Elklan journey was in 1999 when we were commissioned by Cornwall Local Education Authority to write a course to support teaching assistants working with children with speech, language and communication needs in Cornish mainstream primary schools. Following the employment of speech and language therapists by Cornwall Local Education Authority in 2000 we were asked if we
could support them delivering our successful ten week course. Thus began the difficult task of taking material which we had taught and making it very clear to somebody else so they could pick up and teach it. We managed this, and decided to see if other speech and language therapists in the rest of the UK would be interested in using it.
Small beginnings
Our first Elklan Total Training Pack course was held at the Royal College of Speech & Language Therapists training rooms in November 2001. In great fear and trepidation we trained six people, one of whom is continuing to use the programme eight years on. From these small beginnings we have gone on to write training packages for parents, carers, education and health staff which cover the age ranges 223 years as well as courses supporting children with autism spectrum disorder, unclear speech, complex needs and hearing impairment. In September 2001 we submitted the primary course for accreditation through the Open College Network South West Region. By this time Liz had moved to Northern Ireland and so Henrietta worked extremely hard to complete the very demanding process. As a result, all our courses are now accredited, and this adds value for both staff and employers. As Elklan has grown we have shared our
training packages with specialist language teachers so they co-teach with a speech and language therapist. This has helped to improve collaboration between health and education staff on the ground as well as enabling learners to benefit from the expertise of the two disciplines during the training sessions. Elklan trains the local speech and language therapists and specialist teachers to become Elklan tutors. Elklan tutors are given all the materials required to teach others in their area. After the initial training is complete we continue to have an ongoing relationship with tutors. Telephone and email support is available and message boards have been developed online to encourage tutors to help each other. There are also message boards for the learners to chat about the courses they are completing, and these make interesting reading. Sometimes learners want practical support around completing portfolio tasks and using the website. One post we received gave us the heartening news that, as a result of completing the training, she wanted to look further into a career in speech and language therapy. We endeavour to listen to the needs of both our tutors and learners, and take the feedback we receive very seriously. Our courses are not static but have evolved over time and continue to do so. We respond to the information received from others by changing and updating the courses and incorporating suggestions made by tutors and learners. This is challenging as there are frequently as many different ideas and opinions as there are people involved. We seek to resolve issues and listen to others views through a series of meetings that we hold annually in different parts of the country. Following these useful discussions we periodically make changes to the course material and are grateful to our more experienced tutors for acting as guinea pigs to ensure that what we have written is clear to others not always an easy task! We continue to learn through constructive criticism and the written feedback we receive from every learner who completes the accredited programme across the UK.
Figure 1 Top tips from learners to learners 1. During the sessions do what the tutor tells you to do, even if it seems crazy at the time. 2. Apply what you have learnt into your context this takes time, effort and discipline. 3. Contribute to discussions and workshops, as you learn more that way. 4. Be prepared take a pen and some note-paper with you. 5. Volunteer (its less embarrassing in the long run). 6. Be aware that, while everything you hear may not be directly relevant to you, it will be for someone in the room. 7. Respect confidentiality and the issues others may be concerned about. 8. Listen to all those contributing, especially when feedback is given from group work; its good to get ideas from colleagues as well as from the tutor. 9. Be willing to learn. 10. Go with a positive attitude and enjoy yourself.
Figure 2 Top tips from learners to trainers 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Use visual aids. Ensure plenty of time for discussion. Give us time to reflect and put what we have learnt into practice. Enable us to learn from each other through small groups and discussions. Use practical ideas that are fun. Keep your voice interesting. Keep the sessions short, focused and full of information. Make sure the room is well lit and well ventilated and that the chairs are comfortable. Consider the timing of the sessions try to find a time when it is easy to stay awake. Arrange lots of coffee breaks.
Figure 3 Top tips from trainers to trainers 1. 2. Know your material well prepare effectively. Give yourself time to set up and ensure all the technology works before you stand up to speak. 3. Practise what you preach use multi-sensory teaching and vary activities to suit different learning styles. 4. Dont use jargon (be aware that what we think isnt jargon probably is). 5. Ensure you have frequent learning and refreshment breaks and a comfortable learning environment. 6. Use labels so you can address contributors by name. 7. Always have an eye on the clock - stick to the timetable and finish on time. 8. Stick to the course content. Dont get side-tracked by learners with an agenda, but speak with them afterwards. 9. Know your audience. 10. Maintain a sense of humour at all times and expect the unexpected...
Need to know
One of our key principles is only to teach information that learners say they need to know to support children more effectively. Elklan explores what is required to implement speech and language therapy programmes, as well as offering many practical strategies to support childrens speech, language and communication across the curriculum. We strive to enable educational establishments to use their staff resources more effectively. We have found over the years that, to be most effective, training needs to be linked in with service delivery. This enables speech and language therapists to work in collaboration to provide the best possible support for children. Many of us have been involved in training
others at some point and have some tips to pass on, often learned through harsh experience. We asked trainers and learners from around the country to share their top tips to help us all to be more effective in the training we offer (figures 1-3). So, does Elklan work? In November 2007 Herefordshire Education Authority and Speech and Language Therapy Department undertook an independent audit to evaluate the impact of Elklan Speech and Language Support for Under 5s in the county. From 2004-2007, 371 early years practitioners attended courses from 46 early years settings, with a potential impact on over 1000 children. The audit showed that the Elklan Training Programme has had a significant impact on raising the quality of provision not only for young children with speech and language difficulties but for all children attending preschool settings in the county (Jackson, 2007, p.1). The author reports specifically that staff can identify and meet the needs of children with speech
and language difficulties, share information with parents and refer on appropriately. They also support the work of speech and language therapists with individual children. The training has helped to create a shared ethos and collaborative working approach amongst practitioners, agencies and childrens services in Herefordshire (Jackson, 2007, p.1), something which the Bercow and Task Force reports both mention as being crucial to the success of future interventions. A smaller audit has been completed by John Andrea, speech and language therapist in Oldham. His evaluation study measured the effectiveness of the Elklan Primary school course, Speech and Language Support in the Classroom. He measured how participants knowledge, skills and ability to liaise effectively with other professionals had been affected by the training. He carried out the Wilcoxon Matched-Pairs Signed Ranks Test on the data. He found significant improvement in all three areas - knowledge, skills and liaison - at significance level of p =/< 0.05 (Andreae, 2008).
Editors choice
So many Journals, so little time! Editor Avril Nicoll gives a brief flavour of articles that have got her thinking.
In the short but beautiful My journey into relationship-based practice, Kristy Collins describes the familiar anxiety we feel when faced with strong parental emotions, and how our natural desire to solve problems quickly is counterproductive. She demonstrates the value of a dynamic therapy approach, creating a safe environment, holding the strong emotions, and the importance of relationships (parent / therapist, parent / child, therapist / child) to long-term success. Her comment about the mother in the clinical scenario is telling: As her confidence grows, so does mine. (p.168) (ACQ (2009) 11(3), pp.167-168) Advocating consistency of parental language with a child with communication difficulties and English as an additional language doesnt address the fascinating and natural phenomenon of code-switching. In Code switching in bilingual children with specific language impairment, GutierrezClellen, Simon-Cereijido and Leone find no significant differences compared with children with typically developing language. They conclude there is no support for the recommendation to avoid or prevent mixing the language in communication with these children at home, at school, or in a clinical setting (p.106) and that we should value the information code-switching provides about their bilingual development. (International Journal of Bilingualism (2009) 13(1), pp.91-109) In How do individuals cope with voice disorders? Introducing the Voice Disability Coping Questionnaire, Epstein, Hirani, Stygall and Newman emphasise that managing the stress of illness is a process not a goal. Seeking social support and information is more positive for outcomes, while avoidance and passive coping may be useful in the early stages but can have a long-term negative impact on quality of life. This clinical tool is for use before and after intervention as well as to guide it. I would be interested to compare it with a more dynamic, solution focused tool where the questioning aims to prompt and support adaptive coping. (Journal of Voice (2009) 23(2), pp.209-217)
In Great Yarmouth speech and language therapists Susan Lyon and Louise Hess have been responsible for changing their service to their school-aged population. From one which was delivered via the local clinic, it is now based in schools with therapy integral to the childrens school day. This change involved training education colleagues to enable them to work collaboratively and effectively. They trained classroom assistants with the Elklan 10 week course Speech & Language Support in the Classroom and the two day overview of the same information was given to class and advisory teachers, educational psychologists and Special Educational Needs Co-ordinators (SENCOs). As a result they have found that children with speech, language and communication needs do best when staff attend training and use a designated learning support assistant to support them. They also found that when staff are actively involved in target setting in collaboration with the therapist and follow these targets that children make significant progress. They say, As a team we can report feeling more positive about the service we provide to school age children, their families and their schools...We are also excited by the real progress children are making in a language friendly environment (Lyon & Hess, 2007, p.23). Other evaluation reports are available on the Elklan website. We think one of the reasons for Elklans success is our working partnership, as our styles complement each other well: Liz says, I really enjoy the privilege of meeting with and supporting speech and language therapists from across the UK. We have a wide network of therapists and teachers that we have trained to be Elklan tutors and, because we meet with many of them annually, they have become friends as well as colleagues. There really is an Elklan family. I find all the administration really hard work, and am pleased that I have Henrietta to cover up my mistakes and offer support. However, the feedback from Elklan learners is heart warming and allows me to feel I am doing a worthwhile job. Some have honestly said that Elklan has changed their working life and they now feel so much better equipped to work with the children they are responsible for. Henrietta adds, I enjoy the contact, discussions and feedback with tutors and learners but also revel in the constant and diverse challenges that Elklan demands. The challenges range from basic accounts to organising multi-cultural DVD clips; from matching diagrams in Welsh to Welsh text without understanding a word of it; from simple emails to one requesting information about weaver fish (used in a vocabulary map in our book Language Builders). I am less fond of the fear of not meeting other peoples expectations and e-mails from the printers announcing a delay in producing
the books because the machines have broken down - a factor which is definitely beyond our control! Whatever training you do we hope that you continue to find it worthwhile and enjoyable and that, above all, it helps those children who need our help the most. SLTP Liz Elks (e-mail lizelks@elklan.co.uk, tel. 0289 042 2069) and Henrietta McLachlan (e-mail henrietta@elklan.co.uk, tel. 01208 841450) are speech and language therapists. Together they are Elklan, Sunnyside, Wadebridge Road, St Mabyn, Cornwall PL30 3BQ, www.elklan.co.uk. References Andreae, J. (2008) Elklan course Primary Lyndhurst / South Failsworth Schools Feb-May 2008. Pre and Post Course Rating of Students Knowledge and Skills. Speech and Language Therapy Service, Oldham Primary Care Trust. Bercow, J. (2008) Bercow Review of Services for Children and Young People with Speech Language and Communication Needs. Available at: http:// www.dcsf.gov.uk/slcnaction/ (Accessed 14 October 2009). DHSSPS (2008) Report on Speech and Language Therapy Services for Children and Young People Improving outcomes for children and young people with speech language and communication needs Northern Ireland. Belfast: Speech and Language Therapy Taskforce Northern Ireland Executive. Available at: http://www.dhsspsni. gov.uk/regional_speech_and_language_ therapy_task_force_report.pdf (Accessed 14 October 2009). Jackson, L. (2007) Speech and Language Support for the Under 5s. Herefordshire Evaluation Report. Speech and Language Therapy Service, Herefordshire County Council. Available at: http://www.elklan.co.uk (Accessed 14 October 2009). Lyon, S. & Hess, L. (2007) All Change, Bulletin of the Royal College of Speech & Language Therapists 665 (September), pp.22-23.
REFLECTIONS DO I SUPPORT AND LEARN FROM COLLEAGUES WHO USE SIMILAR APPROACHES, EITHER VIRTUALLY OR IN PERSON? DO I FOCUS ON WHAT PEOPLE REALLY NEED TO KNOW WHEN I OFFER TRAINING? DO I UNDERSTAND THE RELEVANCE TO MY PRACTICE OF INFLUENCING AND TAKING ADVANTAGE OF POLICY DEVELOPMENTS? Do you wish to comment on the difference this article has made to you? Please see the information about Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends
Heres one I made earlier
Heres one I made earlier...

Alison Roberts with two more low cost, flexible and fun therapy suggestions for groups.
The name game

This is a help for clients who find it hard to remember peoples names, or lack confidence in using them. For fuller therapeutic value, it is important to introduce this game and draw it to a close carefully. I always point out to the clients at the start that most people have some degree of difficulty in remembering names. This game can be done as a group or individual exercise. MATERIALS Blank cards index cards or postcards are good as they are big enough to hold a decent-sized picture, or you can cut your own from any card Cutout magazine or newspaper pictures, of people of varying ages and types. Outlandish characters are memorable, and so are those performing an activity. Have about thirty pictures available, for the clients to choose from, although you will probably use only five at a time. Glue Pen Lined paper BRAWN Stick the pictures on the cards. This can be done within the group session as a cooperative exercise, taking turns with the scissors and glue, and using the opportunity for a social chat as you work. Write a number in a corner of each picture card and a corresponding number down the side of the paper. The numbered paper will be your name record. You will need a new one of these each time you play the game with a new set of clients. Alternatively you can decide on a set of names, which you will keep permanently. IN PRACTICE - PREPARATION With your clients, choose names that you feel suit the people in the photos; for example, for a man photographed with a prize fish you might like the name Mr Pike, a pretty young girl might be Jenny Sweet, an elderly lady seen at a craft market might be Mrs Woolly, a boy photographed in the rain might be Ron Mac. Make a note on your numbered paper of the corresponding names. Go over the names and photos several times with the clients. Dont try to tackle more than a few names at a time overloading may end in too much of a struggle. The idea is that they will learn the skill of selecting a detail from a persons appearance or lifestyle, which reminds them of the persons name. IN PRACTICE SLTP After a few minutes present the cards, one at a time, and the clients - either all together as a group, or individually - attempt to recall the names. To make the task harder, the recall attempt can take place after another activity, and again at the following session, and again several weeks later. As time goes on and the clients learn the names, you can introduce more and more photos with their names. We found that the clients were pleasantly surprised at how easy it became to remember names when they were associated with the characters idiosyncrasies or occupations. The next step is to think of actual people who the clients are in some way connected with, such as members of staff. Ideally you will have photos of these people, and can then discuss which aspects of their appearance, job, hobbies and so on you can use as memory stimuli. You can also remind the clients that saying the name several times silently to themselves, and using it a lot in conversation when they have just been introduced, will help it stick. Writing down the name and the memorable feature of a person after meeting them is great for name recall ready for the next time they meet that person.
Sound effects
An excellent and funny listening game for a group of older children or young teenagers. MATERIALS A few pre-written stories that would be enhanced by sound effects. IN PRACTICE Read the story aloud to the group. Now go back over it and discuss potential sound effects that could be added. Retell the story, leaving small gaps to be filled by the clients making the appropriate noises. EXAMPLE One windy day [wind howls] we went for a walk on a farm, squelching through deep mud [squelch]. We were laughing [laugh] and enjoying the sounds of the farm animals [various] when all of a sudden we heard the most tremendous crash [crash]. Across the field we saw that a barn had begun to collapse, and beams were still thudding down [thuds]. We ran across as quickly as we could in the squelching mud [fast squelches] to see if anyone needed help. Under the collapsed roof we could hear someone calling [help help] and we wondered what to do [What shall we do? What shall we do?] We rang the fire brigade from my mobile [ring] [help request] and in the meanwhile tried reassuring the trapped person that help was on its way. It seemed to soothe the person who turned out to be a boy called Tom to whistle pop songs to him [whistle pop song]. Soon the fire engine and an ambulance arrived, sirens blaring [siren] and the firemen moved the heavy beams with a great effort [effortful straining]. Tom was not badly hurt, mostly just frightened, but as he was lifted out he remembered his dog Buster who was lost, and who might also be under the collapsed roof. We told him that the firemen would look for the dog and that we would help. Off Tom went in the ambulance [siren]. We called and called for Buster [Buster! Buster!], who eventually came bounding up to us from another field, barking loudly [woof woof]. We looked after Buster for a few days, until Tom was out of hospital, and then the two were reunited, very pleased to see each other, with Tom laughing and the dog barking [laugh / woof].
student education
A primary provision under occupation

Role-emerging placements which occur at a site where the profession has no established presence - are not new in occupational therapy, but it was a novel experience for supervising speech and languageGwen therapist Leona Cook and staff at a primary speech and language provision. Looking back on the placement with occupational therapy tutor Jeannette Head and final year students Harriet Easter and Stefanie Roberts, Leona asks if it is an option for speech and language therapy too. A. LONG-ARM SUPERVISION JEANNETTE HEAD
the on-site supervisor and the off-site supervisor both during the placement and when the assessment reports are being finalised. However, the challenges of being an offsite supervisor are balanced by the countless rewards. Enabling students to realise their potential, developing their professional identity, clinical reasoning, and resourcefulness has been satisfying and I have enjoyed the opportunity to be part of promoting the value of occupation in health and wellbeing. My professional practice has developed as a result and I would definitely encourage others to embrace the challenge. READ THIS IF YOU ARE INTERESTED IN BROADENING STUDENT PLACEMENTS MODELS OF SUPERVISION INTERPROFESSIONAL LEARNING students.) After three heady days of digesting facts about learning styles, models of supervision, course structure and paperwork, the full extent of the preparation became apparent. I was initially doubtful that I would be able to support the students successfully or understand their competency frameworks! Meeting with Jeannette, their long-arm occupational therapy supervisor, was a reassuring experience, helping to hone ideas and smooth out anxieties. The placement was a 12 week full-time final block placement with built-in study and supervision. I was initially concerned that the role-emerging placement was the two students first experience of paediatrics. However, the professions focus on occupation means that skills and approaches learnt in their adult work is directly transferable to working with children. Only students who are already coping well are sent on role-emerging placements, and they have weekly visiting clinical occupational therapy supervision and can contact the long-arm supervisor between visits if they need more support. When the students arrived we asked them to observe all the children and make up their own minds about who to work with. They took account of teachers concerns by giving them questionnaires to complete. The students did really well, and the benefits of supporting them have been enormous for me personally, for the provision and for the children. I now have a greater understanding of the occupational therapists role, particularly the overlap between the speech and language and occupational therapy professions. Both therapies put children at the centre of interventions, developing their functional skills for everyday life. These commonalities can include social skills, developing self-esteem, developing sensory integration, listening, attention, engagement, participation, music groups and use of games as a therapeutic tool. As a provision we have a deeper understanding of the childrens strengths and weaknesses in ad-
As with all health and social care professional courses, placements play a vital role in preregistration occupational therapy education. With the increasingly diverse needs of practice, Canterbury Christ Church University aims to provide occupational therapy students with a broad range of placement experiences. A role-emerging placement is a practice placement which occurs at a site where there is not an established occupational therapy role (COT, 2006). Informal supervision is provided by a member of the staff (from a non-occupational therapy background) in the setting. Formal professional supervision is provided by an off-site occupational therapist (longarm supervisor) either from the students university or a locally based clinician. Evidence supporting the value of roleemerging placements is well documented in occupational therapy literature (Fleming et al., 1996, Alsop & Donald, 1996, Bossers et al., 1997, Huddleston, 1999, Friedland et al., 2001, Totten & Pratt, 2001, Baum, 2002, Fisher & Savin-Baden, 2002, Thomas et al., 2005, Wood, 2005, Thew et al., 2008). These placements offer many benefits for the setting, for the profession and for the student. They enable the development of professional roles into new areas of practice, thus potentially creating future job opportunities. They offer the chance for service enhancement, providing service users with access to a service they would not otherwise receive. They also promote the profession, further developing opportunities for inter-professional and interagency collaboration. As a long-arm supervisor, I know that planning role-emerging placements is not without challenges and requires careful consideration. There needs to be a clear agreement of the roles and responsibilities of the on-site and off-site supervisors. It is especially important that there is regular communication between
As a speech and language therapist based in a primary speech and language provision, I had for some time been acutely aware of the childrens occupational therapy needs. The teachers and I observed issues around dressing, balance, coordination, body awareness, strength of movement, fine motor skills, sequencing, problem-solving, socialisation, spatial awareness and concentration / focus. A couple of the children had managed to access group occupational therapy sessions at the local Child Development Centre before entering our provision but, in Medway, there is currently no occupational therapy in community clinics and only a limited advisory service to schools. I was therefore very interested to hear about a speech and language therapy colleagues experiences of supporting occupational therapy students within an education setting. Role-emerging placements offered a solution enabling us to access and learn about this important service. I enrolled on the three-day Practice Educators Course provided by Canterbury Christ Church University for people supervising occupational therapy students. (They also run a course for speech and language therapists supervising speech and language therapy
B. GREATER UNDERSTANDING LEONA COOK
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dition to improved knowledge about aspects of development such as fine and gross motor skills. We have also noticed that, as our understanding of what occupational therapists do has improved, we are better at identifying children who may require their services. The children have had access to fun therapy that has aimed to develop functional abilities like writing, concentration, visual perception and social interaction. There have been challenges during the placement although these have all been overcome. Supporting students always takes time away from face-to-face contact with clients and having more personnel meant the need for flexibility in terms of room space. My greatest challenge as a speech and language therapist was stepping back without feeling guilty that I should be more hands-on in my supervision. The students were the experts, not me! Some practical tips based on my experience are in figure 1. cupational therapy, for example creating our own pictorial timetable for our sessions. Working in a non-traditional setting helped us to consolidate our understanding of our professional role. We recognised from the start Occupational therapy promotes the importance of remaining occupational independence and participation in all based in our approach and we found that this aspects of life. It aims to help children came naturally to us due to our training and do as much as they can for themselves experience. This enabled us to set up our own in spite of any physical, cognitive, service and focus on the areas we felt the chilsensory, psychological, behavioural dren would benefit from the most. We carried or social barriers. Information about out assessments and facilitated four groups: how occupational therapists work with fine motor, gross motor, visual perception and children is in the leaflets Helping Children social interaction. Although we had a strong to Develop and Thrive at http://www. occupational therapy perspective, it was imcot.co.uk/MainWebSite/Resources/ portant that we organised time outside of the Document/OT-Children.pdf and What are school to discuss our intervention with occuOccupational Therapists?: Child Health pational therapists working in paediatrics and Services at http://www.scotland.gov.uk/ access their assessment tools. The support we Publications/2005/09/06111938/19399. received from our university supervisors was also essential to gain reassurance that we were following correct procedures with this client group. We felt a weakness of the role-emerging placement was not being able to reflect with an occupational therapist l-r Leona, Stephanie and Harriet directly after intervention or learn from their practice. However, not having an occupaFigure 1 Tips for non-occupational tional therapist on-site allowed us to be creatherapy practice educators tive in our approach and gave us the freedom to learn by trial and error. As a result we feel 1. Be prepared! Draw up your induction pack and student resource file. more confident in our own skills and idenOccupational therapy students are tity. This is supported by Thew et al. (2008) proactive and ask for this information in their research of students experiences of prior to placements. role-emerging placements. An additional 2. Organise time during the placement for the students to meet and liaise constraint working within the school setting with occupational therapists in your was the amount of time we had to work with local area. the children. It was obviously limited due to 3. Discuss the needs of occupational the demands and timings of the school day. therapy students with colleagues in
Occupational therapy with children
During our third year at Canterbury Christ Church University, we were given the opportunity to work in this non-traditional setting. On site we were supported by the speech and language therapist in addition to guidance from two occupational therapy university lecturers. Although this placement presented us with unique challenges in terms of our role and responsibilities, we used the situation to promote our profession. This was our first experience of working in paediatrics and alongside a speech and language therapist. This, coupled with the challenge of there not being an established occupational therapy role in the school, led to our initial apprehension about this placement. However, the absence of an occupational therapist enabled us to be autonomous from the start and utilise our core occupational therapy skills in designing our service and managing our own caseload. We gained a positive experience from working with Leona, who provided us with continuous supervision and the opportunity to learn and observe her practice. Although she did not have the expertise in guiding our occupational therapy intervention, she supported our integration into an educational setting. As we had limited knowledge regarding speech, language and communication disorders, she provided us with invaluable information about the childrens development. For example, we were unfamiliar with augmentative and alternative communication (AAC), but were given guidance on how to implement these tools in our intervention sessions. This proved to be a successful and valuable learning experience which will enhance our future practice. Most of the materials available to us were geared towards speech and language. We needed to adapt the tools to make them specific to oc-
C. FROM APPREHENSION TO AUTONOMY HARRIET EASTER & STEFANIE ROBERTS
Workshop for parents
As part of this placement, we conducted a joint workshop for parents. Our aim was to provide parents with guidance on supporting their child at home. We focused on activities to develop gross motor, fine motor and visual perception skills. This was delivered by a presentation and demonstration of activities and provided the opportunity to inform parents of occupational therapy. It was complemented by the speech and language therapists advice on reading at home to develop language and reading skills. We compiled an activity pack, which provided information on fun games and activities parents could try with their child. We felt this was a valuable approach to working inter-professionally to support parents in
4. 5. 6. 7. 8.
your setting, including reflection and planning time. This is particularly important within an educational setting where a teachers approach to training may be different. Send the students a timetable for the first week, building in settling-in time. Make contact with other Practice Educators working in non-traditional settings. Brainstorm with colleagues ideas for the placement, such as suitable clients, specific tasks. Orientate yourself through the paperwork. Ask for two students this can be particularly successful as they are able to support one another.
student education
developing their childrens important skills. We gave a feedback form to the four parents who attended and their answers are in figure 2. This was our first experience of being on placement with another occupational therapy student. This placement would not have been as successful if we had not developed such good team-working and peer support. Our individual experiences and strengths complemented each others practice as we learnt how to use this effectively to develop our skills. For this placement, we created a peer-evaluation form as a tool for reflecting on each others practice (figure 3). This helped to consolidate what we had learnt from the experience and focus on how we could enhance our intervention further. As we co-facilitated the sessions, this was also important for ensuring we shared the same insights and common goals.
Acknowledgements
Figure 2 Feedback from parent workshop
The students would like to thank their supervisors Jeannette Head and Rupert Kerrell, Canterbury Christ Church University, for their ongoing support and encouragement throughout the placement. Thank you also to Andrea Holloway, Fiona Beck and Cathy Roberts for volunteering their time and guidance. They would also like to thank Warren Wood Primary School, Rochester for the opportunity to work in their school, with special thanks to Leona Cook and all of the children.
Number of parents (out of 4) who answered yes

Do you think your child would benefit from having access to OT at school? Before the workshop had you heard of OT? Did you find the activity ideas useful? Would you try any of these activities at home? 0 1 2 3 4 5
References
D. POSITIVE EXPERIENCES THE COLLECTIVE VIEW
Our experiences of this role-emerging placement have been positive, and Leona is continuing to supervise other occupational therapy students in the provision. The placement enabled us all to exchange ideas and develop a greater understanding of each others roles. We feel the children have benefited from an additional perspective that has ultimately allowed them to develop a wider range of skills. Role-emerging placements require a preparatory time commitment from the on-site practice educator alongside an understanding that students need non-contact time away from the placement site. It is imperative that students incorporate reflective time including access to the universitys resources, and this needs to be planned into their timetable. The students would recommend a third year role-emerging placement in a non-traditional setting as this has provided them with a valuable experience that they will take into their future practice. Could role-emerging placements in pairs be part of the future for speech and language therapy students? Prisons, care homes and childrens centres all offer possibilities, as do opportunities to access hard-to-reach groups through projects run in the statutory or voluntary sector for people who are homeless or have suffered domestic abuse. Leona is not sure if this model is appropriate for speech and language therapy students, so would be very interested to hear from anyone who has already tried it out. SLTP Jeannette Head is a Practice Placement Tutor, Occupational Therapy, Canterbury Christ Church University, e-mail jeannette.head@canterbury. ac.uk. Leona Cook is a Highly Specialist Speech and Language Therapist / Dyslexia Teacher with NHS Medway, and a part-time lecturer on the postgraduate speech and language therapy course at Canterbury Christ Church University, e-mail cookl023@medway.org.uk. At the time of writing Harriet Easter and Stefanie Roberts were final year Occupational Therapy Students at Canterbury Christ Church University.
Alsop, A. & Donald, M. (1996) Taking stock and taking changes: creating new opportunities for fieldwork education, British Journal of Occupational Therapy 59(11), pp.498-502. Baum, C. (2002) Creating partnerships: constructing our futures, Australian Occupational Therapy Journal 49, pp.58-62. Bossers, A., Cook, J., Polatajko, H. & Laine, C. (1997) Understanding the role emerging fieldwork placement: a qualitative inquiry, Canadian Journal of Occupational Therapy 64, pp.70-81. College of Occupational Therapists (2006) Developing the occupational therapy profession: providing new work-based learning opportunities for students. College of Occupational Therapists. Guidance 4. London: COT. Fisher, A. & Savin-Baden, M. (2002) Modernising fieldwork, part 2: realising the new agenda, British Journal of Occupational Therapy 65(6), pp.275-82. Fleming, J.D., Christensen, J., Franz, D. & Letourneau, L. (1996) Fieldwork model for nontraditional community practice, Occupational Therapy in Health Care 10, pp.15-35. Friedland, J., Polatajko, H. & Gage, M. (2001) Expanding the boundaries of occupational therapy practice through student field-work experiences: description of a provinciallyfunded community development project, Canadian Journal of Occupational Therapy 68(5), pp.301-309. Huddleston, R. (1999) Clinical placements for the professions allied to medicine, part 2: placement shortages? Two models that can solve the problem, British Journal of Occupational Therapy 62(7), pp.295-98. Thew, M., Hargreaves, A. & Cronin-Davis, J. (2008) An evaluation of a role emerging placement model for a full cohort of occupational therapy students, British Journal of Occupational Therapy 71(8), pp.348-353. Thomas, Y., Penman, M. & Williamson, P. (2005) Australian and New Zealand fieldwork: charting territory for future practice, Australian Occupational Therapy Journal 52, pp.78-81. Totten, C. & Pratt, J. (2001) Innovation in fieldwork education: working with members of the homeless population in Glasgow, British Journal of Occupational Therapy 64(11), pp.55963. Wood, A. (2005) Student practice contexts: changing face, changing place, British Journal of Occupational Therapy 68(8), pp.375-78.
Figure 3 Peer Feedback Form (Stefanie Roberts & Harriet Easter, 2008) 1. Preparation: Did the student adequately prepare for the intervention/session? Was the equipment and environment appropriate? 2. Content: Was the activity appropriate to the intervention aim? Was the session / each activity an appropriate length of time? Was the activity appropriate to the age of the child/ren? 3. Delivery: Was the session clearly explained to the child/ren and brought to an appropriate close? Did the student recognise the need for adapting the activity and respond appropriately (i.e. grading)? Non-verbal 4. Positive feedback / further development (Plus childrens response and interaction):
REFLECTIONS DO I LOOK FOR INNOVATIVE WAYS TO BRING A MUCH-NEEDED SERVICE INTO MY WORKPLACE? DO I PREPARE ADEQUATELY FOR A NEW ROLE THROUGH A MIX OF FORMAL TEACHING, SELF-DIRECTED LEARNING AND NETWORKING? DO I PROMOTE UNDERSTANDING OF SPEECH, LANGUAGE AND COMMUNICATION SUPPORT NEEDS TO STUDENTS FROM OTHER PROFESSIONS?
Do you wish to comment on the impact this article has had on you? Please see the information about Speech & Language Therapy in Practices Critical Friends at www.speechmag.com/About/Friends.
10
Winning ways
A drop of golden sun

A survey sent out to a sample of readers included an open question about which concerns they would most like life coach Jo Middlemiss to address in 2009. In this fourth article she suggests that, to help us cope with pressure, we could all do with a little head-fake and kindness.
ome you may know that a few years ago I compiled a book (Middlemiss, 2008) about my sister Maggie, who died in 1982. During the last few weeks of her life she made a tape for her baby son to listen to when he was 21. What happened after that is another story but suffice to say the whole process, from hearing the tape to this present moment, has been a journey of immense significance for a multitude of reasons. Although I almost know the tape off by heart, I sometimes listen again when I receive a comment from someone new to it. I like to imagine what it must be like to listen to it for the first time. Most recently I realised that the last words I hear from Maggie as she tries to teach her son to sing Doh a deer are ...a drop of golden sun. Why do I want to tell you this? I think its because I have realised we can hear a thing over and over again and not be aware of what it is actually saying to us. On one level its just a song but, in this context and in the world of metaphors, this tape has proved truly to be a drop of golden sun. My son has asked me repeatedly if I have watched a You Tube video called The Last Lecture. It is presented by a very youthful looking professor called Randy Pausch who is diagnosed with terminal liver cancer. It presents as a lecture about an innovative way to educate but is in fact about living life to the full. He introduces an idea called head-fake. As I understand it, this is about learning the real lesson while you think you are doing or learning something else. Its pretty hard to recognise this at the time; usually it is only on reflection that we realise there was even a life lesson going on. My 94 year old mother needs looking after. She isnt aware that she needs looking after, and just thinks we are visiting a lot. Fortunately for her she had lots of children and we can spread the care. I spend about two and a half days a week with her and basically I live her day. I see some pretty awful television, and quite a lot of the time we live in a loop of repetitive questions and answers. The head-fake is that I am learning patience: how to keep even a hint of exasperation out of my voice as I answer the same question for the 12th time. I have also learned that my mother and I sing well together and that she knows the harmony to hymns and songs that I know too. We are spending hours practising our turn for
READ THIS IF YOU WANT TO APPRECIATE LIFES LESSONS HARNESS A NATURAL HIGH HAVE MORE GOOD DAYS
the Christmas Party and getting excited about showing off to the family. My head-fake here is that I thought I knew everything about my mother but I didnt even know that we could sing harmonies together. It has been like a gift - another drop of golden sun. I recently attended a workshop given by Dr David Hamilton on The Science of Kindness. David is a research chemist to trade and has written several books on the connection between thoughts and health. This time he introduced us to the hormone oxytocin. Oxytocin has many uses and many names and I can hardly believe that I had never heard of it. It is known as the love hormone, and sometimes called Helpers High. It surges at the time of great loving - childbirth, breastfeeding - and kindness. It is a wondrous thing when science and goodness meet and agree. Oxytocin also surges when we even think of a loved one, when we do something kind or generous, when we dance or sing, or have a good cry. Spelling is not my greatest skill and I was having problems with this word. On my notes I had written oxy-toes-in. It wasnt till I had seen the correct spelling that I realised I was wrong. However I have this mistake as another head-fake because, if we dip our toes in the water of gratitude, kindness and appreciation, we suddenly realise that it is easy to get the little surges of oxytocin that can make all the difference between a good and a bad day. It brings you back to the fact that you may not be in control of what happens in your day, but you can always control your reaction to it. You can be in charge of your daily dose of oxytocin - a natural little drug that it is impossible to overdose on. Someone asked Dr Hamilton at the workshop if there was a pill that could be bought. Indeed there is a pill - apparently it is pre-
scribed when induction of labour is recommended. However Mother Nature gives it out freely and safely; all we have to do is be kind, loving, generous and appreciative. All of these little gestures or drops of golden sun can accumulate and contribute to life lived on the sunny side of the street, no matter what the SLTP weather.
Reference Middlemiss, J. (2008) What Should I Tell You?: A Mothers Final Words to Her Infant Son. Brechin: Printmatters. Jo recommends Wallace, D. (2004) Random Acts of Kindness: 365 Ways to Make the World a Better Place. London: Ebury Press. Hamilton, D. (2008) Its the Thought that Counts: Why Mind Over Matter Really Works. London: Hay House UK Ltd. Pausch, R. (2008) A Final Farewell. The Wall Street Journal Online. Available at: http://www.youtube. com/watch?v=mIysXLiA5s0&NR=1 (Accessed 3 November 2009). Pausch, R. & Zaslow, J. (2008) The Last Lecture. London: Hodder & Stoughton General. Jo is looking forward to Hamilton, D. (2010) Why Kindness is Good for You. London: Hay House UK Ltd.
Jo Middlemiss is a qualified Life Coach, who offers readers a complimentary half hour coaching session (for the cost only of your call). Please note that Jo moved in May 2009 and her new telephone number is 07803589959.
11
participation
Walking with Dobermanns (part 2)

In the second of two articles inspired by the late Dr Mark Ylvisaker, Sam Simpson, Emma Gale and Ashleigh Denman continue to reflect on the impact his ideas have had on their practice with people with brain injury, and the relevance for other difficult-to-serve client groups. In part 1, Sam discussed identity reconstruction. Here, Emma and Ashleigh focus on group and individual project work in rehabilitation and community settings.
READ THIS IF YOU HAVE CLIENTS IN NEED OF A RELEVANT AND ENGAGING PROJECT PURPOSE AND MEANING IN THEIR LIVES OPPORTUNITIES TO DISCOVER THEIR STRENGTHS
r Mark Ylvisaker was Professor of Communication Sciences and Disorders at the College of Saint Rose in New York from 1990 until his death in May 2009. He worked with children and adults with cognitive, communication and behavioural disability for over 30 years in rehabilitation, special education and community settings. In keeping with his philosophy and primary focus within therapy on identity reconstruction and re-engagement with life, Ylvisaker proposed the use of projects. These projects facilitate a positive sense of self and overcome motivational barriers for clients who present as dobermanns rather than poodles (see part 1). This includes: adults who - temporarily or permanently - are unable to work, manage a family / household, or achieve a sense of productivity and meaningful contribution in other culturally valued ways children who have difficulty succeeding in traditionally valued school, sports and recreational activities. Ylvisaker defined a project as a structured activity that: 1. Focuses on a personally meaningful goal ideally one that includes a concrete product linked to the clients interests and abilities 2. Requires deep processing and thorough analysis / investigation of many dimensions of a problem or activity 3. Requires considerable planning and organising, thereby creating a meaningful context for practising the use of organisational and memory strategies / aids 4. Creates a meaningful work context for practising all aspects of executive functioning (including reflection on
l-r, Ashleigh, Sam and Emma personal strengths and needs, goal setting, planning, initiating, inhibiting, monitoring and evaluating, strategic thinking and behaviour, flexibility) Creates a meaningful context for practising language and communication skills, including peer-related communication Creates a meaningful context for practising co-operative effort, positive social interaction and behavioural regulation Ideally creates an expert role for the client, thereby helping the person develop a self concept that embraces a sense of competence Ideally includes a focus on helping others, with the goal of facilitating a nonegocentric perspective, thereby enabling the person to develop a self-concept that embraces a sense of contribution and productivity 9. Requires several days to months to complete, thereby integrating the individuals activity from day to day and week to week 10. Ideally integrates meaningful activities in more than one context of the persons life. For example, the project may be worked on in more than one therapy, such as occupational therapy and speech and language therapy, and may require some self-directed work in the clients own time, such as in the evening, at home.
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GROUP-BASED PROJECT WORK WITH EMMA GALE

I work intensively with a small but diverse client group of adults with brain injury, and it is not easy to find common themes for groups. A project-oriented approach allows me to work on different individual goals with people with a wide range of abilities and needs. In a recent group a man who was practising the skills he needed to go back to work at his investment bank worked very productively with a carpenter with severe aphasia. Last summer, a group of clients were struggling to find a purpose and meaning within their rehabilitation: Omar: eighteen, lacking insight into his cognitive disabilities and feeling left behind at an age when his peers were moving on to college and work Wayne: wrestling with memory impairments but determined to persevere to get back to work as a project manager Jim: stuck in a wheelchair and feeling useless, and battling with anxiety and memory problems Sasha: grappling with dysarthria and a lack of drive which was so different from her pre-injury, workaholic style. All had expressed frustration at being in hospital and were struggling to feel connected with their family, friends and previous life roles. I offered them the opportunity to work on a project together, to plan and organise a fundraising activity to raise money for charity. We spent a session discussing possible charities. This was at a time when the news was filled every day with stories of teenagers being killed in senseless knife attacks. Omar was passionate and persuasive about the need to support kids to lead positive lives, having come from a tough neighbourhood where his peers had lost their lives this way. Having found a charity which gave financial support to disabled kids, at the end of a very lively discussion they agreed to do a sponsored event. This would be a stationary exercise bike relay race lasting 12 straight hours - the Tour de Putney! My role as project facilitator involved maintaining the fine balance between the autonomy of the group and ensuring that the group maintained direction. In line with Ylvisakers apprenticeship model, my job was to scaffold tasks to ensure that they were achievable for each participant. With twice weekly meetings to feed back on progress over an eight week period, I needed to juggle deadlines for myself and also for the other participants this was a huge frontal lobe challenge for me, and I could not have managed without the support of a colleague who acted as co-facilitator. I was also lucky to have access to rehabilitation assistants, who were scheduled to work alongside participants who needed support to complete tasks outside of our regular meetings.
Identify strengths
The project also allowed each participant to identify their strengths for Omar it was persuading people to part with their cash, in line with his ambition to be Sir Alan Sugars next Apprentice! Sasha discovered that strangers understood her speech well when she used the chunking and over-articulation that she had practised in therapy sessions. Wayne had worked on a number of memory strategies such as using his mobile phone to programme reminders. Through this project he was at last able to put them into practice to meet deadlines independently. Finally, the identified strengths for Jim were his teamworking skills and empathy with others. The morning of the Tour de Putney came round fast. The first person needed to be on the bike at 7am, with the last person crossing the finish line at 7pm. Omar campaigned to be the last person on the bike, seeing it as the most prestigious slot. When the others pointed out that he should also take the first slot if he wanted the last one, astonishingly he agreed, despite his apparent inability to get up before 10am. I have to admit to being nervous as I drove into work: would he have got out of bed in time? I neednt have worried. There he was, still in his pyjamas and half asleep, cycling away. The whole unit had thrown themselves into the spirit of the occasion, with a French theme to the day French music, French food, even strings of onions and garlic tied to the bike. Jim, who couldnt take a turn on the bike itself, was team coach, ensuring that people were on the bike in time, well hydrated, with their choice of music, and pep talks as necessary.
INDIVIDUALLY-BASED PROJECT WORK WITH ASHLEIGH DENMAN

In addition to the powerful impact of group work in rehabilitation illustrated by Emma, Ylvisaker (1998) highlights the value of individual project work. Since first hearing Mark Ylvisaker speak in 2003, I have used individual projects based on his principles regularly in my work in both rehabilitation and community settings. It has proved to be a useful tool in several ways as it: engages the client in goal planning helps with structuring and timing of input offers a clear outcome measure leads to both implicit and explicit learning. Ylvisakers executive function routine Goal-Obstacles-Plan-Do-Review (GOPDR) is a particularly useful structure when planning projects. At the beginning of the first session the initials GOPDR are written down the side of a large piece of paper. As the project progresses information is added to the sections. At the beginning of each session the overarching goal is revisited and reflection on how well the plan is progressing is carried out. Making the process explicit enables clients to keep focused on the task in hand, and understanding the structure enables them to apply this to future tasks or projects. One of my clients recently worked on a project to plan and deliver a presentation at a speech and language therapy Specific Interest Group (SIG). Since her brain injury at the age of 18, Lara had made good progress in a variety of rehabilitation units. Initially speech and language therapy input was impairment based, working on prosodic variation in her speech and accurate articulatory placement, as well as developing clearer oral and nasal airflow distinctions as she has a slight velopharyngeal insufficiency. Over time the focus of the input had shifted to improving her self-monitoring skills and the identification of compensatory strategies. Lara had become very proficient at knowing when communication breakdown was likely to occur and using her well-known and regularly rehearsed compensatory strategies. This involved immediately repeating, rephrasing and slowing down, whilst trying to make her speech as crisp and clear as possible. At the age of 22, when I met her, Lara was hoping to return to work but was concerned about how her dysarthria would impact on how she was perceived by unfamiliar people. She was aware that, although her one-to-one communication was very effective, she struggled with more complex communicative situations. The most challenging situation she could envisage was standing up and talking to a group of unfamiliar people. Despite this, when discussing how an individual project might help her both with her communication skills and her ability to plan and organise, Lara came up with the idea of planning and delivering a presentation about her speech and language therapy input to date.
the participants all reported a real feeling of achievement, of having made a difference
As for the outcome, apart from raising several hundred pounds for a delighted and slightly bemused charity, the participants all reported a real feeling of achievement, of having made a difference. They also took away a sense of their own strengths and greater awareness of the support systems they needed and when to use them. This is one of several projects I have facilitated. Others include the creation of a unit newsletter, planning and shooting a training video for new staff, and planning unit social events, including Christmas parties and summer barbecues.
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participation
A whole new phase
As luck would have it, I had just volunteered to host a SIG a few months later and Lara agreed to deliver her presentation at the meeting as the keynote speaker. Over the next few months, Lara using the GOPDR structure planned her presentation, familiarised herself with PowerPoint, collected together props to liven up the talk, practised in front of some familiar team members, assisted in the organisation of the day and finally delivered her presentation. The audience were genuinely impressed and the positive feedback she received was both validating and confidence building. This kickstarted a whole new phase in her life where, suddenly, getting a job became a realistic goal. Following the presentation Lara reviewed the process and was able to identify obstacles that she had successfully overcome. She was also able to describe how she would use the GOPDR structure for future projects in other real-life contexts on discharge. Other projects I have facilitated include: 1. Self-advocacy DVDs This involves the production of a DVD with the primary purpose to orientate and train future or current staff in how best to interact or communicate with the client. These have been particularly useful when clients are transitioning to another unit, another area or when significant changes in staff support teams are happening. 2. The expert client This involves the client becoming an expert in a relevant area. One client was struggling to demonstrate safe driving skills in his electric wheelchair. A project involved him in research and educating other clients in the unit, which promoted insight and behaviour change. Individual projects can take many forms. They provide an opportunity to be creative, innovative and responsive to a clients
interests and abilities. Whilst they may be challenging at times, and require changing, redefining or downsizing, they are always absorbing, motivating and memorable for both client and therapist.
Acknowledgement Our thanks to Omar, Wayne, Jim, Sasha and Lara for allowing us to share their stories. Reference Ylvisaker, M. & Feeney, T. (1998) Collaborative Brain Injury Intervention: Positive Everyday Routines. San Diego: Singular Publishing. Recommended reading Ylvisaker, M. (2005) Ongoing Project-Oriented Intervention for Children and Adults with Disability: Collaboration and Apprenticeship. Handout provided by Mark Ylvisaker for this series of articles. Available at www.speechmag.com/Members/Extras. Ylvisaker, M., Feeney, T. & Capo, M. (2007) LongTerm Community Supports for Individuals with Co-Occurring Disabilities After Traumatic Brain Injury: Cost Effectiveness and Project-Based Intervention, Brain Impairment 8(3), December, pp. 276292.
Inform and inspire
Our intention in writing these two articles was two-fold. Firstly, we wanted to acknowledge the impact Mark Ylvisaker has had on our clinical work and to demonstrate how his ideas have influenced speech and language therapy practice in brain injury in the UK. Secondly, we hoped to inform and inspire therapists working in other clinical areas to find out more about his work and consider its relevance to their clients. Mark Ylvisaker has described rehabilitation as a commitment to enter the lives of people with disability, to create collaborative relationships with them and the everyday people in their lives, and to support them in part by serving as an ongoing source of optimism, creativity, flexibility, and enthusiasm in the face of obstacles that often seem overwhelming (1998). All three of us are eternally grateful to him for sharing his inspirational vision with us. Since we set out to write these two articles, tragically Mark Ylvisaker has died, and they have become our personal tribute to him. SLTP Sam Simpson is a specialist speech and language therapist and trainee counsellor at intandem (www.intandem.co.uk), e-mail sam@intandem. co.uk. Ashleigh Denman is principal lead speech and language therapist with the Gloucestershire Brain Injury Team, e-mail ashleigh.denman@ glos.nhs.uk. Emma Gale is clinical lead speech and language therapist at the Royal Hospital for Neuro-disability in London, e-mail egale@rhn. org.uk. Part 1 of this article was in the Autumn 09 issue, pp.12-15.
REFLECTIONS DO I RECOGNISE THE IMPORTANCE OF MY OWN ORGANISATIONAL SKILLS TO MY PROFESSIONAL DEVELOPMENT? DO I SEEK OUT APPROACHES WHICH ARE ABSORBING, MOTIVATING AND MEMORABLE FOR CLIENTS AND FOR ME? DO I SERVE AS A SOURCE OF OPTIMISM, CREATIVITY, FLEXIBILITY AND ENTHUSIASM FOR MY CLIENTS?
Do you wish to comment on the impact this article has had on you? Please see the information about Speech & Language Therapy in Practices Critical Friends at www.speechmag.com/About/Friends.
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Presented by: MARI CAULFIELD Speech & Language Therapist DIR International Faculty ICDL KATHY WALMSLEY Occupational Therapist DIR International Faculty ICDL www.icdl.com
INTRODUCTORY INTERDISCIPLINARY COURSE: Wed 24th & Thurs 25th March 2010 EXTENDED CLINICALWORKSHOP: Fri 26th March 2010 Venue: Galway Bay Hotel, Galway, Ireland INTRODUCTORY INTERDISCIPLINARY COURSE: Mon 29th & Tues 30th March 2010 EXTENDED CLINICAL WORKSHOP: Wed 31st March 2010 Venue: Edinburgh Training and Conference Centre, Edinburgh, Scotland. Visit www.trainingways.com or telephone 00353 91 796777 for further information.
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cover story
Whether youre thinking of a career in speech and language therapy or are already qualified, complete Julie Leavetts light hearted questionnaire to discover your positive qualities.
1. When dressing for work in the morning you:a. Wear a gorgeous Armani suit, sheer stockings, Jimmy Choos and Gucci watch. b. Dress smartly but casually to prepare for a range of situations. c. Are lucky if you can find matching shoes from the pile of clothes on the floor. d. Try to find a pair of trousers that have knees left in them. 2. When addressing a client/service user you:a. Use their title and surname always. b. Always ask for his/her preference and make a clear legible note in the file. c. Are useless at remembering names, but you never forget a face. d. Call them Mum or Dad even though your parents are nowhere in the vicinity. 3. When meeting your client for the first time you :a. Enjoy the video-conferencing facility that enables mutually convenient meetings. b. Like to meet face-to-face in a setting that is comfortable and convenient for your client/relatives whilst being efficient and cost-effective for the service. c. Realise youve double-booked with your dentist. d. Are usually sat in the Wendy House. 4. Your organisation is offering you a timemanagement course. You decline on the basis that:a. You have an excellent P.A. b. Your training is up to date and you are confident in your own abilities/skills. c. You changed your watch battery last week. d. Your clients usually arrive 15 minutes late to allow for any over-running clinics. 5. You like to accumulate your therapy tools by:a. Inviting company reps to demonstrate products whilst you sample the free wine and canapes. b. Reading the relevant catalogues and submitting the appropriate equipment requisition form to the budget holder. c. Having a look in your Dads shed at the weekend. d. Visiting local charity shops or raiding kids toy boxes. You frequently wail What are we going to do without Woolies? 10. When a client leaves the session you would:a. Shake hands and wish them well. b. Confirm you have subsequent appointments scheduled. c. Try to remember who it was again. d. Frisk their pockets to see where that missing lego went.
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Do you have what it takes to be a paediatric speech and language therapist?
Coffee Break Quiz
6. Your oromotor skills box of tricks contains:a. Your assistant Sandra usually deals with that sort of thing.. b. A collection of useful and appropriate materials which the medical rep left on her last visit. c. Oromotor??? The car only went for its MOT last week!!! d. Novelty bendy drinking straws, party blowers, several half-used bottles of bubbles, plus one of those blowy things with a ping pong ball at the end of it. 7. You walk into a clinic room and see an unfinished puzzle lying on the table. You would:a. Remember your office is now on the 17th floor. b. Leave it there one of your colleagues has obviously set up an activity. c. Realise you forgot your nephews 2nd birthday last week. d. Complete it in 0-3 seconds, whilst simultaneously rearranging the furniture in the room, checking emails and answering the telephone. 8. In the staff room you notice an empty crisps tube on the table. You:a. Leave it for the cleaning staff. b. Wish that people would respect the rules about clearing up their mess. c. Are disappointed cheesy chive is your favourite flavour. d. Grab it quick itll make a great musical shaker. 9. A child sticks a homemade badge on you as a token of his appreciation. You:a. Ring the drycleaners immediately and arrange for your jacket to be cleaned. b. Keep it on until they leave when youre sure they wont return, you file it. c. Recycle it, your nephew might like it and it might make up for missing his birthday. d. Proudly show it to everyone you meet.
11. A friendly colleague invites you to eat lunch at a well known burger chain. You:a. Already have your favourite table booked at the bistro round the corner. b. Go with her to keep her company. It will be a useful CPD activity to evaluate the textures/ consistencies offered on the menu. c. Are delighted as you forgot your lunch today. d. Ask for a childs meal, as youre collecting the free toys. 12. When walking down the High Street you stop suddenly because youve just seen:a. This seasons latest collection from Chanel b. A poster advertising an interesting conference c. A George Clooney look a like d. 75% discount in a toy shop. 13. When youre not working you like to relax by:a. Drinking cocktails at your favourite sushi bar. b. Filing. c. Planning how to spend your Lottery win. d. Colouring in. 14. On receiving a copy of Speech and Language Therapy in Practice you:a. Order multiple copies for your team to read b. Set aside time to review and reflect on articles relevant to your CPD targets c. Cant find the horoscope d. Initially flick through to see if you recognise any colleagues or friends, then escape with it later on the train, at coffee break, in bed, in the bath
HOW DID YOU DO? Turn to p.19 to find out what you bring to the profession...
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this house believes

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OUR NEW SERIES AIMS TO DEVELOP YOUR SKILLS FOR CRITICAL APPRAISAL MAKING DECISIONS EVIDENCE BASED PRACTICE
Doctorate in Speech and Language Therapy (DSLT)

Are you an experienced SLT with a strong interest in research? keen to carry out a research project in your work environment? The new UCL Division of Psychology and Language Sciences is offering a doctoral programme for speech and language therapists who wish to carry out research. Students will be based in Chandler House and in an excellent environment for clinical practice research. Project supervisors are likely to come from one of four specialist research departments in the division: Language and Communication, Developmental Science, Speech, Hearing and Phonetic Sciences and Linguistics or from associated Research Centres (http://www.ucl.ac.uk/psychlangsci). The second intake of this new professional doctorate will be in September 2010. It is a four year part-time programme, with up to two days per week attendance in the first two years. By the end of the second year you will have completed a detailed project proposal, obtained ethics approval and written your literature review. The final two years focus entirely on your own project (with your supervisors). For further information about the programme, see http://www.ucl.ac.uk/lifesciencesfaculty/research-programmes/speech-language-therapy. Applications will need to be received by 31st January 2010 and interviews will be held in April. For information on admissions please contact Anna Casey (a.casey@ucl.ac.uk).
Rachel Harkawik and Paula Leslie examine the case for gluten and casein elimination diets for children with autism in relation to the impact on speech and language therapy - and find the evidence wanting.
This House Believes explained
In her teaching, Paula Leslie uses a debating idea from the British Medical Journal to get her students to critically review a controversial subject. By understanding the strengths and weaknesses of the arguments on both sides, the students are better prepared to develop their own views. Students are strictly limited in word count and number of references to foster concise and relevant writing. Their work is now being adapted for Speech & Language Therapy in Practice. The debating format means: the Proposition is required to prove its case, while the Opposition aims to show why the Proposition is wrong either side can interrupt with a point of information while the other side is speaking our authors reach a conclusion based on the evidence and readers can continue the floor debate via the Critical Friends process see www.speechmag.com/About/Friends.
PhD in the Division of Psychology and Language Sciences

The new Division of Psychology and Language Science is offering Ph.D. programmes in each of the 8 Research Departments (http://www.ucl.ac.uk/psychlangsci/research). Applicants with a degree in Psychology, Speech and Language Therapy or a related discipline are invited to apply. Collaborations often take place across Research Departments and with other Centres of Research within UCL (e.g. Institute of Child Health, The Ear Institute, Institute of Cognitive Neuroscience, Neurology). The strength and breadth of UCL's research environment provides a uniquely rich and stimulating environment for research training (http://www.grad.ucl.ac.uk). General information about research programmes can be found at http://www.ucl.ac.uk/lifesciences-faculty/ research-programmes/research-pals/ and information on applying for an MPhil/ PhD programme in our division can be found at http://www.ucl.ac.uk/lifesciencesfaculty/research-programmes/pals_research_generalinfo/. Applications to the Division for competitive funding awarded by UCL must arrive by 31st January in the year you wish to start.
The Catherine Renfrew Studentship for Doctoral Studies in Speech and Language Therapy
The studentship provides support for a Speech and Language Therapist, practicing in the UK or abroad, to pursue doctoral studies at UCL in any area of clinical practice. The successful applicant may enrol on either the DSLT or PhD programme. The studentship will cover UK fees. Additional financial support may be provided in order to facilitate research training and activity, according to individual need. Applications are especially encouraged from candidates whose research studies are based in the workplace, with the support of their employer. The award of the studentship is managed by a committee of senior staff representing SLT-based research at UCL. Applications should be sent to Stefanie Anyadi (s.anyadi@ucl.ac.uk) at the same time as applications for DSLT or PhD are submitted. Further enquiries may be addressed to the Chair of the committee Professor Jane Maxim (j.maxim@ucl.ac.uk). Rachel Paula
Rachel Harkawik is a clinical fellow in the medical speech-language pathology clinical doctoral program and clinical coordinator at the University of Pittsburgh, USA, e-mail reh52+@pitt.edu. Paula Leslie is Associate Professor, Communication Science and Disorders at the University of Pittsburgh, USA, e-mail pleslie@pitt.edu. Paula is also a specialist advisor in swallowing disorders for the Royal College of Speech & Language Therapists.
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this house believes
This House Believes in autism diets

The proposition case: More time for therapy
With the number of reported cases of autism on the rise the push to find a cause has intensified. As there are no conclusive findings, different interventions are used to try to reduce the deficits associated with autism. One approach of paediatricians and families is the removal of gluten and casein products from the childs diet. Both are naturally occurring proteins; gluten is found in food such as wheat and barley, while casein is in milk. Due to increasing media attention on diet modification both from ongoing research and celebrity endorsements (McCarthy, 2007) parents may consult speech and language therapists to determine if dietary changes would be beneficial. As a profession we should be ready to comment on this topic from an evidence based standpoint rather than based on weak anecdotes. Our role is limited to helping guide, educate and answer questions from parents on how these diets may impact on speech, language, and swallowing services. Our debate therefore considers the evidence for gluten and casein-free diets in relation to their potential effect on our service delivery.
Defining the topic
POINT OF INFORMATION: None of the 30 participants were randomised into dietary groups, and a control group was not used. Observed changes were reported by parental diary entries in which no steps to ensure validity or to control for parental bias were noted. Not all children showed the same improvements. No attempts were made to determine why some children appeared to benefit from dietary changes over others. A study by Whiteley et al. (1999) also observed changes in behaviours after 22 children were placed on a gluten-free diet. These were reported both by parental interview and seen on the Behavior Summarized Evaluation (BSE, Barthelemy et al., 1990) observation scores. The reported changes may allow for additional practice of targeted skills - and increased practice is needed when acquiring new skills. The Whiteley et al. (1999) study found that the children with autism had higher levels of peptides in their urine, which could be impacting on the central nervous system and causing the undesirable behaviours. The authors hypothesised that this was because they could not break down casein and gluten correctly; eliminating these proteins from their diet would reduce the peptide level and therefore the behaviours. POINT OF INFORMATION: A later publication by Shattock & Whiteley (2001, p.267) said, because of inaccuracies in published reports, other researchers (including us) have been unable to replicate the findings. In the same publication they also stated that using elimination diets as a source of intervention is largely unproven in terms of efficacy (p.269).
munication and interaction after intervention as compared to the control group who showed no changes in this parameter. In the 2002 study, the diet group had significant changes in non-verbal communication, eye contact, reaction when spoken to and language peculiarities. No comments about verbal language and receptive changes were reported. The results suggest that a gluten-free and casein-free diet can positively influence an autistic childs language abilities. Speech-language services will still be needed but changes to what can be worked on in therapy may occur. Aspects such as non-verbal language may not need as much attention and thus other areas of deficit may be addressed. Most influential may be the decreased resistance to communication and interaction. Like behavioural improvements, this may allow for more practice of skills in therapy. POINT OF INFORMATION: In both studies, 20 participants were paired according to autistic traits, IQ, age and severity to ensure equality of dietary and intervention groups. One member of each pair was randomly selected to be in the dietary group. The parents were aware which intervention group their child was in although the researcher who was conducting testing and interviewing was not. (Single blinding was chosen over double blinding due to ethical issues as reported by the authors.) Monitoring of diet compliance was not conducted, weakening the confidence the reader has in the reported results. Generalisation was also limited by the number of subjects and the length intervention was carried out for. It should be considered that placebo effects may have influenced the results, since information on changes in behaviour was gathered during interviewing of the childs parent.
Impact on outcomes
Often factors outside the control of speech and language therapists may have the largest impact on our therapy outcomes. We must consider the amount of time devoted to managing behavioural issues, such as lost attention, and how this may affect progress.
Impact on behaviour
Children with autism have a wide range of impairments that influence how therapy is performed. Nazni et al. (2008) examined the effects of elimination diets over a two month period on selected behaviours in autistic children. Findings indicate children placed on casein-free and / or gluten-free diets showed statistically significant improvements in attention, sleep, hyperactivity, and anxiety / compulsions. The improvements observed in the study may directly affect how therapy is conducted. With enhanced attention, decreased fatigue due to improved sleep, and reduced hyperactivity, the time devoted to the childs therapy goals may increase.
Impact on communication
The effect of a gluten-free and casein-free diet on communication in children with autism was investigated by a group in Norway. Linguistic abilities were studied consisting of non-verbal and verbal language, and expressive and receptive language (Knivsberg et al., 2002). In 2003, Knivsberg et al. then studied childrens abilities and their resistance to communication and interaction. Statistically significant improvements in the ability of the diet group to communicate and interact were shown compared to the control group. Eighty per cent of the diet group also had no resistance to com-
Summing up the case for the proposition
Gluten and casein-free diets have positive effects on some children with autism in regards to attention, sleep, hyperactivity and anxiety, and may decrease resistance to communication and interaction. These changes may have a positive, direct impact on how therapy is conducted.
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This house believes
The opposition case: Costs outweigh benefits

With restrictions to what can be eaten on gluten and casein-free diets, concerns about nutritional safety arise. Is there evidence that the benefits of elimination diets outweigh the costs of dietary restriction? search and stated the specific search strategy used. They concluded that diet placed extra financial cost and limitations on foods of choice for the affected family member and we could not recommend their use as a standard treatment on the basis of the limited data available (p.16). Both reviews reflect the lack of research on dietary restrictions.
Judgment:
The motion is defeated

The diagnosis of autism spectrum disorder is devastating. Though recent research is continuing to gain more insight about the cause(s) of this disorder, no cure has yet been discovered. As speech and language therapists we must remember that the parents of children with this disorder are in a fragile position. Families are trying to deal with the loss of the child whose future they had imagined, and to care for the child that they have. This child may be at the very mild end of the spectrum, or have challenging behaviour and learning disabilities. Parents may have other children as well and have to balance all these factors. They will be desperate for something that helps. Many of us have friends outside of our working lives who are in this situation - and it is hard watching them over the years trying to cope with it all. Nonetheless, our duty as professionals is to back rationale with evidence and be mindful of our professional boundaries. Although our role lies in helping these children with their speech, language, and swallowing needs, parents may call upon us for advice concerning nutrition and behavioural concerns. We need to be careful of commenting on areas managed by nutritionists and psychologists, and to be aware of the evidence and its quality. The studies cited look at the participants as a sample from the autistic population and not as individuals. Elimination diets may be beneficial for an individual with autism. Reviewing the literature on how modified diets may help behaviour, attention and so on, we can see the attraction - but the evidence is not robust. Balancing that against the potential damage from malnutrition, where we do have good evidence, leaves us unable to support the move to a restricted diet. We need to be able to talk this through with families and direct them to other professionals who are in a better place to advise. We should be aware of the promises made in the media and popular literature and address them, whilst respecting a scared family trying to do the best they can.
Nutritional risks
Elimination diets place major restrictions on the foods that can be eaten, and potentially affect the childs vitamin, protein, and mineral levels. Arnold et al. (2003) examined if a gluten and casein-free diet would impact on amino acid levels in autistic children. Results indicate that autistic children, both on restricted and non-restricted diets, had poor protein nutrition. Those children on restrictive diets had a greater number of deficient amino acids and overall poorer protein nutrition than children on no restrictions. The authors note poorer protein levels have the potential to place a childs developing brain at risk. This is particularly relevant when considering the age at which autism is identified, and how much brain development is still occurring. The authors also observed that parents often lack medical supervision when following these diets, increasing the risk of malnutrition. Point of information: Retrospective studies restrict the control of several variables and reduce the level of evidence of the work. The limited number of children in the restricted diet group (n=10) questions the generalisation of results. Due to the nature of the study, authors had to assume the dietary restrictions were followed, and that information written in the charts was valid.
Summing up the opposition case
Gluten and casein-free diets have potential negative effects on children with autism with the possibility of protein malnutrition. The current evidence to support the use of this diet is limited, has poor external validity, and does not give a clear indication of the benefits of dietary intervention.
Efficacy review
To summarise the evidence on dietary restriction, Christison & Ivany (2006) published a review on the efficacy of gluten and casein-free diets. Results indicated that the evidence was small and flawed (p.s168). Reviewed studies had small subject numbers, often lacked a control group, and had heterogeneous populations. The possibility of placebo effects was also noted due to the high demands of diet implementation. The authors concluded the evidence failed to clearly support or refute the use of restricted diets. Point of information: This review would be difficult to replicate based on the information given. Search terms and the criteria for article inclusion were omitted. Only two databases were used in the search, leaving possible research undiscovered. Similar conclusions were however found in a stronger systematic Cochrane review by Millward et al. (2004), which contained information on both the inclusion and exclusion criteria. The authors conducted a rigorous
Arnold, G., Hyman, S., Mooney, R. & Kirby, R. (2003) Plasma amino acids profiles in children with autism: Potential risk of nutritional deficiencies, Journal Autism And Developmental Disorders 33, pp.449-454. Barthelemy, C., Adrien, J.L., Tanguay, P. & Garreau, B. (1990) The Behaviour Summarized Evaluation: Validity and Reliability of a Scale for the Assessment of Autistic Behaviours, Journal of Autism and Developmental Disorders 20, pp. 189204. Christison, G. & Ivany, K. (2006) Elimination diets in autism spectrum disorders: Any wheat amidst the chaff?, Developmental And Behavioral Pediatrics 27, pp.s162-s171. Knivsberg, A.M., Reichelt, K.L., Hoien, T. & Nodland, M. (2002) A randomised, controlled study of dietary intervention in autistic syndromes, Nutritional Neurosciences 5, pp.251-261. Knivsberg, A.M., Reichelt, K.L., Hoien, T. & Nodland, M. (2003) Effects of dietary intervention on autistic behavior, Focus on Autism and Other Developmental Disabilities 18, pp.247-256. McCarthy, J. (2007) Louder than words: A mothers journey in healing autism. New York: Dutton Adult. Millward, C., Ferriter, M., Calver, S. & Connell-Jones, G. (2004) Gluten- and casein-free diets for autistic spectrum disorders. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003498. DOI: 10.1002/14651858.CD003498.pub3. Nazni, P., Wesely, E. & Nishadevi, V. (2008) Impact of casein and gluten free dietary interventions on selected autistic children, Iranian Journal of Pediatrics 18, pp.244-250. Shattock, P. & Whiteley, P. (2001) How dietary intervention could ameliorate the symptoms of autism, The Pharmaceutical Journal 7, pp.267-269. Whiteley, P., Rodgers, J., Savery, D. & Shattock, P. (1999) A gluten-free diet as an intervention for autism and associated spectrum disorder: Preliminary findings, Autism 3, pp.45-65.
References
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COVER STORY (CONT.) / speechmag

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Coffee Break Quiz

How did you do? (from p.15)
Mostly as Corporate You definitely fit the executive role. Good at delegating to other members of staff, with excellent networking and social skills, you have high expectations both of yourself and of those around you. A corporate work environment would be where you feel most at home. Mostly bs Conscientious You are highly professional within the workplace and like to follow guidelines and procedures. You are a reliable and conscientious person who believes passionately in their work and in making a difference. Do make sure your colleagues also see your lighter side as well as your professionalism. Remember the saying about all work and no play...? Mostly cs Currently chaotic This really isnt the profession for you! Look at your many positive skills and seek advice from your careers office. Depending upon which path you decide to follow, you either need to hone up your organisational skills or choose a career that has few constraints on your creative and naturally chaotic approach to life.. Mostly ds Characterful Your natural sense of fun and genuine naivety means you are perfectly suited to working with children. You are happy to get down to their level both practically and intellectually. You have a good sense of humour and are an expert at making therapy resources from all sorts of odds and ends. You probably also have an impressive range of facial expressions and interesting voices. The Downs Syndrome Association has established the following Speech and Language Therapy courses and conferences with Symbol UK Ltd (Speech and Language Therapy Advisors to the DSA). For further information of all the events listed below, or to receive a copy of our full programme of conferences for 2010, please contact Lesley Alabaf on 0845 230 0372 or email lesley.alabaf@ downs-syndrome.org.uk. Full details are also available on our website www. downs-syndrome.org.uk 3-day Co-worker Training Course Teddington (Greater London) 25 Feb, 25 March and 22 April 2010 This course trains staff and local support networks to run speech and language groups to assist people who have Downs syndrome to develop their communication skills, with the support of Speech and Language Therapists. Eating and Drinking Problems experienced by Children with Downs Syndrome Bristol, 9 March 2010 This conference will look at the difficulties faced by children with Downs syndrome with eating and drinking. Factors such as anatomical, motor, sensory, etc will be explored as well as strategies to overcome the difficulties. Speech and Language Development Cardiff, 10th March 2010 This conference aims to improve the understanding of the communication needs of children with Downs syndrome, and is suitable for professionals and parents of children in the early years and of a school-age. 3-day Specialist Development Programme for Speech and Language Therapists working with people who have Downs Syndrome Manchester, 10-12 May 2010 This specialist 3 day course will improve the knowledge, skills and expertise of speech and language therapists working with people who have Downs syndrome. It will include research and EBP, and discussions of strategy.
Winter09 speechmag
Winter 09 Extras
New article - Sandwell on show www.speechmag.com/Resources/Originals Diana McQueen and Jane Oates report from the Education Show 2009 where their team took a stand to Find out what delegates knew about speech and language therapy Showcase their departments resources Act as a resource for delegates www.speechmag.com/Members/ Mark Ylvisakers handout Ongoing Project-Oriented Intervention for Children and Adults with Disability: Collaboration and Apprenticeship (see pp.12-14) Lesley Johnsons client consent letter (see pp.26-28)
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19
reviews
reviews
CAREER
A Career in Speech and Language Therapy (2nd edn) Jannet A Wright & Myra Kersner Metacom Education London ISBN 978-0-9547457-1-4 19.95 This doesn't detract from the overall quality of information provided, but does serve to highlight the lack of guides available to the UK speech and language therapist. Helen Lawson is a final year student studying for a Graduate Diploma in speech and language therapy at Queen Margaret University, Edinburgh.
Invaluable resource
As a mature student trying to find information about the speech and language therapy profession I found this an invaluable resource. It provided an excellent overview with practical advice as well as case studies and an example session. The book covers many areas - what the job entails, human communication, types of disorders, how and where therapists work and what skills are necessary to become a student and subsequently a therapist. Whilst there is some repetition, the style is very easy to follow making the book as accessible for a school / college student as it was for me. The case studies and profiles are comprehensive and give a fascinating insight into many aspects of the profession whilst providing a rounded view of the possibilities and directions open to graduates. The book finishes with sections on applying for courses and attending interviews, becoming a student and life once youre qualified. It is meticulously researched and written and, although slightly expensive, I would thoroughly recommend it to anyone thinking of entering the profession. Nicola Platt, from Sutton Coldfield, wrote this before starting a part time undergraduate degree in speech and language therapy at Birmingham City University.
NARRATIVE
StoryBoards 2 Felicity Durham Speechmark ISBN 9780863837482
41.99+VAT
A useful tool
followed by methods used to treat them, and research taking place. Unfortunately, this book isnt well organised and you have to rely on the index to navigate your way through its many sections. However, once you get past the erratic layout, the book contains a wealth of useful information. I would recommend it for any clinician or student who wants to understand current theory, as well as the therapy methods used to treat speech sound disorders. Ive found it especially handy as a student for brushing up on various different speech difficulties and at 39.50 it wont break the bank. Philippa Greasley is a student at the University of Sheffield and a speech and language therapy assistant.
DEMENTIA
Dementia (From Diagnosis to Management A Functional Approach) Michelle S. Bourgeois & Ellen M. Hickey Psychology Press ISBN 978-0-8058-5606-4 40.00
This practical resource will be of benefit to the generalist or specialist working in a busy clinic situation. It aims to develop childrens imaginative and storytelling skills in a colour coded and structured way. It is easy to use and presented in a colourful format with pictures representing where, when, how, saw, felt and what happens. The child is then encouraged to formulate a story from these cards. The lotto board activity gives structure and will help the under-confident child to link ideas and achieve a story. Some combinations of cards can produce a humorous result, adding to the childs interest and enjoyment. Children will relate well to most of the subject matter, but we struggled with interpreting one of the pictures showing emotion. Some of the vocabulary items such as harp, telescope and pearl caused difficulty for some children we worked with. As there is no who / character cards, we assume all the stories relate to the childs adventures. Departments on a budget may find it pricey, but this is a useful tool for story generation activities. Alison Taylor and Karen Shuttleworth are speech and language therapists with Cumbria PCT.
MIND, BODY AND SPIRIT
Mind/Body Techniques for Aspergers Syndrome: The Way of the Pathfinder Ron Rubio Jessica Kingsley Book ISBN 978-1-84310-875-7 13.99 DVD ISBN 978-1-84310-890-0 19.56
A fascinating exploration
Excellent starting point
SPEECH SOUND DISORDERS

Childrens Speech Sound Disorders Caroline Bowen. Wiley-Blackwell ISBN 978-0-470-72364-7 39.50
This books aims to be a practical guide for therapists working in the area of dementia. Chapters range from an introduction to the main forms of dementia to diagnosis, treatment and management approaches. With such a wide remit, it takes on a huge task. It is engaging to read, with appendices containing examples of questionnaires and assessments being particularly useful for the practising clinician. For students, it is undoubtedly an excellent starting point for gathering information on any aspect of dementia. However, the book is clearly written with American therapists in mind, making repeated references to US policies and assessments that are unlikely to be used here in the UK.
Wealth of useful information
Aimed at clinicians and students, this book represents a detailed overview of childrens speech sound difficulties. It covers issues such as assessment, intervention and delivery, and makes links between current research and current practice. The rather academic tone means you wont find any practical therapy techniques or activities inside. Instead, it describes every speech sound disorder going,
This book and DVD are a fascinating exploration of the interaction between mind, body and spirit. Rubio discusses the challenges in working with clients with Asperger syndrome and how he reaches out to them using three key concepts - the holistic model, the warrior archetype and rites of passage - to bring mind and body together. Read this book for practical support in improving confidence and self-esteem and reducing anxiety and frustration particularly for clients who findtalking therapychallenging. The core principles can however be applied to anyone, and are a thought-provoking method of encouraging introspection and empowerment. The DVD makes good use of repetition and is clear and well-paced but may need several viewings if intended as a therapeutic tool. It is all of clients well-practised in the techniques, and I would like to have seen a new client included. Many clinicians will relate to similarities with Alexander Technique or aspects of voice therapy where breathing, core stability and balance / posture are key. However, if the reader has no pre-existing knowledge of mentoring, Eastern philosophy and / or martial arts, then application of the physical techniques may prove challenging. Although the DVD and book are sold separately, the concept is difficult to appreciate using only one or the other. Overall, fascinating for anyone wishing to adopt a mentoring / coaching type strategy in therapy - it left me wanting to be a personal trainee of Ron Rubio! Andrea Szego is a specialist speech and language therapist with Berkshire West PCT.
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reviews
ASPERGERS SYNDROME
What Did You Say? What Do You Mean? a) An illustrated guide to understanding metaphors b) 120 illustrated metaphor cards plus booklet Jude Welton Jessica Kingsley a) ISBN 978-1-84310-207-6 12.95 b) ISBN 978-1-84310-924-2 19.56
The book would be useful for parents and anyone working in the field, particularly students, newly-qualified therapists and other professionals new to this area. It would be particularly useful for therapists and teachers interested in developing more functional skills in teenagers and young adults. Helen Malique is a speech and language therapist with Waltham Forest PCT.
Welcome additions
AUTISM (2)
This pack and guide aim to develop awareness of metaphors commonly used in English, and are designed for use with children with Aspergers Syndrome. Both contain a good summary of the difficulties which these children are likely to have with metaphors and provide some helpful strategies. The cards consist of written metaphors with a picture of their literal meaning and a corresponding set giving the actual meaning. They come with useful detailed instructions and are well presented and robust with clear illustrations. They are intended mainly for group work. The guide is for work with individual children. It uses the same illustrations and provides an explanation for each metaphor. Both cards and guide are welcome additions to the limited resources available in this area. Sarah Harper is a non-practising speech and language therapist with a special interest in autistic spectrum disorder and pragmatic language development.
Managing Meltdowns (Using the S.C.A.R.E.D. Calming Technique with Children and Adults with Autism) Deborah Lipsky & Will Richards Jessica Kingsley ISBN 978-1-84310-908-2 9.99
Good insight
metal and toxic exposure, body chemistry, detoxification, the gut, impaired nutritional statues, the immune system The list goes on and is not a read for the faint hearted! It attempts to simplify and explain the biomedical terms and guide the reader through assessment, treatment and recovery. There are numerous references to research and websites to gain further information and support. Although the style is very chatty at times, the chapters on body chemistry are still very technical and hard going. Despite my initial scepticism, I gained a lot of information from the book but would be hesitant to recommend it generally to parents or other professionals unless they had specialist knowledge of autistic spectrum disorder. Jane Stonehouse is a consultant speech and language therapist with North Bristol NHS Trust.
AUTISM (1)
Autism Life Skills (10 Essential Abilities Your Child with Autism Needs to Learn) Chantal Sicile-Kira Vermilion ISBN 9780091929084 11.99
This interesting quick read gives a good insight into the mind of an individual with autism when facing a threatening situation. Deborah Lipsky is a high-functioning individual with autism and her own life-experiences help to illustrate the strategies outlined. Deborah emphasises the need for routine and ritual and explains what happens when these break down. The acronym S.C.A.R.E.D. (Safe, Calm, Affirmation, Routine, Empathy, Develop an intervention strategy) is used to offer practical techniques to anyone in a 'first response' situation of encountering an individual with autism in 'meltdown'. The good layout includes do / don't recap lists at the end of each chapter. As the authors are both American there is quite a lot of American terminology used. I would recommend it to people who work with older children and adults with autism, and will use the strategies to help develop intervention plans and write identification cards for my clients. Rachael Cunningham is a paediatric speech and language therapist working in Edinburgh.
SOCIAL COMMUNICATION
Lovable Liam Series (Lovable Liam, Liam Says Hi , Liam Goes Poo in the Toilet, Liam Says Sorry , Liam Knows What To Do When Kids Act Snitty, Liam Wins the Game Sometimes) Jane Whelan Banks Jessica Kingsley Publishers ISBN 978-1-84310-907-5 37.50 for set
Appealing and lively
Very practical
This is an easy to read, informative book. The author has a child with autism, and has been involved in the field as a parent and professional for nearly 20 years. Ten clear chapters focus on important Life Skills for children and young adults with autism: sensory processing, communication, safety, self-esteem, pursuing interests, self-regulation, independence, social relationships, self-advocacy and earning a living. Lots of examples and Practical Tips from the authors experiences with her son (now a teenager) are included, along with advice gained from interviewing adults with autism. This makes the book very practical, and really emphasises the wide range of difficulties people with autism experience.
AUTISM (3)
Hope for the Autistic Spectrum A Mother and Son Journey of Insight and Biomedical Intervention Sally Kirk Jessica Kingsley ISBN 978-1-84310-894-8 17.99
Alternative viewpoint
I approached this book with caution due to the title. It is written by a parent who describes her journey through her sons development, diagnosis of autistic spectrum disorder and treatment using a biomedical approach. This is certainly an alternative viewpoint of the causes of autism, presenting it as a treatable disease encompassing genetics, heavy
These six books are beautifully yet simply illustrated and written in an appealing childfriendly typeface. They are suitable for reading to children aged 3 years +, or independently by 5-8 year olds. Each colourful book positively targets a different skill needed to form positive relationships: toilet training, learning to greet a friend, how to apologise and how to lose with grace, basic social skills and how to cope in different everyday situations. The targeted issue is clearly identified on the cover. They could be read individually or as the complete series. Although they use simple language, the authors Canadian English may have an impact on the familiarity of the vocabulary for some children. This lively series is definitely a valuable resource for parents and their children, speech and language therapists of all levels of expertise, teachers and other health professionals working with young children. It could be enjoyed at home, school or in the clinic, and be particularly useful to those working closely with young children who have social communication difficulties such as autism and other spectrum disorders and syndromes. Caroline Oldman is a specialist speech and language therapist working with the Tooting Early Years Team across the Integrated Childrens Centres (0-3Years) for Wandsworth PCT.
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reviews
VOICE
Emotions in the human voice (Vol. II) Clinical Evidence Ed. Krzysztof Izdebski Plural Publishing ISBN 978-1-59756-118-1 41.00
Resources
Drinkup is a hands free drinking system suitable for clients such as those with Multiple Sclerosis and Motor Neurone Disease. www.drinkup.uk.com A British Stammering Association / Michael Palin Centre film for head teachers. http://tinyurl.com/clx19x Including young people with speech, language and communication difficulties in secondary school (England and Northern Ireland). 12.50, www.afasic.org.uk Foamfetti air-dry sculpting mix may be useful for creative activities with a range of ages. www.learning-resources.co.uk I CANs Chatterbox Challenge fundraiser 2010 has a Minibeasts and the Garden theme. To register for a pack go to www.chatterboxchallenge.co.uk Training and supporting children and young people, including those with learning disabilities, to undertake their own research. http://childrens-research-centre.open.ac.uk/ research.cfm Getting a result - a DVD to ensure young deafblind people going through the transitional planning process have their voices heard. 15, e-mail eileen.boothroyd@sense.org.uk Fifteen week online postgraduate modules in dementia studies. http://www.dementia.stir.ac.uk/Education_ Training_Postgraduate The Deafblind Directory allows service providers, whether individuals or organisations, to become part of a one stop resource. www.sense.org.uk/deafblind_directory icommunicate is an online community providing free information and resources written by speech and language therapists. www.icommunicatetherapy.com Memory Games Junior and Senior is working memory training software. Free demo at www.shinylearning.co.uk Pre-prepared hot drinks Slo Hot Chocolate and Slo White Coffee are now available on prescription at Stage 1 and Stage 2 consistencies. e-mail newsletter@slodrinks.com LearningGrids.com is updated fortnightly with free resources for teachers to use with Clicker, WriteOnline, ClozePro and Jigworks. www.cricksoft.com; www.learninggrids.com Online access to an Applied Behaviour Analysis curriculum. www.rethinkautism.com
Interesting but little practical value
Measures of Childrens Mental Health & Psychological Wellbeing: A Portfolio for Education and Health Professionals aims to assist early identification of children with emotional and psychological needs. www.gl-assessment.co.uk Commtap, the web-based Targets and Activities Project for sharing activities to work on childrens communication, hopes to launch its next phase before the end of the year. www.commtap.org The Health Professions Council has enhanced its information for students. www.hpc-uk.org/students The IntelReader mobile handheld device is designed to increase independence for people who have trouble reading standard print through dyslexia or visual impairment. www.intel.co.uk/reader Imagine the Difference is a free resource for teachers designed to fit into plans with minimum preparation. www.scope.org.uk/imaginethedifference The worlds thinnest cochlear implant the Cochlear Nucleus 5 System - is said to be less obtrusive to wear, easier to use and less complex for surgeons to implant. www.cochlear.co.uk Black Sheep Presss new materials include Phonological Worksheets, Time for Sounds Reception and worksheets to accompany Caroline Bowens book Childrens Speech Sound Disorders (reviewed on p.20). www.blacksheeppress.co.uk All past issues of Augmentative Communication News and Alternatively Speaking are now available free online. www.augcominc.com As part of its Teens to Adults campaign, the Dyspraxia Foundation has produced guidelines for secondary school teachers. http://www.dyspraxiafoundation.org.uk/services/ed_classroom_guidelines_09.php BRIEF, which provides training in the solution focused approach, has revamped its website. www.brief.org.uk Make Them Go Away is a pack to help schools tackle bullying of young people with special educational needs and disabilities. http://www.youtube.com/ watch?v=FzWUgZ9f6Lc The STARS (Stroke Training and Awareness Resources) website offers free online training for health and social care staff. www.stroketraining.org
This is the middle edition of a series of three books which aim to give insight into the complex relations between voice and emotion on a multidisciplinary level. The 12 chapters are each penned by a different author. In a well-written introduction editor Professor Krysztof Izdebski reports having being inspired to compile the book following the 2004 Pacific Voice Conference entitled Emotions and Voice. The format of the majority of the chapters mirrors journal articles that is, they are written reports of studies carried out to evaluate emotions in the human voice, for example Vocal psychodynamics in the voice clinic, How the stress chain affects voice. The exception to this is a chapter by Jo Estill, which provides an excellent stand-alone summary of the Estill Voice model. While an interesting read, the book is arguably of little practical value for speech and language therapists looking to update therapy skills. Sue Addlestone is clinical lead in voice at North Manchester General Hospital and associate lecturer in voice at Manchester Metropolitan University.
CHILD LANGUAGE
The 50 Best Games for Speech & Language Development Maria Monschein Hinton House Publishers ISBN 978-1906531-13-3 9.99
Expensive for what it is
This little book is one of a series providing ideas mostly for use in the classroom. It contains games for groups although they could be adapted for individuals. They provide practice for issues including oral and finger motor skills, problem sounds and sentence construction. Some need props and preparation, others rely on pretending, some need a bit of space to play and a degree of physical skill. The games are explained well with variations to extend them. While experienced therapists may get some new ideas the book would probably be most useful for students, newly qualified therapists or those planning on running groups for the first time. At 9.99 it is possibly a little expensive for what it is. Helen Dixon is a speech and language therapist SLTP with Cumbria PCT.
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how i
How I create creativity (1):
Extra! Extra! Read all about it!

Keith Park on the genesis of an exciting approach to language and communication which, as it becomes embedded in the culture of schools or day centres, creates the conditions for ongoing learning and development.
work in three schools for children with severe and profound learning disabilities, developing poetry, drama and storytelling workshops. I also do this on a part-time freelance basis. The emphasis in these workshops is increasingly on performances in community settings, which in the London area has included Shakespeares Globe Theatre, Westminster Abbey, St Pauls Cathedral, Middle Temple, The National Theatre, and in May 2008 The House of Commons. Language and communication is integral to my work, and I often collaborate with speech and language therapists. My role is constantly evolving, perhaps following a chance remark that sets me thinking, or simply saying the right thing at the right time and taking advantage of opportunities and contacts. The most rewarding aspect is when the young people I work with take an idea and run with it in new and unanticipated directions, as this story exemplifies... Two years ago at Charlton School in Greenwich (south-east London), a teacher was having a light-hearted grumble about Christmas. Christmas again, she moaned, same old donkey, same old manger, same old crib, why cant we do something different? She then winced as we all heard one pupil swear at a teacher in the corridor, and she said Listen to all that rabbit! When I looked confused, she explained: Cockney rhyming slang rabbit is short for rabbit and pork which is short for talk. I was intrigued. Cockney Rhyming Slang originated sometime in the 19th century as a way of confusing outsiders as to the topic of conversation among local East Londoners. It mainly consists of substituting one word with another that rhymes with it and is often paired with another word. For example, stairs may be called apples and pears, phone may be dog and bone, and road may be frog and toad. Sometimes, just to make things even more confusing, the rhyming substitute is dropped, so the verb to look, which can be re-phrased as butchers hook, becomes just butchers (see www.cockneyrhymingslang.co.uk).
READ THIS IF YOU WANT TO TAP INTO POPULAR CULTURE MOVE INTO COMMUNITY SETTINGS DO SOMETHING DIFFERENT
Many of the pupils and staff at the school are Londoners, and most are familiar with rhyming slang. By using a language form that is familiar to the school population, we came up with what we call an Eastenders version of the Nativity, which, although it has nothing specifically to do with the long-running TV soap, does contain rhyming slang and gives us all the chance to try out an over-exaggerated Cockney accent. Currant bun is rhyming slang for son so the chorus, in the style of tabloid headlines, went: Extra! Extra! Read all about it! Mother Marys Currant Bun! The aim was to make it sound like newspaper sellers calling out the headline news of the day. We all had a good laugh and thought that was more or less it. A colleague then also tried it in a nearby special school and the staff and pupils all enjoyed it, but the week after (and this is going to sound straight out of The Vicar Of Dibley) the local vicar phoned the school and invited the pupils to perform it in the local church. So they all dressed up as newspaper sellers - which apparently means long coats, fingerless gloves, flat caps and a rolled up copy of one of the days tabloids - and performed in front of about 250 people. Pupils in the school I visit continued to ask for Extra Extra until it became a running joke: Can we do Extra! Extra!? I would reply, but its May! then they would say, So can we do it again then?
Fresh, funny and familiar
It can sometimes be difficult trying to explain why people like the things they like. It was, and is, our understanding at school that the pupils enjoyed this particular story because a) the language is fresh and often very funny, and in many cases familiar to them as Londoners and b) it also refers to a television programme they know and like. Encouraged by their enjoyment,
I decided to use their interest and motivation to write a sequence of Bible stories in Cockney Rhyming slang. Because many of the pupils and staff are keen on football, it seemed logical to write the story of David and Goliath in the style of football chants and the first two lines quickly became established as favourites: We are the Philistines! Israelite losers! This particular story is usually referred to as that football one and there is much good-natured banter when the final two lines (Israelites: 1 ; Philistines : 0) is followed by a football result from the weekend: Chelsea: 3; West Ham 0 and then a resounding shout of Result!! So the number of stories has grown and grown, each one trying to reflect some aspect of life that catches the interest of the pupils. One day I overheard three teenagers talking about the Carry On films and so the story of Samson and Delilah was turned into Carry On Samson with, of course, Barbara Windsor as Delilah, all wideeyed innocence and innuendo, asking Samson: Howd you get so/Well endowed? This was followed by the story of Noah, done in short-wave radio conversations between God, Noah and his family, and then the story of Abraham and Isaac through email and text (Abraham asks Isaac to help him install a firewall on his computer and is stopped by a text message from angelofthelord.com). Many of the pupils and staff are fans of the long-running BBC comedy Only Fools And Horses so we tried the story of Adam and Eve in the style of Del-Boy. The chance to do some really over the top pretend Cockney proved so popular that we then went on to The Prodigal Son of Peckham Market which contains some of the nonsensical phrases used by Del-Boy: Roast potatoes/Fatted calf/Mange Tout Rodney/Cor not arf! It was at this point that a colleague asked me if any of the stories had caused offence. I had never thought of this, and of course there is no offence intended, but I thought I should find out, and so I sent a copy to the Archbishop of Canterbury. One of his staff replied with a very positive letter. Duly encouraged,
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how i
I then approached the clergy of the church of St Mary-le-Bow and asked if we could perform some of the stories in the church. They also were extremely supportive and welcoming, and we have been performing the stories there on a regular basis for two years. The church of St Mary-le-Bow houses the Great Bell of Bow and, by tradition, anyone born to the sound of the Bell is a Cockney. The clergy of the church then had the idea of inviting the Pearly King and Queen of Bow, who came and joined in the performance. In tandem with the performances at St Mary-le-Bow, we were also developing pantomime scripts both in school and also for performance at The Churchill Theatre in Bromley. In January 2007 we did a series of workshops on Mother Goose and the education officer for the theatre invited us back in January 2008 for some Peter Pan workshops. I suggested to one pupil, PJ, that he might like to try writing a script for us to use. Ten months later he asked me if we were going to do Peter Pan and, when I said that we were, he produced his script and said, Can we do this? I wrote it. So in January 2008 PJ directed a series of workshops at The Churchill Theatre which were then transferred to Richmond Theatre at the invitation of its education officer. I noticed that in PJs script, each episode was accompanied by an illustration. These included sketches of Peter Pan, Captain Hook, and the Darling family children. This talent tied in nicely with another development. Sometime in 2007 I had written to the staff and clergy at Westminster Abbey asking if we could perform the sequence of Bible Stories in Rhyming Slang in the Abbey. They agreed, and so in February 2008 we performed them in the Nave of the Abbey, much to the enjoyment we hope of the many tourists who cheered us on our way. The performance was so successful that Abbey staff agreed that we could come back in July 2008 and repeat it in the Abbey gardens. This also took place and was a great success. When we had finished, I suggested to PJ that the Adam and Eve story would look good with some of his illustrations. Little did I realise what would then happen. PJ went home and, without any assistance or guidance from family or friends, produced a series of pictures to accompany the story of Adam and Eve that we performed at Westminster Abbey and St Pauls Cathedral (figure 1). the words. PJ suggested, I can stand behind Thomas and whisper the words to him, he can call them out, and so hell be the leader and everyone can copy him. This extraordinary behaviour has spread to several others in the group, who now help others to lead the activity. Some of the pupils and staff at Charlton School call the activities I use drama; others use the term interactive storytelling or even call and response which is a strange school habit of describing an activity by its method, rather like saying tabletop for when the group sits at the table and does either drawing, writing, or reading. As Liz Skilton has described (2008), I would regard this type of activity as one of language and communication. The rhythmic exchange of a four beat line can quickly establish a powerful communicative atmosphere and provide language and communication opportunities for anyone with or without disabilities. More specifically, for teaches and therapists working with people with severe and profound learning disabilities, the skills areas are awareness, anticipation, turn-taking, showing self, seeking physical proximity, gaze alternation, and declarative pointing. themselves. They explained to the audience of 250 people that they too were part of the group and had to join in the response lines, which they did with great enthusiasm. The intensity of the standing ovation they received at the end of the performance is impossible to describe. If any readers of Speech and Language Therapy in Practice would like to come and join one of the sessions, either in a school or in a community setting, please contact me at keithpark1@onetel.com. On Wednesday 20th January 2010 we will be in Canterbury Cathedral for more of the rhyming slang Bible stories anyone is welcome but please contact me first. In addition to the Bible Stories, various groups have already started Shakespeare (The Tempest), and new versions of stories by Hans Christian Andersen (including The Red Shoes and The Princess And The Pea re-set in contemporary London: If she couldnt kip/On one mushy pea/Then shes got to be/Royalty!) Bible Stories in Cockney Rhyming Slang (Park, 2009) is available from Jessica Kingsley Publishers at www.jkp.com. There is also a short film about it on You Tube that you can find if you put the book title on the search panel of www.youtube.com. Alternatively, adapt the Bible stories to your own regional SLTP dialect and have a go yourselves! Keith Park is an advisory teacher who works with children and adults with multi-sensory impairments in a variety of educational and community settings, e-mail keithpark1@onetel.com.
I would regard this type of activity as one of language and communication.

So, when we perform Bible Stories in Cockney Rhyming Slang at Westminster Abbey, the class teacher may describe the activity as Religious Education, the speech and language therapist as Language and Communication, the head of the English department as Drama or Poetry or even, as a visiting drama therapist once said, Applied Theatre. It reminds me of a piece of dialogue from the film Pretty Woman, where the man (Richard Gere) meets a woman (Julia Roberts) on the street, and takes her back to his apartment. He says Whats your name? She replies, What would you like it to be? At the risk of sounding obscure, my own preference is to call it creating creativity. It may sound clumsy, but its what seems to happen. I would suggest that, once this type of activity has become embedded within a school or day centre culture, it can assume a life and momentum of its own. This means that it is owned by everybody, and is not seen as being the project that I work on in school. Best of all, it can be led by the pupils themselves. Last year, shortly before the group went to The House of Commons, they were invited to perform at Bafta (The British Academy of Film and Television Awards). Although I went with the group, I did not participate in the performance, but stood at the back as a spectator and watched while the eight teenagers did it all
References
Park, K. (2009) Bible Stories in Cockney Rhyming Slang. London: Jessica Kingsley. Pilcher, P.J. (2009) Pinocchio by Carlo Collodi, adapted by PJ Pilcher, SLD Experience Summer 54, pp.13-18. Skilton, L. (2008) Joining in as never before, Speech & Language Therapy in Practice Summer, pp.26-28.
Extraordinary behaviour
PJ has now written several pantomime scripts and has directed his script of Peter Pan at Richmond Theatre. His script of Pinocchio has been published (2009), and he has told his parents that he wants to be a professional writer and director. PJ, like several of the others in the group, is autistic, and has started to do things that are very un-autistic. For example, Thomas (also autistic) asked to lead an episode. I said yes of course, but he then said he didnt know
REFLECTIONS DO I GIVE THOUGHT TO "ESTABLISHING A POWERFUL COMMUNICATIVE ATMOSPHERE"? DO I LABEL ACTIVITIES IN A WAY THAT ACKNOWLEDGES THE BREADTH OF THE LEARNING EXPERIENCE? DO I SOW SEEDS OF IDEAS WITH CLIENTS, THEN WATCH HOW THEY GROW THEM?
Do you wish to comment on the impact this article has had on you? Please see guidance for Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends.
24
how i
Figure 1 Adam and Eve (Genesis 2 & 3), illustrated by PJ
Adam and Eve Had it made Lovely garden Nice bit of shade Didnt need nothing No these and those [these and those = clothes] It was kushti! [great or fine] So it goes.
Chorus: Cos they didn t Adam and Eve it [believe it] When God sa id Oi! Apple leave it!
The serpent Hello sssweetheart! Sssunny day! Sssplendid orchard! Ooooh I sssay! Ssscrummy apple! What a sssight! Go on darlin Have a bite!
Chorus
Adam
Chorus
Ooh! An apple! Just for me Im Hank Marvin! [starving] Time for tea! Thats well tasty Arf a mo! [Arf a mo = half a moment = wait on] Were both starkers! [stark naked] Oh no!
God Big Barney Rubble! [trouble] What are you like? Garden of Eden? On yer bike! From now on Youre Toblerone [all alone] You want grub You grow yer own!
Chorus
Epilogue So they had to Scapa Flow [Scapa pronounced scarper flow = go] Had teapot lids (Thats kids, you know) Heres to Adam! is fork and knife [fork and knife = wife] The first pot and pan [pot and pan = old man = father/husband] With is trouble and strife! [trouble and strife = wife]
Chorus
Amen - innit!
25
HOW I
How I create creativity (2):
Defining who I am
Lesley Johnsons inspiring tale of a collaborative approach to developing narrative in people with learning disabilities owes much to the enthusiasm, imagination and commitment of the Northern Star Community Arts Project, Bacons End Day Centre, Open Storytellers and the Solihull Care Trust clinical psychology and speech and language therapy departments.
Stories give meaning to our lives we are storytelling creatures who are constantly reviewing and interpreting our experiences and making links with what has happened to others. (Storytracks, 2009) istening to other people telling stories whether they are traditional, scary or romantic - helps us to make links with our own lives. It reminds us where we are in our own story, giving us a starting point for aspirations. Being able to tell others about our experiences helps us to evaluate and learn from them and make choices about the future. Being able to share a little of our lives with other people helps us to forge relationships: If you want to know me, then you must know my story, for my story defines who I am (McAdams, 1993, p.11). Yet people with a learning disability, especially those with problems with communication, may not have the skills or the confidence to tell personal anecdotes successfully. Our storytelling project started in September 2007 with an inspiring visit from the Unlimited Company, now called Open storytellers. Four members of the company came including speech and language therapist Nicola Grove and musician Jane Harwood. Their training explained how to set up a storytelling group, and their wonderful practical ideas for structure of the sessions, opening and closing activities and stories are now available in a BILD resource (Grove, 2009). We were fortunate to receive funding from Northern Star Community Arts for the training, contacts with professional storytellers and involvement in a storytelling project to capture the stories of the local community. This notfor-profit community company (Reg 4403293) is supported by the Big Lottery - Reaching Communities, Fair Share, Solihull Community Foundation and Birmingham Community Foundation, and works in partnership with local organisations. With the majority of its work being made possible only through the grant funding and donations it receives, Northern Star remains totally independent of local authority and other statutory control. Importantly for us, it is a small organisation willing READ THIS IF YOU WANT TO GIVE MEANING TO CLIENTS LIVES MOVE OUTSIDE TRADITIONAL SETTINGS DEVELOP MULTIDISCIPLINARY WORKING to embrace new projects and respond quickly to the needs of the local community. We planned the pilot of our project for January 2008. Our aim was to try to measure the effectiveness of storytelling groups. After a taster session for 15 people, 12 people with learning disabilities volunteered to join the storytelling group. Their communication skills ranged from 3-4 word level comprehension, with a much wider range of expression l-r, Karen, Lesley and Debbie Feeney from short, unclear phrases to full sentences. We were able to complete baseline assessThe group ran for 15 weeks over four months, ment with six members of the group using and was divided into three sets. We spent five The Bus Story (Renfrew, 1997) and structural weeks looking at the structure of stories inanalysis of a personal story (Grove, 2009) (fig- cluding setting, key characters and key events. ure 1). We were unable to complete baseline We spent the next five weeks looking at the assessments on the other six members due to emotions portrayed in the stories and the final availability of rooms, staff and people over the five weeks encouraging the telling of personal Christmas period. stories A session plan is in figure 2. Seven staff participated in this project: DebAfter the first few sessions, when everyone bie Feeney, Northern Star; Karen Moore, day was comfortable with the structure, we tended centre co-ordinator; Elaine Jones and Lesley to use four members of staff taking it in turns to Johnson, speech and language therapists; lead. We used three members of staff to each Stacey Carroll, speech and language therapy lead one of three small groups and an addiassistant; Dr Ruth Williams, clinical psycholo- tional member to be free to support individugist and Sophie, a clinical psychology trainee. als who may have needed any assistance durOur objectives were: ing the session. We had access to a small quiet 1. To evaluate storytelling as a therapeutic room should any member need time out. intervention to improve participants ability to Stories were selected to fit with seasons, tratell their own stories and to apply emotional dition, and the choice of the service users. The evaluation to them. collaborative nature of storytelling is the key to 2. To investigate the delivery of psychology this approach. The story is told by the storyteller and speech and language therapy services once through in its entirety, and the second and outside traditional day centres. sometimes third rendition is told collectively by 3. To promote the community presence of peo- Figure Moiras feelings about hernot new flat the1 group. The storyteller does question the ple with a learning disability in partnership group about what happens next but scaffolds with organisations outside the Care Trust. or facilitates the telling of the story.
Figure 1 Structural Analysis of Personal Stories Participants are asked to tell a story about something that has happened to them. Analysis of these personal stories is as follows: Structural features Abstract or preface Setting information Events Resolution Coda Evaluation Meaning Explains what the story is about References to place, time and key protagonists Two or more events which are coherently related to each other What finally happened A pragmatic signal that the narrative has ended Conveying the emotional significance of the event
26
HOW I
The use of collaborative storytelling enabled the group members to practise storytelling techniques. We initially chose familiar traditional tales such as The Gingerbread Man and Rapunzel as these were more easily remembered and therefore retold more accurately. We also chose stories that had key repetitive phrases: for our scary story about a giant, Hairy toe! Hairy toe! I want my hairy toe! occurred throughout the story, enabling immediate and successful participation. Recording these key phrases onto Big Mac communication aids also helped participation and created anticipation. We wanted to teach service users to tell their own stories confidently and with increased coherence. The group work focused on teaching story structure, for example how to set the story geographically and in time, looking at key protagonists and the sequence of events. We placed heavy emphasis on emotional evaluations in stories, helping people to develop some anticipation of emotional reaction. In the final few weeks of the project we encouraged telling of personal stories based on the theme of the main story. For example, when looking at the story of George and the Dragon, we asked, When have you had to be brave? This interestingly brought a host of stories from the group about surviving dental and medical treatment and bullying in the past. The stories we chose towards the end of the project were designed to encourage the telling of personal stories around the themes of choice making, change, and experiences of fear, sadness and happiness. A story from one lady about the happiness of her nieces wedding and the wistfulness of I wished it was me proved quite poignant. Helping people develop the ability to apply emotional evaluation to their own stories supports choice and decision making, person centred planning and increasingly - capacity assessments. Weighing up which personal experiences - or aspects of them - are positive or negative, remembering how you felt and being able to communicate this is an important functional skill. So, how successful were we in meeting our objectives? 1. To evaluate storytelling as a therapeutic intervention to improve participants ability to tell their own stories and to apply emotional evaluation to them. Before and after project results of structural analysis of personal stories are in figure 3. For all but one of the four participating members, the number of events included in personal stories increased and for all of them the number of emotional evaluations increased. The Bus Story (Renfrew, 1997) measures the ability to retell a story by counting key pieces of information. There were clear increases in the Bus Story scores of all six participating members, in half the cases more than doubling (figure 4). The story of one client, DC, is in figure 5 (p.28). Although we had no control group, the measures suggest that this model for thera-
Enabling participation
Figure 2 Session plan
Figure 4 Bus Story scores Participant Scores Jan 08 JO AB DC TP T N 10 13 8 8 7 21 Scores June 09 29 37 16 11 19 34
Figure 3 Structural Analysis of personal stories - scores Participant JO AB DC TP T N Scores Jan 08 Events Evaluations Scores June 08 Events Evaluations
5 3 10 8 3 2 8 7 4 1 9 2 Did not wish to do personal story ( probably due to difficulties with expression) 20 0 17 3
peutic intervention was successful. We did not apply any language analysis to participants stories, as we felt the content or amount of information was most relevant. However, the detail of the transcripts shows more logical sequencing of events in stories and an increase in descriptive language. It is worth noting that, while we can develop and improve the narrative ability in people with a learning disability, they need to have had experiences which they can talk about. Stories are usually events that happen that are out of the ordinary. This group work highlighted that some people either have lives of monotony or need more imaginative ways of recording their experiences to help them retell them. We tried to encourage people to bring in objects, leaflets and photographs of their news, but this relies heavily on the support of staff. We have used communication scrap books in other parts of the service to record special events such as visiting the theatre. We were pleased to notice that, in addition to improvements in narrative ability, participants made progress in listening and responding to stories, which in turn promoted their ability to make and keep relationships within the group. One member of staff com-
mented that, to see someone move from using one word phrases to asking questions and interacting with his group is brilliant. 2. To investigate the delivery of psychology and speech and language therapy services outside traditional day centres Solihulls Adult Learning Disability speech and language therapy service has always provided a service for local day centres, as this is a practical model to gain access in one location to large numbers of service users. As Solihull is currently in consultation with parents, carers and service users about the modernisation of day services, looking to provide more person centred provision, we needed to see how delivering therapy outside the usual model would work practically. Several key points emerged. Firstly the room required for this size of group and type of activity is quite large, and funds are required to rent appropriate rooms and resources, such as chairs, flipchart and refreshments. We are indebted to Northern Star for providing the funds and facility for this project. Secondly, transport to the venue was provided from the local day centre by the centre management. We were very reliant on the efficiency
27
HOW I
of staff and drivers to get the participants to the venue on time. This worked well, although attendance was restricted by the number of places on the bus. Finally, the project could not have happened without the member of staff released from the day centre. Karen Moore accompanied participants, organised packed lunches and medication and supported psychology and speech and language therapy staff who did not know all the participants well - with guidelines and risk management. Although Karen was generally there, the management at the day centre also made a commitment to provide cover when she was not available. Karen developed significant storytelling and group management skills during the project and reports, Storytelling has changed my practice as it shows how empowerment of a hero or heroine can change someones life path. It gives the service user the tools to evaluate past, present and future experiences. Clearly a number of organisational factors need to be in place before a project of this nature can be successful. In our case, the contributions of Northern Star and management and staff at Bacons End were critical. 3. To promote the community presence of people with a learning disability in partnership with organisations outside the care trust The storytelling group was held in a room rented for us by Northern Star in a local church. The group was held on the same day as the church provided a luncheon club for the local community. As the weeks progressed, we observed an increase in conversations between group members and other people attending the church. Northern Star also facilitated professional storytellers to come to the church, sometimes just to tell stories to our group but sometimes for the local community. Our group was therefore able to join in storytelling events within the community setting with other people who lived in the vicinity. Northern Star had also commissioned a professional storyteller to collect and tell stories from different groups of people within the local area, ranging from reminiscences of older people to current tales from the young. Northern Star facilitated the involvement of our group, helping them create their own story to be included in the published collection and to be part of the celebration with the rest of the community. All 12 participants, when asked, stated they particularly enjoyed being able to access this group in a venue outside the day centre. Although Debbie Feeney had worked with professional storytellers providing the local community with access to storytelling events, this was her first experience of working with people with a learning disability. Her view is that, it moves storytelling beyond entertainment its doing something worthwhile with storytelling. Since this project Northern Star has provided several new projects for peo-
Figure 5 Debbie C. Debbie is a 41 year old lady, who lives at home with her parents. She has 3 word level comprehension. She is highly motivated to initiate conversation but finds keeping to topic, identifying and naming of facial expressions and maintaining attention difficult. Severe anxiety can lead to some negative behaviour. To enable Debbie to get the most out of the group we needed staff from Bacons End to be very vigilant in providing reassurance as needed while she was on the bus journey. Debbie initially found it very difficult to hear stories that involved weather, especially storms and loud noises. At first she was not able to explain why she disliked this so much but, as time went on, she was able to explain her fear of being struck by lightning. This was so pronounced that we needed extra lighting on particularly dull days in order to keep her attention on the activities and not the weather outside. Over the time of the group, Debbies tolerance of weather stories increased, as did her attention and listening skills measured using EKOS (Johnson & Elias, 2002). Her Bus Story score also doubled.
Debbie enjoys a story
A professional storyteller
ple with learning disabilities, all based in the churchs community rooms. Service users particularly enjoy the luncheon club and craft workshops.
Resources Open storytellers - www.openstorytellers.org.uk Storytracks www.storytracks.co.uk References Grove, N. (2007) Exploring the absence of high points in story reminiscence with carers of people with profound disabilities, Journal of Policy and Practice in Intellectual Disabilities 4(4), pp.252-260 Grove, N. (2009) Learning to tell a handbook for inclusive storytelling. Glasgow: BILD Publications. Grove, N. & Harwood, J. (2007) How storytelling contributes to quality of life for people with learning disabilities. SLD Experience 48, pp.27-30. Johnson, M. & Elias, A. (2002) East Kent Outcome System for speech and language therapy. Ashford: Eastern and Coastal Kent Community Services. Contact Annie.Elias@ eastcoastkent.nhs.uk. McAdams, D.P. (1993) The Stories We Live By: Personal Myths and the Making of the Self. New York: Guilford Press. Renfrew, C. (1997) The Bus Story Test. Milton Keynes: Speechmark Publishing.
Positive experience
Delivering this type of intervention outside the traditional day centre proved to be a positive experience for both service users and the community in which we worked. I had not conducted a group over such a long period as five months before. Whilst it demanded rigorous planning, I felt it led to greater knowledge of the group members and greater insight into their communicative difficulties. Developing this approach with colleagues in clinical psychology gave us a better understanding of each others roles. Although the number of completed data sets was small, we felt that overall we made a positive improvement in the development of peoples narrative ability thereby improving self-esteem and the ability to reflect on experiences. Interactive storytelling can only serve to assist people in planning their services and enable more effective choice making: The personal story needing to understand who I am where I live work and play comes before understanding the abstract concept of where I want to be in the future (Grove & Harwood, 2007). SLTP Lesley Johnson is a speech and language therapist with Solihull Care Trust, e-mail Lesley. Johnson@solihull-ct.nhs.uk. The letter she used to seek consent from service users for inclusion of their scores and photos is at www.speechmag. com/Members/Extras.
REFLECTIONS DO I VALUE STORYTELLING AS A LIFE-AFFIRMING THERAPY TOOL? DO I FACILITATE RECORDING OF CLIENTS OUT-OF-THE-ORDINARY EXPERIENCES? DO I LOOK FOR OPPORTUNITIES TO INCREASE MY CLIENTS COMMUNITY PRESENCE?
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In Brief...
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`In Brief is a new section of Speech & Language Therapy in Practice for 2009 suggested by readers to showcase short, practical ideas. One lucky contributor in each issue will receive 50 in vouchers from Speechmark, a company which publishes a wide range of practical resources for health and education professionals working with people of all ages (visit www. speechmark.net for more information). Brief items (up to 500 words) may include therapy or assessment tips or a description of a resource you have developed. It may also be a reflection on the best piece of advice I have been given, or the things I wish theyd told me at University. Although what you write will be substantially your own work, please acknowledge any influences. E-mail your entries to avrilnicoll@speechmag.com.
Non Thwaite and Gwenan Roberts consider what, with the benefit of experience, they wish they had known before... One thing at a time
ve always been rubbish with understanding times and dates. The 24 hour clock is a mystery that once made me misunderstand and miss a plane flight home from Bolivia. I have no clue which months contain 28 days, and tend to triple book social dates as I have a vacuum where my mental calendar should be. I still hang on to the childhood idea that the summer holidays are an endless stretch of everlasting days and am shocked when a new term begins. Visual tools are something I constantly recommend for the children and adults on my caseload as the concepts of time and dates are so abstract and difficult for them. Its gradually dawned on me how important visual tools are for my own use too. I wish, that when I first started working, a version of myself from the future had drilled into me the habit of timetabling timetablewriting time into each month. Ive learnt that I need to see what Im doing for the whole month ahead on a crisp, organised page. This stops me from booking too much in or having an event sprung on me as I turn a diary page. Ive learnt that drawing happy faces on annual leave days and using different coloured highlighters for meetings, locations and appointments make me feel calm and happy. I get an absurd satisfaction from drawing a line through a day thats been done. Another top tip I would have given myself would be write down what youre going to do before you do it, then do it and only do that until youre done. This helps me focus on one thing at a time, rather than buzzing around biting small bits from my to do list or becoming distracted with thoughts of Ill just make this phone call / check my e mails / talk to the social worker. Unless I write down what Im going to do before I do it, these thoughts tend to turn into actions and, before I know it, I havent completed the action I first intended to do.
Writing something down before I do it puts a little pause into proceedings and makes me more aware of what I want to be doing rather than reacting instantly to thoughts. Amazingly enough, Ive learnt that its only really possible to do one thing at a time no matter how much I think I can multitask. Again, the simple act of writing down what I need to do, doing it then crossing it out leads to feelings of calmness and efficiency. These skills come as easy as breathing for some therapists but are ones Ive had to learn from copying organised peoples habits and reading time management books. In a job that needs huge amounts of organisation and flexibility, involving being in a plethora of different places every week, my monthly timetable and writing any task down before doing it are tremendously useful tools for me. Non Thwaite is a highly specialist speech and language therapist, Learning Disability Team, Betsi Cadwaladr University Health Board. Recommended reading Forster, M. (2006) Do it Tomorrow and Other Secrets of Time Management. London: Hodder & Stoughton. Maurer, R. (2004) One Small Step Can Change Your Life: The Kaizen Way. New York: Workman Publishing.
Some time ago I attended an eight week Mindfulness course at Bangor University (http://www.bangor.ac.uk/mindfulness/) and wished that I had learnt this so much earlier in my career. Instead of holding on and trying to control changes, I have learnt to let go and accept the possibilities of opportunity. I have learnt to observe my reactions and thoughts and realise that they are just that reactions and thoughts. I have learnt that things will be harder if I try and pull against letting go, and waiting to see how things will pan out, lets me get on with the things that I am doing now, rather than spend my time worrying about the things that may never happen. I dont know how I will react tomorrow, I dont know how things will be, but right now things are just as they should be. Gwenan Roberts is a consultant speech and language therapist (learning disabilities) with Betsi Cadwaladr University Health Board.
Just as they should be
hanges, changes, changes! The only thing that we can be certain of is that things never stay the same. Having worked in the NHS for close on 30 years I have seen more than my fair share. Each time a new set of changes are suggested, I feel the fear and the panic arise as I anticipate a loss of control of a way of working that I understand and know. That is until now...
Non and Gwenan wrote these pieces during a writing for publication workshop in Llanfairfechan with Speech & Language Therapy in Practice editor Avril Nicoll. Avril is happy to arrange this for any group of speech and language therapists (minimum of 10). It takes around 3 hours. Non says that for her the workshop was confidence boosting, and made me think that ideas or practice we may consider as ordinary or humdrum may be extraordinary, useful or reassuring to other therapists, and therefore that its worth sharing them. For more information, telephone Avril on 01561 377415.

Speech &amp; Language Therapy in Practice, Winter 2009

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