COVER STORY: HOW I

Learning by teaching
As a Regional Makaton Tutor, Non Thwaite has a special interest in the transfer of training in the use of sign to everyday settings. Having discovered the potential of giving pupils the power to teach Makaton to staff, Non carried out a promising Makaton peer tutor pilot project with the support of an Action Learning Set of other therapists, a clinical psychologist and a university lecturer.
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How I get signing into practice (2):

ven though Makaton workshops are met with enthusiasm and receive great feedback, skills learnt arent always transferred to and used in the everyday settings of participants as much as they could be. Since qualifying as a Regional Makaton Tutor Ive been exploring ways of addressing this, particularly at Ysgol Pendalar, a special needs school in Caernarfon, North Wales, because we are aiming for a Centre of Excellence Award from the Makaton Charity. To obtain then keep - the award, a high standard of signing and symbol use by all staff has to be achieved. This would be a strong incentive for the school to maintain excellent standards of Makaton use, thereby having a positive impact on the communication environment for the pupils. I sent a questionnaire to school staff at Ysgol Pendalar to find out what helped and hindered them to use Makaton. One trend was that staff felt less confident signing in the presence of professionals such as me, and more confident when they were with children who signed. This set me thinking - why not reverse things and allow the children to adopt the role of a Makaton tutor? I set up a mini project in 2008 to introduce signing to fringe members of staff. I asked for volunteers amongst the older pupils to teach some basic Makaton signs to the taxi drivers and escorts whilst they waited for the school doors to open at the end of the day. I didnt formally evaluate this, but could see the pupils and taxi staff enjoyed themselves. It seemed an effective way of introducing signing, and less intimidating than if I had done it myself. I had also been inspired by Tamsin Crothers of 1Voice when she spoke about the importance of AAC users having role models (Claxton & Crothers, 2007). I started thinking that, if some older pupils acted as peer tutors to younger pupils, they could possibly teach and consolidate new skills, act as positive role models, and maybe even encourage staff to sign more. Topping (2005) states the benefits of peer tutoring are well documented and reciprocal; this effect is described as learning by teaching.

Cover photo of (l-r) Ashlee, Non and Jieu by Steve Ford, www.stephenfordphotgraphy.co.uk

Although there is research supporting the use of peer tutoring in mainstream and special needs schools, I havent been able to find any that specifically looks at AAC. I discussed my ideas with my line manager who facilitated a meeting with Steve Noone, Clinical Psychologist. Following this an Action Learning Set was established whose membership consisted of speech and language therapists from the Learning Disability Team, Steve Noone and Dr Carl Hughes, Co-Director of the Applied Behaviour

Analysis course at Bangor University. This group provided me with support and encouragement to develop my ideas into a pilot project. If it hadnt been for the group I probably would have set up the project quickly without much thought about formalising data collection and evaluation. Too often I think that we as therapists have great ideas that, with some reins, thinking and planning, could be developed into valuable evaluation projects. The group helped me think in a

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COVER STORY: HOW I

Figure 1 Number of times Jieu signed spontaneously while looking through the book Pre intervention 2 Immediately post intervention 22 1 month post intervention 18 2 months post intervention 20

more systematic way and took the mystery out of research. I realised it doesnt have to be complex - in fact, they encouraged me to slim things down. I learnt that if the project was to throw out more questions than it answered, this would only be a good thing. I remember being surprised when some completed questionnaires were labelled as really good data. On discussion, I realised what a fortunate position we are in as practising clinicians. We have a rich source of data at our fingertips and, because of the relationship we have with school staff, its not a problem to obtain it.

days. The sessions took place on beanbags in the reading room of Jieus classroom, a quiet and familiar place. The sessions were videotaped by the classroom assistant and lasted about ten minutes. Jieu sat on my knee and, although I didnt take an active part in the storytelling, I prompted Ashlee when she made a very occasional mistake and praised and encouraged both Ashlee and Jieu. I looked at the effect of the intervention on Jieu in several ways: Baseline Data 1. Multiple Probe testing a few weeks before intervention and immediately before intervention: Asking Jieu to imitate my signs (can you do this?) Asking Jieu to sign to a verbal command (can you sign biscuit?) Testing his comprehension of the signs (Wheres the biscuit?) Testing his expressive signing in response to a visual prompt (show him a picture of a biscuit / actual biscuit and ask Whats this?) 2. I asked Jieus teacher to keep data regarding the signs he used (spontaneous and imitated) before intervention 3. I looked at the story book with Jieu to see if / what he would spontaneously sign before the intervention Data collection during intervention 1. Video of each of the five sessions 2. Jieus teacher to keep data on the signs used throughout the day during the intervention period. Data collection after intervention 1. Multiple Probe Testing repeated 2. Teacher to continue to keep data 3. Looked at the story with Jieu to see if / what he spontaneously signed immediately after the last session, and then a few months post intervention. Pre intervention, Jieu only signed twice whilst looking at the story. Post intervention, Jieu signed up to 22 times whilst looking at the book, and this effect seemed to be maintained over time (figure 1). According to Jieus teacher he also generalised some of the signs (such as sand) to the classroom setting. Of the ten signs used in the story, Jieu signed seven of them, with sand and biscuit being signed the most. Interestingly, in one of the pre intervention assessments, Jieu was very interested in obtaining the sand and biscuit. This seems to

Creative

As I enjoy creative writing I decided to write a short story that the peer tutor could read and sign to the younger pupil. I devised a simple story about a mischievous teddy and dolly. The language was at a one to three key word level. I selected functional vocabulary that would be useful in the everyday life of the classroom, including teddy, dolly, sand, biscuit, yes, no, more, eat, look and bye. The left page included the script of the story along with matching symbols on Velcro strips. The right hand page had a cartoon picture to match what was being said and signed. Teachers from the primary and secondary areas identified Ashlee and Jieu as suitable candidates. Ashlee attends the Older Unit where she receives her education as well as work experience opportunities. She is a sociable young woman who has well developed expressive language, excellent memory, well developed literacy skills and a good level of comprehension of spoken language. Jieu is in the youngest class of the school. He expresses himself mostly with signs, symbols, some vocalisations / words and body language. He enjoys looking at books, making jigsaws and singing, especially the Bob the Builder theme. Both Ashlee and Jieus parents gave written consent for their children to be involved. The first part of the project involved teaching the story to Ashlee, the peer tutor, until she was fluent at reading and signing the story. We met three times and followed a Model, Teach, Test style of teaching. I modelled the story (Model) then we read and signed through the story together (Teach) and then Ashlee read and signed the story by herself (Test). This gave a definite, predictable and safe shape to our sessions and was an effective way for her to learn. Once Ashlee was fluent, we arranged for her to read the story to Jieu once a day over five

confirm that signs which represent attractive or motivating items are often picked up and used quicker. No significant effects were seen on the multiple probe assessment when post and pre intervention data was compared. However, whilst watching the video clips, I observed many positive changes. It became apparent that the quality and accuracy of Jieus signs for look and biscuit improved as the sessions went on. This is a very positive effect as it will make Jieus communication easier for others to understand. Jieu communicated in a multi modal way during the session, sometimes pointing to symbols then signing them, and quite often vocalising or saying close approximations to words as he signed. Questionnaires from teaching staff completed seven months post intervention were positive. Jieus teacher felt that he had benefited by learning new signs which he still uses, thus suggesting that Jieu had generalised what he had learnt during the storytelling sessions to other environments. I asked staff if they would do anything different in future as a result of the project. Responses included a suggestion to leave a copy of the story book in class so that Jieu could become a peer tutor himself to other members of his class, and a new story book to develop the project further. One teacher responded that he was going to make more of an effort to use Makaton to aid pupils comprehension and communication skills. Another member of staff said she had learnt that repetition of a signed story was an effective way of teaching new signs. Effects on self-esteem can be hard to quantify, but observations and comments suggest that taking part in the project had a positive effect on the peer tutors self-esteem and confidence. Both teachers reported that Ashlees self confidence had grown as a result of being a peer tutor. On the first day, Ashlee was noticeably shy, walking down the corridor with tense shoulders. By day five, she skipped. Ashlee said that reading the story to Jieu made her feel good and happy and that her mum was proud of her. Both Jieu and Ashlee seemed to enjoy the sessions and the staff questionnaires confirmed that they thought this too. Both received a star of the week badge in assembly for their involvement in the project. Video clips were shown during school assembly to share their success with the rest of the school. The project had a nice ripple effect. More than one teacher said to Ashlee that they were impressed with and proud of her. One day, on the way back to class after a session, a

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teacher from another class asked Ashlee what she had been up to - and Ashlee walked in and spontaneously read and signed the story to that whole class. The teacher was amazed that Ashlee knew all she did, and actually learnt a few signs from watching her. Whilst teaching the story to Ashlee we both looked back at the video of our sessions. This worked as a powerful reinforcer for Ashlee as I was able to point out the positive bits where she did really well. Jieu also taught some signs to Ashlee, for example from Old MacDonald, so the learning was two-way. I hypothesised that Jieu would learn new signs from Ashlee but I hadnt considered that he would take any notice of the sentence strips and symbols included in the story book as a prompt and reading support for Ashlee. Jieu was really interested in these, tearing off the Velcroed sentence strips, and often pointing to symbols above words before signing them. This shows the potential positive effect on literacy skills. I think he was interested in being able to physically handle the sentence strips by tearing them off. e. encouraging school staff to repeat similar ideas and to make more of an effort to use Makaton signing f. developing ideas within the school regarding integrating peer tutoring into the curriculum g. gathering evidence to help Ysgol Pendalar gain a Centre of Excellence award h. giving me huge job satisfaction! So far three students from the Applied Behaviour Analysis (ABA) Masters at Bangor University have used my project as a basis for their research thesis. Ive been involved with the planning and procedure aspects of their research, giving advice on clinical aspects such as using Talking Mats as a measure of self-esteem with the peer tutors, and how to pitch language. One aspect I advised on was involving the peer tutors classroom assistants rather than the ABA students in teaching the story book to the peer tutors. I wanted school Acknowledgements Id like to thank the many people whove been involved in this project: Gwenan Roberts and the learning disabilities speech and language therapy team for their support as well as members of the Action Learning Set including Steve Noone and Carl Hughes; Pete Jones who drew the gorgeous cartoons to go with the story; Val Jones, speech and language therapy assistant, for all the laminating and Velcro work; Wendi Evans (Assistant Head, Makaton Co-ordinator, Local Makaton Tutor and Jieus teacher); Clare (Jieus classroom assistant and brilliant camera woman during the project); Geraint Roberts (Ashlees classroom teacher) and Ieuan Roberts (Headmaster) for all their support, generous time and for allowing me the opportunity to do the project at Ysgol Pendalar. Id also like to thank Ashlee and Jieus parents for consenting to their involvement. My biggest thanks go to Ashlee and Jieu, who were brilliant, taught me a lot, and whose company I enjoyed very much. References Claxton, K. & Crothers, T. (2007) Role Models: Who Needs em?, Communication Matters 21(1), pp. 2-4. Available at: http://www. communicationmatters.org.uk/page/cmj2007 (Accessed: 18 January 2011). Hooper, H. & Walker, M. (2002) Makaton peer tutoring evaluation: 10 years on, British Journal of Learning Disabilities 30(1), pp.38-42(5). Topping, K.J. (2005) Trends in Peer Learning, Educational Psychology, 25(6), pp.631-645. Resources ABA Masters, Bangor - www.bangor.ac.uk/ psychology/postgraduate/masters/aba.php Action Learning Sets see www. actionlearningsets.com/php/news.php?id=4 ASDAN - www.asdan.org.uk/ Makaton - www.makaton.org/ 1Voice - www.1voice.info/ Talking Mats - www.talkingmats.com/

Impact on behaviour

The videos captured a clear link between language levels / visuals and behaviour. When I tested Jieu on his ability to sign to verbal command can you sign biscuit? he withdrew and became agitated. He was much more involved when the tests were visually supported (with signs and or symbols). I felt uncomfortable using verbal commands alone to communicate with Jieu as it wasnt fair on him, therefore discontinued this aspect of the multiple probe assessment. This type of video clip would be useful during training as an example to show that how we communicate has an impact on someones level of comprehension and, consequently, their behaviour. I also sent out a brief questionnaire to Jieu and Ashlees parents asking them for feedback. Jieus parents wrote, The project did help Jieu a lot to do Makaton signs. Hes been using them at home. Hes so brilliant at it. Well done and thank you very much for your help. Ashlees parents wrote, Ashlee really enjoyed the project and enjoyed the responsibility - it made her feel really grown up! The teacher of the secondary age pupils is considering including this peer tutoring work as part of the ASDAN accreditation scheme in the future. The peer tutoring project had many positive effects including a. developing the frequency and accuracy of the tutees ability to sign whilst looking at a story book, with anecdotal evidence of generalisation to everyday situations b. providing the tutee with a role model who uses Makaton signing c. an increase in the peer tutors self-esteem and confidence d. an opportunity to show Makaton in action and its benefits to the whole school

I wanted school staff to be empowered to run similar sessions independently in the future and also to make sure that the whole school was an integral part of the research
staff to be empowered to run similar sessions independently in the future and also to make sure that the whole school was an integral part of the research. Research has shown that, where peer tutoring schemes using Makaton have been set up, they were only maintained in establishments where a facilitator remained (Hooper & Walker, 2002). I therefore felt it was imperative to have school staff as facilitators. The project has been expanded and includes a number of peer tutors and tutees as well as a control group. Initial results appear positive and the students are writing up their theses. From chatting to some of the peer tutors they seem very proud of the work theyve done and are keen to do more. A classroom assistant asked me when the next story book would be coming out, so its good to know that this is an approach that generates enthusiasm amongst both pupils and staff. I would encourage therapists to liaise and set up links with their local university. There is much to be learnt and - similar to peer tutoring - its not a one sided relationship as, during meetings, it felt as though the learning SLTP occurring was reciprocal. Non Thwaite is a Highly Specialist Speech and Language Therapist with Betsi Cadwaladr University Health Board, and a Regional Makaton Tutor, email Non.Thwaite@wales.nhs.uk.

REFLECTIONS DO I APPRECIATE HOW MUCH DATA IS POTENTIALLY AVAILABLE TO ME THROUGH CLIENTS AND COLLEAGUES? DO I LOOK FOR SUPPORT TO TRY OUT NEW IDEAS MORE SYSTEMATICALLY? DO I MAKE USE OF MY OTHER TALENTS AND HOBBIES IN MY WORK?
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