early intervention

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Little girl showing a visual dictionary that the teacher has made with all Year 2 sight words.

Improving communication with EAZe

In common with other areas of the country, too many children in Bridgwater enter school with poor communication and literacy levels. Could the inclusion of speech and language therapists in their general education make a difference? Lizzie Astin, Katie Roberts, Emma Withey and Melanie Crawshaw take us on a journey into the classroom through an Education Achievement Zone programme.

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if you are planning to change the way you work need to strengthen partnerships want to encourage multisensory techniques

ducation Achievement Zones (EAZs) were established in areas across the country where attainment levels were low. They are funded in part by the Department for Education and Skills and by the private sector. We were appointed to speech and language therapy posts as part of the Bridgwater Education Achievement Zone Programme. Critically, our brief is to work alongside teachers so that we understand the challenges of teaching and they have the opportunity to develop greater insight into language development. In turn, this influences their practice and the classroom environment, helps them recognise the childrens preferred learning styles, and raises attainment levels. What makes our posts so different is that we work with teachers in whole class situations. This means we dont have caseloads of specific children, see children on an individual basis, write case notes, or draw up individual education plans. Bridgwater EAZs aims are to: 1) raise standards of achievement in the 3-19 year age group; 2) create new opportunities for learners of all ages; and 3) work in partnership with business, industry and the community. These aims will be achieved through programmes that support families and learners, raise the quality of teaching and learning, work in partnership with business and other organisations and join up services to tackle social exclusion. Bridgwater EAZs long-term aims are to ensure that the young people leaving school and further / higher education are: well adjusted young people able to take control of their lives not frustrated and angry because they cannot be understood or understand more likely to be able to secure work/training able to communicate well with family and friends. We were employed from 1 September 2000. Our initial brief was open-ended and broad. We were asked to begin working in Reception and Year 1 classes in eight mainstream primary and infant schools. This gave us a clear target group and the opportunity to work with teachers and establish ways of working which would help children gain access to the curriculum and prevent behavioural problems developing due to children becoming frustrated through a lack of being able to understand tasks set or simple instructions. After seeking advice from a speech and language therapist who worked for an EAZ in Salford, we devised a brief (figure 1a). Before going into the classrooms, we met with groups of teachers and discussed the teachers understanding of communication and their specific planning for language in the curriculum. This discussion stemmed from the brief in figure 1a and a questionnaire (figure 2), which we devised with the support of a research psychologist. We spent time in the classrooms observing and building a rapport with the children, teachers and nonteaching assistants. A random sample was taken for pupil assessment in the form of the British

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Picture Vocabulary Scales II, The Bus Story Test, and the school-age Boehm Test of Basic Concepts. This enabled us to ascertain the childrens average language levels. General weaknesses were found in both receptive and expressive language skills but in most cases they would not be severe enough to warrant being referred for speech and language therapy.

Figure 2 Text of questionnaire Bridgwater E.A.Z. Project Speech and Language Therapist Questionnaire

Good listening

With the agreement of individual teachers, narrative skills and listening skills were addressed initially by working with groups of children. A common complaint from teachers was that the children just werent listening and so this provided a good starting point for us in the schools. Our objective was to increase teachers understanding that listening is an active process that involves a number of skills. We took groups of children out of the classroom and devised sessions that enabled the children to develop an understanding of the rules of good listening and to practise those skills. We started by encouraging the children to look and make eye contact with a speaker. We ensured that there were no particular linguistic or conceptual demands entrenched in the activities. This gave us the opportunity to provide positive feedback to the children in the form of verbal praise, signing and symbols. Once the children had developed good eye contact with the speaker, we used this skill to encourage the children to actively listen and to think about the words they hear. We provided the teachers with session plans and discussed our approach and the children progress with them. It was then that we encouraged the teachers to help the children generalise these skills in the classroom by using the same signs, symbols and vocabulary. This also enabled us to work in the classroom alongside the teacher and gave us an opportunity to reinforce and model the use of positive praise as a vehicle for enhancing self-esteem, confidence and behaviour. We also began to analyse the childrens Bus Story Test scores to discover that the expressive language scores were significantly lower than the receptive results achieved and this also provided a discussion point with teachers. We helped develop childrens narrative skills using big books or topic books. We spent several sessions focusing on the target book: reading, making predictions, clarifying and defining vocabulary, role play, picture description, story sequencing, extending and changing the ending, setting and location of the story. This enabled us to develop our rapport with teachers. We now plan on a regular basis with teachers and work exclusively in the classrooms alongside them, reinforcing, modelling and co-teaching. We also work with teachers to develop materials which support and acknowledge the childrens different learning styles, the goal being to influence teachers practice so all children can access the curriculum. In particular we are encouraging them to use all the principles of Somerset Total Communication which include using signs, symbols, body language, gestures, photos, real objects, drawing and facial expression; this way

What makes our posts so different is that we work with teachers in whole class situations.
Figure 1a EAZ speech and language therapy brief 2000-2001

The EAZ aims to support the acquisition and development of language skills of children in Bridgwater. Your views and comments regarding communication in the classroom would help us greatly. Please could you complete this short questionnaire? Your replies are confidential. Please place the questionnaire in the envelope provided and return to one of the speech and language therapists or the EAZ office. About the project: 1. Are you aware of the aims of the EAZ? NO Please tick YES If you answered yes, please can you state one of the aims? 2. Were you aware that speech and language therapists were part of the project? NO Please tick YES 3. What do you think the role of the speech and language therapist in the school setting is? Please tick all that apply Working with: whole class small group individuals children with speech and language problems Enhancing communication: within the classroom skills of teachers of children with speech and language problems To: provide extra assistance in the classroom joint plan with teachers work alongside teachers liaise with teachers and classroom assistants

to work alongside Reception and Year 1 teachers. to identify possible blocks to childrens learning/accessing the curriculum. to think about and identify possible training needs of staff in schools. to ensure that teachers and others in schools develop a better understanding of language development, and an understanding of childrens preferred learning styles and how this needs to be taken into consideration in teachers planning.

Figure 1b EAZ speech and language therapy brief 2001-2002

To work in partnership with teachers in the classroom to effect change in teacher practice in order that the curriculum is accessible to all children irrespective of preferred learning style. To achieve this objective we will: provide Total Communication language training to whole school communities. This training includes simplifying language and increasing use of Visual, Auditory and Kinaesthetic (VAK) teaching that interlinks with the principles of Teaching for Effective Learning. continue to jointly plan the curriculum with teachers at regularly scheduled intervals throughout the year. model appropriate language and use of visual, auditory and kinaesthetic approaches in the classroom. work in the classroom without withdrawing any groups of children. evaluate the effectiveness of the project through assessment of children, teacher observation and self evaluation. liaise with teachers, special educational needs coordinators and learning support assistants at a mutually agreed time for technical and linguistic support for the use of Total Communication (symbols, signs, etc). continue to link and liaise with the advisory service for Somerset Total Communication, Teaching for Effective Learning, Physical Disability Service, community therapists within Somerset Coast Primary Care Trust.

About Communication: 4. Please can you rate the importance of language in the following areas of the curriculum? [Please rate from 0-5, 0 = not important at all, 5 = very important] Maths Literacy History Science Information Technology Physical education Geography Art English Drama Music Please can you briefly say why you feel some are more important than others 5. How would you recognise the following in your classroom? A child with poor attention A child with language delay Low self-esteem 6. What strategies do you use with a child who has poor comprehension skills? Please tick all that apply Gestures Simplifying language Symbols Placing them near a teacher Slowing down rate of speech Calling their name to gain attention Signing Restricting language to short, Raising voice unambiguous sentences Using shortened instructions Please state any other strategies that you use:

About Planning: 7. Which areas of the curriculum if any do you formally plan for the following social skills? Please write in the box next to each social skill. Listening Eye contact Turn taking Conversation skills Initiation and maintenance of communication
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the needs of the visual and kinaesthetic learners will be addressed. Somerset Total Communication was already being used successfully in early years and some school environments and in day centres in Somerset for adults with learning difficulties. We qualified as Somerset Total Communication trainers and this led to a systematic training programme for staff in school. This training has tried to address the lack of understanding of the importance of multi-sensory communication techniques which need to be used when a childs vocabulary and understanding of words and concepts is limited. This is in the main due to a lack of language and communication training for teachers. The understanding and knowledge we have gained by working alongside teachers has given us the opportunity to take examples of a breakdown in communication between the teacher and child and provide practical ways such problems can be overcome or, more importantly, prevented in the future.

Time to plan
Through training and discussion with teachers and staff we are increasing their knowledge of communication and the necessity for adults to provide children with the appropriate language to access the curriculum. Supply teachers are paid for by the EAZ so there is time for the teachers and speech and language therapists to address the National Curriculum and plan together during the school day. Co-teaching is an excellent opportunity

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1. Office Role play Area - labelled with symbols 2. Display: Seaside vocabulary. Symbols used to encourage the children to use it as an interactive board (eg How many buckets are there?) 3. Visual timetable: Placed at childrens eye level.

to model Somerset Total Communication practice for the teachers and allows them to observe their pupils and another style of teaching. Our brief at the end of the first year was rewritten in the light of what we and staff in schools had learnt and has become more sharply focused (figure 1b, p.9). We hope this will result in changes for the children so they will know what they are expected to do and when, as this will be communicated in a variety of ways. be able to recognise and learn more words because pictures / symbols are there next to the words. know which areas of the room should be used for different activities, therefore avoiding confusion. be able to explain to the teacher what they have just been asked to do, and act on it. be able to learn more because they are allowed to experience more. be praised and encouraged frequently for efforts with communication. know what they have learnt and feel good about this. In some schools work, we have been undertaking has been discussed and supported by the senior management team and/or we have been working closely with the literacy coordinator or special educational needs coordinator. Where this approach has been taken, certain practices have been established across the school. These include visual timetables, importance of using symbols as well as word labels, development of resources and the role of classroom assistants. Teachers are using more visual and kinaesthetic modes of teaching. Classrooms look different. Symbols, drawings and photos are being paired with written text to assist children in accessing the curriculum and their environment. Some teachers have come to believe that symbols are a bridge to literacy which can positively impact on the childrens confidence and self-esteem. We believe we are being successful because we are spending scheduled time each week in specific classrooms. This has allowed us to understand the challenges of teaching and work alongside the

We qualified as Somerset Total Communication trainers and this led to a systematic training programme for staff in school.

teacher. Since we are not just consulting or withdrawing children we have the opportunity to demonstrate different approaches and provide materials to enhance communication. We are training staff and are able to support and follow up on the training. We have had the opportunity to develop strong professional relationships with staff and have unplanned, spontaneous conversations (teachable moments) during class and break times. Initially the time spent in each class was dependent on reading score results and other deprivation factors. Recognising the importance of early intervention, we spent all our time in the Reception and year one classes working alongside teachers and encouraging them to use principles of Somerset Total Communication in their daily classroom practice. This enabled us to introduce the principles to the school and to allow teachers to talk to each other to promote the practice. We have been moving up the schools and are beginning to work in years 2 and 3. Where we work in the school - and what our focus is - is agreed following discussions with the headteacher and their senior management team, and the EAZ project director. It has been very beneficial for us to work together as a team of speech and language therapists on the same project. We have been able to share ideas, learn from each other, provide support, and develop and deliver joint training packages. Between us we have also been able to liaise with speech and language therapy colleagues and others working with a range of children with additional needs and share and develop good practice. We have learnt a lot. Demands faced by schools to deliver curriculum content are considerable and way beyond what we had anticipated. There is a significant difference in the amount of knowledge and expertise in language development teachers have as opposed to speech and language therapists due to the very different training programmes. Many teachers have minimal language training and have little understanding that language acquisition is developmental. Schools have

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..resources...resources...
a lot of people popping in and out to offer advice, so this advice needs to be coordinated. All this can explain why school speech and language therapy programmes do not work optimally unless they are well supported, very specific and ideally linked into the curriculum with a one-to-one support for the child.

ADHD information

Opportunity
This project has provided an opportunity for professionals to work together in a way which is not normally possible for the majority of speech and language therapists or teachers. This has led to good communication becoming recognised as the key to encouraging effective learning. The way we work with colleagues in schools will continue to change and develop. Our plans include working with parents and developing parent/child interaction as children enter school, working with teachers on language development in particular curriculum areas including science and maths, and working with a number of teachers in the secondary sector. Our two professional groups have to work together to address the ever growing complex needs of many children in mainstream education. We need to ensure that what we have learnt is not lost and that health and education work together to provide services in a holistic way which meets the needs of the child/young person rather than the service providers. Lizzie Astin, Katie Roberts, Emma Withey and Melanie Crawshaw are speech and language therapists with Bridgwater Education Achievement Zone which has links with Somerset Coast PCT speech and language therapy service.

A drug company has produced a patient education pack for those affected by attention deficit hyperactivity disorder. Janssen-Cilag Ltd has included information on psychological, educational and social measures as well as drug treatment, along with suggestions for books, support groups and internet sites. The booklet is available from prescribing consultants and the company, tel. 01494 567567, www.concertaXL.co.uk.

Sex after stroke

A new leaflet from the Stroke Association discusses sex after stroke. The importance of communication is emphasised, and readers experiencing language difficulties following a stroke are advised that a speech and language therapist will help them and their partners find suitable ways of communicating their feelings and emotions for each other. Sex after stroke From The Stroke Association, tel. 01604 623933.

Take the bus

A subscription service for nurseries, schools and parents includes interactive learning software for children aged 3-11 linking into the national curriculum. The Big Bus aims to bridge a perceived gap between computer games and curriculum content. For prices and a free taster, see www.thebigbus.com

Software from Crick

ClozePro software, from the makers of Clicker, provides a range of cloze activities customisable for all ages and abilities. Users can for example use it to work on word finding or spelling, both on-screen and as printed worksheets. Single user 90, additional user licence 12. From Crick Software, tel. 0845 1211691, www.cricksoft.com.

Incentive Plus
A speech and language therapy catalogue of resources for promoting effective communication skills in adults and children. Tel 01908 526120, www.incentiveplus.co.uk

Stroke - good practice

The Stroke Association has produced a resource pack for those working in social care with responsibility for planning, commissioning and delivering services for those affected by stroke. The third in a series of guides, it identifies good practice and includes case studies and other sources of information. Stroke - good practice in social care (ref SCP) Stroke - good practice resource pack (ref R1) Stroke - good practice in primary care (ref PCO) All from The Stroke Association, tel. 01604 231000.

Downs syndrome answers

Resources
Contact the Somerset Total Communication Project team at Resources for Learning, Parkway, Bridgwater, Somerset TA6 4RL. Boehm Test of Basic Concepts 3rd ed (Boehm-3) is available from The Psychological Corporation, www.tpc-international.com. British Picture Vocabulary Scales 2nd ed from NFER-Nelson, www.nfer-nelson.co.uk. Bus Story Test by Catherine Renfrew from Speechmark, www.speechmark.net.

Fragile X

Reflections
Do we plan new services in a phased way giving all involved a chance to develop their brief together? Do we do our research first to find out what people already know and where there are gaps? Do we liaise at management and at ground level to ensure developments get established?

The Fragile X Society has published a report of the talks given at its National Family Conference in May 2001. The genetics of Fragile X and their impact and implications for families was discussed by Dr Angela Barnicoat, while Dr Jeremy Turks presentation was Fragile X behaviour reducing the undesirable and enhancing the desirable. Three booklets - Fragile X Syndrome: An introduction / An introduction to educational needs / Education and severe learning difficulties - are available free. Details tel. 01245 231941, e-mail lynne@fragilex2.k-web.co.uk.

The Downs Syndrome Association answers common questions with an updated version of its most popular publication. The Association hopes this format, along with increasing use of audio tape and video, will improve accessibility of its material for people with learning disabilities. People with Downs Syndrome - Your Questions Answered is 2.50 from the DSA, tel. 020 8682 4001, www.downs-syndrome.org.uk.

Voice on the web

Voice experts Gillyanne Kayes and Jeremy Fisher have launched Vocal Process on the web, including a page dedicated to speech and language therapists. www.vocalprocess.net

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