Group therapy

Once upon a time in Harrow...

Summer narrative groups give Nicole Goldstein and colleagues in a mainstream schools team the chance to work with children and each other in a different context.
READ THIS IF YOU WANT TO RUN THEME-BASED GROUPS OFFER CLIENTS MORE CREATIVE ACTIVITIES WORK WITH COLLEAGUES IN A DIFFERENT CONTEXT

he mainstream schools team in Harrow provides input to over 70 schools across the borough. For the last six years the team has run week long summer groups based around narrative. In 2006 a former colleague measured progress in the different areas of language and communication targeted in the groups as part of an MSc dissertation. Initial results suggested that statistical progress was made over the week, although further analysis of maintenance of progress is required. In response to findings and experience to date we reviewed various aspects of the groups and made changes for 2007. Previously our referral criteria focused on those children we felt would benefit most, such as those with specific language impairment who typically have a significant discrepancy between their verbal and non-verbal skills and can achieve set targets in a short space of time. However our outcome measures have indicated that the majority of children make progress as a result of the groups, regardless of their diagnosis (delayed language, autistic spectrum disorder, conductive hearing loss with associated language difficulties). In 2007 we therefore broadened the criteria to include any child with language and communication difficulties on the speech and language therapy schools caseload aged between five and eight years who could participate in a group setting

and had no major behavioural difficulties. As a result the number of children referred increased. Planning began at the end of April 2007 when the co-ordinating therapists discussed criteria for the groups and sent referral forms to all therapists. We then had a painstaking prioritisation process involving each therapist ranking the children referred according to the groups inclusion criteria. The co-ordinating therapists then took the top child for each therapist as a priority and worked down the list. This allowed the initial batch of invites to be sent, through school, to twelve children in each of reception, year one, year two and year three classes across all Harrow mainstream schools. Following responses from parents, we sent a second batch and so on until all four groups were filled with ten children. We approached a school in the centre of the borough to host the groups, and they provided four classrooms and access to the playground and hall.
Figure 1 Timetable guide

Relevance

To increase specificity of aims and their relevance to the classroom, we sent a brief questionnaire to teachers of different year groups across Harrow schools. We asked which aspects of language would be most useful to facilitate curriculum access for children in their class, for example following two part instructions / asking or answering wh-questions. Three to four therapists and assistants were assigned to each year group and then the fun began! Each group of therapists chose a story which would provide a theme to base activities around: Reception - Goldilocks and the Three Bears Year One - Gingerbread Man Year Two The Gruffalo (Donaldson & Scheffler, 1999) Year Three - Version of Shrek (Dream Works Animation). A timetable guide (figure 1) provided a structure for the therapists to plan activities which focused on the aims derived

9.15 - 9.30 9.45 - 10.15

Introduction / gelling games and recap of previous day Language, story and / or creative activities

10.15 - 10.30 SNACK TIME 10.30 - 11.15 Language, story and / or creative activities 11.15 - 11.45 Outdoor games / activities 11.45 - 12.00 Story activity and review of the day

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Group therapy

from teachers feedback. This included targeting descriptive language such as big / medium / small; concepts of time like first / last; the concepts why / because; emotions and feelings; and being able to follow instructions of different complexities. Typical gelling activities for the first session included Fruit Salad, Simon Says and Chinese Whispers, or games using a parachute. This was followed by an activity based around the chosen story. In the Goldilocks group, for example, we discussed emotions like scared, angry, excited and upset as they appeared in the story. We then played a game to reinforce these concepts, such as running to the picture of the given emotion or matching a given face to a picture of the emotion. Snack time gave the opportunity to develop requesting skills as well as making choices. The second session of the day was more creative, and followed a plan, do and review format to encourage sequencing skills as suggested in Locke & Beech (2005). For example, having discussed the emotions in the story, the children in the Goldilocks group used decorative icing on biscuits to show different emotions on faces. We split play time into free play - allowing therapists the opportunity to observe social interaction - and structured play with outside games including Duck, Duck, Goose, Grandmothers Footsteps and Whats the Time, Mr. Wolf? In the last section of the day we recapped the story and reviewed the day using the visual timetable. At the end of the week each year group performed a short play of the story. Parents were invited and each child received a certificate.

Positive parents

We gave parents a brief synopsis of the aims and typical daily timetable at the beginning of the week. Each day, we gave children a small piece of homework so parents could reinforce skills taught. On the last day we asked them to complete a feedback form with their child. This showed an extremely positive response to the groups. Thirty of the forty children who accepted a place attended the groups. Twentysix parent / child forms were returned (87 per cent) and, of these, 100 per cent enjoyed the groups. Creative activities were enjoyed the most including making biscuits and painting as well as working as a group, playing outside and making new friends. Other feedback from parents included the group is a great way of helping children learn in the holidays, the group looks very organised, it also helps the child get on with the other children, this group was a great idea, we just wish it was longer than a week. Except for occasional brief feedback when collecting their child, there was no opportunity for therapists to provide any information that may increase parental knowledge or understanding of their childs communication needs. Parent workshops may therefore be an area to develop in the future. Therapists involved in the group were also asked to provide feedback and 100 per cent either strongly agreed or agreed that they enjoyed planning and taking part in the summer groups. All also either strongly agreed or agreed that they had developed their skills during the week by working with other therapists and by observing how different children responded to different types of intervention. Further, 100 per cent either strongly agreed or agreed that the children benefited from the groups, reasoning that

summer groups provide an opportunity to develop attention, language and social skills in an environment designed specifically to target these areas. Summary reports written at the end of the week also facilitate carryover of targeted areas into the school environment by the schools speech and language therapist. The summer groups provide: Intensive therapy for a range of mainstream school children in an environment where they experience success in achieving the aims set out for them. The chance for parents to be involved to an extent, which can be difficult when working in school at term-time. An opportunity for therapists to work in a different environment with colleagues and to see the children they work with in a different context. Overall the groups are a positive experience for all those who participate and -apart from the exhaustion at the end of the week - it is a pleasure to be able to provide this service. Nicole Goldstein now works privately at Ruth Jacobs Childrens Therapy, e-mail goldstein_nicole@hotmail.com. To contact the Harrow team, call Melanie Abba (Principal, SLTP Schools Team) on 0208 869 2476.

References

Donaldson, J. & Scheffler, A. (1999) The Gruffalo. London: Macmillan. Locke, A. & Beech, M. (2005) Teaching Talking. (2nd edn) London: GL Assessment.

REFLECTIONS DO I USE OUTCOME MEASURES TO REFINE INCLUSION CRITERIA FOR DIFFERENT TYPES OF THERAPY? DO I HAVE A SYSTEM THAT GIVES PRIORITY FOR THERAPY TO THOSE MOST LIKELY TO BENEFIT? DO I CONSULT OTHER PROFESSIONALS BEFORE SETTING THERAPY TARGETS?
How has this article been helpful to you? What holiday groups do you run? Let us know via the Summer 08 forum at http://members.speechmag.com/forum/.

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