HOW I

HOW I EXTEND THE REACH

READ THIS IF YOU WANT TO ENCOURAGE OTHER AGENCIES TO TAKE THE LEAD TAP INTO ALTERNATIVE BUDGETARY SOURCES TARGET PEOPLE WHO MAY BE EXCLUDED FROM THERAPY

HOW I (1):

THE MOVE TOWARDS INTEGRATING CHILDRENS SERVICES IS A COMMON STRATEGY ACROSS THE UK (RCSLT, 2006) BUT LEARNING TO WORK MORE CLOSELY WITH OTHER AGENCIES IS NOT A STRAIGHTFORWARD TASK. OUR CONTRIBUTORS HERE FOCUS ON TWO IMAGINATIVE PARTNERSHIP PROJECTS THAT ARE SUCCEEDING IN BREAKING DOWN BARRIERS. Reference RCSLT (2006) Communicating Quality 3. London: Royal College of Speech & Language Therapists.

Preparing for independence

WITH MANY CHILDREN UNABLE TO ACCESS THERAPY, SCHOOL TRAINING NEEDS UNMET AND JOBS FOR NEW GRADUATES AT A PREMIUM, A 6 MONTH COLLABORATIVE PROJECT BETWEEN A CLUSTER OF PRIMARY SCHOOLS AND A SPEECH AND LANGUAGE THERAPY SERVICE OFFERS ONE SOLUTION. DEBBIE HALDEN, KIRSTY FERGUSON AND JILL KENNEDY REPORT.

EXTENDING THE REACH (1) PREPARING FOR INDEPENDENCE EXTENDING THE REACH (2) FUNDING GAPS PRACTICAL POINTS: EXTENDING THE REACH 1. 2. 3. 4. 5. 6. 7. 8. Start from a strategic level Clarify consent issues Consider skill mix Include direct therapy in the package Support others to develop their skills Provide resource materials Offer training Consider rewards and incentives for participation 9. Evaluate outcomes 10. Promote your service

est Lothian primary schools are divided into eleven cluster groups related to the eleven secondary schools into which they feed. In common with other areas, the St Kentigerns cluster has a large number of children with speech and language difficulties in their schools. Many are no longer on speech and language therapy caseloads, having been discharged for failing to attend. Others are not designated a high enough priority to receive regular therapy. Each cluster group receives a small budget to spend independently to promote the aims of its forward plan. The St Kentigerns cluster head teachers initially suggested using six months of this budget to fund speech and language therapy assistants to work in the ten primary schools. As this would have led to a high need for training and supervision, they agreed to the paediatric speech and language therapy leads alternative suggestion of employing two new graduate therapists. As well as giving the opportunity for close collaborative working between teachers and therapists, this initiative would provide the schools with people who already had basic knowledge and could be supervised more easily.

Moves the focus

This cluster group project provided an excellent opportunity for developing input along the lines of the Service Model for Packages of Support outlined in a recent position paper from the Royal College of Speech & Language Therapists (Gascoigne, 2006). This moves the focus of therapy away from the speech and language therapist taking the lead in intervention and impairment towards preparing schools to take the lead in working with the child at the level of participation. Before the speech and language therapists were employed, meetings took place between the head teachers of the primary schools involved and the paediatric lead speech and language therapist to exchange ideas and discuss the feasibility of providing for these needs. The head teachers were keen that school support staff, class teachers and support for learning teachers should receive training and the opportunity to work in close collaboration with the

therapists. They also made requests for social skills training and phonological awareness work. Kirsty Ferguson and Jill Kennedy were employed for six months, each providing eight sessions to the primary schools in the cluster group. The cluster provided the funding and the speech and language therapy service had management and employment responsibility. Five schools were allocated to each therapist. The other four sessions came from more experienced therapists who initiated the social skills training, provided in-service training to teachers and support/classroom assistants and provided supervision for the project. Supervision for Kirsty and Jill was provided at two levels. Firstly, on a fortnightly basis, they received clinical supervision from an experienced therapist who was able to discuss the management of individual cases with them. Secondly, Debbie provided supervision at a project level to check that all aims such as liaising with school staff, introducing phonological awareness groups, organising parental awareness sessions and responding to other requests from the schools were being systematically addressed. This ensured a tight roll out programme so that all agreed aims were covered in the six months of the project. At the beginning Kirsty and Jill met with individual head teachers to discuss the needs within their school and the amount of support assistant time that would be available. They carried out assessment of new referrals and children on the caseload and started individual therapy. At the same time, we offered in-service training to the schools. Support / classroom assistants were given a basic overview of comprehension, expressive language and speech difficulties in children. We also offered training to Support for Learning teachers, to provide an overview of Sunnybank Speech Sound Coding, which is widely used by speech and language therapists in West Lothian. This system for developing phonological awareness and phonic skills capitalises on the speech and language impaired childs often strongly developed visual skills by colour coding speech sounds according to their place of articulation, and can eventually include colour

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Figure 1 Comments from children and staff

coding of letters. At this stage we also started social skills training in two schools as a rolling programme. As the social skills groups progressed, Kirsty and Jill used some of their time to assist an experienced therapist so they could continue future groups. Support / classroom assistants also attended to develop skills which would allow them to sustain other groups following the end of the project. We provided detailed social skills packs to support / classroom assistants to help them with future groups. The next initiative we introduced was phonological awareness groups. Discussion took place with head teachers regarding suitable children, which provided the opportunity for children not on the caseload to be involved. We dealt with the issue of consent by not taking the children on to speech and language therapy caseloads. While children who were known to us had individual therapy aims, we only worked with noncaseload children in the context of these groups, teaching them general principles of phonological awareness. We used colour coding as a base for the phonological awareness groups. Support / classroom assistants were given the opportunity to assist so they could continue the groups independently. They provided valuable information about what the children had covered in class regarding sound awareness, which enabled the group content to be immediately relevant. In total, seven phonological awareness groups took place. Having helped in social skills groups run by an experienced therapist, Kirsty and Jill jointly offered social skills groups to other schools. As with the phonological awareness groups, discussions with head teachers led to children who could benefit but who were not on the caseload being offered a place. Again, no consent was sought for noncaseload children as for them we were addressing general aims rather than specifically assessed therapy goals.

Comments from children Social skills groups Dont talk over others Listen Dont fidget Look at the person who is talking I loved the games liked it all I really would have liked the group to go on for a long time Looking at mum when she is talking to me Phonological awareness groups Red sounds are made with the lips Knowing where the sounds are coming from Having fun but learning sounds at the same time Made my work easier

Comments from School Staff Social skills groups More able to take turns Listening skills improved Building confidence More able to stay calm in stressful situations More accepting of others and class group is not as difficult Whole group enjoyed working together and new friendships have been formed Staff confidence increased, good use of strategies in class setting Phonological awareness groups Children are more confident with regard to sound recognition and pronunciation. Positive change in attitude toward reading / Level A [Scottish curriculum] literacy programme/spelling

Suggestions
In addition to the main groups, schools put forward their own suggestions for additional provision. One school asked for help with structured play as they saw such sessions lending themselves to developing childrens social skills. We also saw the opportunity for vocabulary building, so Jill took both ideas into account when planning her input. She was directly involved in structured play for four weeks where she worked alongside a classroom assistant with a group of children who had been identified by the class teacher. Within the structured play sessions we aimed to develop the childrens semantics, vocabulary and social skills while at the same time skilling up the classroom assistant in these areas. Another school suggested a vocabulary and word finding group, prompted by the evident vocabulary deficits in some of the younger children. In this instance all the children included were already on our caseload. The school identified six main topics for the group: clothes, animals, transport, food, the outdoors and home. Detailed plans for each topic were provided so the support assistant could continue the group and work with other groups in a similar way in the future.

We organised a drop-in session for parents of children on the caseload from six schools. It was held at a health centre, which was fairly centrally located for the cluster group schools. We prepared information and advice sheets on comprehension, expressive language, listening, sound system and social skills development. The session gave parents the chance to gain an overview of speech and language development and ask specific questions about their childs therapy. The response to this was poor and in future we would not necessarily offer this unless schools were very keen. At the end of the project we wrote reports for all children on our caseload and gave evaluation questionnaires to all children and staff involved. The questionnaires were designed by an educational psychology research assistant. Results are encouraging, and typical comments are in figure 1. All school staff who returned the questionnaires felt the range of groups offered was successful at meeting the schools needs. Seven out of ten staff responded that needs were met a great deal. Responses from pupils were also positive. Eighteen out of 20 children involved in the social skills groups enjoyed them a lot while 19 of 21 felt that what they had learned had helped them in class. Five out of seven school staff whose children had been involved in social skills groups rated the benefits at the top end of a six point scale. Support staff in one school have already successfully continued a social skills group independently. With respect to the phonological awareness groups, 19 out of 23 children who returned the questionnaire said they enjoyed the group a lot. Seventeen of these children felt that what they had learned helped them in class. All staff who completed questionnaires about phonological awareness groups felt the groups had helped children. Four main positive themes emerged from the project audit: 1. skilling up of staff 2. resources (training / phonological awareness / social skills packs) 3. support given to the groups 4. impact on children. The project provided the opportunity for close collaboration with school staff. Children who had been discharged for failure to attend could effectively ac-

cess regular therapy. Children with severe difficulties could access twice weekly therapy. Also, children who were not on the caseload benefited from speech and language therapy input in areas such as social skills and phonological awareness. We welcomed the chance to work intensively and collaboratively with the school staff in the St Kentigerns cluster group. We would have liked to withdraw more gradually from groups through a period of offering support and advice rather than taking the group lead. Designated time for discussion with class teachers would have been appreciated and we would ideally include this in any similar future projects. An opportunity to negotiate with support / classroom assistants regarding optimum times of groups would be ideal. We plan to approach all cluster groups in West Lothian with the results of the project. One other cluster group has already expressed an interest in spending some of its budget on social skills training. We are keen to market what we can offer. Debbie Halden is a speech and language therapist in West Lothian, e-mail debbie.halden@wlt.scot.nhs.uk. Kirsty Ferguson and Jill Kennedy were the new graduate therapists involved in this project. Kirsty now works in Forth Valley while Jill has remained in West Lothian.

Acknowledgement
Thanks to Kristen Allen, Research Assistant West Lothian Educational Psychology Department for the design and implementation of the audit of the project.

References
Gascoinge, M. (2006) Supporting Children with Speech, Language and Communication Needs within Integrated Childrens Services: RCSLT Position Paper. London: Royal College of Speech & Language Therapists.

Resource
Sunnybank Speech Sound Coding originated at Sunnybank Language Unit in Aberdeen and has been further developed at Crossgates Speech and Language Class, Fife. Further information from Jennifer Reid, eSLTP mail jenniferreid@nhs.net.
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