Spring 2011

Articles from the Spring 2011 Issue

‘Relocation, relocation’

Bamford, K. & Kasch, R. (2011)

An accessible process to put people with learning disabilities in control of where they live

Government policy supports people with learning disabilities to live in a place and with people of their choosing, as owners or tenants, or in residential care. The practicalities of this include having the capacity and means to understand and express choices. Since 2008 Karen Bamford and Rachael Kasch have been involved with an increasing number of capacity to consent assessments regarding change of accommodation. This led to consultation with other professionals and the development of a process map for communication support from initiation of the move through to the move itself. Stage 1 establishes an individual’s understanding of the options using Talking Mats. In Stage 2 the individual is supported to make choices – such as a tenancy arrangement – based on their preferences, needs and financial circumstances. Stage 3 supports the move itself. Karen and Rachael share some of the challenges they have come across with implementation as well as positive feedback.

In Brief:

(1) Joan Murphy and Tracey Oliver on the use of Talking Mats in managing daily living discussions for families affected by dementia and (2) Maggie Robinson suggests a simple easy-to-prepare game for working on phonology.

‘TOPICCal applications’

Adams, C., Gaile, J., Lockton, E. & Freed, J. (2011)

How TOPICC (Targeted Observation of Pragmatics in Children’s Conversations) helps you plan, prioritise and show the outcome of intervention for a child with pragmatic difficulties

Catherine Adams, Jacqueline Gaile, Elaine Lockton and Jenny Freed report on a new assessment procedure developed for an intervention research project with children who have disproportionate difficulty with pragmatics. We are seeing increasing numbers of such children in speech and language therapy clinics, and need a practical format for observation or testing and outcome measurement. As well as not being too time-consuming, this needs to be applicable to a variety of children from preschool to adolescence. The authors based TOPICC on an in-depth research tool, ALICC (Analysis of Language Impaired Children’s Conversation). The process of developing TOPICC’s validity for use with 85 children in the Social Communication Intervention Programme (SCIP) is described. Detail is included of how TOPICC helped the researchers assess and plan intervention for one participant, Charlie (8;4 years), and how his profile changed considerably over the next 6 months. The authors also discuss TOPICC’s advantages and limitations.

‘Whose goal is it anyway? Part 1: A strong foundation’

Simpson, S. & Sparkes, C. (2011)

The first of our new series introduces the terminology, perspectives and key principles of client-centred goal negotiation

As goal negotiation means different things to different people, Sam Simpson and Cathy Sparkes ask readers to complete a practical task to clarify their own understanding. They highlight the importance of early conversations to reach a shared terminology with clients. They then discuss key principles of client involvement, identification of strengths and problems, multidisciplinary team involvement as well as long-term, preliminary and short-term goals and plans of action to achieve them. A second task asks readers to reflect on the extent to which they embrace the core principles in their own practice and service.

‘Reducing the risk’

Guthrie, S. & Roddam, H. (2011)

The challenges of choking incidents and the impact of electronic reporting and training

Choking incidents are stressful for the individual involved and for anyone who has to recognise what is happening and assist. Concerned by the under-diagnosis of dysphagia and increased risk of asphyxiation from choking among people with learning disabilities or mental illness, Susan Guthrie and Hazel Roddam explored how enhanced electronic reporting of choking incidents could help. Susan added 10 additional prompt questions to the standard open questions already in the system to encourage greater detail in reporting and learning from incidents. This was accompanied by staff training workshops. Susan and Hazel reflect on the difference the resulting increase in quantity and quality of reporting has made, and the need for further research to discover strategies for reducing risk.

Here’s one I made earlier

Alison Roberts with more low cost, flexible and fun therapy suggestions for groups: True story and Every cloud.

‘Journal club 3: systematic reviews’

Reid, J. (2011)

The third in our series to take the mystery out of critical appraisal looks at articles based on systematic reviews

Jennifer Reid’s series aims to help readers access the speech and language therapy literature, assess its credibility and decide how to act upon their findings. The content is based on the critical appraisal education format which has evolved in Fife and is delivered through a series of small group journal clubs. This article explains systematic reviews, including those with meta-analysis, and their value to our profession if they are well conducted. Jennifer presents a 9 question appraisal framework for considering articles which are based on systematic reviews. The downloadable version of the framework is available alongside the article.

‘Opening doors’

Clewley, K. (2011)

A 3 stage model including joint client/carer groups for people with aphasia

Kit Clewley found that clients with aphasia improved in the use of communication strategies during speech and language therapy groups but did not generalise this to the home environment or other settings. Carers were also not using communication strategies they had been advised to try. Practice-based research led to the Trust accepting training for carers as an essential part of aphasia management, but generalisation remained an issue. Kit evolved a new 3 stage model which made full use of technical instructors and volunteers. Stage 1 is separate training in parallel for carers and clients. Stage 2 puts clients and carers together to consolidate training. Stage 3 is a functional goals group for clients and carers together. The successes, limitations and future plans for the service are discussed.

‘Boundary issues: Where work and home life meet’

Reynolds, J. (2011)

Boundary issues: Maintaining boundaries through clarity about roles, while not damaging the therapeutic relationship

Joe Reynolds provides the fourth response in our series considering everyday events which need to be on our ethical radar screen: ‘You have just completed a house purchase. When you next visit the property, you recognise the family that has moved in to the house next door. They have a child with severe learning difficulties, and have made several complaints to the NHS body you work for about the speech and language therapy service you provide to the child.’ Recognising this scenario is simply an extreme version of a common experience where work and home life meet, Joe discusses ways to maintain boundaries through clarity about roles, while not damaging the therapeutic relationship.

‘How I get signing into practice (1): It’s Signsational!’

Green, D., Reed, W. & Angier, R. (2011)

A Signsational way for parents, carers and staff to develop the confidence and skills to actually use signs they have learnt 

The speech and language therapy team for people with learning disabilities at Yourhealthcare found that, in spite of a rolling programme of training to encourage parents and carers to use sign in their own environments, they still lacked the confidence and skills to do this. They introduced an intensive course in a community facility that emphasised everyday chatting and interaction. In this article they share their experience of running it three times. Planning, preparation, structure and resources are described, with speech and language therapy assistants vital to the process and music proving particularly useful in both expected and unanticipated ways.

‘How I get signing into practice (2): Learning by teaching’

Thwaite, N. (2011)

A Makaton peer tutor pilot project supported by an ‘Action Learning Set’

However enthusiastically people participate in Makaton training, they don’t necessarily then use signs in their everyday settings. As a Regional Makaton Tutor, Non Thwaite has been working with Ysgol Pendalar, a special needs school, to help them obtain a Makaton Centre of Excellence Award. With staff indicating they felt less confident signing with other professionals, Non asked older pupils to teach basic signs to taxi drivers and escorts at the end of the day. This proved popular, and Non began to hear more about the benefits of peer tutoring for both the older pupil and their younger schoolmate. Non was supported to set up her project in a systematic way through an Action Learning Set of key professionals. She used her creative writing skills to construct an appropriate story and identified Ashlee as the peer tutor and Jieu as the tutee. Non describes the implementation of the project, data collection at baseline and during and after intervention, and the impact of the project on both pupils, their parents, the school, the supporting university and Non herself.

‘My Top Resources as an RCSLT adviser’

Butler, C. (2011)

Personal thoughts on what resources are needed to be a good RCSLT adviser

Claire Butler is a national adviser in dysphagia for the Royal College of Speech & Language Therapists (RCSLT). While she says the role may be quite different from one therapist to another, she offers her personal thoughts on vital resources including an effective organisation system, flexibility and research tools.