Summer 2011

Articles from the Summer 2011 Issue

‘Total Communication – Now!’

Smith, C. & Arnold, A. (2011)

An inspiring project to help adults with learning disability and those around them communicate more effectively

Total Communication Now is a project in Devon which creates opportunities in local places for people with learning disability, support workers, other professionals and family carers to create meaningful visual aids to support communication. It also advises organisations on inclusive communication. Hoping to inspire readers to be bold in their ambitions, Charlotte Smith and Andrea Arnold trace the evolution of the project, and emphasise the importance of involvement at a strategic level for securing funding. Mobile kits, the commitment of speech and language therapists across different Trusts, workshops and roadshows, and solution focused and participatory appraisal approaches have all played their part. Examples show how the outcomes have addressed every tier of the Royal College of Speech & Language Therapists model of service delivery (capability in the community, capability in mainstream, capability in specialist learning disabilities services, specialist interventions). Future developments are also discussed.

‘Whose goal is it anyway? Part 2: Getting the process right’

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

The second of our new series offers a flexible framework for a goal negotiation process from first meeting to discharge

Having covered terminology and key principles in the first article of this series, Sam Simpson and Cathy Sparkes now turn to the actual goal negotiation process. Three phases (Initial, Ongoing, Preparation for discharge) and 11 steps are discussed and applied to acute, rehabilitation and community settings. A practical activity invites readers to consider the model in relation to their own service.

‘Communication on probation’

Iredale, R., Parow, B. & Pierpoint, H. (2011)

An exploratory study of speech, language and communication difficulties among offenders completing community sentences

Community sentences allow offenders to undertake rehabilitative programmes and work in the community under supervision of the probation service. Judges and magistrates can select up to 12 different requirements, which often involve verbally mediated interventions, and breaches can mean a return to prison. Rachel Iredale, Beth Parow and Harriet Pierpoint report the findings of their exploratory study of speech, language and communication difficulties among offenders completing community sentences in South Wales, illustrated with quotes from participants. The results are consistent with larger studies into young offenders, in that “communication does seem to be a problem”, and the authors discuss the role speech and language therapists can play. Thanks to Jan Mitchell and Jackie Freer, forensic speech and language therapists in Northumberland, who peer reviewed the first draft of this article.

In Brief – Accent on aphasia

Caroline Newton and Carolyn Bruce draw attention to the practical implications of research which suggests that an unfamiliar accent can have a subtle but significant effect on comprehension in people with aphasia, and possibly other communication difficulties too.

‘Journal club 4: intervention studies’

Reid, J. (2011)

The fourth in our series to take the mystery out of critical appraisal looks at articles based on intervention studies

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 intervention studies. It starts with questions to help readers establish whether the article is reporting an intervention study or something else. Once you have established it is an intervention study, the article offers a 10 question framework for appraising it. The downloadable version of the framework is also available.

‘Read to succeed’

Wright, K. (2011)

A collaborative project to improve the quality of routine book sharing with preschool children in an area of deprivation

Speech and language therapists in the Kensington and Chelsea community early years service to nurseries support staff in children’s centres to create a language-rich learning environment. The aim is to compensate for the high levels of ‘transient’ language and communication difficulties found in areas of social disadvantage. Having noticed the paucity of book use in some settings, the team considered the literature and worked in partnership with the library service to develop the ‘Read to succeed’ programme. Kate Wright explores the challenges they faced in reaching parents, and the more successful strategy of targeting identified practitioners, who have improved the quality of book sharing and incorporated it into their daily routine. An informal observation form of 33 ‘best practice’ interaction / reading strategies and activities is also available.

‘Boundary issues 5: (Over)extended roles’

Armstrong, L. (2011)

Boundary issues: providing an evidence based service to existing clients while evolving a new role

Linda Armstrong provides the fifth response in our series considering everyday events which need to be on our ethical radar screen: ‘You are one of 3.5 whole time equivalents working with adults with acquired neurological, voice and fluency disorders. A full-time member of the team has been evolving a new role. There is no new money, and no benefit to the team’s usual clients. Where before you had the flexibility to adapt and innovate, you are now struggling to provide them with an evidence based service.’ While speech and language therapy always has and will continue to evolve, Linda Armstrong cautions that we need to do this in a strategic way, as new roles without new resources are detrimental to existing services which already have evidence suggesting our involvement can be effective and beneficial.

‘How I use the evidence in dysphagia management (1): Prepared, proactive and preventative’

Harding, C., Smith, C., Harrison, K., Cocks, N. & Vyas, C. (2011)

An evidence-based problem solving framework to support infants and children with complex needs who have difficulties with early feeding, eating and drinking

Community generalist speech and language therapists and developing specialists are increasingly involved with assessing infants who develop feeding problems in the first few days or weeks of life. As well as supporting the family, these therapists want to be able to identify risk indicators in relation to general eating and drinking management. Celia Harding and colleagues review the literature to provide a problem solving framework which aims to support clinical confidence and competence. This encompasses the caseload (children with physical disabilities, developmental delay, prematurity, other medical conditions), the impact of stress, and what we know about the kind of support people want and need. An example is included of a developing specialist therapist putting the framework into practice.

‘How I use the evidence in dysphagia management (2): A question of taste’

Crawford, H. & Bake, J. (2011)

Implementing oral taster programmes with people with learning disabilities and dysphagia who gain their nutrition via PEG

In the past, Hannah Crawford and Julie Bake felt the risk of implementing any level of oral intake with an adult with learning disabilities who was dysphagic and suffered recurrent chest infections was too high to justify. This view changed as they reflected on the ethical and practical issues discussed in key papers and family concerns about the impact on quality of life. They now work towards implementing some level of oral intake for all clients receiving percutaneous endoscopic gastrostomy (PEG) feeds who have shown they want to have this. Decision making is on an individual basis and guided by a framework which considers client preference, clinical experience and best available evidence. Hannah lists the reported and observed benefits, then Julie outlines her work as a nutritional practitioner in implementing a taster programme with a 62 year old gentleman living in a group home.

‘My Top Resources for working with people with dementia’

Balzer, K. (2011)

Ten top ideas for working with people with dementia in community settings

Kate Balzer gathers together the most popular ideas from special interest group SIGDOM’s therapy swap shop of resources for working with people with dementia in the community. These include a presence in care homes, personal objects and Talking Mats.

Well beyond the basics

Speech & Language Therapy in Practice editor Avril Nicoll reflects on a challenging but invigorating two days spent immersed in speech sound disorder assessment, diagnosis and intervention with international expert Caroline Bowen.