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Dec 2005 • Issue 644
1945-2005
Celebrating 60 years
Looking back at Speech and Language Therapy Week
December 05 cover 25/11/05 12:34 pm Page 1
Royal College of Speechand Language Therapists2 White Hart Yard, London SE1 1NX
Telephone: 020 7378 1200email: [email protected]: www.rcslt.org
President George Cox
Senior LifeVice President Sir Sigmund Sternberg
Vice Presidents Simon Hughes MPBaroness JayBaroness Michie
Chair Sue Roulstone
Deputy Chair Rosalind Gray Rogers
Hon Treasurer Gill Stevenson
ProfessionalDirector Kamini Gadhok
Editor Steven Harulow
Deputy Editor Annie Faulkner
Publications Editor Sarah Gentleman
MarketingOfficer Sandra Burke
Publisher TG Scott(A division of McMillan-Scott plc)
Design Courts Design Ltd
Disclaimer:The bulletin is the monthly magazine of the Royal College of Speech and LanguageTherapists.The views expressed in the bulletinare not necessarily the views of the College.
Publication does not imply endorsement.Publication of advertisements in the bulletin isnot an endorsement of the advertiser or of theproducts and services advertised.
C O N T E N T S
COVER STORY:
Looking back atSpeech andLanguageTherapy WeekSee page 14-16
December 2005 • Issue 644
Megan Hide, SLT at Llandough Hospital
4 Editorial and letters
6 News: 2005 RCSLT Honours; Were you affected by HPC de-registration; Royal opening for Marjon SLT facilities; RCSLT welcomes new Head of Professional Development and more
12 Sarah Hulme discusses a pilot scheme offering innovative training for childcare staff
17 Sue Jones focuses on the issues of prioritisation around the management of a clinical voice disorders caseload
18 Mary Riley and Laura Broadstock report on the positive results of collaboration on language groups for children with moderate learning difficulties
20 Professional issues: The RCSLT's revised standards on CPD
22 Reviews: The latest books and products renewed by SLTs
24 Letters extra: A response to Celia Harding's article on functional nutritive sucking
25 Any questions: Your chance to ask your colleagues and share your knowledge
26 Opinion piece: Geraldine Wotton wonders why there is an 'immaturity of thinking' in working with children who have Down syndrome
27 Specific Interest Groups: The latest meeting and events around the UK
Contents December 22/11/05 4:51 pm Page 1
bulletin December 2005 www.rcslt.org4
editor ia l & let ters
L E T T E R S
Life in the fast lane
Long live the CollegeCongratulations on your excellent
diamond jubilee Bulletin. From cover
to cover, it makes for engrossing
reading.
The '60s years are especially
interesting for me, because I became a
student at The Central School of
Speech and Drama during the early
part of that decade.
Some random reminiscences of my
own: it is gratifying to see a photo of
Jennifer Warner conducting a tutorial.
We students learned a great deal from
her seminars. Miss Warner worked
tremendously hard to mould us into
competent (we hope) SLTs.
All of our teachers, staff and
contracted lecturers alike, were
excellent. In later years I heard and met
Betty Byers Brown at an American
Speech-Language-Hearing Association
convention, in Chicago, I think. I was
also Joan van Thal's last student at the
Royal Dental Hospital in Leicester
Square.
Together with brothers Byrne and
Donegan, I helped the College to move
into the St John's Wood premises. At
that time we male students were
conspicuous by our paucity, so they
had to use whomever they could find.
The lecturers were so used to saying
brother, that once Miss Wynter
inadvertently addressed me as Brother
Lawrence. Unfortunately, I fall far short
of the faith of that illustrious person. I
am still searching for God when I am
washing the dishes, for example.
You have provided us with an
excellent historical overview of the life
of the College and our profession. Best
wishes for the next 60 years and
beyond. Long live the College!
Lawrence Fotheringham
Chatham, Ontario, Canada
Advisers pleaIn response to your story on RCSLT
advisers (Bulletin, August 2005, p10-
11), I would like to make a plea for
more SLT paediatric advisers to step
forward in Scotland.
At the Scottish Education
committee, we really need your
expertise and help in responding to the
ever-growing number of papers we are
asked to comment on.
In Scotland, we have a particular
shortage of paediatric advisers in the
following fields: AAC; dyspraxia; head
injury; head/neck oncology and
learning disability.
If you, or a colleague, would like to
become an adviser, more information
on what the role involves and an
application pack are available on the
RCSLT website, visit:
www.rcslt.org/resources/clinicaladvisers
Fiona Whyte
Bulletin thrives on your letters and emails
Write to the editor, RCSLT, 2 White Hart Yard, London SE1 1NX
email: [email protected] include your postal address and telephone number
Letters may be edited for publication (250 words maximum)
As 2005 rapidly draws to a close, it is
time to draw breath, reflect on what has
happened in the past year and look
forward to the next.From an RCSLT point of view, the past 12 months
have simply flown by. The RCSLT’s diamond jubilee
year saw the signing of the Mutual Recognition
Agreement, the appointment of two new country
policy officers, a major manager’s conference in
April, the launch of the Clinical Guidelines in print
and the completion of the new website, the trial of
the online continuing professional development
diary and, of course, the frenetic activity of Speech
and Language Therapy Week in October (see pages
14-16 for details).
Internally, the RCSLT began a process of
structural change to better equip the organisation
to meet the immediate challenges it faces and make
the most of the opportunities as they present
themselves. This major exercise is still ongoing and
details will be unveiled officially when it is
completed in the new year.
Even at this stage, with my fairly clear diary, 2006
promises to be even busier than 2005. There is a
national RCSLT student study day in February, the
rollout of the RCSLT’s online CPD diary in April
and the Realising the Vision conference from 10-12
May in Belfast.
Add to this an enormous amount of
government-led activity in the four UK countries
that will affect the profession and inevitably occupy
the RCSLT policy team. In England, for example,
this includes the inquiry into special educational
needs, the white paper on education, and the
potential implications of the push towards a
patient-led NHS.
So, dear reader, enjoy whatever you do over the
festive period. I look forward to keeping you up to
date on all the latest speech and language therapy
developments in 2006.
Steven Harulow
Bulletin editor
004-005 22/11/05 4:36 pm Page 4
www.rcslt.org December 2005 bulletin 5
editor ia l & let ters
L E T T E R S c o n t i n u e d
Responding to voice concernsI welcome the opportunity to respond to
the comments made by Louise Bass
regarding the effects of laryngectomy
surgery (Bulletin Supplement, October
2005, p3).
I regret that Louise feels that there is a lack
of understanding and support for the
difficulties experienced by people who have
laryngectomy surgery. As a profession, SLTs
are actively engaged in raising both public and
professional awareness of the issues she raises.
In answer to her concerns regarding the
professional acceptance of the term voice
restoration it may be helpful to clarify terms
that we, as professionals, use.
My understanding is that the term voice
restoration refers only to surgical voice
restoration (SVR). This is a specific
technique, in which a valve is inserted into
a surgically created hole to enable air from
the lungs to be used to produce voice.
As far as I am aware the term voice
restoration is not used to describe any other
methods of speech such as oesophageal or
artificial larynx speech. The term pseudo or
alaryngeal voice more accurately describes
any voice not produced by a voice box.
I have worked as an SLT in the field of
laryngectomy for nearly 35 years, long
before SVR became available. When this
technique was pioneered in the early 1980s
it was a great breakthrough and did indeed
enable many people who would previously
have remained voiceless to have their voices
“restored”.
This does not mean that a valve restores
“normal” voice, but that it is the closest to
normal voice of all other methods, given
the loss of the voice box.
For some their voices are actually better
than before surgery when the cancer caused
the loss of normal voice.
Of course, as Louise rightly says, this
technique does not suit everyone and many
people use a range of alternative methods
of voice rehabilitation very successfully. For
women in particular, the change in voicing
can be markedly different. As SLTs we strive
to provide each individual with the best
and most appropriate method for them and
not be too prescriptive.
I would like to thank Louise for
highlighting her concerns and raising this
debate and would welcome views from
others, both professionals and
laryngectomees. We can only improve our
practice by listening and responding to
issues raised by those using our service.
Kaye Radford
RCSLT adviser in head and neck cancer
email [email protected]
Keep the NHS publicI was pleased to see the emphasis that
RCSLT is putting on responding to
Commissioning a Patient-led NHS, both in
the Bulletin (September 2005, p6) and on
the website (www.rcslt.org
/news/news_commissioning).
Members who share my concerns about
these issues may be interested in the
campaign to keep the NHS public. Visit:
www.keepournhspublic.com and register
your support.
Several SLTs have already signed up to it.
Jenny Sheridan
Susan Wallace was a dedicated and skilled
SLT. She qualified in 1978 at Jordanhill
College where she gained a BSc. After
qualifying she worked in a variety of
locations across Scotland, initially working
in Dundee and for the past 17 years in Glasgow.
Much of Susan's work as an SLT was dedicated to adults with
learning disabilities (ALD) and she was an acknowledged expert
and RCSLT adviser in this field. She played a significant role in
shaping the speech and language therapy adult learning disability
service in Glasgow, from Lennox Castle Hospital to the current
community-based teams.
As a clinician, Susan was a great advocate for her clients and was
tireless in her efforts to ensure their communication and dysphagia
needs were addressed. At management level she campaigned to
ensure service managers and planners of strategy were aware of the
communication issues that surround people with learning
disabilities, their environments and within wider communities.
As a highly regarded colleague, Susan shared many long
conversations, exchanging and exploring ideas, always striving to
achieve the best for the clients she worked with. Sound values, a
warm heart, thoughtfulness and a wealth of experience and
knowledge shone through in all aspects of her work.
Susan developed a special interest in learning disability and
hearing impairment, and became very skilled and knowledgeable
in this area. She raised awareness around this unmet need and
together with audiology colleagues campaigned for flexible,
sensitive and responsive services to fill the gap.
More recently, Susan represented Scottish therapists at the ALD
leads group at the RCSLT. Speech and language therapists in
Scotland will recall her for her enquiring mind, always asking the
questions that others were struggling to articulate.
A devoted daughter, wife and mother, Susan would regale her
colleagues with many a story about her family. She was especially
proud of her daughter Sonia who is currently at university
studying psychology.
Sadly, Susan died on 18 September 2005 after a short illness.
Colleagues, family and friends will remember her warmly for her
energetic, enthusiastic and tireless approach to life.
Jill Murray
Susan WallaceMarch 1956 – September 2005
OBITUARY
004-005 22/11/05 4:37 pm Page 5
bulletin December 2005 www.rcslt.org66
news
Twenty three years after their first collaborativesuccess, Jayne Comins, Felicity Llewellyn and JudyOffiler have got together again to update theirextremely popular Communication Activities forAdults.
Originally compiled for use with people withdysphasia, this book is also valuable for working witholder and day-centre clients, and can be used forgroup warm-ups.
With more than 100 graded communicationactivities for individuals and groups, this practicalbook is an excellent resource for health professionalsand activity providers.
The first edition, published in 1983, came out at a
time when there were hardly
any therapy materials on the
market, and therapists spent
considerable time putting
together their own resources
when they could have been
spending more time with
clients.
The book became a bestseller,
providing over 100 ideas for
word games and group
activities. Many required little
or no preparation beforehand,
and others needed only a
flipchart, pen and paper.
“We felt that many of the examples in the original
edition had become outdated. Spotted dick has
stopped being a staple of the British diet; ciabatta and
pesto are today’s replacements. Ronald Reagan and
Margaret Thatcher are no longer stalking the
corridors of power; instead, we are governed by the
likes of Tony Blair and Arnie Schwarzenegger,” the
authors say.
“So, as well as dozens of new activities, this edition
includes a completely new set of examples.”
Visit: www.speechmark.net/speechmark/new
Titles.htm
An interprofessional dysphagia framework has now
been developed following consultation with a range of
professionals using interviews, surveys and focus
groups.
The framework informs strategies for developing
the skills, knowledge and ability of SLTs, nurses, other
healthcare professionals and non-registered staff to
contribute more effectively in the identification of
people with, and management of, swallowing
difficulties.
During the process of developing the role
descriptors, draft dysphagia competencies have been
developed in collaboration with Skills for Health and
the Sector Skills Council.
The role descriptors include the content from these
competencies, with additional material to prescribe
professional activities in order to meet the needs of
the professional groups.
Both the role descriptors and Skills for Health
competence models are undergoing field testing to
enable them to be included in the suites of national
workforce competencies (NWCs) that cover the health
workforce. This additional material can be mapped to
other NWCs available from Skills for Health.
Ten sites will test the draft NWC units within falls
and stroke, paediatrics, mental health and adult
learning disabilities client groups.
The role descriptors will be field tested at Sheffield,
Portsmouth, Wales and Derby within stroke,
paediatrics, mental health, head and neck and adult
learning disabilities.
Mary Heritage and Clare Coles represent the
RCSLT on the project’s intercollegiate steering group.
Liz Boaden is on the research team.
The full report will be available following completion
of the project in the 2006. For more information
email: [email protected]
N E W S I N B R I E F
Neuro-diversity voiceIndividuals with autism and related
conditions will have a stronger voice at
the Disability Rights Commission (DRC)
after the formation of a new Autism and
Neuro-diversity Group. Run by people
with autism and neuro-diverse
conditions, such as dyslexia and
dyspraxia, the group will recommend
issues for DRC attention.
Visit: www.drc-gb.org
Delivering patient safetyThe National Patient Safety Agency
(NPSA) has made a new multimedia
pack available to 600 NHS trusts in
England and Wales. Compiled by experts
on health and safety, Delivering Patient
Safety can be customised to suit local
needs and resources.The NPSA has also
launched Seven steps to patient safety for
primary care: a guide explaining how
healthcare staff can improve patient
safety locally.Visit: www.delivering
patientsafety.com and www.npsa.nhs.uk
The HPC in focusThe Health Professions Council (HPC)
launched the first issue of its newsletter
in November, aimed at keeping people
informed about their work. HPC in focus
features articles on renewals, fitness to
practice and CPD.To subscribe, email:
[email protected] or visit:
www.hpc-uk.org
Learning disability portal A new website aims to provide
information on learning disabilities.The
site features frequently asked questions
on learning disability and has an A-Z
resource on common issues.Visit:
www.understandingindividualneeds.com
MS research volunteersUniversity of Wales Institute student SLT
Rhiannon Leach is researching the timing
of multiple sclerosis patient referrals to
speech and language therapy, and the
role MS nurses play in the referral
process. She is seeking volunteers who
work with MS clients to complete a short
anonymous questionnaire on their
patients. Email: [email protected]
Communication activities revisitedTogether again for the first time in 23 years
Dysphagia competencies ready for field testing Mary Heritage and Liz Boaden outline the latest activity in the development ofinterprofessional competencies for management of dysphagia
006-007 24/11/05 3:28 pm Page 1
www.rcslt.org December 2005 bulletin 77
news
The RCSLT is pleased to welcome Sharon
Woolf as its new Head of Professional
Development.
Sharon commenced her new role on 1
November and has excellent credentials for
the position. Within her remit are pre-
registration education, continuing
professional development (CPD) and
workforce development.
She previously worked as education
manager at the Health Professions Council, a
post that involved visiting universities to
assess their allied health professional
programmes.
Prior to this Sharon worked at City and
Queen Mary’s universities at department level
and in central administration, where she had
a quality assurance remit.
In the short time Sharon has been with the
RCSLT she has already attended a
Department for Education and Skills
stakeholder event to discuss the proposed
integrated qualifications framework and has
spoken to the Royal College of Paediatrics
and Child Health (RCPCH) about the
RCSLT’s online CPD developments.
“Other representatives at the forum from
allied health professions and RCPCH have
been very impressed with the route we are
taking with regard to CPD. We plan to
develop a full CPD profile that will support
SLTs at all stages of their career pathway,”
RCSLT welcomes new Head of Professional Development
RCPCH affiliate schemeIndividual SLTs can take advantage of a new RoyalCollege of Paediatrics and Child Health affiliate schemefor health professionals who work with children.The benefits include:• Receipt of all RCPCH publications (excluding the
handbook)• Membership of the RCPCH book club• Discounted RCPCH spring meeting conference fees
(approx 40%)• Reduced subscription to the Archives of Disease of
Childhood (currently £75 instead of £206 per year)• Use of RCPCH facilities for meetings (subject to
availability. A charge may be made)
Affiliate subscriptions cost £50 per year.Tel: 0207 3075623, email: [email protected] or visit:www.rcpch.ac.uk for details
Were you affected by HPC de-registration?After the completion of this year’s Health
Professions Council (HPC) registration
period for SLTs, the RCSLT became aware of
members who attempted to register well
before the 30 September deadline, but who
were not successful.
While the RCSLT has received anecdotal
evidence that this may have been a
widespread problem, we need to know the
real extent of unsuccessful registration if we
are to act on behalf of members.
If you have been affected, email:
[email protected] and state when and how
you sent off your payment and any other
correspondence, and whether you have had
problems contacting the HPC after finding
out you were not on the Register.
In replying please provide the following
information:
� When did you send your HPC
registration form?
� Did you send a cheque or have you
signed a direct debit form?
� Have you attempted to contact the HPC
(state by what means, eg letter, phone
call, email) and were you successful?
Sharon said.
“ ‘Upskilling’ and ‘portability’ are two key
words that are coming from government in
terms of qualifications. Higher education
institutions have been recording students’
transferable skills for some time. Employers
and employees now need to recognise the
value of transferable skills gained from both
formal qualifications and professional
experience.”
A message from HPC Stakeholder Manager Sarah Dawson:The renewal period for SLTs finished on the 30 September 2005.The HPC has now removed from the Register everyonewho did not return their renewal form on time.The HPC lapsed 972 SLTs.This represents approximately 9% of thenumber of renewal notices sent to registered SLTs. You can check registration on the HPC Register (http://register.hpc-uk.org/lisa/onlineregister/RegistrantSearchInitial.jsp). If your name does not appear on the Register, but you wish to beregistered, then you will have to apply to go back onto it. It is important that if you wish to return to the Register you willneed to complete a readmission form that can be downloaded from the HPC (www.hpc-uk.org/apply/readmission)It is illegal to practise under the protected title speech and language therapist if you are not registered with the HPC.Each individual is responsible for maintaining his or her own registration. If you or your colleagues require any advice orsupport regarding this matter you can contact the HPC registration department on 0845 300 4472 lines are openMonday-Friday, 8am - 6pm.
Fair for All –Disabilityconsultationin ScotlandThe Disability Rights Commission
(DRC) and Scottish Executive Health
Department in Scotland have launched a
consultation on Fair for All – Disability,
offering SLTs and their service users in
Scotland an opportunity to get inclusive
communication and total
communication issues firmly on the
agenda.
We need your input as SLTs, either in
your capacity working for the NHS or as
part of a national level RCSLT response.
Visit: www.rcslt.org/government/
arounduk/scotland
006-007 24/11/05 3:28 pm Page 2
bulletin December 2005 www.rcslt.org88
news
2005 RCSLT HonoursThis year's honours were presented at the RCSLT diamond jubilee gala event inLondon on 10 October. The awards recognise the outstanding achievements ofmembers and other individuals in the field of speech and language therapy
RCSLT FELLOWSHIPSHonours for distinguished services to the RCSLT
Honours acknowledge RCSLT members who have contributed outstanding service toCollege and recognises members who have carried out work of special value to theRCSLT
Frances Cook is an expert in the field of stammering. She has worked
in the profession for over 25 years and is manager of the Michael Palin
Centre (MPC) for Stammering Children, developing it into an
internationally recognised centre of excellence. Frances also monitors
the MPC's research programme and presents papers on the
assessment and treatment of stammering in the UK, Europe and
America. She has also been honoured with the 2003 Clinician of the
Year Award from the International Fluency Association.
Yvonne Edels has transformed postgraduate teaching in the area of
laryngectomy and has contributed hugely to the evidence base in
head and neck cancer. She was head of department at the Middlesex
Hospital, which pioneered gastric pull-up reconstruction after
extended laryngectomy surgery. In 1983 she edited Laryngectomy:
Diagnosis to rehabilitation, the only UK textbook on the subject to date.
In 1997, Yvonne took the first MacMillan Cancer Relief funded post for
specialist head and neck cancer rehabilitation at Charing Cross
Hospital.
Roberta Lees became a lecturer in speech and language therapy at
Jordanhill College in 1968. The college merged with Strathclyde
University in 1993 and since then she has held a number of senior
positions, including her current post as reader in the Department of
Education and Professional Studies. She is one of the foremost
international researchers into stammering and has been an RCSLT and
British Stammering Association adviser for many years. Roberta
received an MBE for her work in speech and language therapy research
and teaching in 2005.
Dr Joe Reynolds is a speech and language therapy manager based in
Leeds and is well respected within the profession in the UK, serving as
an RCSLT committee member. He has also been active in European
speech and language activities, serving as the RCSLT representative on
the standing Liaison Committee of Speech and Language Therapists in
the European Union (CPLOL). As honorary treasurer, he contributed to
the success of the 2003 CPLOL international conference and is involved
in planning for the 2006 Berlin conference.
Margaret Oakley has given long and distinguished service to the profession. After qualifying in
1971, she worked as the Isle of Wight's chief therapist, setting up a language unit at St
Catherine's School in 1977. With her enthusiasm and determination the unit flourished and by
1982 had become a residential specialist school for students with primary speech and language
disorders. Margaret's vision was for a further education centre to offer post-16 language
impaired students a two-year study programme. The Grove Hill Further Education centre opened
in 1994, with Margaret as its head.
Fellowships are given to RCSLT members
who have given long-standing distinguished
service to the profession in the context of
research, publishing and teaching. This
award entitles holders to call themselves
'Fellow of the Royal College of Speech and
Language Therapists'
Professor PaulCarding is the
UK's first (and
only) professor of
voice pathology.
As clinical head of
the speech voice
and swallowing
department at
Freeman University Hospital, Newcastle
upon Tyne, he has pioneered multidiscipli-
nary working in voice for specialist voice
therapists. An RCSLT adviser for 15 years
and chair of the research committee for
five, he has also been a voice consultant to
the Royal Shakespeare Company and
associate editor of the International Journal
of Language and Communication Disorders,
and Logopedics, Phoniatrics, Vocology.
Dr StephanieMartin is an
educationalist
with 30 years'
service teaching
on speech
therapy courses
at Central School,
the University of
Ulster and University College London. Her
contribution to the voice syllabus in each
university has been remarkable and her
research work has contributed to the
training of SLT students across the UK.
Stephanie's work in preventative voice care
courses for teachers in training has been
formally commended by groups working in
this field and she was awarded a PhD for
her thesis on this topic.
008-009 22/11/05 4:41 pm Page 1
www.rcslt.org December 2005 bulletin 99
news
Look out in 2006for details on
how to nominatesomeone for
RCSLT Honours
HONORARY FELLOWSHIPS
Honorary fellowships acknowledge and
honour non- and overseas SLTs who have
contributed distinguished services to speech
and language therapy
Dr HelenMcConachie is a
clinical
psychologist
working with
children who
have
developmental
disabilities and
their families, helping them to function on
their own terms and gain easier access to
services. Helen works closely with SLTs and
has championed their work in her multidis-
ciplinary and clinical research, leading
projects and supervising postgraduate SLTs.
During her time at the Augmentative
Communication Service at Great Ormond
Street's Wolfson Centre, she inspired and
supported the speech and language
therapy team in shaping the direction of
the service.
Colin Whurr has
had a long
association with
speech and
language therapy
publications, in
his role as chair of
Whurr Publishers.
Throughout, he
has encouraged would-be authors and
given much needed support. Colin also
supported the British (and later) European
Journal of Disorders of Communication,
publishing it at a time when the College's
finances were in a difficult position. Colin
has been a stalwart friend of the profession,
offering constructive advice on how to
publish.
The Sternberg Award for Clinical Innovation
This annual £1,000 award is supported by RCSLT Senior Life Vice President Sir Sigmund Sternberg
The joint winners of this award are:
Anne Hurren, chief SLT at Sunderland Royal Hospital, for her work, in
collaboration with a multidisciplinary team, on the development of the
innovative Sunderland Air Pressure Meter. The device measures tracheal air
pressure at the stoma and allows SLTs to assess if a patient is a suitable
candidate for a hands-free tracheostomy valve.
Sean Pert and Carol Stow (pictured with Sir Sigmund), specialist
SLTs at the Baillie Street Health Centre in Rochdale, developed
assessment tools for the Mirpuri, Punjabi and Urdu languages in their
area, working with local bilingual speech and language therapy
assistants. The project produced je zindegi (this life), an early
sentences assessment, and the Bilingual Speech Sound Screen (BiSSS).
The Catherine Renfrew Award
This £500 award celebrates the life and achievements of one of speech and language therapy's
early ambassadors and gives an SLT the opportunity to follow in Catherine's footsteps by
networking internationally
Dr Roshan McClenahan is clinical lead SLT for neurology at the Royal Free
Hampstead NHS Trust. The award enabled her to present a paper on The
development of a short screening test for aphasia at the American Speech-
Language-Hearing Association conference in San Diego in November.
The Speechmark Bursary
The Speechmark Bursary is a £1,000 contribution towards funding research visits or project work
outside the applicant's country of work
Nana Akua Victoria Owusu plans to spend six months in Ghana, researching the situation of
children with communications disabilities, focusing on the perceptions of health and education
workers, and the cultural beliefs that can affect the delivery of speech and language therapy
services. Her research will help to inform UK practice when working with ethnic minority communities.
The RCSLT Student Research PrizeThis aims to encourage consideration of clinical implications of research, by recognising final-
year projects that can demonstrate clear implications for clinical practice
Samantha Hawkesford, formerly of the University of Central England,
wins this award for her project entitled: Children's phonological awareness
abilities since the introduction of the National Literacy Strategy.
The RCSLT Diamond Jubilee Special Recognition Award
Allan Tyrer is honoured for his volunteer work at the British Stammering
Association (BSA). Since 1999, Allan spent two days a week turning the BSA
website into what is now widely acknowledged as the foremost web-based
resource on stammering. As a result of his work, the focus of the BSA's
information service has changed dramatically and over half of information
enquiries now come through the website. Allan has donated an estimated
£50,000 in terms of his time.
008-009 22/11/05 4:41 pm Page 2
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news
During the consultation meetings managers have
listened to current developments in workforce
planning and discussed the approach they think the
profession should take to develop workforce planning
guidelines.
For the guidelines to be meaningful and effective, it
is essential to gain approval and consensus from all
departments. Therefore, the consultation has involved
the departments of health and education, and allied
health professional leads in England, Northern
Ireland, Scotland and Wales, and Skills for Health, to
establish the direction workforce planning may be
taking in each country.
Traditionally, workforce planning has been based
either on historical local development, from funding
made available for specific care groups and targets, or
on a ratio of staff per head of population.
This led to the idea of 'notional caseloads' in some
areas of care.
With this approach there has been little ability to
consider the effects of local demography or changes in
practice.
In addition, it has had limited success with
commissioners of services, leading to inequalities in
service provision across the UK.
The present workforce planning direction
encourages us to focus on the needs of the local
population.
This 'planning tools' approach involves assessment
of the needs of the local population and the
workforce skill mix that is available (not only in
speech and language therapy services but in the wider
workforce).
This process may be more complex and time
consuming, but should result in a more effective
involvement of stakeholders and the use of evidence
for best practice.
At present there is little evidence for the efficacy of
either approach. The RCSLT Workforce Planning
Project, therefore, plans to test each approach.
A pilot study is assessing the effectiveness of using a
notional caseloads methodology by collecting data
from SLTs who provide services to people with stroke
and communication and/or swallowing problems
across the UK.
The study aims to ascertain whether meaningful
workforce figures can be reached through consensus
and activity data, and if this approach has currency
with all stakeholders.
A second pilot study will test the planning tools
approach by focusing on children's speech and
language therapy services in Northern Ireland.
This will include stakeholders, from service users
through to those in education and health services, as
well as Skills for Health.
The results of these two pilot studies, and further
consultation with the profession and stakeholders,
will inform recommendations on how to workforce
plan for speech and language therapy services, and
form RCSLT guidelines.
I would be happy to hear your comments, queries
or observations on this project.
Stef Ticehurst
RCSLT Workforce Planning Project Officer
Email: [email protected]
N E W S I N B R I E F
Child health mappingThe Department of Health (DH) is
undertaking its first annual data
collection exercise to find out about child
health service provision across England.
Its primary purpose is to support the
implementation of the child policy
agenda, in particular the National Service
Framework for Children and Young
People.Visit:
www.childhealthmapping.org.uk
Still delays for MNDThe Motor Neurone Disease (MND)
Association says nearly a third of people
diagnosed with the disease are meeting
delays because of inappropriate or late
GP referrals.The Association has
published clinical guidelines on
managing MND in conjunction with a
multidisciplinary team.Visit:
www.mndassociation.org
DNR and stroke recoveryA University of Birmingham research
report says stroke patients with 'do not
resuscitate' (DNR) orders in their medical
notes are seven times more likely to die
in the first 30 days after their stroke than
those without. Published in the
International Journal for Quality in
Healthcare, the report's authors say DNR
stroke patients are less likely to receive
care from a specialist stroke unit or team.
British Medical Journal
CorrectionsThe correct email address in the Liquidise
me article in November's Bulletin
Supplement (p3) is:
In November's Bulletin article on the SLT
and Assistant of the Year (p7), SLT of the
Year Award winner Daniel Hunter is
pictured left, and not right, in the
photograph.
Developing toolsfor effectiveworkforce planningOver the past nine months, the RCSLT Workforce PlanningGuidelines Project has held consultation meetings with SLTmanagers' networks across the UK to ascertain the profession'sworkforce planning concerns. Stef Ticehurst explains the latestdevelopments
010-011 24/11/05 3:27 pm Page 1
www.rcslt.org December 2005 bulletin 1111
news
Speech and language therapy students from the College of St Mark
and St John (Marjon) were delighted to welcome HRH Princess Anne
to open their new speech sciences laboratory on 28 October
The speech sciences laboratory is one of the many facilities provided
within the multi-million pound Peninsula Allied Health Centre (PAHC)
on the Marjon campus in Plymouth and represents collaboration
between the Universities of Plymouth and Exeter, and Marjon.
The facility provides opportunities for students from a range of
healthcare disciplines to learn together. Speech and language therapy
staff and students enjoy an attractive clinical suite and modern office
facilities.
During the opening, Drs Sally Bates and Lucy Ellis demonstrated
the learning resources available for students. The Princess met Gillie
Stoneham and a group of third year students working with actor
Anthony Richards, who took the role of a patient recovering from
CVE, and was particularly interested in electropalatography and its
potential teaching, clinical and research application.
The students demonstrated the use of actor simulation in clinical
skills development, a technique that has been developed for use with
second and third year students, and also with clinicians participating
in clinical educator training programmes.
Course head Anne Ayre was pleased to demonstrate the filming and
editing equipment used to capture clinical activities, and described its
application for teaching and research purposes to the Princess.
Royal opening for Marjon SLT facilities
Core standards for care pathways in stammering
Care pathways potentially offer many benefits
for clients, clinicians and services, particularly
in the light of the anticipated changes in the
NHS and the way services are to be
commissioned, provided and 'chosen'.
Care pathways should be transparent
systems that ensure a client's journey through
therapy is properly and effectively charted
and reviewed. They should include clear
guidelines and criteria for clinical decisions
from referral through to discharge and
indicate when alternative referrals (eg
specialist) are required.
The client or carer will be key partners in
decision making, the clinician will be clear
about the services they can and cannot
provide and the manager will have evidence
for service development and planning.
The core standards agreed at the Leeds
meeting, following a broad range of
presentations from participants working in a
variety of settings, were:
� Evidence based assessments
� Comprehensive therapy options tailored
to individual need
� Access to specialist support/alternative
clinical route
� Protocols and guidance for
each step on the care pathway
� Clear criteria for moving
through each stage of care
pathway, discharge and
follow up or re-referral
With clear support mechanisms:
� Health education in terms of
information and advice
leaflets, accessing services and
typical care pathways
� Clinical governance
� Continuing professional
development of clinician
including regular supervision
� SLTs should offer therapy
programmes that are within
their own competencies and
supported by appropriate
training
It has been very satisfying to see
the increasing number of services across the
UK that have now established local care
pathways for at least one section of their
dysfluency service, most commonly for the
pre-school population.
We would welcome your comments or
feedback in relation to these core standards
and the prototype care pathway.
Frances Cook – Michael Palin Centre for
Stammering Children
Email: [email protected]
Specialist SLTs in disorders of fluency have been working on core standards for carepathways in stammering since 2002. Following a meeting at St James Hospital, Leeds, inMay 2005, participants achieved a consensus on the core standards required
(from left ) Students Debbie Jones, Julie Jutsum, Alex Kirk.(Far right) Dr Sally Bates
010-011 22/11/05 4:43 pm Page 2
bulletin December 2005 www.rcslt.org1122
feature TRAINING CHILDCARE STAFF
ACT!: Innovative trainingfor childcare staff
Our early years speech and language therapy
service has been running adult-child
interaction (ACI) training for nursery staff in
the London boroughs of Camden and
Islington for some years. The theory and
effectiveness of ACI and parent-child
interaction (PCI) therapy is well documented
(Cummins and Hulme, 1997).
We offered our original training
programme to staff in the two local
education authorities' (LEAs') maintained
nurseries. PCI therapy has a high profile
across the two boroughs, and staff in the
maintained nurseries are often already
familiar with its principles.
The training programme encompassed a
one-day nursery-based staff inset session,
followed by a course of four weekly small
group tutorial sessions. The inset session
covered the theory and practical techniques
of ACI. The tutorial sessions allowed for
more detailed and experiential learning; staff
brought videos of themselves playing with a
child to each tutorial, and analysed their own
interaction using the self-rating scale.
We modelled these practical sessions on
our ongoing work with speech and language
therapy students (Parker and Cummins,
1997), and it has proved very successful over
the past eight years. Staff feedback has always
been very positive and the programme has
been replicated within many other PCTs. One
participant was inspired enough to later train
as an SLT.
In 2001, however, changes within the LEAs
meant all childcare settings in the boroughs
became registered with the new Early Years
Development and Childcare Partnerships
(EYDCPs). In order to be in line with the
LEAs' central offer of training to all members
of the EYDCPs, we were faced with the
prospect of offering training to over 200
childcare settings - a huge increase on the 18
we had so far targeted.
The potential to increase our profile and
impact on staff interaction styles in a wide
range of non-maintained settings was very
exciting, but presented us with a range of
challenges:
� a huge increase in the number of
childcare settings we could now
potentially target for training
� many staff have little or no experience of
speech and language therapy
� staff are often not familiar with the
principles of PCI
� private nurseries do not have inset days
designated for training
To meet this challenge we developed a one-
day training programme that can be offered
centrally or to individual nurseries. It
encompasses both theory and practical in an
accessible way for child care staff. As a pre-
requisite to the training day, we ask each staff
member to bring a video of themselves
playing with a child that they are willing to
show to their peers.
The day's programme is as follows:
� introduction/expectations
� overview of common speech and
language difficulties
� facts and myths about speech and
language development
� principles of ACI with video examples
� video analysis in small groups - using the
ACI tally count (ACT!)
� aims and objective setting
� play ideas
� evaluation/questions
The most innovative aspect of this session is
the use of an adapted self-rating scale, known
as ACT! This was devised because the original
parent/carer self-rating scale (SRS)
(Cummins and Hulme, 1997) can take up to
30 minutes to explain to adults.
The SRS was devised and is used within
Islington's early years SLT service as a
discussion document for parents and SLTs
analysing parents' interactions with children
with complex language disorders. It was
considered to be too cumbersome and
detailed to use in a single day training
session.
ACT! is a simple and practical tool that is
accessible enough for staff to effectively and
independently analyse their own skills in
relation to their interaction with a child. It
looks at the adult's balance between
initiating/directing, and responding/
reinforcing (see table one). We know children
with language disorders need more practice
but, in reality, often receive less in childcare
settings where staff are more directive, use
more complex language and provide fewer
contingent models (Girolametto and
Weitzman, 2002). In this context developing
these skills continues to be a priority.
Tally counting enables staff to make
independent judgements about their
interaction strengths and weaknesses in
relation to a particular child, without the
need for extensive explanations of
terminology.
On the training day the staff analyse their
videos in small groups without the SLT being
part of their group. Since many of the staff
have little or no experience of speech and
language therapy and PCI, we wanted to
make the video analysis as unthreatening as
possible. The SLT is available for support and
guidance, and to answer questions, but we
encourage staff to work together and support
each other.
During the practical session the staff are
given the following instructions to complete
their copy of ACT! When the group
reconvenes, they are asked to identify one
target for developing their own interaction.
We initially trialled the programme in one
private nursery and have since run it in
several of the local children's centres and LEA
nurseries, with great success. It has become
Sarah Hulme discusses a pilot scheme offering innovative training for childcarestaff using a simple self-rating tool
012-013 22/11/05 4:44 pm Page 2
www.rcslt.org December 2005 bulletin 1133
an integral part of the care package for
nursery key-workers of children attending
our pre-school language unit in Islington and
is part of the core training offered to Sure
Start local programmes and children's
centres.
We are seeking funding to help us to
analyse the initial and post-training videos
made. However, initial analysis is very
positive. At initial video, most staff were very
directive with the children, as shown in the
samples (table two). This is reflected by the
research, which suggests that larger groups of
children receive language input that expresses
management functions concerned with group
safety or task compliance, as opposed to the
more responsive language input that we
would like children to receive (Palermus, 1996).
On follow-up, three months after the
training session, staff who were very directive
featureTRAINING CHILDCARE STAFF
at the initial training session had reduced
their use of questions and directions, allowing
the children more time to initiate.
All video analysis was carried out on three-
minute samples of video.
Interestingly, the staff 's use of comments,
praise and repetition remained stable. This
indicates they were allowing more silence at
follow-up, but would benefit from further
input to increase their use of facilitative
language in response to the child.
In response to this finding we have added a
follow up half-day session, which gives the
trainers the opportunity to discuss and advise
on the type of more facilitative strategies that
staff might use in place of the directives they
have discontinued.
In the feedback, all of the staff identifiedSarah Hulme – Principal SLT, early yearsservice, Hunter Street Health Centre,Londonemail: [email protected]
References:Cummins K, Hulme S.Video – a reflective tool. Speech andLanguage Therapy in Practice, Autumn 1997; 4-7.Girolametto L,Weitzman E. Language facilitation inchildcare settings: a social interactionist perspective.Enhancing caregiver language facilitation in childcaresettings. Hanen Centre Publication. Proceedings fromsymposium, 18 October, 2002.Palermus K. Child-caregiver ratios in daycare centregroups: impact on verbal interactions. Early ChildDevelopment and Care 1996; 118, 45-57.Parker A, Cummins K. A service resource – new venturesin group placements for students. Speech and LanguageTherapy in Practice,Winter 1997; 13-15.
Acknowledgements:Thanks to Busy Bees Nursery, Perivale, for taking part inthe pilot, and to Deirdra Leahy, specialist SLT, IslingtonPCT, for the video analysis.
table one: ACT! ACI tally count
ACT! looks at the adult's balance between initiating/directing and responding/reinforcing
the practical session and usefulness of theory
as excellent or very good, and all have stated
that it was highly relevant to their workplace.
Staff comments about what they had learnt
from the day include, “... that silence is very
important in encouraging children to talk,”
and “... that not asking so many questions and
sitting back and observing encourages the
child's speech.”
All staff said they would recommend the
course to other nursery staff, and one stated,
“It was a brilliant course!”
In summary, ACT! is a simple, effective
tool for use in a combined theory/practical
day training session. A follow-up session would
be helpful to further develop staff skills.
Asking questions Directing child/ Repeat or copy Say something suggestions child/praise child about what child
is doing
Number of times
Instructions given to staffIn your small group please watch your video twice1. The first time observe your general impressions.2. The second time count the number of times you use
each of the following types of utterance:• asking questions• directing the child/making suggestions• repeating what the child says/copying the
child/praising the child• saying something about what the child is doing
Count up your scores, and with the help of yourcolleagues decide:• what would you do more of next time?• what would you try to do less of next time?
table two: sample showing staff intervention in the trainingsession and the follow-up video
Staff A Staff B Staff C
training follow-up training follow-up training follow-upsession video session video session video
number of questions asked 61 11 26 3 32 13
number of directions or commands used 5 0 10 2 9 3
012-013 22/11/05 4:45 pm Page 3
London
The RCSLT held its diamond jubilee
celebrations at the Scotland Office on 10
October. At the event, RCSLT President Sir
George Cox gave out this year's honours,
fellowships and special achievement awards,
including the Diamond Jubilee SLT and
Assistant of the Year Awards. The evening was
also an opportunity for SLTs, assistants,
RCSLT council members and officers to meet
politicians and civil servants from health and
education across the four UK countries.
bulletin December 2005 www.rcslt.org1144
feature SPEECH AND LANGUAGE THERAPY WEEK
Guernsey
Guernsey SLTs were the main topic of press,
radio and TV coverage during Speech and
Language Therapy Week.
According to department head Barbara
Evans, the Guernsey public were,
“bombarded with coverage about
communication impairment and how to
help… that's great for our patients and also
for the profession as well”.
During the week, the speech and language
therapy department opened its doors to
many different age groups. Individuals with
communication problems attended a
consultation event aimed at raising awareness
of how people can help to break down
communication barriers.
Local secondary school students also
undertook Breaking down the barriers to
communication workshops, and pre-schoolers
and their parents were treated to a party,
including a bouncy castle and language-based
games.
Health Minister Peter Roffey opened the
new department at the Princess Elizabeth
Hospital on 11 October.
Northern Ireland
Therapists and support workers across
Northern Ireland took part in Speech and
Language Therapy Week events in hospitals,
schools, shopping centres and many other
public places across the Province.
For example, Craigavon and Banbridge
Community HSS Trust hosted a speech and
language therapy exhibition in Craigavon
Civic Centre; St Gerard's Educational
Resource Centre opened its new speech and
language therapy suite, and Patricia McKenna
at the Clogher Valley Sure Start team ran a
Snappy sounds music and rhyme workshop.
Among the VIP visits planned during the
week, George Russell, assistant director at the
Department of Health, Social Services and
Public Safety, met SLTs at Homefirst
Community Trust. Writing to RCSLT
Speech and LanguageTherapy Week 2005Thank you to the many RCSLT members who requested and used their Speech and LanguageTherapy Week packs and information literature. From the responses we've had, you clearlyenjoyed taking part in the activities you put together and feel that the week was veryworthwhile. Here, we look back at the events of Speech and Language Therapy Week, 10-14October 2005, using your images
The 2005 award winners at the RCSLT diamondjubilee event in London on 10 October
Phot
o:G
eoff
Wils
on
RCSLT vice president Baroness Michie with chairProfessor Sue Roulstone
Phot
o:G
eoff
Wils
on
Barbara Evans gives instructions on how to play alanguage-based game
Phot
o:Br
ian
Gre
en/G
uern
sey
Pres
s
SLT Michelle Habgood shows students some of hervisual aids
Phot
o:A
dria
n M
iller
/Gue
rnse
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14-16 22/11/05 4:46 pm Page 2
www.rcslt.org December 2005 bulletin 1155
Northern Ireland Policy Officer Alison
McCullough after the event, George said, “I
gained a valuable insight into the work of
SLTs in school settings, which is beneficial for
my own work in this area of learning
disability.”
Clare McGartland, Western Health and
Social Services Board Allied Health
Professions Commissioning Officer, visited
the Royal Belfast Hospital to see its cleft
palate services and videofluoroscopy clinic.
After the event she commented, “I found the
day very worthwhile and indeed, learned a
lot. I know that the insight gained will help
me in my role of AHP commissioner.”
Llandough Hospital
The Llandough Hospital adult speech and
language therapy department ran an excellent
campaign during the week. Department
members threw a party for their past and
present clients to acknowledge their hard
work in making “our jobs easier through your
determination and enthusiasm”.
They also organised information boards
with members of the paediatric team in the
hospital front entrance, day centre, canteen
and stroke rehabilitation unit. An observer's
day on 7 October provided an opportunity to
discuss the role of SLTs with people
interested in the profession as a
career.
During the week, the Welsh
Assembly Government's
Dominic Worsey (from the
Department of Healthcare
Standards, Quality Standards
and Safety Improvement
Directorate) spent a
morning shadowing SLT
Claire Helme on the wards. As a result of
his visit, Dominic wrote an article for his
directorate bulletin. In this he acknowledges
that, “my visit will certainly stay with me for
a long time and I won't forget the staff and
patients that I met and the warmth with
which they welcomed me.”
Bexhill and Rother PCT
Bexhill and Rother PCT paediatric speech
and language therapy team decided to
concentrate on making the public more
aware of Makaton signs and symbols during
their Speech and Language Therapy Week.
They organised a host of events, including
a special session at the Arthur Blackman
Clinic, where senior specialist SLT Sarah
Norman runs a baby signing group.
A sponsored Makaton sing/sign-along
fundraising event involving teachers and SLTs
from Torfield School, supported children in a
Gambian school. Children collected
sponsorship for learning the signs and songs.
The team also transformed the paediatric
speech and language therapy department at
Eversfield Centre with a large display
featuring information on baby signing and
speech and language therapy, and ran
activities for children.
The week also coincided with the launch of
the team's new Makaton Users Group
(MUGS), which offers parents a forum to
exchange ideas, practice signs and learn new
ones. The team plans to build up a lending
library of Makaton resources in the near
future.
Airdrie Health Centre
The speech and language therapy team at
Airdrie Health Centre in North Lanarkshire
raised awareness of their work by setting up
display boards at clinics in Adam Avenue,
featureSPEECH AND LANGUAGE THERAPY WEEK
Northern Ireland Policy Officer Alison McCullough(centre front) with the St Gerard’s team
Orla Connolly (right) and Carol Hunterat the dysphasia awareness day
SLT Megan Hide welcomes guests to the Llandough party
Gerald (client and guest at the party) draws thelottery winner
Mums and babies at a Makaton signing session
Phot
o:H
astin
gs
and
St
Leon
ard
’s O
bse
rver
14-16 24/11/05 3:26 pm Page 3
bulletin December 2005 www.rcslt.org1166
feature SPEECH AND LANGUAGE THERAPY WEEK
Airdrie Health Centre and Monklands
Hospital.
Alison Tait, SLT, said “The purpose of the
week was to highlight the work we do and
give people the chance to get information on
the services provided in the area. We were
also keen to promote speech and language
therapy as a career path.”
They succeeded getting a news story and
photograph in their local paper, the
Coatbridge and Airdrie Advertiser, which lead
to positive feedback from the public, as well
as coverage in the North Lanarkshire NHS
magazine, the Pulse.
North Devon NHSPCT
Staff at the North Devon NHS PCT
organised an open day event for the week at
Barnstaple Health Centre. Angela Grant, head
of speech and language therapy said, “The
As well as having stalls in St Peter's
Hospital and Ashford Hospital foyers, they
manned a stand at the Brooklands Shopping
Centre to catch unsuspecting shoppers. The
stalls featured events with AAC company
representatives demonstrating products from
Toby Churchill Ltd and Possum Ltd.
They succeeded in getting an article and
photographs in the Surrey Herald, featuring
the work of SLT Debbie Thomas from St
Peter's Hospital with a dysphagia client. The
Eagle radio station interviewed Ashford
Hospital SLT Afshan Siddique and Nicola
Murray SLT appeared on the BBC's Southern
Counties radio breakfast show.
The department also gave out RCSLT A
career in speech and language therapy leaflets,
information on paediatrics, stammering and
voice services leaflets, and speech and
language therapy department information.
Staff also got the public to fill out a mini-quiz
to learn more about speech and language
therapy.
Staff considered that their hard work on
the week paid off, as they feel they have
demystified some of the myths the public
have about speech and language therapy and
noticed an increased level of enquiries to
their service. They also think the events
helped to raise team moral.
open day is a good opportunity for the public
to meet members of the team, ask questions
and find out if we can help.”
The event included a drop-in session with
senior SLTs Annarella Prime and Erica
Sturdy. The team also set up a stand at the
North Devon library in Barnstaple, featuring
RCSLT balloons and provided information
leaflets on speech and language therapy to the
public.
Ashford and StPeter's NHS Trust &
North Surrey PCT
The speech and language therapy department
at Ashford and St Peter's NHS Trust and
North Surrey PCT decided to head out into
their local community to promote speech and
language therapy during the week and to
raise awareness of stroke and related disorders.
SLTs from the paediatric team in Airdrie with their display
Phot
o:C
oatb
ridg
e an
d A
irdrie
Ad
vert
iser
Annarella Prime and Erica Sturdy, senior SLTs atBarnstaple Health Centre
SLTs on the stand at the St Peter's Hospitalpostgraduate centre
£500 Speech andLanguage TherapyWeek competitionSome of you have commented that
you didn’t have time to collate allyour media clips before the 1
November deadline.
We’re pleased to say that we’veextended the closing date to 10
December.
Send your entries to: Speech andLanguage Therapy Week
competition, 2 White Hart Yard,London SE1 1NX.
14-16 22/11/05 4:47 pm Page 4
www.rcslt.org December 2005 bulletin 1177
Prioritising clinicalvoice disorders
Voice specialists, in common with SLTs
working in other clinical fields, are under
growing pressure to assess and treat ever-
increasing numbers of patients.
The profession is successfully developing
its assessment and diagnostic role both in
multidisciplinary and in SLT-led parallel
voice clinics.
This, together with other health service
pressures, may lead to resource implications
for patients who require ongoing therapy.
Resource pressures, in turn, may force
many clinicians to consider prioritising their
patients. But what criteria do they use to
make these judgements, and on what
evidence do they base their decisions?
Voice disorders are complex and reports
show patients vary widely in how their voice
problems affect their quality of life, including
social, emotional, work and lifestyle issues
(Scott et al, 1997; Wilson et al, 2002).
Many clinicians have found discrepancies
between how severely dysphonic a patient's
voice may sound in the clinic and how it is
affecting them on a day-to-day basis.
Patients with severe dysphonia owing to
laryngeal cancer may view their voice quality
as secondary to curing the disease.
A professional singer with a normal
speaking voice, however, may worry more
about losing part of their singing range as it
could affect his/her career.
Clinicians routinely use perceptual
evaluation, patient self-report scales, case
history information and laryngeal
examination to inform diagnosis and
management decisions and therapy planning.
These tools are also used to gain baseline
measures and outcome information.
The most common formal perceptual
analyses used in the UK are the Grade,
Roughness, Breathiness, Asthenia, Strain
(GRBAS) scale (Hirano, 1981) and the Vocal
Profile Analysis (VPA) scheme (Laver, 1980).
Patients' self-report scales include the Voice
Handicap Index (Jacobson et al, 1997), Voice-
Related Quality of Life Scale (Hogikyan et al,
1999) and the Voice Symptom Scale (VoiSS)
(Deary et al, 2003), all of which have been
validated and used in research. Some
clinicians also use their own informal
assessments.
However, there may be inherent problems
with both types of assessments. They often
only reflect how the patient presents on the
day of clinic attendance, which may not be
truly representative of the patient's voice
disorder.
Studies (Jacobson et al, 1997; Speyer et al,
2004; Murry et al, 2004) indicate that there is
a moderate relationship between clinicians'
rating of voice quality on a perceptual scale,
patients' self-rating of voice quality and
patient self-report quality-of-life scales.
None of these studies addresses consistency
of the voice from day to day or week to week,
yet this is a common problem in voice
disorders. It may affect quality of life and
possibly motivation for therapy.
As clinicians dealing with substantial
caseloads, should we use the information
from perceptual analysis and patient self-
report scales to aid our prioritisation
decisions? And, if so, how?
Patients are commonly seen strictly in
order of referral, but should they perhaps be
prioritised according to who has the 'greater
need'?
Prioritisation could be based on the
severity of dysphonia, how it affects their
quality of life or a combination of both.
This would require the same measures to
be taken routinely at the first assessment so
patients' responses can be compared.
Consistency would also be of value.
This might help clinicians prioritise
caseloads where the resource pressures
cannot be met and where prioritisation
methods need to be based, as far as possible,
on objective data.
Sue Jones discusses issues of prioritisation around the management of a clinicalvoice disorders caseload
featureCLINICAL VOICE DISORDERS
Sue Jones – Head of SLT ServicesWythenshawe Hospital, Manchester email: [email protected]
References:Deary I, et al.VoiSS: a patient derived symptom scale.Journal of Psychosomatic Research 2003; 54: 483-489.Hirano M. Clinical Examination of Voice. (1st Ed.) Springer-Verlag, 1981.Hogikyan N, Sethuraman G.Validation of an instrument tomeasure voice-related quality of life (V-RQOL). Journal ofVoice 1999; 13: 557-569.Jacobson B, et al.The Voice Handicap Index (VHI):development and validation. American Journal of Speech-Language Pathology 1997; 6(3): 66-70.Laver J. The Phonetic Description of Voice Quality.TheCambridge University Press, 1980.Murry T, et al.The relationship between ratings of voicequality and quality of life measures. Journal of Voice2004;18(2):183-192.Scott S, et al. Patient-reported problems associated withdysphonia. Clinical Otolaryngology 1997; 22: 37-40.Speyer R,Wieneke G, Dejonckere P. Self-assessment of voicetherapy for chronic dysphonia. Clinical Otolaryngology2004; 29:66-74.Wilson I, et al.The quality of life impact of dysphonia.Clinical Otolaryngology 2002; 27, 179-182.
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feature COLLABORATIVE WORKING
But we can’t do that...
Burnley's former Calder View Community
(now Holly Grove) School catered for
children with moderate learning difficulties
(MLD). The school had primary and
secondary departments on one site. In 2003
we found ourselves, like many of our
colleagues, sinking under an increasing
speech and language therapy caseload. Over
seven years, the SLT caseload had doubled to
90 children and their language needs had
become more specific and complex.
We spent most of our time on annual
review assessments and reports. The school
had only eight sessions of speech and
language therapy input, and the funding for
an SLT assistant, who was previously carrying
out therapy, had stopped. She had been
seeing up to 18 children a week, under our
management.
We put various strategies into place to try
and manage the caseload. This included
giving practical ideas to classroom staff, ideas
at annual review to integrate specific aims
into class activities, training for teaching
assistants (TAs), signing and symbol training,
and the discharge of children whose language
was in line with other skills and could be
managed in the classroom (11 children were
discharged during the previous year).
Although we did see some children for
therapy, the waiting list was increasing and
despite our efforts we felt we were not
meeting children's specific needs.
Traditionally, many SLTs deliver therapy in
groups according to language aims. There are
several drawbacks to SLTs-only running
groups. For example, withdrawing children
from mainstream classes reinforces the
perception that only SLTs can deliver therapy,
it can stop children from accessing a valuable
lesson, and it is not collaborative working.
We felt we could continue to assess,
formulate aims and offer strategies, but could
also train others to deliver the input. For
example we could:
� use the skills of experienced TAs who had
delivered speech and language therapy
programmes or helped in groups
� timetable the primary department to run
language groups at the same time so no
lessons were missed
� allocate children to groups based on
language targets from their annual review
– not on age
� train all primary department staff to run
the groups
These strategies would empower teaching
staff, and make them more aware of language
difficulties and specific strategies. We would
also be complying with government advice, as
government literature strongly advises
working with other agencies (Every Child
Matters, 2003; The National Service
Framework for Children, 2004).
We discussed our ideas with the head
teacher who supported the principle of
language groups. There was initial resistance
at taking children out of their peer groups.
Class one was already running streamed
language groups two-three times a week and
we felt this to be appropriate. The rest of the
primary school, however, was to participate.
We faced many problems: room and staff
availability, training, attitudes to the role of
the SLT and the teacher regarding language
stimulation, timetabling, allocation to groups
according to annual review aims, number and
size of groups, allocation of children not on
caseloads, and resources. We tackled and
overcame each problem.
We proposed that 45 children be allocated
to one of seven groups. Two of the groups
would focus on different areas of grammar
and two on semantics. One group would
focus on social skills and verbal reasoning,
one on sounds and another on listening
skills. Two members of staff, either a teacher
and a TA or two more experienced TAs,
would run each group.
We presented the proposal at a school staff
meeting. Staff gave feedback on the
groupings, and made suggestions, such as
which children should not sit together. We
gave each group a resource box, with the aims
written on each box, and demonstrated
activities. We also identified equipment that
would benefit the groups. This was funded at
the start of the next financial year, with the
school buying over £300 worth of equipment.
The groups ran from October 2003 until
June 2004, once a week in a 45-minute slot.
All groups ran simultaneously on Thursday
afternoons during the first lesson.
We supported the groups on a rotational
basis, offering demonstration, advice and
recommendations as needed.
Initially the staff were unsure of their
capabilities, but as the year progressed they
became more confident and actively sought
our advice. They were proud to demonstrate
different activities they had implemented and
the children's progress, and over time,
accepted ownership of the groups.
The general format of the groups was:
� timetable
� social rules and game to target one social
rule
� activity one, targeting one of the groups'
aims
� activity two, targeting another of the
groups' aims
� fun game to finish - targeting another
aim, eg marble run
We audited the effectiveness of these groups
by giving questionnaires to 14 staff and 45
children.
Of the nine staff (64%) who responded, all
thought the language groups were a useful
addition. Typical comments included,
“Targets are specific to each child”; “Children
have a chance to talk, gives lower ability
children chance to shine; progress is easier to
assess” and “A chance to use my knowledge
and qualification as a nursery nurse”.
All respondents thought the language
Collaboration with teachers on language groups for children with moderatelearning difficulties has had positive results for staff and pupils. Mary Riley andLaura Broadstock report
018-019 22/11/05 4:48 pm Page 2
www.rcslt.org December 2005 bulletin 1199
groups should continue. Additional
comments were all positive reflecting the
staff 's enjoyment of running groups and
teamwork. Some simply said, “Thank you”.
The comments from the acting head are
shown in the box above.
Improvements suggested included more
training for staff who need it; demonstration
of equipment and resources; more on-site
speech and language therapy; more help for
children with complex needs; and a formal
plan sheet in education format.
The children's questionnaires were in
pictorial format. We received 41 children's
questionnaires (33 children were on the
caseload and eight were not). Twenty-six
children (79%) on the SLT caseload said they
liked their language group; 29 (88%) of these
rating the groups from 'great' to 'OK'. Half of
children not on the caseload found the group
boring - perhaps indicating that the groups
were not meeting their needs. Most of the
children liked the games best, not realising
they were linked to language targets.
Several changes were suggested after the
audit (see table one).
Our job satisfaction has increased by
working in this way. We all value the teachers'
role and they have seen children's language
skills improve.
There has been carryover of strategies used
in the groups to the classroom. The teachers
and TAs are more aware of the complexities
featureCOLLABORATIVE WORKING
of language and how to target specific aims.
Working together has also increased our
profile.
Our school has suggested introducing
language groups in the secondary
department. We feel that by working together
mainstream settings could also benefit.
At annual review there has been a marked
increase in children achieving their targets,
directly linked to the group they were in. For
example, one child in the grammar group
improved by 18 months on his grammar
score in a 12-month period.
True collaboration only works through true
commitment from both the school and
speech and language therapy service. We, as a
schools team, aim to investigate this approach
in different settings.
Mary Riley, specialist SLTLaura Broadstock, SLTHolly Grove School, Burnley, Pendle andRossendale PCT email: [email protected]
References:Department for Education and Skills. Every Child Matters.DfES Green Paper (CM 5860), 2003.Department for Education and Skills. National ServiceFramework for Children, Young People and MaternityServices. DfES, December 2004.
Note:Calder View School no longer exists. Children with MLD, SLDand physical difficulties from three schools now attend twogeneric learning difficulty schools. One is for primarychildren, the other for secondary.We will let the languagegroups settle in and plan for 2006 to take in the children'swider communication difficulties. Staff appear to be keento do this.
Strategies aimed to empower teaching staff and make them more aware of language difficultiesand specific strategies
suggestions actions
to continue language groups these have been running all year and continue to be successful
to offer further training general training and individual sessions for staff of each group, plus equipment resource-sharing session
to review timetabling changed to first session in the afternoonbut we face continuing problems with number of rooms available
SLTs to advise on rotation (every six weeks) achieved and advice is given on request
school to review the needs of those not on SLT caseload
to create a resource file with aims and higher level activities now in their activities groups
to re-audit to be arranged this academic year
Jackie Poxon, acting head teacherstated:“The SLTs used their knowledge of thepupils on their caseload to designprogrammes based on their needs withclearly defined targets.The impact of the groups has been
clearly visible. Targets were met, moreresources were requested and ideasflowed.It was noted that on summative
assessments (eg British PictureVocabulary Scale) a high proportion ofthe pupils had raised scores, some ofover a year.The structure and focus of the groups,
together with the staffing and supportfrom the SLTs led to overallimprovement in pupil performance,both in formal assessments andgenerally across a wider range ofcurriculum areas.” table one: changes suggested after audit
018-019 22/11/05 4:48 pm Page 3
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profess ional i ssues
Although CPD has been an aspect of speech
and language therapy professional practice
for many years, there is now a greater level of
external interest and scrutiny. The Health
Professions Council (HPC) has introduced
CPD requirements for re-registration for
SLTs, and the NHS has brought in the
Knowledge Skills Framework (KSF),
making an explicit link between CPD
and career progression. These
developments mean SLTs and support
workers will be required to keep more,
and different, records of their CPD
activities.
The RCSLT's role in CPD is to
enhance professional practice. It must
make its systems fit for purpose by
providing appropriate tools to support
members in maintaining their CPD. The
new RCSLT CPD scheme will provide the
mechanism for maintaining HPC registration
and professional certification at the same
time.
The new scheme, which comes into effect
in April 2006, will replace the current RCSLT
log. It includes a revised set of CPD standards
(see table one); an online CPD diary,
allowing members to record their ongoing
CPD activities and receive regular updates on
relevant courses; and a CPD toolkit
containing guidance and formats for
undertaking a range of CPD activities.
Certified RCSLT membership equates to
full, practising members who have agreed to
meet the RCSLT standards on professional
conduct and CPD. All practising UK
therapists must comply with this, and
Streamlining CPDprocesses for SLTs
overseas therapists can opt in, if appropriate.
Support workers are not required to adhere
to the standards, but choosing to do so will
contribute to their professional development.
The new approach is as relevant to support
workers as it is to qualified therapists.
The CPD online diaryThis is a simple electronic way of recording
your ongoing CPD activities and reflections
on learning. Accessed via the RCSLT website
(see figure one), the diary will provide the
mechanism for recording compliance with
the standards and enable the RCSLT to audit
your CPD records. It will make the need for
the log and a counter signature on renewal
forms redundant and will ultimately lead to
online membership renewal.
The system aims to align the RCSLT
requirements with the HPC's and the KSF
and to minimise paperwork. It uses HPC
CPD categories, so you will be able to see
what your range of CPD activities looks like
in relation to these. You will also be able to
collate and print out reflective commentaries
on each activity, cut and paste them into a
word document and reference your CPD
activities to KSF dimensions and levels, if
required.
The diary will be able to send you email
alerts on short courses relevant to your
location and clinical interest, provide a forum
for discussion on CPD matters and generate
reports on all CPD activities. Data will be
backed up every 15 minutes and stored on a
secure computer server, so there will be
minimal risk of your records being lost.
A paper-based version of the CPD record
will be available for those who do not have
access to the online system.
The CPD 'portfolio of evidence'In addition to recording CPD activity in the
online diary, the new scheme requires
members to keep a CPD 'portfolio of
evidence'. This must include an annual
personal development plan (PDP), and
evidence of your CPD activity during the
year. It must also include a range of different
CPD activities (eg peer review, significant
event analysis, audit, etc). It can include all
forms of CPD evidence accepted by the HPC
(see table one in November's Bulletin article,
p21).
The RCSLT has produced a toolkit,
containing guidance and forms on work-
based CPD activities, to help you. In addition
to a PDP template, the toolkit includes
sections on undertaking peer review,
reflective writing, significant event analysis,
In November's Bulletin (pp 20-21) Anna van der Gaag outlined how the HPC's newrules on continuing professional development (CPD) will affect SLTs. This monthAnna and Sharon Woolf, describe the RCSLT's revised standards on CPD and itsplans for supporting members with the broader range of CPD activities theregulator now requires
Figure one. The
RCSLT's CPD online diary page
020-021 22/11/05 4:49 pm Page 22
Anna van der Gaag is consultant to the
RCSLT CPD Project and an HPC Council
Member. She was on the HPC's CPD
Professional Liaison Group, 2003-2004.
Sharon Woolf is the RCSLT's new Head
of Professional Development.
www.rcslt.org December 2005 bulletin 21
profess ional i ssues
mentoring and audit. All members must
complete a PDP annually using either the
RCSLT form or a locally devised template.
RCSLT audit of CPDThe RCSLT will begin random audits of the
online diary from April 2007. The audit will
look at the amount and range of CPD, as well
as records of the impact of learning. Requests
for evidence of CPD activities from your
portfolio may be sought if the diary has a
shortfall in activity. The RCSLT will support
members who are not meeting RCSLT and
HPC requirements, and help get them on
track before the HPC audit starts via the
diary, email alerts and feedback from audits.
Complying with the standards� You must meet the RCSLT standards to
maintain certification status as a full
practising member
� If you do not meet the standards, this
may affect your ability to re-certify.
Falsification of information, or a lack of
evidence of CPD activity, will be subject
to scrutiny by the RCSLT
� If the standards are not met, you will be
given feedback and support, and a further
year before being re-assessed. If you are
still not meeting the standards, you will
not be able to continue as a certified
RCSLT member.
The new scheme aims to minimise
Standard 1: Amount of CPD Undertake a minimum of 30 hours CPD per year (for full-time SLTs) (excluding mandatory training)
Standard 2: Type of CPD Undertake a mix of CPD activities (work-based, formal, self directed, professional activity)
Standard 3: Record of CPD Maintain an up-to-date record and 'portfolio' of activitiesactivities
Standard 4: Reflective account Maintain an up-to-date record of the outcome of of impact of CPD learning (impact on practice)
Standards 2, 3 and 4 mirror the HPC's CPD standards. The RCSLT's Standard 1 shows the minimumamount of CPD required. Information on requirements for part-time and extended leave cases isdetailed above
What type of evidence should be in your portfolio?
CPD activity Purpose/example Number of Type of evidence kept in your CPD portfoliohours 2006/7
Attendance at a lecture or Update on new research in a clinical area 3 Certificate of attendance, course evaluation, reflection onseminar impact of learning in diary
Peer review or significant To review a challenging clinical case 2 Peer review or significant event analysis recordevent analysis
Presentation at a specific Present to colleagues on a new 4 Copy of programme with evidence of your interest group approach to therapy presentation
Developing a new service Improve communication between 4 Service protocol and reflection on your contributionprotocol team members
Review of paper Review paper on a specialist clinical area 4 Letter of invitation to review
Poster presentation at Present findings from a case study 5 Letter of acceptance for posterconference
Attendance at committee* Planning for a local AHP conference 4 Minutes of meetings showing record of attendancemeeting
Audit activity Reviewing waiting times in my clinic 4 Audit record form, minutes of meetings
e-learning module Update knowledge on disability 1 Certificate of completiondiscrimination legislation
Postgraduate degree course Gain higher qualification/undertake Accounts for Degree certificate, evidence of module completionresearch total hours
There will be exemptions and pro rata arrangements in place from the start of the new scheme forpart-time workers and those on extended leave.
For exemptions on RCSLT Standard 1 (see table one), part-time workers employed for fivesessions or less will only need to complete 15 hours per year (50%) of the total CPD requirement.
For those on extended leave, if you are working less than six months in a year, you will need tocomplete a minimum of 10 hours of CPD per year. If you take leave for six to 12 months, you willneed to complete a minimum of five hours per year (eg reading, e-learning). If you are on extendedleave you will be exempt from the audit during the year in which your leave occurs. The onlinediary allows you to log periods of extended leave at any time.
Those in full-time study (eg MSc or PhD) can claim exemption from Standard 2 (see table one)within a specified period. You must inform the RCSLT of your studies via the online diary and let usknow once the study ends. This will then be flagged-up if you are selected for the audit process.Other exemptions will be agreed on an individual basis.
paperwork and maximise the efficiency of
recording CPD for the RCSLT, the HPC and
the KSF. It will require a major shift in the
way CPD is recorded, but is designed to make
it easier for you to maintain both your
RCSLT certification and your HPC
registration.
*Committee meetings need to contribute to your development - if there is no significant new learning as a consequence of attending, you cannot credit the meeting in the CPD scheme
Table one: RCSLT CPD standards from April 2006
Part-time and extended leave requirements
020-021 24/11/05 3:24 pm Page 23
bulletin December 2005 www.rcslt.org22
book reviews
B O O K O F T H E M O N T H
Book ReviewsSpeaking for Myself PLUS! Earlyyears software for developingcommunication, cognitive andreading skillsTOPOLOGIKA SOFTWARE LTD, 2004Single-user licence £39;five-user licence £79;home-user licence £17(ex-VAT)
This software package isworth exploring,particularly forchildren who respondpositively to signing. Signing support isprovided for individual words, shortsentences and some nursery rhymes – greatfor extending parents' and staff 's signing.
The package provides a good range ofinteractive activities targeting basic wordmeaning, listening, comprehension, simplesentence construction and early literacy.These are presented in easy-to-navigatescreens, colourful, but not too busy. Thespeech is very clear, and delivered by bothadult male and female voices.
The signing appears in an overlaid window,presented by an adult actor and accompaniedby speech. The CD also provides resourcesfor printing out material from the
programme.The manual is excellent and includes
simple but sensible suggestions for usersunfamiliar with 'the teaching of reading andthe links between reading and spokenlanguage'.
We recommend this inexpensive package,especially for young signing children ininclusive educational settings and also forclasses in schools and units for children withadditional support needs. Interested parentswill welcome the cheaper version for homeuse.
JENNIFER REID, JANE DONNELLY
SLTs NHS Fife
Motor Speech Disorders, 2ndedition – Substrates, DifferentialDiagnosis and ManagementJOSEPH R DUFFYMosby, 2005 £31.99ISBN 0-32302-452-1
This is an expanded andupdated version of thehighly respected firstedition. As before, it coversin fine detail the neurological andpathological layers of different motor speech
disorders, their recognition and differentialdiagnosis.
The authors have revised sections to reflectdevelopments of the past decade. Newillustrations, diagrams and tables support thetext, and the authors have addedrepresentative clinical case summaries to eachof the main disorder chapters.
Hailing from the Mayo Clinic, the bookretains a strongly medical model bias. Itsstrength lies in the exhaustive detail of theneuropathological underpinnings of thedysarthrias and apraxia of speech, andreference to perceptual and acoustic studiesof these conditions.
It is one of few works to deal with thehyperkinetic and rarer forms of motor speechdisturbance, and contains probably the mostthorough consideration of psychogenicspeech disturbances in the general literature.
Extensive citing of sources makes this afirst-class reference work. Some readers maybe disappointed that only about 115 of the578 pages are directly devoted tomanagement. Nevertheless, this is more thanin most books.
The price represents astonishingly goodvalue for a hardback work of this size.
NICK MILLER
RCSLT adviser – motor speech disorders
Speech language sciences, University of Newcastle
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People with Autism Behaving BadlyJOHN CLEMENTS Jessica Kingsley, 2005 £13.95 ISBN 1-84310-765-1
The author has many years' practical experience of working with people with autism whose behaviours
are of concern. However, there are other ample reasons for reading this book.
It is not primarily for professionals, but is designed carefully for parents and carers. Its construction and
content are interesting, and various ways of using the book are outlined at the beginning.
The book encourages parents to carry out specific exercises enabling them to look at their child's
problem behaviour objectively. It also helps them to take a professional's viewpoint and apply it to their
child.
The author's clear perspective on why behaviours might occur is refreshing and straightforward. Parents
sometimes 'can't see the wood for the trees' when it comes to their child's behaviour. Clements' explanations are illuminating in an area
often fraught with emotion. He then supplies a range of tried and trusted strategies to address the problem behaviour.
Clements introduces excellent 'think pieces' on the topics of medication and relationship styles, and the appendices include useful
checklists.
This is a sound and innovative book for parents but it also has much to interest SLTs.
JANE NEIL-MACLACHLANAdult autism coordinator, RCSLT adviser
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www.rcslt.org December 2005 bulletin 23
book reviews
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Assessment and Intervention inAphasia – A Clinician's Guide ANNE WHITWORTH, JANETWEBSTER, DAVID HOWARDPsychology Press, 2005 £29.95ISBN 1-84169-345-6
This book provides abridge between theoryand practice in theunderstanding and management of aphasiclanguage impairment.
The first section examines the theory andprinciples of a cognitive neuropsychologicalapproach. The second illustrates how themodel described can be used to identify thenature of impaired and retained single word(but not sentence) processing. The finalsection considers the therapy literature.
This is not a dry, exhaustive literaturereview of research. The authors havetranslated key studies into a format that busyclinicians will be able to absorb and use. Iwill definitely use it to help my own clinicaldecision making.
Case studies illustrate deficit patterns. Thetreatment studies are systematic and detailedenough to allow the clinician to replicatethem.
The authors raise issues about how andwhy therapies work. They argue persuasivelythat there is no contradiction betweenfunctional, social aims, and therapy directedat reducing impairments. They advocate thatthe cognitive neuropsychological approachshould not be used in isolation and mustinvolve the person with aphasia.
This book is essential reading for thosewishing to familiarise themselves with theknowledge and resources to undertake acomprehensive analysis of single wordprocessing and to support evidence-basedtherapy.
SARAH ROSS
Stroke specialist SLT, Sheffield
Focus on Solutions: A HealthProfessional's GuideKIDGE BURNSWhurr, 2005ISBN 1-86156-479-1£17.50
The book has a readable style with plenty ofreal case examples and accounts oftherapist/client dialogue. Although the theory
is well covered, the general tone is verypractical. There are 'key points' boxes atregular intervals in the text to help the readerassimilate information.
Although the author explains that SolutionFocused Brief Therapy (SFBT) can be used ina range of healthcare and non-healthcaresettings, most examples are from an adultspeech and language therapy caseload.
In a well-referenced first chapter, theauthor outlines how SFBT has evolved andincludes several theoretical approaches. Insubsequent chapters she demonstratessuccessful use of the approach with, amongothers, stammering, dysphasic andParkinson's clients in individual, group,domiciliary and acute settings. The finalchapter examines audit and efficacy.
I highly recommend this book to anyonenew to SFBT, or to those who have alreadycome across the theory but would like moreconfidence in using it.
EMMA OSEI-MENSAH
Chair, SIG counselling and therapeutic skills
The Impact of Genetic HearingImpairmentDAFYDD STEPHENS, LESLEY JONES (eds)Whurr, 2005£37.50ISBN 1-86156-437-6
This book examines the social andpsychological effects of genetic deafness, andthe genetic interventions associated withthem.
The initial chapters focus on the historyand growth of genetic interventions,including the responses and attitudes of thedeaf community and hearing parents towardsuch interventions.
The authors then use the World HealthOrganisation international classification offunctioning, disability and health to examinethe impact of genetic hearing impairment.This model is used as the framework insubsequent chapters, which focus onchildhood deafness, adults of working ageand the elderly population, and the impact ofspecific conditions such as deafblindness,neurofibromatosis and otosclerosis.
The book concludes with two movingpersonal accounts about what it is like to livewith these conditions.
This thought-provoking book provides acomprehensive review of the literature on thepsychosocial aspects of deafness.
Its title, however, is somewhat misleadingwith less emphasis on genetics than Iexpected. There is simply not enoughevidence to comment on the impact ofgenetic hearing impairment alone, and theauthors had to include research on theimpact of hearing loss in general. The book,therefore, lost some of its focus.
It would appeal to those interested in thepsychosocial effects of deafness and thoseintending to undertake research.
SUZANNE HARRIGANSpecialist adviser childhood deafness
The Ear Foundation, Nottingham
VIP: Voice ImpactProfileSTEPHANIE MARTIN,MYRA LOCKHARTSpeechmark, 2005£39.95ISBN 0-86388-527-6
This evaluation tool is foruse by SLTs working with clients with voicedisorders. It offers a visual profile of specificareas that require change. It can also be usedafter therapy to reflect and reinforce visuallyany change achieved.
It includes a CD-Rom that is very easy touse and the questionnaire is printed in thebook, which can be photocopied.
The 10 sections include topics such asgeneral health, vocal history andenvironment. Each section consists of 10 yesor no questions. The yes responses areconverted to a graph and recorded on the VIPsheet. It takes approximately 15 minutes tocomplete the 100 questions, but the client canfill it in on their own to save time.
Guidelines on how to carry out thequestionnaire are included as well as sixworked examples.
The profile is not designed to be asubstitute for the normal informationgathering process but to complement datacollected from objective sources to build amore complete picture of the client.
It would be most useful to SLTs new toworking in the area of voice.
LINZI HATCHSpecialist SLT Adult neurology and voice,
North & West Belfast HSST
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bulletin December 2005 www.rcslt.org24
let ters
We were interested to read Celia Harding's
article in Bulletin. We take issue with her
implied statement that functional nutritive
sucking skills can only be developed through
the use of finger sucking or the use of a
dummy.
Aside from the small size of the study
(seven pairs of babies) and the lack of detail
given, eg it is not possible to determine at
what gestational age the intervention was
started, it is not clear what the desired goal of
the intervention is as only “full oral feeds”
and “neonatal feeding development” is cited.
Worryingly, there is no mention of these
babies transferring to full breastfeeding. We
assume that most of the babies were bottle
fed since there is a high correlation between
dummy use and lack of success with
breastfeeding.
The author identifies there is no clear link
between intervention and outcomes. She
Functional nutritive suckingand breastfeedingBulletin received this letter in response to Celia Harding's article, Developingfunctional nutritive sucking skills in premature infants, (Bulletin, August 2005, p14-15)
Celia Harding replies:Therapists who work with neonates are
receiving increasing numbers of referrals to
assess infants who have complex feeding
needs. We believe early intervention carried
out in collaboration with parents and
significant others promotes the best
outcomes. One approach is non-nutritive
sucking using a pacifier, finger or empty
breast when preparing an infant for
positive oral experiences and oral feeding
(evidence quoted in article).
As in my study, not all mothers are able
to or want to breastfeed due to a range of
cultural, personal and/or health needs. It is
known that organisations such as the WHO
and UNCF state that use of pacifiers should
be discouraged due to the supposed adverse
effect on breastfeeding. Worryingly, this is
in conflict with the evidence base (Kramer
et al, 2001; Collins et al; 2004) that states
pacifier use has no effect on the
development of breastfeeding.
My aim was not to reduce the
importance of breastfeeding, but to reflect
on the rationale behind an established
intervention, as it is the responsibility of all
practitioners to be rigorous in
understanding the interventions we are
promoting.
References:Collins CT, Ryan P, Crowther CA, McPhee AJ, PatersonS, Hiller JE. Effect of bottles, cups, and dummies onbreastfeeding in preterm infants: a randomisedcontrolled trial. British Medical Journal 2004: 329;193-198.Kramer MS, Barr RG, Dagenais S,Yang H, Jones P,Ciofani L, Jane F. Pacifier use, early weaning, andcry/fuss behaviour: A randomized controlled trial.Journal of the American Medical Association 2001:
286; 322-6.
acknowledges that tactile feedback during
handling has an influence. Indeed, Kangaroo
Mother Care programmes have already
proven the benefits of good physiological
stability and breastfeeding outcomes for very
premature infants.
The underlying premise is that this
intervention is based on babies learning to
bottle feed. For babies who are going to
breastfeed, it is well researched that even
premature infants can develop their suckling
skills if given the opportunity, by being close
to their mother's breast as much as possible.
For instance, a premature baby lying at his
mother's softened breast while receiving a
tube feed does not show “defensive feeding
behaviours”, instead he is having a positive
feeding experience.
Babies do not “learn” to breastfeed, they
need to practise at the breast, while
continuing to receive tube and cup feeds to
help them to maintain their nutrition.
Elizabeth Mayo
International Board Certified Lactation
Consultant (IBCLC) NCT breastfeeding
counsellor, infant feeding specialist,
Cheltenham General Hospital
Co-signed by Sandra Lang (Author of Breastfeeding special
care babies); Sally Inch (infant feeding
specialist, Oxford Breastfeeding Clinic,
Oxford Radcliffe NHS Trust); Clare Meynell
(IBCLC, infant feeding specialist, Chichester);
Irene Ridgers (IBCLC, infant feeding
specialist, Frimley Park Hospital); Gail Cruise
(breastfeeding coordinator, Derriford
Hospital); Hilary Myers (IBCLC, midwife,
West Wiltshire PCT); Anne Tompkins
(neonatal nurse, North Devon District
Hospital, Barnstaple); Sarah Hunt
RCSLT_dec_p24 24/11/05 3:23 pm Page 4
Any Questions?Want some information? Why not ask your colleagues?
Email your brief query to [email protected]. RCSLT also holds a database of clinical adviserswho may be able to help. Contact the information department, tel: 0207 378 3012.
Evaluating storytellingHas anyone found a good way of evaluating the
effectiveness of storytelling groups?
Anita Goveas
T E L : 0207 771 3372
E M A I L : [email protected]
Paediatric dysfluencyWhat do other SLT services do regarding care-pathways for
children who stammer, particularly concerning service
delivery and discharge criteria?
Charis Jennings, Kim Bates
E M A I L : [email protected]
Juvenile metachromatic leukodystrophyWhat is your experience of language loss in a child with
juvenile metachromatic leukodystrophy? What is your
success with AAC, implemented early while planning ahead
for further deterioration?
Joanna Thompson
E M A I L : [email protected]
Laryngectomee careWhat out-of-hours service do you provide for
laryngectomee care?
Sarah Eli
E M A I L : [email protected]
ALD dysphagiaRecently appointed lead SLT for ALD dysphagia wants to
contact others in similar roles.
Karen Bonar
T E L : 02890 552577
E M A I L : [email protected]
Bilingual co-workers I would like to contact other bilingual co-workers to share
their experiences about AfC banding.
Hassan Karolia
T E L : 07771 772794
E M A I L : [email protected]
Learning disability Any ideas on transition clients, ie from school to adult
learning disability?
Fran Virden
T E L : 01743 261181
E M A I L : [email protected]
Children with SLIAre any particular phonics packages useful for children with
specific language impairments?
Jennifer Thoms
E M A I L : [email protected]
Oral hygiene Do you know of any research or have policies on oral
hygiene for people nil by mouth?
Julie Lynn
T E L : 01928 753424
E M A I L : [email protected]
Teacher trainingHave you developed a CD/DVD training package for
teachers, including video of children in schools?
Helen Baugh
T E L : 01423 555869
E M A I L : [email protected]
Dysphagia dietMultidisciplinary group, researching need for user-friendly
recipe book for clients who require a thick purée, seek ideas
to share.
Linda Blackie, Mandi Hodgson
E M A I L : [email protected]
VideofluoroscopyInformation wanted on equipping a videofluoroscopy suite.
Gill Hood
T E L : 01604 545737
E M A I L : [email protected]
Russian phonological developmentDo you have any information on normative data for Russian
phonological development?
Amanda Baxter
E M A I L : [email protected]
Feeder cupsDo you know of published materials on the disadvantages of
parents using feeder cups after six months, especially those
with valves?
Jo Bishop
E M A I L : [email protected]
www.rcslt.org December 2005 bulletin 2255
ask your co l leagues
RCSLT-dec-any Qs p25 22/11/05 4:52 pm Page 20
bulletin December 2005 www.rcslt.org26
Opinion p iece
I have been working with children and young
people with Down syndrome for almost 12
years. What never ceases to surprise me is the
enormous potential these children possess,
despite all the problems they experience, and
there is now no doubt in my mind that with
the correct input they are capable of learning,
and learning quickly.
I am not alone in this opinion. Sue
Buckley, Director of Research at the Down
Syndrome Educational Trust, and the Down
Syndrome Association have long since argued
that children with Down syndrome respond
well to therapeutic input, supporting this
supposition with research and coherent
debate.
However, despite this there persists an
unerring pessimism among many
professionals, including our own, as to
whether such ongoing input can really make
a significant difference to these children's
long-term language and cognitive needs.
Contrast this with the enthusiasm
demonstrated for children at any end of the
autistic spectrum. Look through the job
pages in our speech therapy journals and
there are countless advertisements for therapy
posts as autism advisors/specialists.
Yet there have been no equivalent posts for
therapists working with people or children
with Down syndrome. This is odd, given
there is no evidence to suggest that children
with this condition are less deserving.
Equally perplexing is that, despite our
advances our perception of these children in
many ways, little has moved on from when I
began my training over 20 years ago. Witness
the terminology still used when we talk about
these children. They are said to be visual
learners and are very loving. Most telling of
all is the use of the word 'stubborn'. Yes, there
is something to these terms but they are
Seeing the child withDown syndrome
superficial and tell us little.
So, I wonder, why does this 'immaturity' of
thinking persist despite the evidence? What
clouds our vision of these children's potential
and why do I have a sense that despite the
evidence we have not moved on? This is a
complex issue and one I feel I may not
satisfactorily address here, but I feel it is a
debate worth beginning.
First and foremost, as pointed out to me by
a mum of one of the children I work with,
babies in-utero suspected of having Down
syndrome are recommended for termination.
Those that are with us now are here because
their parents refused to be pressurised into
terminating the pregnancy or were
undetected in the womb, and so effectively
slipped through the surveillance net. It seems
to me that such profound societal
ambivalence to the existence of a group of
people will do much to harm the way we see
them.
Secondly, there is also no question that the
physical manifestation of a child with Down
syndrome adds to the sense of strangeness
and difference in a negative and non-
productive way. Children with autism, on the
other hand, despite their strangeness and
difference are perceived, interestingly, as
beautiful and enigmatic.
No such positive associations seem to be
made universally with reference to children
with Down syndrome. In reality they, like
children on the autistic continuum, fall all
the way along the attractiveness spectrum.
Thirdly, negative social attitudes towards
disabilities undoubtedly become encapsulated
within the language we use. Nowhere is this
better demonstrated than in the use of the
word 'stubborn' when describing these
children's renowned resistance. Such a catch
all term implies a rather mindless bottom-to-
ground fixing and an erroneous and
annoying by product of the child's
'condition'.
Given the enormous challenges these
children face, such a robust emotional
response is natural and to be expected. Not
just because of their processing difficulties
and the plethora of health problems they
experience but, most importantly, because of
the shortfall of expectations they encounter
due to the prejudices we all hold and which
inevitably underpin and pervade our
intervention.
It seems to me, therefore, that these
underlying prejudices contribute powerfully
to the unerring sense of pessimism that still
prevails - simply because they so disfigure
our outlook as far as these children are
concerned.
Only by becoming aware of the potency of
these beliefs will we be able to free ourselves
to make more coherent clinical judgements as
to the real potential of these children. We
need to recognise the value of our input to
the development of these children and
maximise the use of the data available to us
already.
In my experience, when I manage this with
the children I work with, they rise to the
therapeutic challenge and do very well
indeed.
Geraldine Wotton wonders why there is an 'immaturity of thinking' in working withchildren who have Down syndrome
Geraldine WottonIndependent SLTemail: [email protected]
Acknowledgements:I would like to thank the children and their parentswho gave me inspiration to write this article and toMargaret Wright and Annabel Bosanquet for theiradvice and support.
RCSLT-nov- opinion p26 22/11/05 4:53 pm Page 22
Speci f i c Interest Group not ices
Northern Research SIG (N30)
6 December, 9.30am - 12.30pm
Research Governance: An essential guide for
SLT researchers in the NHS. Guest speaker Dr
Léonie Walker, R&D manager, North
Tyneside PCT. Practical session will enable
potential researchers to navigate NHS trust
research systems and Caldicott approvals,
research ethics committees, compliance with
the Data Protection Act and the Trust
Intellectual Property Rights policy.
University of Newcastle upon Tyne, Room
2.22, The Research Beehive
Members free/non-members £10 (inc SIG
membership for 2005-2006)
Contact Dr Helen Stringer, email:
South Wales SIG Learning
Disabilities (W2)
7 December, 9.30am - 4pm
Current knowledge and research on the
communication and people with Down's
Syndrome – Learning styles, motivational
issues and intervention, Helen Connelley,
SLT, Symbol Trust Kent
Sandfields Young Business Centre, Port
Talbot
Members £15 (£10 membership)/non-
members £20 (including food)
Contact Sian Jones or Katrina McLaughlin,
tel: 01792 614100, email:
Adult Learning Disability Central Region
SIG (C12)
12 January, 10am - 4pm
Visual impairment, Rachael Skinner,
practitioner/lecturer – sensory and learning
disability.
CREST Training Room, Woodfield House,
Bewdley Road, Kidderminster DY11 6RL
Members free/non-members £10
Contact Jackie Hartley, email:
[email protected], tel: 01562 746947
SIG in AAC – Central Region (C16)
19 January, 9.30am - 3.30pm
AAC in a medical setting: children and adults:
Helen Cockerill, Guy's Hospital; Janet
Nicholson, Bristol Children's Hospital; Julie
Atkinson, ACT Birmingham; Anne Williams,
Learning Disabilities Service, Cornwall, plus
others.
Oxford Centre for Enablement, Nuffield
Orthopaedic Hospital, Oxford
Members £5/non-members £10 (includes
lunch)
Contact Sally Chan, PCAS, Claremont
School, Bristol. Tel: 0117 9247527, email:
Head and Neck Oncology SIG (North)
(UKRI 10)
20 January, 9.30am - 4.00pm
Current issues in dysphagia for head and neck
cancer patients. Topics include: Evaluating
dysphagia – FEES and videofluoroscopy,
Annette Kelly, UCLH; Functional sequelae of
chemo-radiation, Jo Patterson, City Hospitals,
Sunderland; Dysphagia after total/partial
laryngectomy, Helen Rust, Christie Hospital,
Manchester.
Postgraduate Education Centre, QMC,
Nottingham
Members free/non-members £10
Contact Katherine Behenna/Jackie Farmer,
tel: 0115 970 9221, email:
Yorkshire Paediatric Dysphagia SIG (N16)
23 January, 1.30pm
Ethical issues: Professor Jois Stansfield. This
will be an afternoon of presentation and
workshop. Please bring real problems for
discussion.
Tadcaster Health Centre, West Yorkshire
Contact Angela Hunter, secretary, tel: 01924
483909 or Sue Craig, chair, tel: 01274
365461
For SLTs Working in Child Development
Centres (UKRI03)
24 January, 10am - 3.30pm
Videofluoroscopy, special care pre-term babies,
neuro-disability and cerebral palsy.
Dysphagia specialists Annie Bagnall and
Helen Cockerill will run the day. Only those
enclosing an A5 SAE with apologies, prior to
the meeting, will receive minutes and notices.
Room C318, Cox Building, Perry Barr
Campus, UCE. Visit: www.uce.ac.uk
Members £25/non members £30. Places
limited so book early
Contact Fiona Wilson, Therapies Office,
Children's Hospital, Doncaster Royal
Infirmary, Armthorp Road, Doncaster DN2
5LT. Tel: 01302 366666 ext 3854
SIG Adult Acquired Dysphagia (L4)
25 January, 1 - 4pm
Dysphagia research – feedback from MScs.
Pharyngeal residue: How do FEES and VFS
compare? Annette Kelly; The added value of
FEES in trache care, Pippa Hales; Assessment
of swallowing in ITU, Sue McGowan
Gilliatt Lecture Theatre, Institute of
Neurology, Queen Square, London
WC1N 3BG
Members and students £5/non-members £10
Contact Laura Hobbs, 4 Balfour Road,
Chatham, Kent ME4 6QT, tel: 01634 830000
ext 3225, email:
Managers SIG (C22)
20 March, 9.30am - 4pm
Speech and language therapy managers and
the law
Room B702, Baker Building, University
Central England, Perry Barr, Birmingham
Cost: £20 includes membership. Cheques
payable to 'Speech and Language Therapy
Managers SIG'.
Contact Helen Anderson, SLT Department,
Residence III, North Staffs Maternity
Hospital, Hilton Road, Stoke on Trent, ST4
6SD. Tel 01782 552485/6, email:
To advertise your RCSLT-registered SIG
event for free send your notice by email
only in the following format:
Name of group and registration number,
Date and time of event, Address of event,
Title of event and speakers, costs, contact
details
Details may be edited
Send to: [email protected] by the
beginning of the month before
publication. For example, by Monday 5
December 2005 for the January Bulletin.
www.rcslt.org December 2005 bulletin 27
RCSLT-dec-SIG p27 22/11/05 4:52 pm Page 21
2006 Bulletin Supplement advertising schedule
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