Getting to the ROOT of measuring outcomes: an update on the RCSLT Outcomes Project

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1 THE OFFICIAL MAGAZINE OF THE ROYAL COLLEGE OF SPEECH & LANGUAGE THERAPISTS Demystifying SEMH: evidence-based guidance Condition-specific care pathways: a consistent model of care Getting to the ROOT of measuring outcomes: an update on the RCSLT Outcomes Project 1 RCSLT Impact Report September

2 ELISABETH H. WIIG Introducing the new CELF -5 UK The Clinical Evaluation of Language Fundamentals - Fifth UK Edition (CELF -5UK), provides a streamlined, diverse population. Now available! Why choose CELF -5 UK? Now available in two formats traditional paper-and-pencil or digital via Q-interactive New normative data based on the March 2011 UK Census Battery of 14 stand-alone tests number administered dependent on age Age range now 5 years 0 months to Examiner s Manual UK Index language scores core, receptive, expressive, content, structure and memory Coming soon! ELEANOR SEMEL WAYNE A. SECORD UK Stimulus Book 2 Following Directions Sentence Assembly Semantic Relationships Traditional paper format UK ELISABETH H. WIIG ELEANOR SEMEL WAYNE A. SECORD Stimulus Book 1 New digital format via Q-interactive Sentence Comprehension Linguistic Concepts Word Structure Word Classes Formulated Sentences ELISABETH H. WIIG ELEANOR SEMEL WAYNE A. SECORD Now available in two formats! X235 Find out more at: pearsonclinical.co.uk/celf5uk

3 Contents ISSUE Letters 5 News 11 Opinion: AAC technology: what s in a name? Pam Enderby and colleagues: An update on the RCSLT Outcomes Project, including early results from the ROOT pilot 16 Gemma Arnold and Kay Gillett: Evidence-based guidance to support understanding of social, emotional and mental health 20 Charly Harris: Conditionspecific care pathways: developing a consistent model of care in an adult community service In the Journals 24 Research and Development Forum 26 Ask the Experts 29 Obituary: Cheryl Earnshaw Your speech and language therapy job adverts 32 Clinical Excellence Networks 35 Book Reviews 37 My Working Life: Emma Ladher CONTACTS ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS 2 White Hart Yard, London SE1 1NX Tel: bulletin@rcslt.org Website: ISSN: X COVER ILLUSTRATION Jamie Wignall President: Sir George Cox Honorary vice president: John Bercow Chair: Morag Dorward Deputy chair: Dr Della Money Honorary treasurer: Lorna Bailey Professional director: Kamini Gadhok MBE PUBLISHERS Redactive Publishing Ltd Level 5, 78 Chamber Street, London E1 8BL EDITORIAL Editor: Clare Williams Publications officer: Amelia Dale Contributing editor: Amit Kulkarni Art editor: Yvey Bailey Senior picture editor: Claire Echavarry ADVERTISING Sales manager: Joanne Rose Tel: joanne.rose@redactive.co.uk Recruitment sales: Pooja Badwal Tel: pooja.badwal@redactive.co.uk Display sales: Thomas Ainsworth Tel: thomas.ainsworth@redactive.co.uk PUBLISHER Joanna Marsh PRODUCTION Aysha Miah-Edwards PRINTING Henry Stone DISCLAIMER 2018 Bulletin is the monthly magazine of the Royal College of Speech and Language Therapists. The views expressed in the Bulletin are not necessarily the views of the RCSLT. Publication does not imply endorsement. Publication of advertisements in the Bulletin is not an endorsement of the advertiser or of the products and services. The publisher reserves the right to alter or withdraw any advertisement without consultation. Bulletin 3

4 Clare Hi, tech! Williams EDITORIAL As we emerge from the depths of a cold, dark winter to the cheerful hope of new beginnings that come with the advent of spring, lots of exciting new developments are on the horizon. The one that will affect us most comes as the many hours of hard work that have been invested into the RCSLT s digital transformation start to bear fruit, resulting in a more personalised and user-friendly experience when interacting with the RCSLT via the website and . We re also exploring how we can provide a digital version of Bulletin but don t worry, there are no plans to dispense with the paper version! (Phew!) To keep up to date with the latest news about what s happening and when, read our blog at rcslt-digital-project.org Talking of technology, have you ever considered how calling something hi-tech may make it sound superior? Helen Robinson discusses the potential impact such terminology may have when talking about different forms of AAC in our opinion piece on page 11. Our cover feature (p12-15) also explores the wonders of technology, and offers a sneak preview of the early results from the RCSLT Online Outcomes Tool pilot. Don t forget that it s Swallowing Awareness Day this month too. If you re taking part, remember to share your activities by posting photos on social media and and #swallowaware2018. As usual, we ll be including a round-up of the events in Bulletin, so make sure your cameras are set to high quality so we can feature them in print. Finally, thank you to everyone who tweeted about how much they enjoyed our working abroad issue last month. Our favourite tweets get published in Bulletin, so keep tweeting! Clare Williams Bulletin editor Your RCSLT Nicola McFadyen In my role as PR assistant at the RCSLT, my job is to share the valuable work that you are all doing on social media something that makes each day different! I also monitor the latest trends to bring you the best news from within the profession, which means I learn something new every day too. As well as social media, I also assist with ihthe promotion of RCSLT campaigns, including the Voice Box joke competition and Swallowing Awareness Day (see If you have a story you think our press team would be interested in, please press@rcslt.org for more information. And don t forget to check out our primary social media on on Facebook; on Instagram at and on YouTube at Nicola McFadyen, PR Assistant, RCSLT nicola.mcfadyen@rcslt.org MY WORKING LETTERS LIFE Representing SLTs in rehabilitation research FOLLOW THE RCSLT ON Bulletin thrives on your letters and s. Write to the editor, RCSLT, 2 White Hart Yard, London SE1 1NX. bulletin@rcslt.org Please include your postal address and telephone number. Letters may be edited for publication (250 words maximum). The Society for Research in Rehabilitation held its annual meeting in Bristol on 6 February. At that meeting, Dr Claire Mitchell, Clinical Specialist SLT in adult acquired neurological conditions and research fellow at the University of Manchester, was awarded the Verna Wright prize, not only for the best oral presentation to the Society, but also the best poster! Double congratulations! It would be good to see more SLTs become members of this society, which is a major multidisciplinary rehabilitation research society in the UK. Its aim is to advance education and research into all aspects of the rehabilitation of people with disability and to disseminate the useful results of such research for the public benefit. I have always found that listening to research conducted and presented by other disciplines has taught me a terrific amount! The Society aims to be inspiring and educational, while also providing excellent opportunities for networking for junior and established researchers. For more information, visit Pam Enderby, Professor Emeritus, University of Sheffield Complexities of terminology I m writing in response to a letter published in the December 2017 issue of Bulletin, which related to training materials for autism. I applaud the intentions of the school in their endeavour to develop understanding of autism within young autistic people; however, I was dismayed at the use of the term autism spectrum disorder (ASD). Autistic people do not wish to be referred to as disordered. Although autism can present many challenges for autistic people and those around them, being referred to as disordered is demoralising for many autistic people. Autism is part of one s identity and, often, the biggest challenge for young autistic individuals is overcoming perceptions that their autism is a negative deviation from the norm that should be remediated. The most important step in resolving this problem is for society to stop seeing autism as a disorder and start embracing it as a cognitive difference that can be of benefit to society. It should also not be assumed that person-first language is preferable. Jim Sinclair provides a useful summary of the reasons why many people in the autistic community prefer to be referred to as autistic rather than as a person with autism (see tinyurl.com/ y7avm575). Mark Ashley, Independent SLT AND VISIT: AND FOLLOW THE LINKS 4 Bulletin

5 News QUICK LOOK DATES» 14;03 Swallowing Awareness Day 20;03 Launch of Bercow: Ten Years On review 02;04 World Autism Awareness Day Bercow: Ten Years On ready to launch Tuesday 20 March 2018 is an important date for your diaries, as it s the day that the Bercow: Ten Years On review will be launched, reporting on the support for children and young people with speech, language and communication needs (SLCN) in England. The publication of the report will be marked by an event at the Speaker s House, to which parliamentarians and key system leaders have been invited. The culmination of the review, which has been undertaken by the RCSLT in partnership with children s communication charity I CAN, comes 10 years after the Government published its landmark report on services for children and young people with SLCN: The Bercow Report. Since January 2017, the Ten Years On review has received evidence from more than 2,500 people, including children and young people, parents and carers, practitioners and commissioners, as well as SLTs. The evidence has now been analysed, and the report will include findings and recommendations under the following themes: The centrality of spoken language to children s life chances Children are still being missed An accessible and equitable service Effective support Integrated systemic change The report s recommendations will be aimed at national decision-makers and local system leaders, with the aim of bringing about systemwide changes to ensure children and young people with SLCN receive the support they NEWS IN BRIEF need. In addition, the review will suggest a range of actions that individuals can take, along with supporting resources, to make a difference to the lives of children and young people with SLCN. In January 2018, the All-Party Parliamentary Group on Speech and Language Difficulties received a presentation about the review more information about the meeting can be found on page 6. For a preview of the report, visit tinyurl.com/appg-sld to see the slides that were presented by RCSLT Chief Executive Kamini Gadhok, the Chief Executive of I CAN and the Chair of the Review s Decision-Making Panel. We hope that our members will get involved and help us to spread the word about the review s findings and recommendations, so keep checking our website and social media channels on launch day for all the latest information: Website: Facebook: Caroline Wright, Policy Adviser, RCSLT caroline.wright@rcslt.org International dysphagia developments The International Dysphagia Diet Standardisation Initiative (IDDSI) framework was adopted by the RCSLT and the British Dietetic Association in October In addition, some industry partners for food modification and thickening agents are intending to alter their instructions to meet the IDDSI terminology from April 2018, and all manufacturers will transition to the new framework terminology by April Members are advised to contact their local providers to establish the transition times. The UK IDDSI Expert Reference Group is developing a range of training materials to assist implementation in trusts and schools, available from the BDA website (tinyurl.com/bda-iddsi). In the meantime, if you have any feedback on the IDDSI framework or would like to receive updates, please contact Louise Borjes, RCSLT Project Co-ordinator (louise.borjes@rcslt. org) or visit and sign up to their newsletter. Nominations for the Chief Allied Health Profession Officer Awards 2018 are now open. Categories include: AHP Student Innovation, AHP Support Worker of the Year, AHP Digital Practice, AHP Quality Improvement, AHP Leader, and NICE into Action. Entries close 29 March. See tinyurl.com/ CAHPO18awards for details. Save the date for our 2018 RCSLT Research Champions Workshop, which will be held on 5 July at City, University of London. You need to be a research champion to register. For more information on what is involved in being a research champion and how to become one, see the RCSLT website. Visit: tinyurl.com/zjhcb42 Correction: In January s issue of Bulletin, we featured an article about RCSLT leadership mentors (p12-14); however, the link directing readers to the application form on the RCSLT website was incorrect. For the correct application form, please visit: org/members/professional_ roles/advisers/leadership_ mentors A consultation to gain the views of service users regarding the development of the communication access symbol is now live. We are seeking responses on the symbol itself as well as the accompanying standards. Please encourage your service users to get involved. The survey is available from communication_access_ RCSLT Bulletin 5

6 News TWEET TALK» Shagufta You know you re an aspiring speechie when you get excited when comes through the letter box addressed to you Gill Some great tips on how to support people with communication difficulties on #TimeToTalk day and every day! Parliamentary group previews Bercow review The All-Party Parliamentary Group (APPG) on Speech and Language Difficulties, which was formed following the publication of The Bercow Report in 2008, held its annual general meeting at the House of Lords on 24 January. The meeting had one of the best parliamentary attendances ever, with a number of new parliamentarians joining the Group. As well as the re-election of Geraint Davies MP to Chair and Lord Ramsbotham to co-chair, the meeting also included a preview of the forthcoming Bercow: Ten Years On report, due to be published in March (see page 5 for more information). A presentation highlighting some of the review s key findings, the emerging themes that will form part of the final recommendations, and the next steps, was given by Jean Gross, Chair of the review s Decision-Making Panel; Bob Reitemeier, (L-R) Kamini Gadhok, Lord Ramsbotham, Geraint Davies, Jean Gross and Bob Reitemeier Chief Executive of I CAN; and Kamini Gadhok, RCSLT Chief Executive. After the presentation, the speakers took questions from the audience, which included SLTs and representatives from other sector bodies. More information is available on the RCSLT website: tinyurl.com/appg-sld Peter Just, Public Affairs Adviser, RCSLT peter.just@rcslt.org Introducing the RCSLT CPLOL Action Group The RCSLT CPLOL Action Group was created in 2016 to support the work of the two RCSLT delegates to CPLOL, the umbrella organisation of European speech and language therapists/logopedists. Group members Andrea Robinson, Helen Coward, Lorette Porter and Raman Kaur help the UK delegates to disseminate CPLOL activities and outputs to RCSLT members, plan European Day activities in the UK and respond to diverse enquiries from European SLTs about UK practice and education. If you would like to know more about CPLOL or the Action Group, visit org/members/professional_networks/cplol RCSLT Web Poll Have your say... SLT awarded Australian honour Have you completed an RCSLT elearning course? 73% say no VISIT: In recognition of her dedication and service to the speech and language therapy profession, Dr Caroline Bowen was awarded Member of the Order of Australia as part of the events to mark Australia Day on 26 January. A major public recognition of Dr Bowen s achievements, this civil honour is awarded to people who have made significant contributions to civil society. Dr Bowen has worked extensively across Australia and the UK, and was made an honorary fellow of the RCSLT in In 2011, she was made a life member of Speech Pathology Australia, and, in 2008, a fellow of the American Speech-Language-Hearing Association. Dr Bowen has the distinction of being the only Australian to be awarded fellowship/life membership to these three professional associations, and is one of an elite few in the world to have received such recognition. Gaenor Dixon, National President of Speech Pathology Australia, said: Caroline has an outstanding record of achievement and service to the Australian and international community through her work as a speech pathologist. She is regarded as a foremost international expert in both the clinical field of children s speech sound disorders and the use of technology to improve speech pathology practice. The RCSLT would like to congratulate Dr Bowen on this incredible achievement. 6 Bulletin

7 Esther Recovering after explaining some of the skilled ways we support people with autism if they need to go to court #registeredintermediaries #Autism #RCSLT Bryony So many great articles about international SLT work in this month Bulletin it s giving me itchy feet! SHUTTERSTOCK Working towards a model hospital The NHS has long been condemned as being data-rich but information-poor, and allied health profession (AHP) services are no exception. The Model Hospital portal aims to help NHS providers improve by identifying what good looks like, using metrics that evidence quality outcomes and good use of resources and benchmarking. It provides an opportunity for SLTs and other AHP services to demonstrate the critical impact they make, not only to patient experience and outcomes, but also to their trust s overall productivity and efficiency. The challenge is to find consistent and accurate data that comprehensively describes the quality and productivity of AHP services. Anyone working in NHS providers can access the Model Hospital, and AHP service leads are encouraged to register at model. nhs.uk The portal is populated with data submitted by trusts through existing returns, whether it s allocation of staff to the national Electronic Staff Register or compilation of reference costs. Therefore, it is strongly recommended that trusts record and report data accurately. AHP leads are urged to engage in this process, particularly as the data Member survey The RCSLT member survey closed on 16 February. Many thanks to all who completed it! We have received an overwhelming response. Your views and feedback will help to inform how we shape our priorities and allocate resources to best support your needs. will be used for a more open and integrated approach to performance management across the NHS. AHP leads are also encouraged to access tools and best practice guidance developed by NHS Improvement, such as the AHP job planning guidance (tinyurl.com/ AHPguide), which standardises the framework by which trusts identify the capacity of their AHP workforce. The RCSLT has been working to inform the development of this framework, and is pleased that it reflects work previously undertaken with David Amos on clinical business skills (tinyurl. com/business-skills-webinar). We hope this supports consistency of approach. It is expected that clinical capacity will be reported via the Model Hospital in due course. NHS Improvement is keen to know of any AHP services that already measure productivity alongside quality outcomes, and receive case studies demonstrating improved productivity as a result of a service change or innovation. If you would like to know more or get involved in shaping the Model Hospital, please contact Rosalind Campbell, AHP Productivity Lead NHS Improvement (rosalind. campbell1@nhs.net). You can also follow the conversation on twitter using #supportingclinicalproductivity MORAG DORWARD & KAMINI GADHOK A CO-ORDINATED APPROACH We recognise the significant increase in demand to support patients and service users with dysphagia Since 2015, the RCSLT has taken the lead in coordinating a sector-wide approach to support improved outcomes for people with dysphagia. This work was initiated via an event held in partnership with the NHS England Patient Safety Team (now NHS Improvement - NHSI) following the avoidable death of a patient through a choking incident. The ability to bring key sector leaders together resulted in the establishment of four workstreams, looking at workforce, raising awareness, evidence and data, and resources and guidance. The partnership included representatives from industry, professional bodies and user organisations. In January 2018, a followup symposium was run in partnership with NHSI and the Academy of Medical Royal Colleges (AMRC), with Jo Fillingham presenting the work to date on behalf of NHSI. We were delighted with the level of engagement and the increase in diversity of those who attended, including government representatives from across the UK, the British Geriatric Society and the Care Quality Commission. This symposium aimed to present the findings of the task-and-finish groups, progress that had been made and also identify other actions to be taken forward, eg the need to update the Interprofessional Dysphagia Framework. Presenters included non-slts such as Dr David Smithard, Consultant in Elderly Medicine, and Mirek Skrypak, Associate Director Quality and Development, Healthcare Quality Improvement Partnership, as well as SLT leaders in the field, including Professor Pam Enderby, Dr Sue Pownall, Dharinee Hansjee and Dr Elizabeth Boaden. We will be setting up a UK-wide steering group to help progress the work. We are also in the process of organising a uniprofessional event to be held in June this year, as we recognise the significant increase in demand for speech and language therapy services to support patients and service users with dysphagia. More information on this event will be provided in the near future. Morag Dorward, RCSLT Chair and Kamini Gadhok, MBE, RCSLT Chief Executive. kamini.gadhok@rcslt.org Bulletin 7

8 News FAST 120 FACTS» 10 social care providers have years since The Bercow taken the STOMP pledge Report was published STOMP forges ahead in 2018 In 2017, the RCSLT pledged its support for STOMP, a project devoted to stopping the over-medication of people with a learning disability, autism or both. The STOMP Delivery Group, run by the NHS England Learning Disability Programme, has been working tirelessly to promote STOMP across the UK and improve the quality of life for people with a learning disability or autism, with a range of new developments under way for A number of professional bodies have pledged support for the project and, in 2018, STOMP is continuing to expand more than 120 social care providers have taken the social care pledge to support the project and provide the best services to people taking psychotropic medicines. Healthcare providers across the UK will soon be able to get on board too a healthcare pledge will be rolled out, focusing on how providers can put STOMP into practice, including better collaboration with primary care and the use of alternatives to medication. To provide support and information for GPs, psychiatrists, carers, learning disability teams and pharmacists, Derbyshire Healthcare NHS Foundation Trust has created a set of five short films about STOMP see tinyurl.com/ STOMPfilm In addition, Hazel Griffiths, family carer adviser to STOMP, is designing a resource that will help families with monitoring medication. As a nurse and mother of a son with autism, Hazel knows the impact over-medication can have on individuals and families. My son was 19 when he had an acute reaction to stress due to living away from home, she explains. Without a definitive diagnosis, he ended up on five different psychotropic medicines. Hazel s resource will be rolled out in early For more information on STOMP, visit or sarah.bowes1@nhs.net SHUTTERSTOCK 8 RCSLT online resource of the month If you haven t yet checked out our digital blog, which outlines the latest developments in the RCSLT s digital transformation, now is the perfect time to get reading. As the launch of the new website fast approaches, this is the place to find out what to expect in the coming months, including how your digital experience will be more personalised, easier to navigate and mobile/tablet friendly. To find out more, visit: rcslt-digital-project.org Bulletin Scotland s AAC law goes live Legislation (passed in 2016) that creates a duty on ministers and agencies to provide augmentative and alternative communication (AAC) equipment and the support to use it (including speech and language therapy) will take effect in Scotland as of Monday 19 March. From that date there will be a legislative duty on NHS Health Boards to provide or secure communication equipment, and support in using that equipment, to such extent as they consider necessary to meet all reasonable requirements, to any person who has lost their voice or has difficulty speaking. The legislation states that, where current services for AAC are managed and commissioned by integrated joint boards through delegated arrangements under the Public Bodies (Joint Working) (Scotland) Act 2014 these delegated arrangements will apply to the new duty. If they are not under the auspices of delegated arrangements, then the duty will rest with the NHS board. Directions that cover the definition both of communication equipment and of support in using that equipment have been drafted for health boards and integrated joint boards in collaboration with stakeholders. A number of expert RCSLT members have helped to write these definitions. The RCSLT Scotland Office is working in partnership with SLTs, organisations that represent AAC users and Scottish Government to seek clarification, firstly, on which agencies will hold the duty in each area of Scotland and, secondly, on closing current funding gaps for both the equipment and provision of support to use it. Queries about implementation of the new law in your local area should be directed to the local AAC executive lead. If you have any queries on RCSLT activity in Scotland, please contact Kim Hartley Kean. Kim Hartley Kean, Head of Scotland Office, RCSLT. kim.hartleykean@rcslt.org

9 6 categories in the Chief Allied Health Professions Officer Awards issues of Bulletin published to date Derek Munn Wales Selective Mutism Pathway Project Selective mutism is on the increase, with roughly one in 140 children at primary school in the UK experiencing speech anxiety. The role of an SLT in managing children with selective mutism has been identified based on a consensus-based care pathway of good practice (Keen et al, 2008), and includes early identification, assessment and intervention. The role is largely consultative and should involve multi-agency liaison. In Wales, supporting legislation includes the Additional Learning Needs and Education Tribunal (Wales) Act There has been significant progress made in Wales in raising awareness about selective mutism, and, in 2017, the Wales Speech and Language Therapy Advisory Forum (WSLTAF) requested the development of a Wales pathway for children with selective mutism. The project group involves representation from each of the seven health boards in Wales. At their initial meeting in November 2017, significant variation in service provision was highlighted across Wales for children with selective mutism, with reports of children and families being passed between services, which included speech and language therapy, child and adolescent mental health services, and educational psychology. This is demonstrated in a very powerful parent story currently published on the Afasic website ( which outlines a family s battle to get help and support for their daughter. As selective mutism is not the remit of any one professional group, children with selective mutism are a very vulnerable group (Keen et al, 2008). It is hoped that the development of a Wales pathway for selective mutism will help to ensure that children and their families across Wales are guided to timely, appropriate support. Further information about selective mutism can be found at Judith Chidgey, SLT, Cwm Taf University Health Board (on behalf of the Wales Selective Mutism Pathway Working Group) Reference Keen DV, Fonseca S and Wintgens A. Selective mutism: a consensus based care pathway of good practice. Archives of Disease in Childhood 2008; 93(10): USER TESTING Throughout the years, the RCSLT s work with service users has increased in importance and significance. As part of our planning for the next three years, we recently held the third RCSLT annual meeting with national service-user organisations (some UK-wide; some Scottish) to inform our work and discuss joint plans. We gained some valuable insight, with the discussions confirming some matters, greater emphasis placed on others, and new perspectives added. Children s organisations spoke of the family and parent experience and the challenge of finding information on how you can support your child as a parent. They recognised that information is out there, but it s about signposting and accessibility. Familiar themes included access to specialist SLTs, variability in provision from area to area, and awareness of speech language COLUMN The RCSLT s work with service users has increased in importance and significance and communication needs among other professionals. They also emphasised the importance of NHS and independent SLTs working together effectively. Organisations working with adults focused on the challenges of joining up the system for example, in data collection and sharing and of collective influencing. The range of organisations that work with neurological conditions, for example, discussed how to collaborate more effectively on the common challenges they face, both for communication and swallowing. We will be taking this idea of a communication and swallowing alliance further. We were pleased at how positively each organisation received the news of the work we ve been doing (in partnership with the Stroke Association, Communication Matters, the MND Association and others) to develop the communication access symbol. We then worked together to develop our ideas further for both a symbol design and the associated standards testing how they would work for each service-user group and what would be needed to make them a reality. SLTs do what they do to make people s lives better. With the input from service users, our plans for the years ahead will be closer to that goal. Derek Munn, RCSLT Director of Policy and Public Affairs. derek.munn@rcslt.org Bulletin 9

10 News NEWS IN BRIEF Summer clinic increases NHS capacity A six-week summer paediatric clinic, run by students from Leeds Beckett University (LBU) last year, proved a huge success, quadrupling the NHS capacity for the period and reducing the waiting list as part of a wider initiative. As well as offering children the intervention they needed, the project also gave students valuable clinical experience. Organised by the lecture team at LBU in partnership with SLTs from Leeds Community Healthcare (LCH) NHS Trust, 65 children on NHS waiting lists attended the clinic for individual blocks of intensive speech and language therapy sessions. The children had a range of speech, language and communication needs; some with additional difficulties such as autism, cerebral palsy and learning difficulties. All made progress and were given support plans, with targets and resources, to carry over at home and school. Last November, the Speech and Language Therapy Society at the University of East Anglia (UEA) held a week of activities to raise awareness of speech, language and communication needs and swallowing difficulties, alongside raising 1,493 for Mencap. The action-packed week included a quiz and chips night, a talk at a local high school, a raffle and cake sale, and an augmentative and alternative communication (AAC) information stall. The main event was a 36-hour non-vocal communication challenge, which saw SLT students (and a lecturer) use different modes of communication to raise awareness of those who are unable to communicate using speech, and gain an insight into The students were supported by staff from LCH and LBU, who helped plan the sessions and joined in where needed. One student commented that the experience had: helped my application of theory to practice immensely ; while parents were impressed with the students level of competency. The initiative was a pilot, and there are now plans to develop a sustainable paediatric clinic at the University. Jo Sandiford, senior lecturer/slt Giving voice at UEA their day-to-day experiences. We also encouraged the public to think about what their voice means to them. Three society members had the opportunity to talk about the Giving Voice week on BBC Radio Norfolk, two of whom were using voice output devices. Jess Slater and Chantelle Blazey, UEA Speech and Language Therapy Society Communication as a human right To celebrate the 70th anniversary of the Universal Declaration of Human Rights, Speech Pathology Australia is publishing a special issue of the International Journal of Speech-Language Pathology, which aims to expand the discussion of communication as a human right. Featured within the special edition is an article prepared on behalf of the International Communication Project (ICP) entitled: The International Communication Project: Raising global awareness of communication as a human right. The article is available open access at: tinyurl.com/icppaper Atos Medical: joint statement Following concerns raised by members of the RCSLT CEN Head and Neck South and the British Association of Head and Neck Oncology Nurses (BAHNON) regarding Atos Medical UK/ Countrywide Supplies (CWS) Ltd, a meeting was held to obtain reassurances that Atos Medical/CWS was operating strictly within a legal framework. The meeting found that, although there was nothing to suggest that Atos Medical/CWS was behaving improperly or that its activities could interfere with the rights, privacy or medical interests of patients, the lack of communication around the merger, company structure and implementation of the nursing service has led to misunderstandings. ATOs Medical/CWS has now produced an FAQ document, flow charts and case studies to explain how the company functions and how it connects with patients and clinicians. It has also set up a secure nhs.net address where members can address concerns and seek advice: c.vanas-brooks@nhs.net. The CEN can also be contacted via a secure nhs.net address: rmh-tr. headandneckcen@nhs.net The full statement and accompanying documents have been posted on the Hubs Basecamp pages. For those not on Basecamp, please Hubs@rcslt.org for further information. TCT launches education materials The Communication Trust (TCT), in partnership with the UCL Institute of Education and funded by the Department for Education, has launched a series of materials to help providers of initial teacher education and trainee teachers to embed speech, language and communication into their education. Alongside a series of information sheets are case studies across different stages and subjects, with audio files, lesson plans and tasks to help practitioners apply learning to settings. The materials are downloadable, free, from 10 Bulletin

11 Helen Robinson COLUMN Opinion Helen Robinson reflects on the impact of terminology when describing the tools in an AAC toolkit AAC technology: what s in a name? It s long been accepted that the augmentative and alternative communication (AAC) journey starts with low-tech systems, such as signing, Picture Exchange Communication System (PECS) books and symbol boards, and ultimately leads to a high-tech voice output communication device, perhaps with lite-tech AAC along the way. Many of us are taught, and accept, that the journey starts with one and leads ILLUSTRATION Sara Gelfgren to the other as a linear process, often with the individual abandoning their previous system as they go. However, we are now in an age where one device might be used for all levels of communication, from single messages, to full symbolic or text-based language systems. With this in mind, how useful is it for us to still be using the terms low, lite and high-tech when referring to AAC systems? Recently I ve begun to consider the connotations of these words and how they might reinforce the idea that AAC starts at A and ends at B, and, more importantly, that one might be better than the other. The line between low-tech and lite-tech has always been blurry; often the terms are used interchangeably. However, over recent years, with the availability and popularity of relatively low-cost tablet computers, the line has become even less clear. What was once considered low/ lite-tech, might now fall into the realm of high-tech. Take the BIGmack switch, for example, often seen as a starting point for early communicators; this is now available as an app. So is this still low-tech, or is it now high-tech? How useful is it to be using the terms low, lite and high-tech when referring to AAC systems? High-tech systems are often viewed as the best, the quickest and most desirable. Yet, increasingly I encounter clients for whom these systems aren t the best. For many people, the strategies they ve developed will ultimately serve them better; especially those who find accessing such systems difficult and laborious. That s not to say that these people will never use a communication aid; just that their symbol boards may often be a quicker, easier means of communicating. We might refer to AAC users as having a toolkit of strategies for use at different times of day, in different situations and with different people. No tool is better than another, just different. Using the terms low and high to introduce the idea of AAC to individuals immediately gives the impression that the latter is superior: low is at the bottom; high is at the top. All too frequently we encounter parents, education professionals, support workers and spouses who are reluctant to invest their time and energy into using systems described as low and who can blame them? Perhaps if we were to use less loaded terminology to talk about AAC systems, they might be met with a better reaction? But what should we use instead? The terms aided and unaided might serve us better, with unaided referring to natural strategies, such as eye/finger pointing to objects, speech, vocalisations, facial expression, signing and gesture; and aided referring to any form of communication system where the person is given symbols, photos or text to support their communication. Aided systems might be further broken down into paper-based, eg alphabet boards and symbol books; and electronic, eg tablets, single message switches and dedicated communication aids. I think the terminology is likely to evolve over time, and no doubt others will have further suggestions for ways to describe AAC systems. In my clinical practice, I m making a conscious effort to move away from the terms low-tech and high-tech, but it is a challenge, as these terms are so familiar and accepted that I still find myself using them daily. But it s a challenge worth pursuing as we endeavour to change the perceptions of those clients and families we work with when helping to identify the best AAC tools for that person. Helen Robinson, AAC Service Lead for the Barnsley Assistive Technology Team hrobinson8@nhs.net Bulletin 11

12 FEATURE OUTCOMES PROJECT 12 Bulletin

13 FEATURE OUTCOMES PROJECT Getting to the ROOT of measuring outcomes Pam Enderby and colleagues provide an update on the RCSLT Outcomes Project, including early results from the RCSLT Online Outcome Tool pilot ILLUSTRATIONS BY Jamie Wignall The methods of allocating funds to speech and language therapy services have been evolving over the past 15 years. The aim is to ensure that commissioning groups and other funders invest in services that monitor the quality of their provision, reduce variation in provision, control investment, and can demonstrate impact. In response to this, the RCSLT was stimulated to develop a national approach to gathering outcome information on clients who receive speech and language therapy. We began by identifying an existing outcome measure using the best fit criteria agreed by members, which included psychometric properties, ease of use and ability to collect information on a broad range of client groups (Powell & Lowenthal, 2014). The Therapy Outcome Measure (TOM) (Enderby et al, 2006), which is based on the dimensions used by the World Health Organization s International Classification of Disability and Function (WHO, 2001), was selected as the most appropriate measure. Online data collection tool One of the barriers to gathering data was the variability in digitised record-keeping in speech and language therapy services. Consequently, the RCSLT invested in developing an online data collection tool (Gadhok & Moyse, 2017) to support with data collection and reporting. Different Class Solutions, the company appointed by tender process to develop the online tool, uses an approach known as Agile, in which software is developed in stages by gathering feedback from users to shape the next iteration of the development. Twelve services from across the UK have been piloting the tool known as the RCSLT Online Outcome Tool, or the ROOT to collect TOM data, and we have been working with them to co-produce the tool. They include services for adults and for children, and a mixture of both. Early results The services who have been piloting the ROOT were recruited at different stages; therefore, some services were collecting data longer than others. Since June 2016, the 12 services have entered information The data will assist service managers in demonstrating the impact of their services Bulletin 13

14 FEATURE OUTCOMES PROJECT Information from a single service Figure 1 (below) depicts a report on the outcomes of children with language disorder who have received speech and language therapy. It shows that more than 90% improved their language skills (impairment) and 87% improved their ability to communicate (activity), while around 20% did not improve on their social participation or wellbeing. It would be possible to explore whether new approaches to working with the education settings in this locality could support better outcomes in social participation and wellbeing, and to compare these results with results following this change. Table 1. Overall data fom 12 sites for individuals with non-progressive conditions Number of clients (total = 11,089) on 11,610 clients, covering a range of ages, speech and language conditions and medical aetiologies, including aphasia (862), dysarthria (527) and learning disability (141). Data becomes useful when it can be interrogated and its meaning explored. Depending on the questions being asked and the audience requiring the information, different reports are required, which the ROOT provides (see Figure 1). Table 1 (above) shows overall data from the 12 sites for individuals whose conditions are not progressive in nature. Positive change in number of domains None One Two Three Four 2,864 (23.9%) 1,816 (15.1%) 2,253 (18.8%) 1,629 (13.6%) 3,445 (28.7%) More than 75% of clients improved on at least one TOM domain (impairment, activity, participation and wellbeing), with 27.8% improving in all four domains. Almost 25% of clients did not improve their scores in any of the domains. This may be related to a number of factors; for example, some individuals receive intervention to maintain their skills and abilities; others may have been discharged prior to therapy being complete. Being able to identify why clients are not being affected positively is important, and this data will help services to reflect on possible causes. Benefits of benchmarking Comparing data from different services is highly valuable. It facilitates investigations into whether individuals are being discharged at a similar point in their recovery and whether therapy has a similar impact on the domains. Furthermore, it is possible to identify whether patients are being referred to the service at the same point, and the subsequent impact. For example, in some areas, people may be referred only when they have a severe problem; whereas, in other areas, people are referred with moderate or mild difficulties. It is essential that clinicians and service managers are aware of the impact of their services, know their strengths and weaknesses, and can assure their commissioners/funders that they have this information, and that it informs reviews of their services. Previous work (John et al [a/b], 2005; Enderby & John, 1999) has indicated that some services show greater impact on social participation and wellbeing, while others Figure 1. Report showing the direction of change in TOM between initial and final ratings across each domain for children with language disorder Impairment Activity Participation Wellbeing Episodes = (450) Patients: (449) 90.2% 0.4% 9.3% 87.8% 0.4% 11.8% 79.1% 1.1% 19.7% 77.1% 1.1% 21.7% KEY DOWN SAME UP 14 Bulletin

15 FEATURE OUTCOMES PROJECT Table 2. A comparison of two services: TOM data for children with phonological disorder receiving speech and language therapy Average TOM at start, end and amount of change* (mean) Pilot site/ service Number of patients Impairment Activity Participation Wellbeing Start End Change Start End Change Start End Change Start End Change * A clinically significant change is defined as the practical importance of a treatment effect whether it has a real, genuine, palpable, noticeable effect on daily life. Change relates very intimately to the concept of difference (Rai et al, 2015). It therefore represents a threshold for outcome scores (either patient-reported or clinician-measured) over which either would consider a given change in score to be meaningful and worthwhile (Dvir, 2015). For the TOM, this is set at 0.5. may see more changes in impairment and activity. It is possible such variations are associated with the model of service delivery. Table 2 (above) shows TOM data for children with phonological disorder at two sites. Site 1 is addressing the needs of children with more severe difficulties and shows a clinically significant change on two of the domains. Site 2 is addressing the needs of children with slightly less severe problems and making a clinically significant impact on the phonological disorder/ impairment. It would be interesting to explore these differences. In addition, this feedback may lead the services to review aspects of their intervention and consider whether partnering with other agencies may increase their impact, particularly in the area of wellbeing. They would be able to review whether reconfiguring has the desired effect or not. A statistical note The TOM collects ordinal data that has a sense of order, but for which we cannot be sure that the distances between the consecutive values are equal. Usually, such data should use nonparametric statistics; however, it is now generally agreed that some ordinal data is less qualitative than other data, and that it is reasonable to treat it as interval data and calculate means and medians, as there is sufficient definition to help people perceive the different points on the scale in the same way. Data analysis We are now getting to the position where we have substantial data that can describe the impact of services on clients receiving speech and language therapy. Although the data is overarching, it is reliable and provides us with basic information, allowing us to compare when people access services, at what point they are discharged and whether this varies across the country. The data will assist service managers in demonstrating the impact of their services to those who are unfamiliar with our profession and our role. The data will also assist with reflecting on the strengths and weaknesses of each service to drive quality improvement. The ROOT forms part of the broader work on outcomes carried out by the RCSLT. For more information, visit the Outcomes Project webpages at: outcomes/rcslt_outcomes_project Acknowledgements We would like to thank the many staff in the services involved in the pilot study for their participation and patience. Professor Pam Enderby MBE, Professor Emeritus of Community Rehabilitation, University of Sheffield; Kathryn Moyse, Outcomes and Informatics Officer, RCSLT; and Mark Bedwell and Patrick Guest, Directors, Different Class Solutions Ltd. References & resources Enderby P & John A. Therapy outcome measures in speech and language therapy: comparing performance between different providers. International Journal of Language and Communication Disorders 1999; 34: Enderby P, John A & Petheram B. Therapy Outcome Measures for Rehabilitation Professionals: Speech and Language Therapy, Physiotherapy, Occupational Therapy, Rehabilitation Nursing & Hearing Therapists. 3rd Edition. Croydon: J&R Press Ltd, Gadhok K & Moyse K. The RCSLT Online Outcome Tool. RCSLT Bulletin 2017; 778: 5. John A, Enderby P & Hughes A [a]. Benchmarking outcomes in dysphasia using the Therapy Outcome Measure. Aphasiology 2005: 19(2): John A, Enderby P & Hughes A [b]. Comparing Outcomes of Voice Therapy: a benchmarking study using the Therapy Outcome Measure. Journal of Voice 2005; 19(1): Powell G & Lowenthal D. Outcomes and outcome measures. RCSLT Bulletin 2014; 749: WHO. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization, Rai SK, et al. Approaches for estimating minimal clinically important differences in systemic lupus erythematosus. Arthritis Research & Therapy. 2015; 17(1): 143. doi: /s Dvir Z. Difference, significant difference and clinically meaningful difference: The meaning of change in rehabilitation. Journal of Exercise Rehabilitation 2015; 11(2): doi: / jer Bulletin 15

16 Demystifying social, emotional and mental health Gemma Arnold and Kay Gillett explain how they developed a guidance document to support understanding of SEMH within their team ILLUSTRATIONS BY Paul Reid Children and young people with speech, language and communication needs (SLCN) are more likely to develop social, emotional and mental health (SEMH) difficulties than typically developing peers (Fujiki, Brinton & Clarke, 2003; Tomblin et al, 2000). There is a well-established link between SLCN and behaviour difficulties (Lindsay & Dockrell, 2012), and it s clear that speech and language therapy input plays a crucial role with this client group and can contribute to positive outcomes. Despite this, SEMH continues to be an area of mystery and even anxiety for some SLTs. What is SEMH? a wide range of social and emotional difficulties which manifest themselves in many ways. These may include becoming withdrawn or isolated, as well as displaying challenging, disruptive or disturbing behaviour. (DfE and DoH, 2015, p97) 16 Bulletin

17 FEATURE SOCIAL, EMOTIONAL AND MENTAL HEALTH Figure 1. Example of SEMH guidance document Common behaviours Possible causes underlying reasons Possible environmental reasons Ideas for further assessment/info gathering Strategies/ tools to engage (classroom or session) Possible targets Signpost to other services It s not fair! Black and white thinking ; arguing about unfair treatment Struggling to accept rules or when it is one rule for them and one for another Rigid thinking/ lack of flexible thinking Poor social understanding Poor social communication; assertiveness/ negotiation/ disagreeing Poor comprehension (missing key linguistic or contextual information) Lack of explanation from adult as to WHY something is happening Adults are not facilitating the child s explanation Check understanding around situations when calm if they can do this, it suggests the cause is more emotional rather than SLCN based Receptive language: are they understanding instructions and questions (Blank levels)? Narrative ability Understanding social register Comic strip conversations can they guess what others are thinking/feeling? Support staff to explain WHY something is happening within the language levels of the child (Blank levels and behaviour policy) Perspective of others: X will be able to make a logical prediction around the cause and effect of another person s behaviour in a picture scenario on 4/5 occasions with adult verbal support N/A Team support As two highly specialist SLTs specialising in SEMH, we work in youth offending services (YOS) and across special schools as part of Evelina London s community speech and language therapy service. We also run training for mainstream schools, parents and professionals around supporting children/ young people with SEMH needs. The introduction of the new acronym, SEMH (previously SEBD), as part of the special educational needs and disability (SEND) reforms in England, encouraged us to look more at the causal factors for these difficulties. We felt there was a need to develop a more comprehensive support system for the team, which comprises 90 SLTs working across early years and in schools (as well as other clinical areas), and includes specialists across a variety of areas (autism, SEMH, hearing impairment, developmental language disorder, dysphagia and profound and multiple learning difficulties). Questions and perceptions The team was asked to identify their needs around SEMH, with the following key questions emerging: What is our role with these clients? How do I assess them if they won t engage? What do I prioritise in therapy? Should they be on my caseload? How is SEMH diagnosed? Certain perceptions about SEMH became apparent, which we needed to demystify Certain perceptions about SEMH became apparent, which we needed to demystify: SEMH isn t a diagnosis in itself. It includes a range of social and emotional difficulties as well as conditions with a medical diagnosis. In England, it s one of the four broad areas of need within the SEND Code of Practice (DfE and DoH, 2015). SEMH needs often co-occur with SLCN and other conditions such as autism and learning disabilities. Pragmatic difficulties are related to behaviour difficulties (St Clair et al, 2011), and it has been suggested that pragmatic language skills mediate the relationship between language and behaviour (Law et al, 2015). There is no magic wand interventions and strategies take time. It s not personal! Challenging behaviour is rarely about you as an individual. Perception of behaviour as challenging is subjective. SEMH consists of externalising (aggression, defiance) AND internalising (withdrawal, disengagement, anxiety) behaviours. Internalising behaviours can often be overlooked. Guidance document To provide support, we developed an SEMH evidence-based guidance document (Figure 1, above) and top tips sheet. Bulletin 17

18 FEATURE SOCIAL, EMOTIONAL AND MENTAL HEALTH The purpose of the guidance was to: provide practical support for less experienced SLTs; encourage people to think of the iceberg analogy, ie challenging behaviours can be seen, but unseen factors below the surface could include undetected SLCN, undiagnosed learning needs and social and emotional needs; empower staff they DO have the clinical skills to assess language skills in this client group and to set effective intervention goals; encourage staff to feel confident in taking time for relationship-building with the young person (while recognising potential barriers); and develop confidence to discharge when all bases had been covered. Challenges Other areas/challenges emerged as a result of delivering the different strands of support: The importance of a holistic approach and multidisciplinary working. This can be challenging with time constraints. SLTs needed to be reassured that time spent on this would mean time saved in the future. The importance of the SLT s resilience/ emotional health. SLTs need to debrief and know how to access further support (discussing issues in line management or supervision, or finding out what other health and wellbeing initiatives are available within the organisation). All behaviour is communication. SLTs definitely have a role within SEMH; however, the work may sometimes challenge what we traditionally perceive as our role. There may be more overlap in roles with other professionals it s essential to be able to work as part of a multidisciplinary team, while understanding the scope of your own practice. Less experienced staff may need support with this. The importance of increasing professional confidence by inputting into different areas of Education and Health Care Plans (EHCPs) not just the section focused on language and communication. This means the information in EHCPs is more holistic and represents the child s strengths and needs more accurately. Feedback Feedback around the guidance s practical application and evidence base was gathered via individual case discussions. We received positive feedback on the clear layout, the comprehensive content, the usefulness for discussions with other staff, the hyperlinks that led to useful resources, and suggested SMART targets. Further development was suggested in some areas too much information could be overwhelming, and some people preferred a quick win and were not as concerned with the theory behind a specific approach. Examples of positive comments: It helped me to decide on next steps for the child. It helped me identify appropriate assessment and resources and to understand when our role ended and would be handed back to the school/ other professionals. Before I accessed the support I felt quite out of my depth, especially in terms of what to tell school staff. I had felt like I had done everything that I needed to, but didn t feel confident enough in this decision (ie, to discharge). The support made me feel much more confident speaking to staff/parent. I will definitely be considering the role of higher level language/problem-solving as I hadn t considered this link before. Next steps As a result of the feedback, we plan to revise the guidance to ensure it is as beneficial as possible. We would also like to disseminate to further speech and language therapy teams and adapt the guidance for use in training (schools, YOS officers and police). Gemma Arnold, Highly Specialist SLT. Gemma.Arnold@gstt.nhs.uk Kay Gillett, Highly Specialist SLT. Kay.Gillett@gstt.nhs.uk Children and Young People s Community Speech & Language Therapy, Evelina London, Guy s and St Thomas NHS Foundation Trust References & resources Further support for SEMH: South East SEMH CEN RCSLT fact sheets: language_therapy/docs/factsheets/mental_health Department for Education (DfE) and Department of Health (DoH). Special educational needs and disability code of practice: 0 to 25 years. London: DfE, Available at: tinyurl.com/send-0to25 (Accessed: 29 May 2017). Fujiki M, Brinton B & Clarke D. Emotion regulation in children with specific language impairment. Language, Speech, and Hearing Services in Schools 2002; 33(2): Humber E, Snow PC. The language processing and production of skills of juvenile offenders: A pilot investigation. Psychiatry, Psychology and Law 2001; 8: Law J, et al. The role of pragmatics in mediating the relationship between social disadvantage and adolescent behaviour. Journal of Developmental & Behavioural Pediatrics 2015; 36(5): Lindsay G & Dockrell J. The Relationship Between Speech, Language and Communication Needs and Behavioural, Emotional and Social Difficulties. London: Department for Education, Available at: tinyurl. com/slcnandbesd St Clair MC, et al. A longitudinal study of behavioural, emotional and social difficulties in individuals with a history of specific language impairment (SLI). Journal of Communication Disorders 2011; 44(2): Tomblin J, et al. The association of reading disability, behavioural disorders and language impairment among second-grade children. Journal of Child Psychology and Psychiatry 2000; 41(4): Bulletin

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20 FEATURE CARE PATHWAYS Developing a consistent model of care Charly Harris shares how condition-specific care pathways have helped her adult community service to guide interventions and measure goals Our service, based in East Surrey, serves a population of approximately 180,000. We are commissioned to see adults with acquired swallowing or communication difficulties due to a range of conditions. We recognise that the input we provide and the ultimate objectives of that input vary according to the patient s diagnosis, and, since December 2014, have been developing a series of care pathways to guide our interventions and measurement of goals for all our patients. Rationale for change There were a number of reasons for developing the care pathways. We identified that there was a lack of clarity and consistency within our service regarding the level of input offered to different patients, and that not all therapists were taking the same approach to managing episodes of care. This made it difficult to demonstrate that our service was evidence-based and that we, as therapists, had clear objectives for input. We also felt that we were not always discharging patients efficiently, particularly those with long-term conditions. Some patients with a particular condition were being kept on the caseload indefinitely, while others with the same condition were discharged following a period of intervention. Lastly, we were using Australian Therapy Outcome Measures (AusTOMs) with some patients, but also saw many for whom a formal outcome measure was not appropriate (for example, because our input was brief with the aim of maintaining safety of swallow and no expectation of improvement). Identifying care streams Having seen the team from Kings College London speak about their prioritisation, streams and outcomes model of acute care at the RCSLT Conference in Harrogate in 2014, the aim of which was to develop a transparent model of care based on clinical need (Clark and Rainbow, 2014), I was particularly interested to see how we could adapt the concept of care streams to a community service. We wanted to create a series of care pathways that defined the breadth of our service and could visually demonstrate to patients the path that their care would follow. We also wanted to combine this with a system to measure our goals and outcomes, whether we were using a formal outcome measure or not. We considered the nature of our caseload and reflected on where the variations in our interventions occur. We recognised that we needed some generic pathways because both our dysphagia and our communication referrals may present with a range of medical histories, and our broad objectives for input may be similar; but we also felt we needed some condition-specific pathways. We identified eight care streams: initial dysphagia, long-term dysphagia, motor neurone disease dysphagia, general communication, community neurological rehabilitation team communication, Parkinson s communication, dementia communication, and dysfluency communication. We began using initial drafts for each care stream for nine months before carrying out a review in November Pathway content Each pathway demonstrates the referral and triaging process, the objectives of our intervention and the process towards discharge (see Figure 1 for an example). The objectives can be used to explain our role to patients, and support clinical decisionmaking and process, while ensuring that we maintain a patient-centred approach focusing on individual clinical need. They can also guide the therapist to determine when the time is right to discharge. The clinical content is based on the RCSLT Clinical Guidelines (2006), as the pathways were developed prior to the launch of the RCSLT s online Clinical Resources pages, but future content changes will be mapped against this and other current clinical resources. Throughout every pathway there is reference to multidisciplinary liaison and mental capacity assessment. Consistent, appropriate service The development of the eight care pathways has clarified the services we offer, both for patients and therapists. We are now able to demonstrate how we offer a consistent, appropriate service to our patients and have a clear, evidence-based visual to share that is in accordance with RCSLT Clinical Guidelines (2006). As SLTs, we have benefited from the opportunity to reflect on our clinical activities, including goal setting and discharge decisions. We are now able to demonstrate how we offer a consistent, appropriate service to our patients 20 Bulletin

21 FEATURE CARE PATHWAYS Figure 1. Extract from the Dysfluency Care Pathway First Community Health and Care 2015 Referral received Added to waiting list and assigned to specialist dysfluency therapist Communication assessment carried out Liaison with MDT, timely documentation and consideration of mental capacity throughout Key objectives: SLT intervention and recommendations Take full case history and determine patient s baseline and current communication function (using quantifiable measures), including psychosocial impact Assess individual needs and preferences of patient regarding communication, including own perception of communication Provide advice, strategies and recommendations to maximise communication and wellbeing Provide information to patient, carers and MDT and establish patient expectations for therapy Provide information about the condition, as appropriate, including prognosis Support patient with implications of difficulties Identify if there are goals for therapy, supporting patient to identify own goals Offer therapy to work towards goals, targeting levels of fluency, avoidance reduction and acceptance of stammer in the long term Provide advice about specialist services and resources, eg City Lit, BSA Support self-management Group review Individual therapy Individual review Not appropriate for therapy at this time Discharge when objectives are achieved (or if no therapy goals identified) KEY = Decision point = Action point Bulletin 21

22 FEATURE CARE PATHWAYS Figure 2. Goal measurement from initial dysphagia pathway First Community Health and Care 2015 Care episode goals Baseline End of episode Achieved? (Y, N, N/A) Date No assessment by FCHC team Swallow assessment completed Comments Patient/carer/MDT have no current information about patient s swallow function Patient/carer/MDT have not been provided with any strategies or guidelines to manage swallow Patient not following/using strategies and guidelines Patient at risk of aspiration/choking/ chest infection/malnutrition/ dehydration Patient reports reduced wellbeing and social participation as a result of dysphagia (eg, EAT-10 score) Patient not achieving full potential for oral feeding Patient on initial dysphagia care stream Information regarding patient s current swallow function shared with all appropriate people Strategies/guidelines have been provided and shared with all appropriate people Patient following strategies and guidelines Risks minimised Advice given minimises impact on wellbeing and/or social participation Patient is achieving full potential for oral feeding as agreed by patient/ SLT/MDT Patient discharged or moved to a more suitable care stream/service NUMBER OF CONTACTS WHILE ON THIS PATHWAY Patient-specific goals (goals and achievement status to be agreed with patient/carer) SMART goal Achieved? (Y, N, N/A) Date DISCHARGE CODE Comments Therapy Outcome Measures (Enderby and John, 2015) Date Swallowing/specific condition/other Impairment Activity Social participation Distress/ wellbeing client/carer We also now have a basis from which to carry out further analysis of our outcomes and clinical effectiveness. Initial reviews in 2015 enabled us to gather data on the structure of our service, ie what proportion of each pathway is active at any one time, and therefore the nature of our referred population, which helps us to determine service priorities. We also have a means of measuring our achieved range of outcomes for patients, in relation to clinical care pathway and to number of contacts. We are beginning to integrate the pathways into our electronic records system (emis) so that we can more easily gather data relating to the spread of pathways across our caseload and also collect outcomes data. We recognise that there is more work to be done to develop and refine the pathways in the future, particularly in this climate of workforce transformation, and we hope to be able to share the pathways in full with local services with a view to a wider pilot of their usability. Charly Harris, Highly Specialist SLT and Joint Team Lead, Clinical Lead for Long Term Conditions Support Services, First Community Health and Care, East Surrey. charlotte.harris6@nhs.net References & resources Clark L & Rainbow D. Prioritisation, Streams and Outcomes. A model of Speech and Language Therapy Service Provision for Acute Settings. [RCSLT Conference presentation.] London: Kings College Hospital NHS Foundation Trust, Enderby P & John A. Therapy Outcome Measures, 3rd Edition. Guildford: J & R Press, RCSLT. RCSLT Clinical Guidelines. London: Royal College of Speech and Language Therapists, Bulletin

23 Our monthly look at the latest in published research In the journals To review an article or suggest an article for review, Improving discourse in aphasia SLT role in palliative care One-to-one intervention ISTOCK There is limited evidence of approaches that both ameliorate impaired language and directly impact on real-life communication for people with aphasia. This paper explores whether NARNIA (Novel Approach to Real-life communication: Narrative Intervention in Aphasia) a multi-level intervention for people with aphasia following stroke results in improvement in everyday discourse. In a randomised control trial, 14 people with mild to moderate aphasia were randomised to NARNIA or usual care. Both groups received treatment four times a week for five weeks. NARNIA used a metalinguistic approach to narrative output. Therapy used picture sequences and included identification of main event; verb and noun access; sentence production, with complete argument structure; plus teaching of discourse frameworks, using a mind-mapping approach. Participants also self-evaluated their discourse attempts, ranging from monitoring their success at finding nouns and verbs, to judging the overall clarity of their discourse output. This was compared with interventions representative of usual practice, which aimed to improve word/sentence production, reading, writing or more-functional activities. The NARNIA group made significantly greater gains in macrostructure of everyday discourse and across all language levels, providing promising support for macrostructure being responsive to intervention and the claim that, if we wish to improve discourse, we need to target the discourse level. Jennifer Short, SLT, North Bristol NHS Trust Reference Whitworth A, et al. NARNIA: a new twist to an old tale. A pilot RCT to evaluate a multilevel approach to improving discourse in aphasia. Aphasiology 2015; 29(11): www. tandfonline.com/doi/abs/ / This study, which explores SLTs perceptions of their role in palliative care, reports that other healthcare professionals have a poor understanding of the SLT role, particularly in relation to communication. The authors suggest ways to increase interprofessional awareness and integration. Twelve band 6-7 SLTs participated in this qualitative study. They selfselected via a palliative care clinical excellence network, and their roles spanned acute, rehabilitation and community settings. Semi-structured interviews and a follow-up focus group with subsequent thematic analysis were used to explore the SLTs experiences of and motivations for working in this sector. One main theme (conflict) and three subthemes (pioneering and uncertainty, legitimising the role, and dealing with loss) emerged. The study found that: SLTs work towards a good death for patients; they feel increased responsibility towards palliative patients; there is poor interprofessional understanding of SLT s role, leading to a lack of referrals; and dysphagia is often prioritised over communication. The authors conclude that further empirical research on the role of the SLT in palliative care communication management would broaden the evidence base and support the development of SLT-specific guidelines for palliative care, thereby securing SLTs place in the palliative care team. Anna Robinson, SLT, Community Neuro Team, St George s NHS Trust Reference Hawksley R, et al. Communication disorders in palliative care: investigating the views, attitudes and beliefs of speech and language therapists. International Journal of Palliative Nursing 2017; 23: pubmed/ Direct one-to-one SLT intervention has been shown to be effective with the typically hard-to-treat group of older school-aged children who have language disorders. This encompasses all areas of language and equally benefits all, regardless of gender, autistic spectrum disorder status or age. Seventy-two students aged 9 to 17 were studied over one school term. During this time, the students assigned SLT composed a set of individualised targets, which were worked on on a oneto-one basis by the same SLT. To gather results pre- and post-therapy, measures were devised for each student for each target treated. Every student also acted as their own control; thus, for each target measure, there was also a control measure. Post-therapy tests were administered blind. Overall findings saw that, in the pre-therapy measures, targets and controls did not differ. However, post-therapy, the targeted areas improved significantly more than the controls, with a large and clinically significant effect size of d = This adds to the limited research on older children and adolescents, showing that direct one-to-one intervention can be effective; therefore, direct services should be considered for this client group. Sophie Harding, SLT Smalltalk Reference This section aims to highlight recent research articles that are relevant to the profession. Inclusion does not reflect strength of evidence or offer a critical appraisal. If you find any of these interesting, follow them up and apply your own critical appraisal. Ebbels S, et al. Effectiveness of 1:1 speech and language therapy for older children with (developmental) language disorder. IJLCD 2016; 52(4): onlinelibrary.wiley.com/ doi/ / /full Bulletin 23

24 Amit Kulkarni & Michelle Lawton RCSLT Research & Development Manager Amit Kulkarni introduces a worked example of critical appraisal by research champion Michelle Lawton Critical appraisal: a worked example In last month s R&D Forum, we reintroduced the topic of critical appraisal and signposted you to key resources. This month, to further clarify the process, we aim to show what critical appraisal looks like in practice. Michelle Lawton, an RCSLT research champion, used the Critical Appraisal Skills Programme tool (CASP, 2017) to appraise a qualitative study of SLTs working with people with aphasia. Here, she explains how she developed her critical appraisal skills, before going on to demonstrate them in action. Hopefully, this will illustrate how you could do the same. If you feel parts of the analysis are outside your current level of knowledge, consider finding out more as part of your next CPD activity. Developing skills Michelle says: In my experience, critical appraisal demands a measure of common sense to balance the strengths and benefits against the weaknesses or flaws of a given article. Alongside common sense, a basic grasp of qualitative and quantitative methodologies has helped me to make decisions about whether I feel a study is valid or trustworthy. Having recently completed a systematic review and quality appraisal, I would say that, as with all skills, you need to practise critically appraising research to feel competent. Using a critical appraisal tool, such as the CASP (see the example below), has enabled me to make sense of various aspects of critical appraisal in a structured and coherent way. In addition, comparing and discussing critically appraised articles with colleagues has enabled me to reflect on my own skills and develop critical appraisal competencies, which has been invaluable. The application of time is therefore essential to acquiring critical appraisal skills, and these skills are crucial in enabling you to integrate the best available evidence with your own clinical expertise alongside patient values and expectations. CASP appraisal tools The CASP critical appraisal tools can help to make sense of a variety of research studies. The checklists, which can be downloaded from the CASP website ( net/checklists), are designed for appraising systematic reviews, randomised controlled trials, cohort studies, case control studies, economic evaluations, diagnostic studies, qualitative studies and clinical prediction rule. Each checklist comprises questions that consider three broad issues: are the results of the study valid; what are the results; will the results help locally? Critical appraisal in action The article reviewed below, Speech-language therapists process of including significant others in aphasia rehabilitation (Halle et al, 2013), was appraised using the CASP qualitative checklist. The study aims to explore how SLTs include significant others in the process of aphasia rehabilitation. Semi-structured interviews were conducted with eight SLTs working with people with aphasia in rehabilitation centres. Inclusion of significant others was perceived to be challenging, but ideal, if time allowed. The authors maintain that redefining significant others as part of the patient group will allow clinicians to consider involving carers and families in rehabilitation as standard. Screening questions 1. Was there a clear statement of the aims of the research? Yes. The authors aim to explore the process of working with significant others of people with aphasia in the rehabilitation setting (pp ) from the perspective of the SLT. 2. Is a qualitative methodology appropriate? Yes. A qualitative methodology is appropriate to address the above aims (exploring a process from a subjective viewpoint). Is it worth continuing? Yes Detailed questions 3. Was the research design appropriate to address the aims of the research? Yes. The research design, based on grounded theory was appropriate to address the aims of the research. Grounded theory provides a systematic, inductive (data driven) approach, with the aim of constructing theory (Charmaz, 2008), which aligns with the study s objectives. 4. Was the recruitment strategy appropriate to the aims of the research? No X Although the authors sample participants who have experience of working with significant others in the rehabilitation setting, there is little evidence that participants are specifically sought to develop a theory as it emerges (theoretical sampling), consistent with this methodology. This process is 24 Bulletin

25 COLUMN Research and Development Forum ILLUSTRATION BY Sean McSorley As with all skills, you need to practise critically appraising research to feel competent central to grounded theory as it ensures the emergent theory is grounded in the data. 5. Were the data collected in a way that addressed the research issue? Yes The data were collected in the participants home/work, using a semi-structured interview frame in which the authors provided a topic guide. The authors discussed modification to the topic guide as new areas of interest emerged. Theoretical saturation, the point at which no more new concepts are emerging from the data, is considered (p750, p752). X In terms of the depth of analysis, I would question whether a single interview with each participant would be sufficient. 6. Has the relationship between researcher and participants been adequately considered? Yes The field researcher considered her own interaction with participants from a professional and personal perspective. The authors attempted to reduce socially desirable responses and engaged in a reflexive process in order to challenge their own understandings and beliefs (p752). 7. Have ethical issues been taken into consideration? Yes The study has received ethical approval for conduct. X The authors do not report what information was given to participants prior to consent. 8. Was the data analysis sufficiently rigorous? Yes The authors provide an indepth description of how the themes were derived from the data, providing examples of data coding. Rigour was enhanced through memo-writing and discussion with research team members. The authors engaged in a reflexive process, actively questioning and rechecking whether their interpretations were consistent with the original data source (p752). Although there is no discussion of cases that appear to be deviant from the norm (deviant case analysis) in the method, the authors provide evidence of this in the findings (the other participant, pp756-7). 9. Is there a clear statement of findings? Yes The findings are clearly stated. The authors discuss their findings in the context of potentially contradictory research and report validating their findings with SLTs. X There appears to be limited evidence of integrating deviant data into the theoretical model. 10. How valuable is the research? The authors provide an in-depth discussion of how the model can be adapted to improve outcomes for people with aphasia and significant others. The authors highlight the applicability of the findings only for those working in similar contexts. Applying these findings to the aphasia rehabilitation context would mean reflecting on my own beliefs and actively involving significant others in the process of rehabilitation. Inclusion of significant others and communication partner training could be incorporated into therapeutic interventions and thus become a therapeutic process in and of itself, rather than an idealised bonus. Essential skill Critical appraisal is an essential skill for all clinicians to develop, to ensure that we select the most efficacious and effective treatment interventions for our patients. The CASP tool provides a useful framework for those who are new to critical appraisal or wanting to develop their critical appraisal skills further. Michelle Lawton, SLT, Stroke Association Postgraduate Research Fellow, University of Manchester. michelle. lawton@postgrad.manchester. ac.uk References Charmaz K. Constructionism and the grounded theory method. In: J Holstein, J Gubium (Eds). Handbook of constructionist research. New York: Guilford, Critical Appraisal Skills Programme. CASP Qualitative Checklist. [online] Oxford: CASP, Available at: www. casp-uk.net/checklists (Accessed: ) Hallé M-C, et al. Speech language therapists process of including significant others in aphasia rehabilitation. IJLCD 2014; 49(6): doi: / Bulletin 25

26 Ask the Experts How does multilingualism affect the communication of children with neurodevelopmental disorders? Dr Özge Öztürk 1, Dr Jenny Gibson 2, Katie Howard 1 and Dr Napoleon Katsos 1 1 Department of Theoretical and Applied Linguistics and 2 Faculty of Education, University of Cambridge detrimental to communication skills. Here, we explore these three arguments, followed by a summary of the UK context and recommendations for SLTs. Speaking more than one language can pose both a challenge and an opportunity for multilingual families with children with neurodevelopmental disorders. Take the case of Jose, reported in Fahim and Nedwick s study (2014). Diagnosed with autism spectrum disorder (ASD) and delayed language development, Jose lives with his bilingual English-Spanish family. In addition to all the critical decisions that a monolingual family with a child diagnosed with ASD has to take, Jose s parents must also consider language use at home and in the community: they would like Jose to learn English so he can do well at school and participate in the Englishspeaking society in which they live, but they also value Spanish Jose s mother s native language. Jose is also cared for by his Columbian grandmother, whose English is limited. Around the world, bilingual families of children like Jose may be vulnerable to well-intended but ill-informed advice to abandon their home language to facilitate the development of the community s dominant language (Uljarevic et al, 2016; Hampton et al, 2017; RCSLT, 2006). But what is the scientific evidence to help families make the best decision on language use? Despite the growing prevalence of bilingual children in UK primary schools (NALDIC, 2014) and elsewhere, there is little research into bilingualism in children with neurodevelopmental disorders, which affects an estimated 5-12 % in the UK (Law, 2000). Until recently, there was much uncertainty about the evidence related to bilingualism and neurodevelopmental disorders. However, a recent systematic review by Uljarevic et al (2016) reviewed 50 studies in this area (38 on multilingualism and communication disorders, 10 on ASD, and two on intellectual disabilities), and drew firm conclusions about the nature of these interactions. Synthesising the existing evidence, they concluded that: 1) there is no evidence that bilingualism has negative effects on various aspects of functioning across a range of neurodevelopmental disorders; 2) in the case of ASD, positive effects of bilingualism on communication and social functioning have been observed; and 3) forced monolingualism may be Bilingualism and neurodevelopment A prevailing belief among parents and some professionals is that if learning one language is hard for the child, then two languages will be more difficult to master. The assumption is that if the family switches to the dominant language, the child s language may develop more quickly. The family is therefore advised There is no evidence of systematic negative effects to raising a child with a neurodevelopmental disorder bilingually 26 Bulletin

27 COLUMN ASK THE EXPERTS ILLUSTRATION BY Jack Xander to keep to a single language which is almost always the dominant one in the society. This means that families who have been using a minority language at home are advised to switch to the majority language which they may not speak with native-like competence to help bolster the child s communicative ability (Kohnert, 2007; Hampton et al, 2017). An additional reason for this recommendation is that it is often difficult to find therapy materials in the child s home language, as well as bilingual/multilingual SLTs. The research shows that children with a variety of neurodevelopmental disorders, such as Down s syndrome (Kay-Raining Bird et al, 2005), attention deficit hyperactivity disorder (Bialystok et al, 2016), autism (Reetzke et al, 2015) and hearing impairment (Waltzman et al, 2003), can learn two languages. Monolingual children with neurodevelopmental disorders may develop language skills, although at a slower pace and perhaps not to the same level as their unaffected peers. Similarly, bilingual children with neurodevelopmental disorders learn two languages relatively more slowly and perhaps not to the same level as their typically developing bilingual peers, but they match monolingual peers with a neurodevelopmental disorder, given similar opportunities. In other words, language development can be typical or atypical irrespective of the number of languages the child is exposed to (Cruz- Ferreira, 2011; Kohnert, 2007). Benefits of bilingualism Recent research on bilingualism in typically developing children has shown that learning two or more languages at once is associated with multiple benefits, as long as the child has sufficient support to maintain his or her languages (Adesope et al, 2010). In typically developing children, when compared with their monolingual peers, bilingualism has been associated with higher educational achievement (Taylor, 2013), improved social use of language (Antoniou & Katsos, 2017) and enhanced attention, memory, cognitive flexibility, symbolic representation and other forms of a set of skills known as executive control (Bialystok et al, 2009). These benefits are most likely due to the increased cognitive demand required for managing multiple languages on a daily basis. Forced monolingualism Advising multilingual families to adopt a monolingual approach with children with neurodevelopmental disorders can be problematic, as there is evidence to suggest that parents speaking a nonnative language may result in inadvertent negative effects on the child s social and linguistic development (Fernandez y Garcia et al, 2012). Being monolingual in a bilingual family or community would inevitably limit a child s communication opportunities, negate previous language experiences, deny full participation in family and community life, and effectively turn a disability into a handicap. On the other hand, developing both languages would allow the child to take full advantage of previous experiences with language and to increase the opportunities to use language for meaningful interactions within the family and community. Consequently, reducing the number of languages that a bilingual child with a neurodevelopmental disorder is exposed to does not alleviate the language difficulties; it only creates a monolingual child with a neurodevelopmental disorder. The UK context The RCSLT s guidance on best practice (2006; p270) and the good practice report (2007) prepared by the RCSLT Specific Interest Group in Bilingualism state that the clinically preferred practice is to Bulletin 27

28 COLUMN ASK THE EXPERTS utilise all of the child s daily languages in therapy. The report also recommends that the SLT should empower parents and families to use their home language, and should discuss with them the implications of their language choices for the child s therapy. In addition, Stow & Pert s SLT assessment and intervention report (2015) highlights that, although it may be a common belief among parents that exposure to two (or more) languages may confuse their child, families should be reassured by SLTs that the evidence base does not support this claim. Recommendations A number of useful insights emerge from Uljarevic et al s (2016) systematic review to help support practitioners working with bilingual children with neurodevelopmental disorders. First, although it is important to bear in mind that bilingual experience can vary hugely from individual to individual, research shows that there is no evidence of systematic negative effects to raising a child with a neurodevelopmental disorder bilingually. Secondly, discussions with parents about the potential negative outcomes of restricting language in bilingual families are encouraged. Finally, along with Baker (2012), we suggest that the language use of all stakeholders teachers, SLTs, family members, peers and, most importantly, the children themselves is considered when making the important decision about whether to pursue monolingualism or bilingualism. Current research confirms that assessment and intervention in speech and language therapy for bilingual children should target each of the child s languages. This ensures not only a valid assessment of the child s true linguistic skills but also the best possible therapy outcomes. For example, Seung et al s study (2006) demonstrates that significant gains can be made in a child s dual language development when a culturally sensitive intervention is provided in both languages. Such findings dovetail with the widely held consensus that speech and language therapy should use a holistic approach to meeting the communication needs of children with neurodevelopmental disorders, rather than the traditional approach of providing interventions within isolated treatment contexts (Fey and Stalker, 1986). Ultimately, intervention success depends on the child s ability to generalise communicative attainments in therapy across various communication settings and partners, especially within the family and community. The issues raised here will be explored in depth as part of the AHRC-funded Multilingualism: Empowering Individuals and Transforming Societies project (meits.org). The RCSLT is also currently working on clinical resources regarding bilingualism, which will be published on their website later this year. References & resources Adesope OO, et al. A systematic review and meta-analysis of the cognitive correlates of bilingualism. Review of Educational Research 2010; 80(2): Antoniou K & Katsos N. The effect of childhood multilingualism and bilectalism on implicature understanding. Applied Psycholinguistics 2017; 38(4): Baker D. Particular Polyglots: multilingual students with autism. Disability and Society 2012; 28(4): Bialystok E, et al. Bilingual minds. Psychological Science in the Public Interest 2009; 10: Bialystok E, et al. Interaction of bilingualism and Attention-Deficit/Hyperactivity Disorder in young adults. Bilingualism: Language and Cognition 2017; 20(3): Kay-Raining Bird E, et al. The language abilities of bilingual children with Down syndrome. American Journal of Speech-Language Pathology 2005; 14(3): Cruz-Ferreira, M. Recommending Monolingualism to Multilinguals Why, and Why Not. [Blog post] In: The ASHA Leader Blog. 2 August Available from: blog.asha.org/2011/08/02/recommendingmonolingualism-to-multilinguals-why-and-whynot/ Fahim D & Nedwick K. Around the World: Supporting Young Children with ASD Who Are Dual Language Learners. Young Exceptional Children 2014; 17(2): Fernandez y Garcia E, et al. Unintended consequences: An ethnographic narrative case series exploring language recommendations for bilingual families of children with autistic spectrum disorders. Journal of Medical Speech-Language Pathology 2012; 20: Fey ME & Stalker CH. A hypothesis-testing approach to treatment of a child with an idiosyncratic (morpho) phonological system. Journal of Speech and Hearing Disorders 1986; 51(4): Hampton S, et al. Autism and Bilingualism: Exploring Parents Perspectives and Experiences. Journal of Speech, Language, and Hearing Research 2017; 60(2): Kohnert, K. Evidence-based practice and treatment of speech sound disorders in bilingual children. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations 2007; 14(2): Law J, et al. Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language and Communication Disorders 2000; 35(2): NALDIC. EAL Statistics. The latest EAL facts and figures. Edinburgh: The National Association for Language Development in the Curriculum, Retrieved from: Reetzke R, et al. Communicative development in bilingually exposed Chinese children with autism spectrum disorders. Journal of Speech, Language, and Hearing Research 2015; 58(3): RCSLT. Communicating Quality 3. London: Royal College of Speech and Language Therapists, RCSLT Specific Interest Group in Bilingualism. Good practice for speech and language therapists working with clients from linguistic minority communities. London: RCSLT, Retrieved from: publications2/linguistic_minorities Seung H, Siddiqi S & Elder JH. Intervention outcomes of a bilingual child with autism. Journal of medical speech-language pathology 2006; 14(1): Stow C & Pert S. SLT assessment and intervention: Best practice for children and young people in bilingual settings. London: RCSLT, Taylor F. Multilingual Britain. London: British Academy, Retrieved from: sites/default/files/multilingual%20britain%20 Report.pdf Uljarevic M, et al. Practitioner Review: Multilingualism and neurodevelopmental disorders an overview of recent research and discussion of clinical implications. Journal of Child Psychology and Psychiatry 2016; 11: Waltzman SB, et al. Second oral language capabilities in children with cochlear implants. Otology & Neurotology 2003; 24(5): Bulletin

29 Bulletin remembers those who have dedicated their careers to speech and language therapy FEATURE SUB HEAD XX XXXXX REMEMBERING Obituary Cheryl Earnshaw (née McMurrough) Cheryl joined the Nottingham Speech and Language Therapy Department in August 1998 as a newly qualified therapist, working in schools and clinics in the west of Nottingham. Her empathy, knowledge, systematic approach and soft, gentle voice with its Irish lilt made her a favourite with children, parents, school staff and her colleagues within the department. Cheryl was a dedicated SLT who always went above the basic requirements of the job to make sure that she supported children to the absolute best of her abilities. She had a strong creative flair and used this to develop new and unique programmes and resources that would interest children and specifically target their areas of difficulties. Good enough was a phrase that did not exist in her vocabulary, and she wanted everything that she did to be the best it could be for the children she supported. In 2002, Cheryl joined the Specialist Team working with children with autistic spectrum disorder (ASD) a group of children that she carried on supporting throughout her career. She believed strongly in the rights of children with autism and their need to have an effective means of communication, and she worked closely with parents and teaching staff to make sure that children s communication needs were met. She did this through one-to-one work, coaching and training a wide range of people to help them understand the communication skills and needs of the children she worked with. It was this focus in working with children with ASD that led to her taking a job with the Northampton Speech and Language Therapy Department in Cheryl was dedicated to her role as ASD lead in Northampton, and was a gentle and encouraging support to her colleagues in both health and education. Cheryl helped to establish ASD pathways and worked alongside a variety of professionals. She wrote and delivered training to parents/ carers of children with a new diagnosis of ASD, and to pre-school staff who were supporting these children. In addition to her work in ASD, she also spent some of her work time in a special school for children with moderate learning difficulties, and, in the school holidays, volunteered some of her work time to provide additional therapy hours in the community clinics. Cheryl loved being with people, and her friends and family were very important to her. She had a real capacity to care, and this was shown in her love of her family and friends, her affection for her colleagues and the dedication she showed to the children and families that she supported. She had a love of fine dining and good wine, loved dancing and laughing and, perhaps most of all, enjoyed time spent with her family doing the simple things like playing together and going to the park. We all miss Cheryl for her beautiful, soft voice, sparkling eyes, keen sense of humour, quiet resolve and dedication to her work. Since her death, Cheryl s family have raised thousands of pounds for ovarian cancer charity Ovacome in her memory. Her colleagues in Nottingham and Northampton have all joined this effort, raising around 700 so far. In Northampton, we combined our fundraising with an event to raise awareness of how children with ASD might communicate. Cheryl s contribution to speech and language therapy in both Nottingham and Northampton is long-lasting, and the children, families and colleagues she touched will forever be grateful for the opportunity to know and work with her. Our love and thoughts remain with her husband, Matt, and their two children Sam and Lucy. Vicky Romilly, Helen Colby and Jo Perkins Cheryl s friends and colleagues from Nottingham & Northampton Cheryl was a dedicated SLT who always went above the basic requirements of the job Bulletin 29

30 Appointments APPOINTMENTS CALL JOE MOORE ON Speech and Language Therapist(s) Competitive salary and 10 weeks paid annual leave Two openings: One full time and one locum part time (maternity cover) Pace has been providing first class integrated education and therapy services for children aged 0-18 with cerebral palsy, related sensory motor disorders and developmental delay and support for their families for more than 25 years. We are looking for dynamic SLTs, interested in maximising and furthering their expertise in this specialist field. In the full time role, you will work as part of a dedicated, transdisciplinary team developing integrated classroom programmes, providing detailed assessments, intensive and individual therapy to make a hands-on difference with a small caseload. Our ideal candidate will be experienced in AAC and Dysphagia. The locum cover is required 1+ days/week in our Child & Family clinic-based service. We provide excellent in-service training, access to other CPD opportunities and supervision within an expert and supportive team. Pace is committed to wellbeing, safety & protection of all our children and an enhanced DBS will be required. For further details see: thepacecentre.org/about-pace/vacancies/ For an informal chat and/or further details please contact: Laurel Allen, Clinical Lead SLT, laurel.allen@thepacecentre.org, Tel: Applications should be sent to vacancies@thepacecentre.org or Susan Muir, HR Department, The Pace Centre, Philip Green House, Coventon Road, Aylesbury, HP19 9JL Specialist Speech and Language Therapist Job Ref: NO17717 Kirkwall Health Centre Band 6 26,830-35,933 plus Distant Islands Allowance Full Time: 37.5 hours Permanent An exciting opportunity has arisen for a Speech and Language Therapist to join our enthusiastic and dynamic team. We have recently carried out improvement and development work and are now looking to enhance our Speech and Language Therapy Team. This post involves supporting adults, young people and children with developmental and acquired conditions. There is opportunity to work with a diverse range of communication difficulties and dysphagia management. The successful candidate will have experience working with adults, young people and children in a clinical setting. We offer excellent In-service training, strong clinical supervision and regular peer support. Excellent communication skills and the ability to work autonomously are essential for this post as is the need for the post holder to hold a full driving licence. The post involves travel to islands by plane and ferry. There is the possibility of recruiting to this post as a development opportunity depending on the suitability of applicants and their particular interests and circumstances. The post comes with a relocation package dependent upon hours and eligibility. Local accommodation for sale or lease is usually advertised locally. We will provide links to estate agents and leasing agencies and assistance will be provided if available. Lying off the northern coast of Scotland, between John O Groats and the Shetland Isles, Orkney is an archipelago of over 70 beautiful islands, 17 of which are inhabited. The total population is approximately 22,000 with most people living on the Mainland. The excellent ferry and air connections make travel to the Scottish mainland quite easy. There is a rich archaeological history to be explored, as well as many outdoor pursuits, including diving in Scapa Flow, kayaking, walking, cycling, bird watching, and many more. Orcadian culture is rich, with music and arts and crafts well represented. Rise to the challenge and enjoy the opportunity Orkney is a wonderful place to live and work and offers low pollution, low crime, excellent schools, good leisure facilities, unique wildlife and amazing scenery. For more information on this post please contact Lesley Joy Fidler or Elizabeth Morris, Speech and Language Therapy, on or lesley.fidler1@nhs.net or elizabeth.morris4@nhs.net, Follow the link for more job details and to apply online Closing date for applications: 26th March 2018 This post is subject to a PVG Scheme Record Check EMPLOYER The perfect place to find the latest speech and language therapy vacancies RCSLT Jobs is the official jobs board for the Royal College of Speech and Language Therapy Royal College of Speech and Language Therapists 30 Bulletin

31 TO ADVERTISE CALL POOJA BADWAL ON OR Unlocking Language is an award winning independent Speech and Language Therapy Prac ce based in Canary Wharf, London. We provide services to both adults and paediatrics. We are looking for two paediatric speech and language therapists to join our exis ng team. Vacancy 1: Early Years, Complex Needs, Primary Schools Vacancy 2: Mainstream Secondary schools, Complex Needs, Outpatients Banding: Band 5/6 Pay: 24,000-38,000 dep. on experience Full- me, part- me and term- me considered. The roles are based in London and you will have weekly admin days. We have a large pool of assessments and resources and administra ve sta to support you. You will be provided with a laptop and ipad too. We are a friendly, suppor ve and social team who recently won Healthcare Company of the year at the FSB London 2017 Awards. We have an excellent CPD and supervision structure with opportuni es for career progression. You will have access to company bene ts such as perkbox, pension, exible working and ongoing training and support. To apply please send a cover le er with your CV to info@unlockinglanguage.co.uk. You can contact us on Speech and Language Therapist Equivalent to Agenda for Change Bands hours per week, term time only for 39 weeks per year including INSET days. Start date: May 2018, Permanent Post Parkwood Hall Co-operative Academy is a Residential / Day Special School for boys & girls aged 7 to 19, with moderate to severe learning difficulties and additional, often complex, needs. We seek a Speech and Language Therapist who has experience of working with Special Needs. You would join a growing, established team which includes a Senior Speech and Language Therapist, Two Specialist Speech and Language therapists, and 2 SALT assistants. Application forms and information can be found a or by sending your address to info@parkwoodhall.co.uk stating the name of the vacancy. Please note that we cannot accept CVs alone. Closing date: Shortlisted candidates visit: Interview date: Wednesday 21st March Monday 16th April 4pm Thursday 19th April 9am Parkwood Hall Co-operative Academy is committed to safeguarding and promoting the welfare of children and young people and expects all staff and volunteers to share this commitment Applications are invited from black and ethnic minority candidates and from men, as these groups are under-represented on the school s staff. (Race Relations Act sections apply). This position is exempt from the Rehabilitation of Offenders Act 1974 and DBS Disclosure is required. SPEECH AND LANGUAGE THERAPIST TENURE: PERMANENT GRADE: SO1 (spinal points 29 31) SALARY: 19,728-20,946 Actual pro rated salary HOURS: 30 hours x 44.4 weeks per annum The School Chingford Foundation School recently received the accolade of appearing in England s top 100 schools for sustained improvement in its academic outcomes. This places the school in the top 3% of nonselective, state-funded schools. We are also pleased to host a Sixth Form Centre which was rated as outstanding by OFSTED. The Role Chingford Academies Trust is looking for a dedicated and enthusiastic individual who will be joining a large department with very strong outcomes. If you would like to join a school that aims to provide a secure, caring and stimulating learning environment through expert teaching and support staff ensuring all students achieve their full potential, where staff are hard-working, committed, supported and valued, then please download an Application Form and further details from the school website (www. chingfordfoundation.org) and to jobs@chingford.waltham.sch.uk Closing date: Thursday, 15th March 2018 at 12 noon. Interviews: TBC Start date: April 2018 The successful candidate will be subject to an enhanced DBS Disclosure Check. The Trust requires that all adults who work with pupils promote pupil safety and wellbeing; adhering to Trust policies to ensure effective Child Protection and Safeguarding provision, either directly or indirectly. London s leading independent SpLD Specialist School The Moat School is a unique and successful independent day school in London for children with dyslexia and associated SpLDs. Check out our website for current vacancies: Bulletin 31

32 MARCH CEN NOTICES CLINICAL EXCELLENCE NETWORKS Send your CEN notice by to by 6 March for the April issue, 6 April for May and 6 May for June. To find out more about RCSLT CENs, visit: tinyurl.com/rcsltcens Scotland Dysphagia CEN 5 March, 9am 5pm Topic: Dysphagia, Pneumonia, the Gut, Oh My! Medical SLT decision-making off the yellow brick road with Professor James Coyle, University of Pittsburgh. Venue: The Improvement Academy, Ninewells Hospital, Dundee. Cost: 15. Lunch, coffee and tea provided. For information and to register, visit: dysphagia-pneumonia-the-gut-oh-my. eventbrite.co.uk Yorkshire Fluency CEN 7 March, 9.30am 12.30pm Venue: The Reginald Centre, 263 Chapeltown Road, Chapeltown, Leeds, LS7 3EX. Tea/coffee provided. For more information, phone AAC CEN 8 March, 9.30am 3.30pm Identifying and Implementing Low Tech Solutions, plus AGM. Venue: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE. To book, julie.atkinson@bhamcommunity.nhs.uk East Midlands AAC CEN 8 March, 10am 2pm A chance to network with local therapists regarding local AAC issues. Members of the Lincoln Hub will also be in attendance. Cost: free. Venue: Bennerley Fields School, Stratford St, Ilkeston DE7 8QZ. To book, sofia.nuttall@nhs.net Trent Voice CEN & University of Sheffield 8 March, pm A not-to-be-missed unique opportunity to hear journalist and broadcaster Nick Robinson s story about his battle with cancer and how he got his voice back, followed by drinks reception and book signing. His SLT Julia Selby will also share voice rehabilitation techniques and an update on the long-term impact. Venue: University of Sheffield, The Diamond, 32 Leavygreave Rd, Sheffield S3 7RD. Open to non-members, students and non-slt colleagues. Cost: 15. Proceeds to Macmillan. Tickets are available from tinyurl.com/ EveningWithNickRobinson. For more information, TrentVoiceCEN@outlook.com Counselling & Therapeutic Skills CEN 9 March Location: Birmingham City University. Cost: 10 students, 25 RCSLT therapists, 30 other professionals. Topic: Self care for therapists, including the importance of self care; connecting to current practice in self care; mindfulness and kindfulness; managing challenging thoughts; emotional freedom technique for stress reduction; and applications of self care to the care of others. rachel.lewis9033@gmail.com Essex SLI CEN 9 March, 9am 4.30pm Preschool Word Aware: join us as Stephen Parsons and Anna Branagan share their latest intervention programme. Venue: Cordite Room, Wat Tyler Centre, Pitsea, Basildon, Essex SS16 4UH. Cost: members, 35; non-members, 85. Lunch provided. katherine.farrow@nhs.net WM AAC CEN 14 March, 9.30am 3.30pm Of interest to people working with/who know children, young people and adults with LD who have/might have AAC needs. The programme mixes current research, affordable low-tech resources, a high-tech AAC update and intervention/management methods. Presentations from Manchester Metropolitan University s Identifying Appropriate Symbol Communication Aids project and ACE Centre on Developing and Using a Communication Book second edition. Supplier update from Smartbox. Venue: Birmingham City University, B15 3TN. Cost: free for members (yearly membership: 5 for three meetings). To book, terri.kelly@ bhamcommunity.nhs.uk London FEES & VFS CEN 16 March, 9am 4.30pm Guest speaker Victoria Burnay will present on voice therapy for the dysphagia therapist following FEES; a workshop on VFSS standardisation project; and the AGM. Venue: RCSLT, London SE1 1NX. For further information, FEESVFCEN@outlook. com Respiratory CEN 16 March, 10am 4pm Respiratory CEN Study Day. Venue: Royal Victoria Infirmary, Queen Victoria Rd, Newcastle Upon Tyne, NE1 4LP. Maximum 30 places available. Cost: 30. Lunch and refreshments provided. To book, jessica.blakemore@lthtr.nhs.uk Acquired Brain Injury in Children and Adolescents CEN 23 March, 9am 4.30pm The topic of this meeting will be childhood stroke. Venue: Great Ormond Street Hospital, London WC1N 3JH. Cost: 20. Contact Isobel Hatfield for agenda and to book: ihatfield@thechildrenstrust. org.uk CEN for SLTs with an interest in ABA 23 March, 9am 5pm CEN members Mags Kirk, Fiona Mallin and Tara Millan-Brophy will present their MSc in ABA research thesis findings; plus presentations on specialist feeding issues. Jane McCready of ABAA4ALL will provide an overview of ABA provision in the British state sector. Cost: members, 10; non-members, 30. Venue: RCSLT, London SE1 1NX. Contact the CEN via Basecamp or Bethan Mair Williams at bethan.mair@tiscali.co.uk London and SE ASD CEN 26 March, 9am 4.30pm Autism and AAC, Zones of Regulation, and Floor Time; plus AGM. For more information and to book your place, visit groupspaces.com/asdsig Adult Acquired Dysphagia CEN March CENAAD are hosting US speech pathologist Dr Joseph Murray for a two-day dysphagia seminar. Topics: aspiration pneumonia and dysphagia; dysphagia management in the frail elderly population; visualising disorders during videofluroscopy. Suitable for SLTs with all levels of experience treating adults with acquired dysphagia. Venue: Resource for London, N7 6PA. Price: 120 for two days, including refreshments. Tickets available at tinyurl.com/cenaadseminar. contactcenaad@gmail.com Aphasia Therapy E24 CEN 27 March New topics in linguistics and aphasia research. Study day presented by Elizabeth Anderson, whose research as a linguist focuses on the usage-based approach to language and how this framework can inform aphasia intervention. Venue: Freemason s Hall, Cambridge. Cost: non-members, 30; members, 20. To book, contact Morag Bixley: mdbixley@dmu.ac.uk London Adult Neuro CEN + The Aphasia Research Group (ARG) 27 March, 9am 5pm Progressions in Aphasia: PPA and beyond. For more information and for tickets, visit ppaandbeyond.eventbrite.co.uk AAC London CEN 24 April, 9am 4.30pm Presenting the award-winning comedian who uses AAC: The Lost Voice Guy! Plus AAC updates, case studies and Ask Me Anything session. New venue: The Forum at Greenwich, SE10 9EQ. Refreshments provided. Annual membership: 30 via WebCollect. aaclondoncen@gmail.com South West Brain Injury CEN 24 April, 10am 4pm Theme: day of reflective practice, to include multiple case presentations from CEN members focused around therapy successes and challenges when working with brain-injured adults in acute, inpatient and outpatient neurorehabilitation settings. Cost: 5. Location: Mardon Neurorehabiliation Unit, Wonford Road, Exeter EX2 4U. Agenda to be advertised on Basecamp. For information and to book, sarah.gibbin@nbt.nhs.uk TRACHE CEN April A two-day multidisciplinary event with lectures and case discussions from expert Passy-Muir Valve representatives from the USA, in conjunction with Kapitex. This course is the first of its kind in the UK and will include swallowing and communication assessments on tracheostomy and ventilator-dependent adult and paediatric patients. MDT colleagues welcome. Location: Queen Square, London. Cost: 50 per day. For more information, visit tinyurl.com/trachecen Midlands Paediatric Dysphagia CEN 25 April, 9.30am Theme: SLT Involvement in Gastrointestinal Issues and Tube Feeding. Speakers from specialist services in the Midlands. Discussion groups and parent experience presentations. Venue: St Luke s Church Centre, Birmingham. Cost: 15 for annual membership. Tea, coffee and lunch provided. For more information, cpdcen2017@gmail.com 32 Bulletin

33 Venue hire at the RCSLT special rates for CENs. For further details or to arrange to view our refurbished rooms, NW Fluency CEN 25 April, 1 4pm Speaker: Mueid Kalim, who recently appeared on the ITV Stammering School programme, will be sharing his personal journey of living with a stammer. Please bring child and adolescent cases to discuss. We will share ideas on a given research paper. AGM. Venue: Timperley Health Centre, Altrincham WA15 6PH.Contact Sarah Ellison or nwfluencycen@gmail. com South East CEN in Deafness 25 April, 9.30am 4.30pm Focus on multi-sensory impairment (MSI) plus AGM. Venue: UCL, Chandler House, London WC1N 1PF. Refreshments provided. Annual membership (from April), 15 (covers two meetings); non-members, 10 per meeting; concessions, 5. Limited places available. To book, m.curtin@nhs.net National Selective Mutism CEN 26 April, 9am 4.30pm Evidence and research in selective mutism. Venue: Holiday Inn, Cardiff City Centre. Book via eventbrite at evidence-and-research-in-selective-mutismtickets For more information, contact Anna Biavati-Smith at nationalsmcen@ gmail.com Acquired Brain Injury CEN 3 May, 9.30am 4.30pm Let s Talk Tech. A day of talks and workshops on using technology with brain-injured clients, including theory and practical approaches with social media and apps in therapy. Speakers include neuro-psychologist Andrew Bateman, and a series of lightning talks by therapists showcasing popular apps being used in therapy, plus case studies. Venue: RCSLT, London SE1 1NX. Cost: ABICEN@hotmail.com East Midlands ASD (Children s) CEN 8 May, 9.30am 3.30pm Robyn Steward, author of The Independent Woman s Handbook for Super Safe Living on the Autistic Spectrum, will be giving a talk on growing up with Aspergers and strategies to support communication and social skills. Morning speaker TBC. AGM will also take place. Venue: John Godber Centre, Nottingham NG15 7FQ. Cost: (tbc); 5 for students. Tea and coffee provided; please bring lunch. Katie Cooke at katie@speechtherapyservice.co.uk to confirm attendance. Surrey DLD CEN 9 May, 1 4pm Topic: Supporting and Managing Wellbeing in Students with DLD. Speakers: Stuart Lane, integrative psychotherapist and Amy Morrison, SLT. Venue: Moor House School and College, Oxted. For enquiries and to book, dldcen@ yahoo.com Computers in Therapy CEN (CITCEN) 24 May, 9am 4pm Findings from the Big CACTUS project with Dr Rebecca Palmer and EVA Park with Richard Talbot; CITCEN Toolkit; App Share and more. Cost: 20 to be paid on the day. Limited number of free live-stream virtual-attendance tickets available. Location: Weston-super-Mare. To book, visit tinyurl.com/citcenmay2018 or search CITCEN on Eventbrite. HIRE AN AFFORDABLE VENUE CLOSE TO LONDON BRIDGE The RCSLT is the perfect solution to your room hire needs. We offer a contemporary, affordable meeting space with the flexibility to be set-up in a range of layouts. WHY HIRE AT THE RCSLT? Following our extensive refurbishment, the venue is ideal for seminars, training sessions, conferences and meetings. Our ground floor rooms have natural daylight, amazing audiovisual equipment and breakout areas for delegates to relax and network between sessions. With a dedicated events team, we will ensure your event runs smoothly. Special rates for CENs/SIGs and members with businesses. For further details visit Bulletin 33

34 cluttering: another look with Kathleen Scaler Scott, Ph.D., CCC-SLP In recent years, many advances have been made in understanding the communication disorder, cluttering. Kathleen Scaler Scott, Ph.D., of Misericordia University helps to clarify prior myths and explain recent research findings about clut- tering. She presents the current lowest common denominator definition of cluttering and demonstrates how to apply this definition to assessment, dif- ferential diagnosis, and treatment. For therapists who have been confused about how to identify, assess and treat cluttering, this 76-minute DVD provides practical strategies for understanding and managing complex clients. THE STUTTERING FOUNDATION A Nonprofit Organization Since 1947 Helping Those Who Stutter New DVD No To order item No StutteringHelp.org/Store Maximize your early language intervention services Involve parents by using an evidence-based coaching framework Workshop space is limited! Register today. Autism - More Than Words workshop London, England... Apr 16-18, 2018 Language Delay - It Takes Two to Talk workshop London, England... Jun 20-22, Foundations in Oncology for Speech and Language Therapists The aim of the study day is to facilitate and equip attendees with the knowledge and skills to care for those with communication and swallowing disorders as a result of their oncological diagnosis or treatment. Target audience: Healthcare professionals (Speech and Language Therapists and nurses) caring for oncology patients with communication and or swallowing disorders. The day will also be of interest to healthcare professionals based in an acute setting, community or hospice. Venue: The Royal Marsden Conference Centre, Stewart s Grove, London, SW3 6JJ Date: Thursday 26th April 2018 Book online: Or Contact: conferenceteam@rmh.nhs.uk 34 Bulletin

35 This month s resources reviewed and rated by Bulletin s reviewers Reviews BOOK Who s Afraid of AAC? The UK guide to Augmentative and Alternative Communication AUTHORS: Alison Battye PUBLISHER: Routledge PRICE: REVIEWER: Katherine Broomfield, SLT/HEE NIHR Clinical Research Fellow, Gloucestershire Care Services NHS Trust/Sheffield Hallam University RATING BOOK This is a colourful and accessible book aimed at SLTs, educators, parents and carers. It is a guide to supporting non-verbal communication and focuses on children and young people and their changing AAC requirements. Individual chapters cover communication skills, AAC equipment, service provision and changing environments. The book s written content is supported with images and pictures, making it a useful resource for a wide audience. The focus of each chapter varies: some provide guidance of greater relevance to professionals, whereas others are targeted towards families and carers. The addition of an index would have helped to navigate the book. The information on equipment and services is comprehensive but is likely to become outdated very quickly. Greater detailed information relating to people who acquire communication difficulties would enhance its completeness as a guide to AAC. Who s afraid of AAC? is an ambitious attempt to demystify AAC. It provides basic information on non-verbal communication and offers clinical guidance on assessment and management in AAC. It signposts the reader to other sources of information, such as links to online videos and supporting organisations. It also provides a really clear summary of AAC equipment and software. BOOK The Concise Guide to Decision Making and Ethics in Dysphagia AUTHORS: P Leslie & H Crawford PUBLISHER: J&R Press Ltd PRICE: REVIEWER: Sarah Woodman, Macmillan Trainee Specialist SLT for Head and Neck, South Tees NHS Foundation Trust RATING BOOK This short book is relevant for students and clinicians alike across a broad spectrum of clinical caseloads. It describes in detail the ethics around dysphagia management, including references to capacity and consent, and supports the reader to make person-centred decisions in conjunction with patients, family members and/or caregivers. Each chapter contains useful definitions of concepts that are frequently used within various policies and literature surrounding the medical profession. The four case studies referred to throughout the book are all purposefully vague in order to guide the reader through general processes and considerations around psychosocial factors and quality of life. Through these case studies, the authors address several clinical scenarios that a dysphagia practitioner may regularly face, and discuss possible resolutions. The authors extensive clinical experience has clearly guided the extracts, making them easy to relate to. Each chapter highlights considerations around eating and drinking and how these are perceived in the wider familial and social context. It provokes the reader to think about the situation from a patient and family point of view, and how this may differ depending on the individuals involved. Reading this text may give both new and experienced clinicians a new perspective on dysphagia management. BOOK The Silent Partner? Language, Interaction and Aided Communication AUTHORS: Martine M Smith and Janice Murray (Editors) PUBLISHER: J&R Press Ltd PRICE: REVIEWER: Sally Mordi, SLT, Clinical Lead: Autism (Specialist Education Team), Barnet, Enfield & Haringey Mental Health Trust RATING BOOK This book is written for an audience familiar with augmentative and alternative communication (AAC). The editors have collated a selection of chapters that use research to explore use of communication aids from a variety of perspectives (eg children developing expressive language via communication aids, and adults with acquired neurological disabilities). There is a focus on the impact of a communication device on interactions and how this affects language and interaction style. The importance of both participants skills (eg attention, memory, symbolic representation and language) and joint responsibility in constructing a shared meaning is highlighted. This is illustrated with case studies. Issues of identity and communication roles of the user and partner are explored. This book can be dipped into to explore a particular topic or read as a whole. I found much of the book engaging and thoughtprovoking but, at times, the specialist nature and rather academic style were challenging. However, it was interesting and relevant, and will keep a place on my bookshelf for future reference. Bulletin 35

36 Stammering: Basic Clinical Skills Professional Training for Healthcare Professionals Dynamic 2+ hour DVD demonstration of stammering therapy techniques by experts from around the world to help you work effectively with children and adults who stammer. DVD No nd, 9th & 23rd May 2018 East Midlands Inter-Professional Stroke Educational Programme DVD CHAPTERS INCLUDE: Project Lead: Dr Sunil Munshi A high quality 3 day course providing teaching on the whole stroke patient pathway. The course comprises three modules (Acute Care, Rehabilitation, and Stroke in the Real World) delivered through a variety of interactive teaching opportunities. Venue: Nottingham City Hospital, Nottingham Fee: 250 Explore talking Holding/ and stammering tolerating Identification moment of Explore stammering Pullouts stammering Explore change Cancellations Tools for change Making change Soft starts durable Changing rate Transfer Voluntary Disclosure stammering 15th October 2018 Occupational Stress: Understanding and Management Lecturer: Dr Aftab Laher It is hoped that by the end of the workshop delegates will have enhanced their knowledge, skills and confidence in identifying, assessing and managing occupational stress from a personal, organisational and service user perspective. Venue: London Road Community Hospital, Derby Fee: 130 5th November 2018 From Michael Palin Centre for Stammering Children, London: Frances Cook, MBE, MSc, Cert. CT (Oxford), Reg UKCP (PCT), Cert MRCSLT (Hons); Willie Botterill, MSc (Psych. Couns.), Reg UKCP (PCT), Cert MRCSLT; Ali Berquez, MSc, BA (Hons), Dip. CT (Oxford), Cert MRCSLT; Alison Nicholas, MSc, BA (Hons), Cert MRCSLT; Jane Fry, MSc (Psych. Couns); Barry Guitar, Ph.D., University of Vermont; Peter Ramig, Ph.D., University of Colorado-Boulder; Patricia Zebrowski, Ph.D., University of Iowa; and June Campbell, M.A., private practice, provided additional footage. Training by BPP University School of Health The day will introduce individuals to the principles and practice of Clinical Supervision through analysis and application of key Clinical Supervision skills, the core principles of effective Clinical Supervision and the use of models and techniques to plan and perform it effectively. Venue: London Road Community Hospital, Derby Fee: 150 To order: THE STUTTERING FOUNDATION Effective Clinical Supervision A Nonprofit Organization Since 1947 Helping Those Who Stutter StutteringHelp.org dhft.ncore@nhs.net Click on store and then click professionals Colourful Semantics Fren Frenchay Aphasia Screening Test Sc? a practical al resource urce To What? Me Tell More Action? ere Wh Third Edition By Nicola Ogg N Pamela Enderby Victorine Wood Derick Wade ŶĚ ŽĨ ƚśğ ĮŶĂŶĐŝĂů LJĞĂƌ ƐƉĞĐŝĂů ŽīĞƌ ϭϱй ĚŝƐĐŽƵŶƚ ĂĐƌŽƐƐ ŽƵƌ ǁŚŽůĞ ƌăŷőğ DĂƌĐŚ ϮϬϭϴ ŽŶůLJ ŚŽŽƐĞ ĂŶĚ ƵƐĞ ƚśğ ĐŽĚĞ ďğůžǁ WƌŽŵŽƟŽŶ ĐŽĚĞ z ^ϭθ 36 Bulletin BUL indd Sec1:36 14/02/ :55

37 MY WORKING LIFE Emma Ladher OCCUPATION: JOINT LEAD, ADULT SPEECH AND LANGUAGE THERAPY SERVICE, LYMINGTON NEW FOREST HOSPITAL Being able to set up a service from scratch has been the step up into leadership I was looking for Having developed a range of acquired adult clinical experience from working across a range of acute and community settings, I was keen to develop my leadership skills and take the step up to a band 7 role. So, when an opportunity arose to create and lead a newly commissioned service at Lymington New Forest Hospital, I jumped at the chance. Being able to set up a new service from scratch within a manageable size hospital was the step into leadership I was looking for, although I faced a number of challenges and learnt some valuable lessons along the way. The service delivers clinical input to five inpatient wards, including a medical admissions unit, a general rehabilitation ward and a stroke rehab ward. It was also commissioned to provide speech and language therapy to the Stroke Early Supported Discharge (ESD) service. When I started in post, the team consisted of myself and a part-time band 4 assistant. We now also have a joint service lead. My understanding of how to set up and manage a service has been shaped by working within many well-managed services and observing the qualities of excellent leadership. Before starting this new role, I also spent time talking to SLT colleagues about their experience of leadership, and am now more observant of how others lead around me and what I can learn from them to enhance my own leadership style at any band, we can always be learning about leadership from those around us. In the first few months, I spent time with other teams in the hospital and began working alongside staff in clinical practice. By listening to the teams around me, I was able to understand the needs and culture of the hospital before implementing changes. I gained the staff s trust so that when I did begin to implement change for example, challenging the rationale for nurse-led swallow screens on medical wards, or bringing in new initiatives such as electronic referrals the teams were receptive, and our systems have become more efficient and effective as a result. Working in a small new service, I was aware that I could feel isolated. However, through networking with local services, I have been able to access peer group supervision, as well as support from my local RCSLT Hub and CENs, which has enabled me to establish a robust CPD network. Building good working relationships with fellow SLT leads from other specialities within our trust has also been invaluable to harness professional representation when inputting into trust working parties, such as the nutrition and hydration committee. Despite working with different client groups, we have the same core skillset, and much can be learnt from different perspectives from other fields. Having clear boundaries can make a big difference when handling potentially contentious situations. For example, when I have been approached to provide a service to areas that are not commissioned, having a clear picture in my mind about what the service is commissioned to deliver has enabled me to be confident and clear in communicating my response, while not compromising the current service. Knowing my boundaries has also helped me to establish which issues need action from me and which require input from senior leaders. After working through the initial challenges of setting up the service, we are now able to provide a high-quality service to our patients. One example is being able to provide daily intensive therapy on the stroke rehab ward, as outlined in the Royal College of Physicians 2016 Stroke guidelines. We are also continuing to develop the service according to local needs: running regular in-service training for staff, and making use of existing services we work alongside with to deliver a wider range of specialist services, such as currently developing a videofluoroscopy clinic. Bulletin 37

38 QUICK LOOK DATES Various dates Elklan Total Training Package for 5-11s 5-6 March, Holiday Inn, Salford; 30 April 1 May, COSLA, Edinburgh; May, RCSLT, London; June, Drumcondra, Dublin. This course equips SLTs and teaching advisors to provide practical, accredited evidenceinformed training to education staff and SLTAs in all settings including mainstream schools. Innovative advice and strategies help children maximise their speech, language and communication potential and access the curriculum more effectively. Price: 495. Tel: ; henrietta@elklan.co.uk; visit: Various dates Elklan Total Training Package for Verbal Pupils with ASD 5-6 March, Holiday Inn, Salford; 3-4 May, COSLA, Edinburgh. This revised course equips SLTs and teaching advisors to provide practical, accredited, evidence-informed training to those supporting verbal pupils with ASD in all settings including mainstream schools. Covers a wealth of practical strategies and approaches proven to be effective with these pupils. Price: 495. Tel: ; henrietta@elklan.co.uk; visit: Various dates Elklan Let s Talk with Under 5s Tutor Training Pack 6 March, Holiday Inn, Media City, Salford; 15 May, Cornwall; 27 June, RCSLT, London. This course is designed for SLTAs, EY practitioners and parents to equip them to provide accredited, practical, evidenceinformed training to parents/carers of 2-5 year olds. Participants must have successfully completed the Elklan Level 3 award, Speech and Language Support for Under 5s/0-3s. Price: 235. Tel: ; henrietta@elklan.co.uk; visit: Various dates Elklan Let s Talk with 5-9s Tutor Training Pack 7 March, Holiday Inn, Media City, Salford; 15 May, Cornwall; 28 June, RCSLT, London. This course is designed for SLTAs, HLTAs, TAs, SENCOs, teachers and parents to equip them to provide accredited, practical, evidence-informed training to parents/carers of 5-9 year olds. Participants must have successfully completed the Elklan Level 3 Award, Speech and Language Support for 5-11s. Price: 235. Tel: ; henrietta@elklan.co.uk, visit: Various dates Elklan Total Training Package (TTP) for 3-5s with optional TTP for 0-3s 7-8 March, Holiday Inn, Salford (3-5s); 9 March, Holiday Inn, Salford (0-3s); 30 April 1 May, COSLA, Edinburgh (3-5s), May, RCSLT, London (3-5s); 25 May, RCSLT, London (0-3s); June, Drumcondra, Dublin. This course equips SLTs and teaching advisors to provide practical, accredited, evidence-informed training to staff working in Early Years settings from 3-5 years. The additional day provides information for those working with 0-3s. Teacher/therapist teams welcome. Option to do one day 0-3s for Elklan Tutors who have trained on Total Training Packages for 3-5s or under 5s. Price: 495 for 3-5s two days; 745 for all three days, 3-5s AND 0-3s; 250 for 0-3s one day. Tel: ; henrietta@elklan.co.uk; visit: Various dates Talking Mats Foundation Courses Be more effective in involving people in decisions and attend a Talking Mats foundation course. Locations: Online, 17 March; London, 26 March; North East, 24 April; Stirling, 18 May and 15 June; Manchester, 17 May; Belfast, 17 May. Visit: info@talkingmats.com; tel: Various dates Talking Mats Courses Develop your use of Talking Mats at an advanced level. There are opportunities in the following: Advance Care Planning, 27 March (London); Train the Trainer, 18/19 April; Safeguarding, 20 April (Stirling) and 13 June (London). Visit: info@talkingmats.com; tel: Various dates Assessment & Management of Adults with Dysphagia April or September. Five-day course held in Sheffield, followed by clinical supervision in own Trust. Course Administrator, Irene Wilson: irene.wilson@sth.nhs.uk Various dates Success and Confidence in your Independent Practice 3 May, Midlands; 2 October, RCSLT, London. For therapists who want to start/develop an independent practice. Practical course with lectures/small group mentoring from experienced IP managers. Other venues/dates available. Visit: tel: ; info@eg-training.co.uk Various dates Elklan Total Training Package for 0-25s with Complex Needs 3-4 May, COSLA, Edinburgh; May, RCSLT, London. This course equips SLTs and teaching advisors to provide practical, accredited, evidence-informed training to support communication in 0-25 year olds with more complex needs, in all settings including mainstream schools. It covers pre-intentional to early intentional communication skills. Price: 495. Tel: ; henrietta@elklan.co.uk; visit: Various dates McNeill Dysphagia Therapy Program One course, three different locations: London, 19 June; Edinburgh, 21 June; Birmingham, 26 June. One-day certified course with Dr Michael Crary and Dr Giselle Carnaby providing an intensive, systematic exercise-based approach to dysphagia therapy with adults. LBR funding available (East Midlands), early bird rates, discounts for departmental bookings. jackie.ellis4@btopenworld.com 8 March, Salford Elklan Let s Talk Together Tutor Training Pack This course is designed for all practitioners and parents to equip them to provide accredited, practical training to parents/carers supporting children with verbal ASD. Participants must have successfully completed the Elklan Level 3 course, Communication Support for Verbal Pupils with ASD. Price: 235. Tel: ; henrietta@elklan.co.uk; visit: March, Birmingham Two-Day Masterclass: Selective Mutism for professionals and parents/carers With Maggie Johnson. Suitable for teachers, therapists and parents. Discounts to support joint attendance. Full rate: 350 with resource manual. Day three available on 22 March. Visit: tinyurl.com/yaeprku9; info@coursebeetle.co.uk 23 March, Southampton Voice Clinics Forum 2018 A multidisciplinary approach to the up-to-date management of common conditions presenting to the voice clinic. Sessions on neurological disorders, functional disorders and care of the elite performer. Keynote speakers, panel discussions, case discussions and free paper session. Visit: org.uk (Events); administrator@ britishvoiceassociation.org.uk 24 March, London ALSTIP 27th Annual Conference and AGM Venue: Bloomsbury Holiday Inn, London. This year s conference is bursting with engaging speakers, innovative workshops and interesting exhibition stalls. There are four sessions with four different options to choose from including: Developing marketing skills; Extending clinical skills; Increasing awareness of Speech Therapy projects and reviews by colleagues; Training such as CPR; safeguarding; and information governance. Price: 150 including lunch and refreshments. Visit: March, Midlands Makaton Enhancement Workshop Makaton is a language programme using signs/symbols to help people communicate. This workshop will improve/develop existing Makaton signing/symbol skills. Integral to becoming a Local Tutor. Foundation and beginners available. Visit: tel: ; info@eg-training.co.uk 28 March, RCSLT, London CPD Masterclass The current evidence base for speech interventions: Translating research into practice. With Dr Helen Stringer. For SLTs who are looking for updates on the latest evidence and implications for practice with regard to clinical interventions for children with developmental speech impairments. Price: 215. Visit: tinyurl.com/ y9u6d8hs; info@coursebeetle. co.uk 11 April, Blackburn Mental Fitness: A practical approach to supporting mental health A morning workshop looking at why some patients are better able than others to recover from depression following a trauma in their lives. Delegate fee: 75. Visit: April, London More Than Words Visit: Development/More-Than- Words/2018-Apr-16-London-England. aspx 20 April, Birmingham Shape Coding by Susan Ebbels Learn effective system to help schoolaged children improve understanding and production of grammar. Training is suitable for speech and language therapists and teachers. No prior knowledge of Shape Coding is required. Price: 220. Visit: tinyurl.com/y9u8qmpn; info@coursebeetle.co.uk w/c 23 April Intensive Training Week: Early Intervention Often, auditory learning is confused with auditory training and the link between cognition and language is missed. This intensive week enables you to plan sessions with greater impact. Price: 500. The Elizabeth Foundation, Portsmouth. susanna@earfoundation.org.uk 27 April British Aphasiology Society Research Update Meeting Presentation and discussion of ongoing, recently completed or planned projects in any area of aphasia (therapy, assessment, rehabilitation etc). Free of charge to BAS members. For membership information, visit: research-in-progress@bas.org.uk 3-6 May, Brighton Padovan Method Padovan Method is a holistic therapy based on the physiological developmental stages to stimulate each level of the nervous system and reorganise its circuit. It is a natural process to develop a good sensory motor functioning, linguistic and cognitive processes. info.uk.nfrpadovan@gmail.com May, Canterbury Two-day accredited AVIGuk Video Interaction Guidance (VIG) Training The starting place for those wishing to progress to become an accredited UK VIG practitioner. Using video to support empowerment and change within communication. Price: 400. Visit: tinyurl.com/yajloto8; info@coursebeetle.co.uk May, Hertfordshire PROMPT LEVEL 1: Introduction to Technique These three-day intensive workshops focus on teaching the technique of PROMPT (PROMPTs for Restructuring Oral Muscular Phonetic Targets). This workshop teaches a system for assessing and treating language and speech disorders from a perspective of speech-motor control and learning. Venue: The Red Lion, Watling Street, Radlett, Hertfordshire, WD7 7NP. Price: 800. Visit: events; tel: May, Dublin, Ireland It Takes Two to Talk Visit: Development/It-Takes-Two-to- Talk/2018-May-16-Dublin-Ireland.aspx 18 May, RCSLT, London smile Therapy Practitioner Training: Day 3 Day 3 training for SLTs and specialist teachers in this innovative 10-step therapy that teaches functional communication and social skills in real, everyday settings. Outcome measures integral to each module and generalisation of skills with parents part of the therapy. Suitable for children, young adults and adults with deafness, ASD, DLD, learning difficulties and physical disability, from age 7-25 and beyond. For information and bespoke training to your local team, info@ smiletherapytraining.com; visit: www. smiletherapytraining.com 18 May, London Active Relaxation Training Workshop This one-day interactive workshop is suitable for professionals working with individuals who have health problems made worse by stress and/or fatigue issues. Price: 90. Location: Gatwick 38 Bulletin

39 QUICK LOOK DATES Hilton Hotel. braintreetraining.co.uk; tel: ; visit: co.uk/relaxation_spf.php?id= May, RCSLT, London Elklan Total Training Package for 11-16s This course equips SLTs and teaching advisors to provide practical, accredited, evidence-informed training to staff working in secondary school settings and SLTAs. Teacher/ therapist teams welcome. Price: 495. Tel: ; elklan.co.uk; visit: May, Birmingham ADOS2 administration and coding course ADOS2 is the latest revision of the Autism Diagnostic Observation Schedule and is the most widely used observational assessment in the diagnosis of autism. Visit: ados2training.co.uk 24 May NEW Thera P Practical and parent-centred, not a picture card in sight. Get children to think, imagine and problem solve. Recognise the link between cognition, language and motor skill development, and learn how activities can meet a range of speech and language goals. Price: 90, bring a friend for 10. The Ear Foundation. susanna@earfoundation.org.uk 25 May and 29 June, RCSLT, London Two Day Transcription Refresher and Interpretation Workshop A unique opportunity to revisit phonetics, phonology, ear training and transcription using IPA and new ExtIPA conventions with Dr. Anne Harding-Bell. Day 1: Foundation theory, transcription methods and practice based on the consensus listening protocol. Practical, interactive course relevant to a range of caseloads and ages including cleft palate/ VPD, mild/mod HL, neurodisability, genetic conditions. Day 2: Interpreting speech data to inform target selection and treatment planning using a psycholinguistic approach: focus on working with the sound /s/. Lunch provided both days. Price: secretary@sltconsultancy.co.uk 31 May, London Learning to the use the Therapy Outcome Measure (TOM) One-day training workshop with Prof Pam Enderby. Delegate fee: 175 (Check website for possible CTN member discount). For further details and to book, visit: 1 June, Birmingham An Introduction to working with children and young people with Social, Emotional, Mental Health and SLCN Presented by UK expert Melanie Cross lead author of the Royal College of Speech and Language Therapists clinical guidelines on SEMH. Price: 215. Visit: tinyurl.com/y7wwx2gu; contact info@coursebeetle. co.uk 1-2 June, London LSVT LOUD Training and Certification Course Learn the evidenced-based voice treatment for Parkinson s disease with application to adults and children with other neurological conditions. Price: professional 450, student 250. Venue: Clinical Neurosciences Building, 33 Queen Square, National Hospital for Neurology and Neurosurgery, London WC1B 1NX. Visit: www. lsvtglobal.com; info@lsvtglobal.com 8 June, London Challenging Behaviour Following Stroke and ABI: Improving Patient Outcomes Through the Use of Multidisciplinary Interventions This one-day conference will look at the themes: Assessing and Measuring Outcomes in Challenging Behaviour, Managing and Treating Challenging Behaviour throughout Recovery, and Approaches to Challenging Behaviour in Special Groups. Price: institute@rhn.org.uk; visit: cbconference/ 15 June, Manchester CPD Masterclass: Bilingual Children with Speech and Language Difficulties Presented by Dr Sean Pert. This evidence-based course examines this challenging but rewarding area, providing not only theory, but how to apply this to professional practice. Price: 215 or 190 for two places booked together. Visit: tinyurl.com/yaef3p2z; info@coursebeetle.co.uk June, Sheffield Auditory Processing, Listening, Language & Learning With Dilys Treharne and Alan Heath. Four days of workshops near Sheffield: APD, Test use in assessment, TMP, TLP. Pick and mix. Massive discount for taking all four; early-bird discount available. aplls1@aol.com or fb.me@aplls.org.uk June, RCSLT, London smile Therapy Practitioner Training: Day 1 and Day 2 Day 1 and Day 2 training for SLTs and specialist teachers in this innovative 10-step therapy that teaches functional communication and social skills in real, everyday settings. Outcome measures integral to each module and generalisation of skills with parents part of the therapy. Suitable for children, young adults and adults with deafness, ASD, DLD, learning difficulties and physical disability, from age 7-25 and beyond. For information and bespoke training to your local team, info@ smiletherapytraining.com; visit: 22 June, Birmingham CPD Masterclass: Using the curriculum to address the language needs of children with language delays Aimed at teachers re implementing SALT targets within school day - Claire Vuckovic, Senior Lecturer (SEND and Inclusion) University of Cumbria. Price: 195 or 135 if a therapist and teaching professional book together. Visit: tinyurl.com/y9wbk8cr; info@coursebeetle.co.uk 22 June Conference development of the whole child Explore the child as a whole and how each facet of their development may impact on each other. Providing an opportunity to explore working effectively in a multi-disciplinary way. Price: 100. The Ear Foundation. susanna@earfoundation.org.uk June, London Cognitive Rehabilitation Workshop This two-day interactive workshop is suitable for professionals working with adults who have cognitive problems following brain injury. Location: Gatwick Hilton Hotel. Price: enquiries@braintreetraining. co.uk; tel: ; visit: crwp_spf.php?id=74 28 June, London An Interdisciplinary Team Approach to the Management of Patients in Prolonged Disorders of Consciousness Includes an introduction to terminology, current research and RCP Guidelines, assessment, management and the family perspective. With workshops on interaction and ethical issues. Price: institute@rhn. org.uk; visit: PDOC2018 June, Midlands TalkTools Level One and Level Two Tactile-sensory approach using therapy tools to train/transition muscle movements for speech production. Learn how motor activities are used to improve phonation, resonation and speech clarity. Visit: tel: ; info@eg-training.co.uk 1 September, London Life Coaching and Speech & Language Therapy: Supporting clients and therapists Suitable for SLTs who work with adults or children. Limited places available. Price: 100 (by 27 April) or 120 (after 27 April). Includes lunch and morning/ afternoon tea. 9.30am 4.00pm, Radisson Blu Edwardian Grafton Hotel 130 Tottenham Court Road, London, W1T 5AY. info@apexability.com; tel: November, RCSLT, London smile Therapy Practitioner Training: Day 1 and Day 2 Day 1 and Day 2 training for SLTs and specialist teachers in this innovative 10-step therapy that teaches functional communication and social skills in real, everyday settings. Outcome measures integral to each module and generalisation of skills with parents part of the therapy. Suitable for children, young adults and adults with deafness, ASD, DLD, learning difficulties and physical disability, from age 7-25 and beyond. For information and bespoke training to your local team, info@smiletherapytraining.com; visit: BOOK YOUR QUICK LOOK DATE TODAY Increase the potential of your course or event by advertising in the RCSLT Bulletin Quick Look Dates section. A Bulletin survey shows 77% of readers have attended a course advertised in these pages. Contact Thomas Ainsworth to book your advert. Tel: or thomas.ainsworth@redactive.co.uk Terms and conditions Payment must be received by Redactive Media before we can publish your Quick Look Date advert. Advert text will be edited for consistency. Enhanced coloured boxes: the editor will determine the box colour. Bulletin 39

40 TASTE FOR YOURSELF or visit wiltshirefarmfoods.com DELICIOUS DISHES NUTRITIONAL EXPERTISE SPECIALIST DIET RANGES