In February, I wrote about wanting to spend more time outside in nature, two weeks later my family and I went on holiday to Wales, and 2 months after that we moved here! We’re now based in beautiful Llanelli, and feeling grateful, particularly for our daily walks along the coast.

I’m still seeing a small number of clients in London, on a fortnightly basis. I’m in the process of finding a therapy room in West Wales and excited about seeing clients here, too.

It’s all a big change. I frequently remind myself of the quote: “the only thing constant is change” and try to embrace all the newness. I’ve been reflecting on transitions and how long change takes to feel ‘normal.’

Our baby is now 10 months old and has been completely chilled throughout the whole move, he is a great conversation starter, making friends wherever we go. Obviously it’s been more challenging for our 3 year old.

I reminded myself how supportive visuals can be for little people (and big ones!) We showed him photos of the new house, the removals van, and the train he’d be taking to Wales. He loves the beach and all the new parks. And during the difficult times I’m trying to implement the advice from a book I’m still reading: How To Talk So Little Kids Will Listen: A Survival Guide to Life with Children Ages 2-7 I don’t want to use power over my son, the book has ideas for finding courses of action that work for everyone in the family.

People ask if we’re settling in. Yes, I think so. We’re happy to be here, although it still feels a bit like being on holiday. I wonder how long it will take to develop friendships, grow my first vegetable garden and feel comfortable saying: “ta ra.” Who knows?!

When parents ask about how long the therapy process might take, “who knows?” is not what they want to hear! I try to reassure them by showing them all the changes their child is making, support them to keep practising, and encourage them to believe in the process, their child and their own skills.

I’m hoping a benefit of life in Wales will be more time to write, watch this space. And if you’re a Speech Therapist anywhere nearby, and fancy getting together, please send me an email, I’d love to hear from you.

My partner has taken the kids out for a walk, so I have time to sit down and write this blog post. I’m reflecting on time. What do I want to use my time for? How can I use my time in a way that serves my purpose?

I haven’t written anything here on the blog for 4 months. I enjoy using writing as a tool for reflection, and ‘blog regularly’ features on my Goals for 2017 list. I meant to write earlier in the year about my intentions for my practice in 2017, but I didn’t make the time. I have two children, the youngest just 6 months old: quiet time to concentrate is rare. But I don’t want to think about time with a scarcity mindset, and I don’t want to live my life that way, rushing from one thing to another, frantically trying to do everything. That’s not connecting with my power.

I’m gradually returning to work, soon I’ll be working one day a week. I choose to schedule my day so that I have a long lunch break, which gives me time to go home and feed the baby. I can fit in 6 children for therapy. Writing this, I realise even my language implies scarcity: ‘fit in’ – squeeze. I want to try flipping this into a positive. How about: I get to help make a positive change in the life of 6 children and their families, what a privilege.

I read an interesting book over the holidays, which fed directly into my intentions for my work this year. Movement Matters by Katy Bowman really intrigued me. I feel like I need to read it through several times, as there is so much in there to think about. After reading it twice, I’m determined to stop asking the children (my clients and my own!) to sit down. I work with pre-schoolers, they have a whole lifetime ahead of them sitting down. All those hours, days, weeks – doing something their bodies didn’t evolve doing. And something some of my little clients find so tricky! So from now on in my sessions we’ll squat, and crawl and jump while we do therapy. And if we’re concentrating while lying on the floor, well that’s okay.

Secondly, I need to get out more. Humans are nature, yet today we perceive ourselves as separate from it. I’ve been reading about Forest School (lots of lovely child-led principles) and thinking about how to incorporate the ideas into my work. There is a huge, beautiful garden where I work, and I’m going to use it more. I bought this book about things to make or do with sticks and this one with ideas for outside activities, and I’m going to have a go. Spending time outside, being part of nature while I work and support children – now that’s serves my purpose.

I took my first Hanen eSeminar a couple of months ago, and I’ve been able to apply what I learnt, straight away. I think this is the first eSeminar or online training, that I’ve paid for. It was easy to log in and I could watch the 2 hour video whenever I wanted with 30 days of unlimited access. There was also a handout to download. It was recorded live, so there were some parts when the presenter asked the people watching live to answer questions or vote. It looked like fun! I used this time to make notes and jot down questions.

Definitions of Late Talkers

The eSeminar was titled: Choosing Initial Vocabulary Targets for Children Who Are Late Talkers. I was interested in the topic because I’ve been seeing more and more children under 2 years old, a good proportion of whom are Late Talkers. Some of the information presented was from Hanen’s Target Word program. Cindy Earle who presented the eSeminar began by describing Hanen’s clinical definition of Late Talkers (as opposed to the research definition.) She said that children with less than 24 words at between 18 and 20 months, 40 words at between 21 and 24 months, and 100 words, with no or limited word combinations at between 24 and 30 months, (and no other major concerns in other areas), require therapy.

Communication Goals and Vocabulary Targets

The eSeminar covered risk factors and predictors of change, and then we started thinking about communication goals. I had previously worked on imitation as a goal, but never being noisy! Cindy talked about the importance of learning to vocalise with every communicative turn or “being noisy” and it’s something I’ve incorporated into my work. Cindy moved on to discussing vocabulary targets, providing a useful checklist, including: target words should be motivating for the child to say and starts with a sound in the child’s repertoire. There was also some interesting information about gestures and a discussion about having the word ‘more’ as a target. I hadn’t really considered before that ‘more’ isn’t useful for initiation. I’ve been focussing on verbs and motivating items since watching the eSeminar.

The eSeminar concluded with some video case studies so we could apply what we’d learnt. I really enjoyed the format, the information presented was relevant to my work, and Cindy easily kept my attention for the 2 hours.

Discount on Hanen’s eSeminars about Autism

April is Autism Awareness Month. Or as the folks over at Thinking Person’s Guide to Autism prefer: Autism Acceptance Month. And Hanen are offering 40% off their Autism eSeminars with the code: AAMSEM16. Check out the eSeminars available and remember the offer expires on 30th April.

Win a free eSeminar

The team at Hanen have kindly offered me a free Autism eSeminar to give away! Leave a comment on this post telling me the vocabulary targets you’ve had most success with (“Thomas?” “Up?” “Cake?”) and I’ll randomly select a winner in a weeks time.

I was delighted to hear how well a little client of mine had done with a new activity (a large container of jelly!) at nursery this week, although I was disappointed that his teacher had predicted he wouldn’t be able to access it.

I then read this journal article: The effect of using ‘full’ language when working with a child with autism: Adopting the ‘least dangerous assumption’ by Anne Emerson and Jackie Dearden, Child Language Teaching and Therapy, 29 (2), 2013. This research paper resonated with me because it discussed the implications of underestimating a child’s ability.

The researchers report that the Minimal Speech Approach (MSA) is recommended  in the UK Government guidance on teaching pupils with autism (Department for Education and Skills, 2002: 18) This approach involves using single words or two word phrases alongside gestures and visual supports.

This single case study describes work with Jack, who had been exposed to the MSA approach at his special school. The researchers investigated the effectiveness of a different way of working, they suggest: “it is ‘less dangerous’ to start by assuming understanding and adjusting language when comprehension difficulties become apparent.”

An Alternative to the Minimal Speech Approach

The researchers describe the specific characteristics of the intervention as follows, (I quote from their paper):

• speaking in complete phrases and using a range of vocabulary;
• speaking slowly and quietly, and waiting longer than might typically be expected for the pupil to respond;
• materials and resources to promote interest, interaction and fine motor skills (including pointing);
• initial focus on activities where there was no ‘correct’ answer so that the student could not fail;
an attitude of expectation that the pupil would be able to respond;
• close observation and commenting on pupil responses;
• a willingness to take risks by introducing complex tasks and discovering the extent to which individuals could manage them whilst ensuring success through scaffolding the learning task;
• literacy activities including reading and spelling accuracy tasks such as matching words and pictures and spelling activities;
• reading comprehension tasks.

What a wonderfully encouraging set of principles.

Results of the Intervention

The intervention was carried out during 32 sessions, that lasted between 20 and 30 minutes, over 20 months. Before the intervention teaching staff were using instructions with one information carrying word, after the intervention they reported that Jack was able to understand instructions with three information carrying words. The researchers reported that Jack became more motivated to initiate communication, finding creative ways of getting his message across. The intervention revealed that Jack enjoyed books, was able to match words and pictures, spell words, and sequence words into sentences.

In the discussion Emerson and Dearden state:

Following increased adult expectations, exposure to full language and literacy tasks, Jack demonstrated his ability to respond to more complex questions. Therefore by increasing his opportunities and reasons to communicate, the under-estimation of his cognitive abilities and literacy skill became evident. We contest that he had the means (ability to point) and cognitive ability to follow instructions prior to our intervention but was not being given the opportunity to demonstrate these as he was dependent on adult choice of activity.

The authors describe the teaching staff at Jack’s school as: “initially very sceptical about the approach.” However, over time teaching staff were able to identify that Jack could read, and observe other benefits to using more complicated language.

Reading this paper reminded me that by oversimplifying our language we are underestimating our clients, and limiting their progress. We must incorporate the principles outlined above and expose our clients to a range of interesting experiences.  This is especially important when the children aren’t able to provide such clear evidence as Jack was, of their abilities.

Photo of jelly by Gordon McLean.

I’ve found it challenging to get back into work mode after the winter break. It’s dark when I leave the house and dark when I get home.

Here are three things that have inspired me:

• Observing the progress my clients are making. I’ve reminded myself to slow down and notice the changes in each client. One is now able to produce s clusters, another can make a choice between two options, and a third has started asking questions. Their exciting progress keeps me motivated.
• Doing a little CPD at a time that suits me, sitting at my own desk. I watched this Hanen eSeminar: Choosing Initial Vocabulary Targets for Children Who Are Late Talkers, which deserves a blog post of it’s own. It made me think about which of my children Hanen would classify as Late Talkers and gave practical ideas about the types of words to choose for targets.
• Reading beautiful books which aren’t about speech therapy. I received Erin Boyle’s book Simple Matters in the post this week. The gorgeous photography and inspiring ideas were just what I needed to get out of my winter funk. And I’m sure there are principles I can apply to therapy, for example I’ll definitely think twice about buying more plastic toys, or resources. I also had another look through Joel Henriques’ book Made to Play. Another book with gorgeous photographs and the craft projects range for simple to pretty complicated. I’m going to pick a couple and have a go.

What do you do to stay motivated through winter?

I was selected for the HCPC Continuing Professional Development audit, so I’ve been reflecting on how we apply what we learn to our therapy. As I put together my CPD “portfolio” I noticed some common features of the CPD that I’d found most useful. I’ve used these common features to make my new conference an effective learning experience. 

I needed to demonstrate that the CPD I’d done:

• contributed to the quality of my practice and service delivery and,
• benefits the service user.

What makes learning easy to apply in therapy?

As I reviewed the entries in my CPD diary, I began to see some patterns. The learning I was able to apply immediately helped with a specific problem I was having, or a question I needed answering. For example, several parents told me that their children enjoyed music, but I was stuck with how to use music in a structured way, or how to incorporate my communication targets into musical play. I found a workshop about using music with children with autism that gave me some specific ideas to try to solve this problem. I went away and tried the ideas from the course in therapy sessions the very next week.

In order to apply what I’d learnt, I also needed it to be specific enough. I didn’t need all the answers but I needed to have enough detail to go away and try it. My supervision partner suggested I try incorporating more input tasks into my sessions with a particular client whose progress was slower than I wanted. If she’d left it like that, I think it’s unlikely I would have acted on the suggestion. She gave me three examples of therapy activities I could use, so I was ready to go. I used the activities she’d suggested as well as some of my own, and was happy with the result.

Finally, the learning needs to be relevant to my clients. It’s obvious: it’s tricky to apply learning about selective mutism if I’m not working with any children with selective mutism. Tricky, not impossible. It takes a lot more work to filter through information and pick out bits that would be useful with other children, who may, for example, be shy or lack confidence. And it takes time, which I don’t always have directly after a course or lecture.

Join us for the Therapy Ideas Live Conference

At the Therapy Ideas Live Conference on 2nd November, we’ll be practising person-centred techniques that help clients to meet their needs. We’ve designed the day to make it as easy as possible to apply what you learn at the conference, at work the next day. We’re starting the day figuring out what challenges we have and what questions we’d like to answer. There are workshop sessions, so together we can take what we’ve heard in the talks and apply it to our particular client group. We’ll be practising some of the techniques, so we can get specific, and we’re finishing the day by identifying our next steps. You’ll be all set to apply what you’ve learnt!

Join us for a practical day of interactive learning and workshopping. Register by 19th October to save £50. If you have any questions about the conference, get in touch.

In the conclusion to their book, Jane Stokes and Marian McCormick wrote that they hope it makes you think “Hmmm…” – it certainly does.

As Jane and Marion designed the curriculum for a new postgraduate course in speech and language therapy they collected stories, and then wrote this book to add to the conversation about issues that underlie the SLT profession. The book has 10 chapters, 5 written by Jane and Marian, and 5 contributed by other people. It raises challenging questions and explicitly invites the reader to examine their professional beliefs.

There are a number of chapters I’m looking forward to re-reading and think I’ll review regularly. Marian’s chapter about reflective practice inspired me, and reminded me that one outcome of reflection needs to be a goal for the future. Aoife Gallagher’s chapter “To intervene or not to intervene” had me nodding with agreement. I’ve been considering the role of parental expectations, fear and anxieties in my own clinical work so was interested to read Aoife’s ideas about how to make services transparent and responsive.

In her chapter about supervision Jane introduces models from related fields, that we in speech and language therapy can learn from. Keena Cummins’ chapter on using video clarified issues I’d been struggling with in my therapy sessions. Her analysis of the value of face watching and mirroring between adults made me reflect on some recent interactions with parents. I hadn’t considered the link between spirituality and speech and language therapy. I enjoyed Sophie MacKenzie’s chapter on this topic, which discussed the narratives clients use at different points in the therapeutic journey and person-centred care.

I was scribbling down thoughts and questions as I read this book and enjoyed how it encouraged me to consider why I do what I do. If you’re a therapist who enjoys asking why and getting stuck in to some interesting discussions, I think you’ll enjoy this book. 

The book includes quote from students of Jane and Marian’s course, I was stunned by how insightful they were. If you’re looking to hire a new grad keep your eye out for therapists from the University of Greenwich!

Last week I had what I thought was a winning therapy idea, when it didn’t pan out I had to improvise.

Two of my kiddies are working on verbs and we’d been practising “cutting.” I’m targeting /sn/ clusters (“snip!”) with another child. I was inspired by some recycled packing materials to try a hair cutting activity.

I drew faces on paper and taped wavy, strings of cardboard packing stuff on for hair, it looked great. I handed a pair of children’s scissors to the girl working on “snip” and she gave it a good go. But the scissors were too small and not sharp enough to cut the “hair” – oh dear. We started snipping other bits of paper, and then rapidly moved on to sticking things on to a picture of a “snail.” For the two boys working on “cutting” it was Toca Hair Salon to the rescue – phew.

Therapy is all about improvising: therapy sessions rarely go exactly to plan. We can’t follow a recipe, instead we spontaneously make communication opportunities from whatever is available, and teach parents to do the same.

This is the first time I’ve blogged since I had a baby 8 weeks ago. I’m delighted to be sharing my life with this tiny person, although he sure does change the landscape of my days. Spare moments are scarce, when I find them, I hop into bed for a nap!

I’ve been told by parents I’ve worked with that I didn’t understand particular things because I didn’t have children. In my foggy mental state I’ve reflected on a few things I’ve learnt as a new parent.

I’ve realised how dedicated some parents are. I’ve known families come to therapy sessions with their older child when their new baby was just days old. In those first few weeks I called it a successful day if I could shower and comb my hair. These families had a legitimate reason for cancelling sessions but they didn’t: they came along, took part, and supported their older child. Wow. 

I also now understand how difficult it can be to get to appointments on time. I hate being late, but it’s hard getting me and the tiny person out of the house at a set time. I’ve sacrificed the shower and hair combing to make sure we made it. As a therapist, I can’t organise my day so that families can come to their appointments 20 minutes late although I can try and schedule the appointment for a convenient time. 

As a new mother, I’ve been the “patient” or “client” which takes some getting used to. I hadn’t spent a night in hospital since I was born! I’ve struggled with breastfeeding, when I tried to access support I realised: I didn’t know what normal was, and I needed to listen to my gut.

When I started telling the midwives and then the health visitors that feeding was incredibly painful they all said a variation of: “it is at the beginning,” and suggested I give it time. My gut told me something was up, but I’d never done it before and I didn’t know what to expect, I had no idea what “normal” was. It took lots of tears (mine – not the baby’s!) blood, an infection, and me doing my own research before I insisted on a referral to the tongue tie clinic. After 4 weeks I’d found the reason for all the pain and we could begin to move on. 

As a therapist I want to remember that parents may not know what type of communication to expect at their child’s age and although, of course, there is a huge range of “normal” I can provide them with this information. I also want to give parents time to explain to me what their gut is telling them, and really listen to them. I felt frustrated, overwhelmed, and angry when my need to be understood wasn’t met. I knew the professionals I saw didn’t have a magic wand, and couldn’t make the pain disappear, I needed to be understood.

Finally, although I knew no one I spoke to would have that magic wand, I really wanted them to. I know this is how some of the parents I work with feel. My partner gently reminded me we were looking for small improvements, aiming to move in the direction of painless feeding. He encouraged me to record the progress we were making in a notebook, suggested I review it often, and broke out the bubbly when we made it! I want to be this supporter in the therapy process, and bubbly on discharge is an idea I could get behind! 

Since setting up in independent practice I’ve had almost weekly emails from people who want to train as speech and language therapists. They explain they need to gain relevant work experience and ask if they can come and shadow me during therapy sessions with my clients. 

At the moment I can’t see how having someone observe me carry out therapy benefits my clients, who are my customers. So I’ve been politely explaining that I don’t offer shadowing opportunities for this reason. Am I missing something? Do you deal with these types of enquires differently?

I tend to suggest that people contact their local NHS service; when I worked in the NHS we offered half day observation sessions. Back when I was looking for relevant experience before applying to train as a therapist I had lots of luck with my local volunteer centre. They matched me to a weekly Stroke club and a summer day camp for children with Down’s Syndrome. I received training and worked alongside therapists, during both of these placements.

The guidance for applying for a place on a speech and language therapy degree course says applicants need to demonstrate awareness of client needs and the skills required to work as a therapist. I wondered if I could put together a short workshop that would support the people who ask to shadow me with their applications. I could cover things like:

• an introduction to the range of clients I work with, and their needs, with video examples,
• an introduction to different types of therapy, and ways of working,
• workshop exercises to demonstrate and practise the core skills therapists require,
• a reading or resource list, particularly those written by people with speech, language and communication needs or their families,
• suggestions for how to approach therapists, to ask for observation experience,
• an opportunity for questions and answers.

What do you think? Does this sound useful? If you’re in the process of applying for a therapy degree course would you attend?

Photo by crabchick