Category Archives: Reflective practice

What influences progress in therapy?

Therapy setup

When I caught up with my former NHS colleagues recently, they asked me how my independent practice was going. I commented that I’d never seen children make as much progress. We started unpicking possible reasons for this rapid progress, was it that:

I see the children once a week on an ongoing basis? Or
The parents are particularly engaged because they’re paying for the service? Or
I’m able to tailor therapy to a child’s particular needs? Or
A combination of all three factors? Something else entirely? Continue reading →

Speech therapists can learn about collaboration, facilitation and leadership skills from other disciplines

Rhiannan impro workshop dareconf

At a recent study day (Child Talk What Works consensus event) I heard Dawn Smith, Healthcare Professionals Advisor, talk about commissioning SLT services. She suggested we tell stories about the impact our services have, with compelling headlines and concise evidence. She talked about the importance of making “effective relationships … across increasingly complex systems” and said that the services thriving under the new commissioning arrangements have “transformational leaders.” It was an interesting talk. Continue reading →

Ageing with autism and managing expectations in therapy

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On Wednesday evening I attended the National Autistic Society’s Ageing and Autism launch event. Francesca Happé talked about the huge gaps in the research, and outlined the things we don’t know about what happens when people with autism age. As autism was first used as a diagnostic label in 1943, the children diagnosed then are now approaching their 60s and 70s.

Saskia Baron’s brother Timothy, was one of these children. In 1961 he was diagnosed with “Childhood Psychosis” which later became known as Autism Spectrum Disorder. He is now 57 years old. Saskia talked movingly about growing up with a sibling with autism, and her worries about Timothy’s future. She described how difficult it is for Timothy to let people know when he is unhappy or in pain. More positively, she talked about how she’s observed that Timothy is still able to learn new skills. Saskia agrees that early intervention is important, however, she feels it’s not justified to remove therapeutic resources in late childhood or early adulthood, as the door to learning is still open.

My clients with autism are between 3 and 6 years old, they’ll be approaching old age in 60 years! Saskia’s presentation made me think about two things, how can I support the siblings of my clients? And how can I teach my clients ways to express their pain?

This week I also had a wonderful conversation with Keena Cummins. I’m using her VERVE technique with several families and was thinking about how to manage parents’ expectations. All the children have been making great progress due to the efforts of their skilled and perceptive parents, yet these parents often express frustration that their children aren’t using more words. Keena suggested I’m clear about what I want parents to focus on:

“During these therapy sessions I want you to focus on his playing, I’ll worry about his talking. I want you to think about how you’re supporting him to play, explore the toys, and try out his ideas. We’ll be thinking about his words later.”

This makes sense to me, I’ll try it out this week.

Speech and Language Therapy App Review: Colourful Semantics for iPad

I’ve been using my iPad in therapy for the last couple of years. I tend to use apps which aren’t specifically for speech and language therapy (like the fabulous ones from Toca Boca) as motivators and to work on language and social skills through play.

When the team at London Speech Therapy tweeted a request for bloggers to review their Colourful Semantics app I volunteered. I was given a complimentary copy of the app in order to review it.

The principle of Colourful Semantics appeals to me, as I’m a fan of clear structure, but the hundreds of small pieces of coloured paper always put me off! Watch Helen Blatchford explain how Colourful Semantics works.

This app removes the need for lots of printing, cutting and laminating, it’s all there ready to go. The app is loaded with a set of photos and the corresponding sentences. You can work at various levels: who, what doing, what, where and describe – which are all colour coded. When you start the game, a photo is presented and the child is asked a set of questions, for example: “who is in the picture?” The child responds by selecting the correct symbol from a choice of four and is given feedback as well as an opportunity to practise saying the sentence after the model.

What I like about the app

It can collect data about a child’s performance, the app tracks how a child is doing – what a time saver.
The app is visually motivating for children, and I think they’d find it fun and engaging.
There is a clear structure, so children would quickly learn what they’re expected to do.
The voice that says each sentence is a lovely clear British accent!
The app is customisable; you can turn the music off (I’m easily distracted,) turn the praise off (see my view on praise here) and mute the rather directive: “your turn to say it.”

Things I think could be improved

It seems to present the pictures in the same order each time you play, which becomes repetitive.
The app presents the whole sentence (the cat is eating food outside) when you’re on the simplest level and the child is practising ‘who’ – which is confusing.
It’s wonderful that you can add your own photos to the app, however the procedure is currently time consuming and some of the options (e.g. symbols) I required when I tried to add a picture of myself eating a bowl of soup weren’t available.

Mirla Gaz uses this helpful heuristic when reviewing apps:

“In order for me to recommend a therapy app, I need to feel that it can simplify the life of the therapist and will be a fun learning experience for children.”

This app will be a fun learning experience for children. When I compare this version of colourful semantics to the paper based one, it absolutely simplifies life for the SLT. However, in its current form, adding your own photos is not yet simple enough for me to justify the £27.99 price tag.

Reflecting on 3 months of independence: trying to be myself

Three months ago I left a job in the NHS and started working for myself, as an independent speech and language therapist. It’s been an adventure. First I found two lovely therapy rooms and got myself kitted out with kiddie sized furniture, toys, assessments and a laminator! Then families began getting in touch and my caseload started to grow.

I’ve been reflecting on how things are going. Two blog posts I read recently feel relevant to my situation.

You Are Not a Large Corporation A manifesto for the self-employed by Paul Jarvis, is a list of things that self-employed people can do with their new freedom. I love it! It includes:

You can let your personal values and ethics guide your work and who you work with.

You can be yourself, even if you think it’s not professional. Being authentic draws others in and can be quite contagious. Your personality is awesome enough to let shine in any and every situation.

He also talks about defining success for yourself, breaking the rules, learning from mistakes, and not having a plan.

The post made me think: I spent 7 years working in the NHS, I became accustomed to the NHS way. I’m constantly asking myself, am I doing it this way because it makes sense or because that’s the way I’ve always done it? I’m grateful that I can work in a way that reflects my values rather than having to follow rigid protocol. I’m thrilled by the progress my little clients are making, now I’m able to tailor therapy to their needs.

What about being myself, being genuine, letting my personality out? Nobody told me that I couldn’t do that in the NHS. Perhaps I didn’t have time, or keeping part of myself back was a coping strategy for an overwhelming job. But clients value seeing our personalities. I read this post (follow Dana’s blog, she talks a lot of sense.) It’s a lovely letter from a mother to her daughter’s therapists, she finishes by thanking the therapists for loving Maya:

The therapists loved Maya, despite the fact that they weren’t obligated to do so, and that expression of love gave me the hope and belief that others would see how amazing she is and love her, too.

I’m thrilled that my new role allows me to really get to know the children and their families. We see each other every week and are building relationships. I’m worrying less about being professional and instead I’m focussing on being genuine, because that’s how we connect with and learn from each other.

It’s not all roses and children magically putting two words together. When things go wrong I’m trying to practise mindfulness, remember not to dwell, and move on. Sometimes I find I’m questioning everything, including my skills and sanity! I’m new to this running a business malarkey, it can be tough.

Live tweeting the NAPLIC conference – ‘SLI: what’s in a name?’

Yesterday I enjoyed a great day in sunny Birmingham at the NAPLIC conference. All seven presentations made me think and several challenged some assumptions I’ve held for years. I came away with lots to consider and need time to figure out what to make of it all! Continue reading →

Using “yes, and…” to facilitate change

Change diagram

I’m in a transition phase; I’ve left my NHS role and started work as an independent therapist. I find change tricky. I had an interesting conversation with Abi Roper and Tom Starr-Marshall that made me think — why is change in the NHS so difficult? And in a solution-focused kind of way, what makes particular projects successful?

Looking back, there was a pattern to my attempts at service development (try and follow along with the diagram!):
Continue reading →

Appreciating that therapy is about More Than Words

More Than Words is a wonderful name for Hanen’s program for parents of children with autism or social communication difficulties; they’re right, it is about so much more than words. I find it tricky to answer the question: what is speech therapy? It’s so broad, and the name is a little misleading — during More Than Words I worked intensively with parents without ever targeting speech. Continue reading →

To connect with our clients we must model vulnerability

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I believe that wonderful things happen when we step outside our comfort zone and do things that scare us, when we’re brave and allow ourselves to be vulnerable.

There was recently a discussion on twitter about SLTs presenting a calm exterior even when we’re panicking or out of control on the inside. We all know this feeling! It got me thinking, we need to present ourselves in a way that inspires confidence in the people we work with. We also need to bring our vulnerability to work – and not worry about people seeing our uncertainty. It’s hard and something I continue to struggle with.

Continue reading →

Diving in: supervising new speech therapy graduates

diving

I’m supervising two new graduate Speech and Language Therapists. They’re thoughtful and skilled clinicians who’ve taught me a lot. It’s a difficult time to be starting out in the NHS — just scheduling supervision sessions is a challenge.

When I started working as an SLT I remember feeling like I’d been thrown in the deep end while still getting support from my new colleagues. I’m trying to give my new graduates a similar experience. Learning can be uncomfortable, and that’s okay, but I don’t want them to drown.