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.

Speechmark asked me if I’d like to have a look at the new Word Aware vocabulary resource, by Stephen Parsons and Anna Branagan. I was keen to check it out and said I’d write about it here, on the blog, if it was something I thought I’d use, and it is. So thanks Speechmark, for the complimentary copy.

The blurb on the back of the book says it’s: “a practical comprehensive resource designed to support…effective vocabulary development in pre-school children of all abilities.” The core audience is Early Years practioners, but it would also be useful for SLTs and parents. The approach is described clearly, with multiple examples and suggestions for how to implement it in the classroom. If a practioner was able to set aside the time needed to read the book, I think they’d be able to get started. However, if you wanted more support and ideas, Stephen and Anna regularly run workshops on how to set up and run the program.

This resource comes with access to a website, where you can print out supporting materials, which I much prefer to CD-ROMs.

An inclusive, whole class approach

The book starts with a detailed, interesting and clearly referenced introduction, which would be very useful for teaching staff and is a great refresher for SLTs. I like the fact that the approach is designed for the whole class, so it’s inclusive and that there is a strong emphasis on the importance of Adult Child Interaction. The reader is directed to Keena Cummins’ work for more information about this.  While reading the intro, I noted down the phrase: “enthralled rather than overwhelmed” (by new words) what a lovely reminder.

The book describes four strands to the teaching approach:

• Make words count
• Teach vocabulary
• Fun with words
• Word detective

Practioners are encouraged to provide an enriched word learning environment, teach vocabulary using the STAR method (see below), enjoy, celebrate and reinforce vocabulary, and finally teach children how to learn new words.

The STAR process teaches words in a structured and specific way, it is adapted from Blachowicz and Fisher, 2010. STAR stands for:

• Select – the most useful vocabulary
• Teach – the selected vocabulary in a meaningful way
• Activate – the meaning by using the words in context
• Review – the taught words to ensure they are retained.

The resource contains detailed directions with comprehensive examples for how to select vocabulary. In terms of how many words to teach, the authors suggest one topic word, one text based word (from a book), and one concept, per week. And just one word, per teaching session.

How do I teach a new word?

The book describes a teaching sequence, so adults can teach new words in the same (effective) way each time. The 6 step sequence includes selecting a picture or symbol to represent the word, and singing the Word Aware song!

To activate the word the child needs to hear it used in different ways, by different people, over a period of time. The book provides lots of suggestions for this stage, for example, treasure hunts are a great way to “activate” adjectives. Finally, we need to review words. This can be done with word bags, and there are several word bag activities described in the book.

Extra resources included in the book

The teaching concepts chapter includes plans for introducing and teaching over 80 concepts. These describe specific activities for each concept, and are a great time saver when planning.

The book also includes chapters about supporting children with higher needs, developing word learning strategies and involving families.

Ways of using the book

I plan to use the STAR process in my individual therapy sessions with children who are working on their vocabulary. I found the guidance about how to select target words, and the ideas for activating and reviewing them useful. I will share the practical activities with parents and teaching staff. I’ll definitely use the concept plans, I don’t think they’d need much adapting to use in a one to one session with a child. And I’ll also recommend this resource, and way of working, to Nursery and Reception class teachers.

This is quite a hefty book, there are 250 pages, and I think to get the most out of it, and the approach, people would need to set aside the time to read it through. Although you could skip over some of the concept plans, you’d still need 2 or 3 hours, if you’re new to the approach, as I was.

I’m excited to try these concrete ideas for teaching vocabulary, in my therapy sessions. Perhaps I can write a follow up blog post when I’ve had a go!

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.

A discussion with a therapist friend prompted me to think about how we measure the success of our independent therapy practices. There seems to be a tacit assumption, here in the UK, that as independent therapists we’re aiming to grow our practices, hire a team of therapists, and that more (employees and clients) is best.

My five year (and ten year!) plan doesn’t involve employing other therapists, working lots more hours or making lots more money. So what other metrics do we have for measuring progress with our businesses?

When I try and visualise a successful outcome for my business, I’m interested to notice that my mind is drawn first to how I will be feeling, when I’ve reached my business goals. I will be calm, not frazzled, I will enjoy my client work which will be challenging and rewarding, not frustrating and overwelming. I will be supported by, and support, a group of like minded colleagues.

So if someone were to record a documentary film, a day in the life of my therapy business when I’d reached my goals, what would the camera show? Me smiling and relaxed – my shoulders would be low. I’d have breakfast, and coffee, with my family, before I left for work. High energy sessions with happy children, and me feeding back to parents the progress their child was making. On my computer screen my caseload would show throughput, there would be no waiting list, as soon as I finished up with one child, a new family (who I was excited to work with) would enquire. I’d eat a healthy lunch, while reading a relevant research paper, and get home with energy to spare to play with my son before bed time.

Not quite what you tend to see written in a business plan! (Although I also have financial targets that I need to meet.) I’m interested in other ways (besides money) that we measure success, and other goals that we strive for.

Let me know how you measure your own success, what does it look like for you?

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!

I recently attended a workshop at The Music House for Children on introducing musical learning to children with Autism. I was energised and inspired by the session and left with several practical ideas I’m keen to try out. The workshop was led by Kirsty Keogh, it was refreshing to hear from a professional outside of speech therapy. Kirsty is experienced at working with children and young people with Autism, I could see from the videos examples how well the children responded to her.

She shared lots of practical ideas about how to use music with groups of children and during individual sessions. I’m going to try the “Island approach” – different instruments are laid out on around 6 mats on the floor. The instruments on the mats stay the same each week, except for those on one mat which change to introduce new instruments. The child chooses which instrument to explore, and then the adult joins them. It looked similar to Intensive Interaction, following the child’s lead and gently extending.

Kirsty suggested that when the child chooses an instrument or is given one, we give them time and space to explore it, by initially not doing anything ourselves. This made so much sense to me, but I realised I tend to jump in and start modelling how things work. I’m going to try waiting! I’m also going to try the way Kirsty suggested to get children to stop playing. A big, loud, dramatic buildup encourages stopping more than quietly trailing off. Starting slowly and softly can help some children with Autism access music, and low pitched instruments are easier for some children to tolerate.

Kirsty suggested we think beyond nursery rhymes, to songs with different rhythms, in different keys. She showed us how a song like Ipi N’tombi can be used as a call and response to encourage vocalisation. It’s impossible to sit still during this song!

Kirsty also shared some resources. Some of my clients would love this vibration speaker, which makes the sound vibrate from any hard surface you place it on! And Kirsty said it’s pretty robust. Drums for Schools have good value percussion instruments. And A Little Birdsong, has songs and ideas for pre-school children.

I played a lot of music as a child and teenager, and I’d love to play more now. I’m going to learn some simple tunes on the piano, and perhaps try and take some Ukulele lessons! They’re inexpensive, portable and sturdy – a winner!

Photo by Tam Tam

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.

Tuesday 12 August at 06:00 PM BST (view in your timezone), £45

Are you considering a career in speech and language therapy? Participate in this 90 minute webinar to learn about client needs, therapy techniques and skills. Find out if SLT suits you and complement any shadowing opportunities. This will help you to apply for SLT courses.

Through case studies you’ll learn:

• what needs clients have and several therapy approaches that work
• what core skills therapists need (and how to identify your existing skills that are relevant)
• how to approach therapists to arrange observation sessions (and other ways to get practical experience)
• how to find resources (books, blogs, videos) to learn more about speech and language therapy and prepare your application form.

You’ll also have a chance to ask questions and afterwards you’ll receive a video recording of the webinar.

Buy a ticket to the Introduction to Speech and Language Therapy webinar.