Lucy Sanctuary

Lucy states in the introduction that “the resource is for children who have had speech therapy to say the speech sound ’s’ but are not yet using it in their everyday talking.” It was designed for children aged five to ten years old. It’s helpful that she is so clear about the intended audience.

I haven’t had the chance to try the games with any children or families yet, as I don’t currently have anyone on my caseload working on the ’s’ sound! What really appeals to me about this resource is that it stands alone; Lucy describes exactly how to play each game, I wouldn’t need to “translate” anything for the families. If I was confident a child could produce ’s’ accurately at word level, I could suggest parents and school staff buy a copy of Play Games with S and give them responsibility for supporting the generalisation phase. I’ve realised that I sometimes don’t explain speech sound homework very clearly to parents, and they end up practising something else entirely for a whole a week! I think this would be avoided with this resource.

The colourful hand drawn pictures are lovely and I think they’ll appeal to children. Lucy talks about ideas for prompting children while playing the games and includes a rating scale to encourage children to monitor their own production. The games include lots of “classics” so adults will have some awareness of how to play them. I enjoy a memory game, so I’d probably start with Pairs.

I have two pieces of feedback. I wonder if there is a way of updating Happy Families to make it more inclusive and less heteronormative. And the book comes with a CD-ROM, although we have more computers than people in our house, we don’t have any that read CD-ROMs! I guess there are a lot of challenges with putting the picture resources online or providing a one time downloadable PDF, but as I can’t use the CD-ROM I’m back to scanning in the pictures.

I think this resource would be really useful to encourage the key people in a child’s life to take on the generalisation phase of speech work. And working through this book would give teaching assistants skills they could use to work on other sounds with other children.

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?

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?

I had a think.

The role of parents

The parents I work with take an active role in the therapy process, however, when I worked in the NHS this was also the case – so it can’t be that simple. I think timing may be a factor: parents contact me when they’re ready for therapy. In the NHS they might have to wait 6 months for a block of therapy, which comes at a time that doesn’t suit them (moving house, one parent away on an extended business trip, death in the family etc.) Parents then look like they’re struggling to engage with the therapy process, when the sessions have just come at an inconvenient time.

A friend suggested that parents who access NHS therapy are often engaged at the beginning of the process but become increasingly frustrated with the lack of flexibility they’re offered. I’ve seen the opposite happen in independent practice: parents engage with the service, they then see progress, and this reinforces their work and commitment. They feel ownership of the therapy process and continue to work hard at home, which means more progress and more reinforcement, and they continue to stay engaged with the process.

The flexibility to be client centred

Seeing the children on a weekly basis must have an impact on progress, however, I think my flexibility to provide them with exactly the type of therapy they need is more important. I’m not restricted to offering blocks of 6 sessions and then a long “consolidation” period, I can get to know the children and their families and they can get to know me. I’m not limited to seeing the children in groups containing a wide range of abilities and I’m not restricted in the type of therapy I can offer depending on the child’s diagnosis or the care pathway they end up on. I’ve spent a whole therapy session negotiating with a child and his mother how and when they’ll practise at home. I’d have struggled to justify this type of session in the NHS, but without it we weren’t going to get anywhere.

What motivates a therapist?

My motivation has changed since I began working independently; I still want to support children to develop their communication skills for the best start in life, I now also need to maintain my business to make a living. As most of my clients find me by personal recommendation from existing clients, I need to provide a quality service that meets their needs. In contrast, in the NHS I was judged on my ability to meet targets, such as waiting times for initial assessments. This can lead to situations that don’t make sense to families or support progress, such as being invited to an appointment two days before Christmas, so a therapist meets her target.

How stressed is your therapist?

Finally, I wonder about the contribution of therapists’ stress levels on progress. Being my own boss has significantly reduced my stress levels, I’m excited about therapy again. I’m now able to bring my whole brain to work, I feel confident to try new therapy approaches and I notice subtle details that perhaps I missed when my workload was out of control. Could these little details account for some of the progress I’ve been seeing?

Have I missed out a key factor? Therapists, what have you found supports progress? Parents, what did you notice about a time your child made speedy progress?