My favourite therapy prop: a 20 year old toy dog

dressing up dog

Last week was Speech Pathology Australia Week & talk on twitter turned to favourite toys for therapy. I love toys that can be used to work on several different targets. Meet Dog, he’s one of my favourites because he’s so versatile, and the children love him! Wikipedia tells me that Pound Puppies were sold in the 1980s, I think I was given mine for Chanukah when I was 8 or 9 years old. Who knew he’d be starring in therapy sessions more than 20 years later!

I’ve recently been dressing up Dog to work on the verb: wearing. Here’s what a therapy session might look like.

When I teach a new word, I begin by modelling it a lot in different contexts. The child and I take turns choosing items for Dog to wear, and I comment: “wow, Dog is wearing glasses. I’m wearing glasses and Dog is wearing glasses.”

Accessorising ourselves

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Then we start putting on funny accessories ourselves and I keep modelling the target word: “You’re wearing goggles, you’re ready for a swim.” “I’m wearing a monkey hat, it’s warm!” Children learn by doing; in this activity they’re wearing different things, while I model the word. It’s also fun to take photos of the child wearing different accessories, and talk about what they’re wearing in each photo.

Dressing paper dolls

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Next we try a paper based activity, like this doll game. We dress the dolls (while I keep modelling the target word) and then I’ll try to cue the child in to using the word himself. I’ll say something like: “My doll is wearing a yellow dress and boots, your doll is…?”

There’s an app for that

DSC_9972I found this free iPad app, which is good to end on. The child selects clothes and shoes for the doll – it’s another fun opportunity for more modelling and perhaps the child will be ready to use the word himself.

Tip: children want to keep trying different clothes on the doll. So when it’s time to talk about what she is wearing, I take a photo of the outfit and switch to the photo app. Then the child can’t change the clothes anymore and can focus on describing what she’s wearing!

Practise at home

I give the parents the paper dolls to take home, encourage them to practise the other activities as well, and remind them to talk about what they’re wearing throughout the day.

If your child is struggling to learn new words and you’d like an assessment or advice, get in touch.

Use simple language when your child starts nursery

 

handprints

Here in the UK we’re about halfway through our school summer break. Which means in two or three weeks time children all over the country will start nursery for the first time. I did a  quick google search and found hundreds of ‘how to prepare your child for nursery’ posts. I thought I’d add a couple of points from a communication perspective.

Use simple language during the settling in period

When your child experiences strong emotions, they may not be able to use the language skills they have when they’re calm. I’ll give you a couple of examples.

If your son usually understands well and can follow complicated, multi-step directions he won’t be able to use this skills when crying hysterically that you’re leaving. Use very short simple sentences to support his understanding, you could try something like:

“I’m going to work.”

“You’re staying here, at nursery.”

“You’re playing with (key worker / friend.)”

“I’ll come back after story time.”

The same inability to access skills can happen with talking. Your daughter might normally use multiple phrases joined together with conjunctions to make requests, but if she’s incredibly shy or feeling anxious she won’t be able to tap into this skill. Try not to assume she’ll ask for what she needs in the first few days at a new setting. Be sure nursery staff regularly talk about things she’ll need to know, for example, the location of the toilets, and where to hang her coat.

Learning English at nursery

If you have been speaking a language other than English to your child at home, it is normal for them to experience a ‘silent period’ when they start in an English speaking setting. Your child will be listening carefully to what people are saying and may not say anything themselves for several months. Nursery staff will know how to support your child by using very simple language with gestures. Staff may include them in small group work to develop their confidence and know not to pressure them to respond verbally.

After spending time listening, children tend to begin talking by using words they have heard other people use a lot (sometimes “sit down!” or “be quiet!”) They then gradually begin to build their own phrases and sentences.

Remember to keep speaking your home language at home, so your child doesn’t forget it! If your child is learning English at nursery and after 3 – 4 months of daily attendance is still silent it may be worth asking a speech and language therapist for advice.

Today at work I made phone calls and ate sandwiches for lunch

Parents often tell me they’re frustrated that their child doesn’t talk about what they did at nursery. I remind parents that “what did you do at nursery today?” is a huge, open question, normally asked at the end of the day when a child is likely to be tired. You may have more luck finding out what your child got up to, by talking about your day first, as a model:

Adult: “When I got to work, I took my coat off and made a cup of tea.” (expectant pause!)

Child: “At nursery, I hanged my coat up, and do a painting with Mary”

Try it!

Photo by emmacraig1

Want to make changes at work but keep getting stuck? The Dare Conference can help.

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The Dare conference is an exciting new event about learning how to make change, and I’m part of the team behind it. The presentations cover a range of themes that will help attendees learn skills and techniques for getting better outcomes. It’s aimed at digital professionals, I’m going to explain why the ideas are also valuable for people who work in health care (or social care, or charities, or anywhere with other people!)

At the conference people will be talking about:

  • learning from mistakes,
  • dealing with uncertainty,
  • redefining success,
  • responding to negative feedback,
  • being honest,
  • and failing to launch new projects.

When I think back to my time in the NHS, these were all huge issues for my team. Let me give you an example.

When a friend returned to work after her year off on maternity leave, she asked where we were up to in terms of the projects she’d been working on before she left. I was horrified to realise that in a year we hadn’t launched a single project. We’d got stuck – our bosses told us not to tell families about upcoming changes, we were making the same mistakes again and again, and judging our service by meaningless metrics, like number of client contacts. I’d spent my time in unproductive meetings where people responded: “no, but…” to other people’s ideas. No one was taking responsibility for change, including me.

There was also a blame culture. We didn’t respond to individual pieces of negative feedback in a thoughtful or sensitive way, so these escalated into formal complaints. Which led to everyone looking for someone else to blame instead of trying to figure out what we could learn from the situation.

If you’re facing these challenges today come to the Dare conference and learn how to get unstuck. The speakers at the Dare conference aren’t superheroes who have all the answers; they’re going to share their struggles and what they learnt along the way. I think these lessons don’t only apply to folk working in the digital community. We all need to learn how to really listen, to build on each other’s ideas and make changes, in order for our teams to be successful.

The Dare conference is taking place at the South Bank Centre in London on the 23 – 25 September. Check out who’ll be speaking and all the details here.

Are you trying to make a difference in people’s lives but experiencing barriers to making changes? This conference is for you. If you’re a health professional use the discount code ‘therapyideas’ to buy a ticket for £299 +VAT.

Help us spread the word about this event; send the conference details to everyone you think might benefit from support to make change. Tweet about it, or post a message on Facebook or LinkedIn. I hope to see you there!

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.

The speech therapy process is like a long walk

Rhiannan on the coast path

I spent last week hiking 50 miles along the Pembrokeshire coast path. It was beautiful, stinking hot and a trip I’ll remember for years. The hours of walking gave me time to think, and I realised a long distance walk is a good metaphor for the therapy process.

A long journey

50 miles over five days sounded straightforward when I was planning the route. Factor in a heavy backpack, rough terrain and a freak heatwave and those miles were long. The therapy process can be long too. Children may need to develop skills in several areas, they may learn quickly and then take time to generalise, or it may take time to find a therapy approach that works.

It’s challenging and there’ll be tough parts

The walk seemed hardest when it was steep and hot, then suddenly easier when the path flattened off and the sea breeze began to blow. Therapy has easier and tougher parts too. At times something clicks and children suddenly get it, at other times no one is in the mood. There may be frustrations and times when we want to give up. We need to keep going and wait for the sea breeze.

Repetition makes it easier

We bought a new tent for this trip: the first time we put it up, it took about 40 minutes! The second time was faster and by the sixth night we had it down to an art. Therapy get easier too. Families get used to practising at home and find creative ways of integrating activities into each day. Children get used to how therapy sessions work, they get to know the therapist and what to expect.

Celebrate all progress

When we got to the top of a steep climb, we’d take our backpacks off and celebrate with snacks and water! It’s important to notice and celebrate progress in therapy too, however small. Remember how far we’ve come.

People may not understand

Some people we passed on the trail looked at us like we were crazy, one man even suggested we take the bus! When I was struggling, the strange looks people gave me made me feel lonely and the walking seem harder. I ignored people’s judgements and kept going. Sometimes friends and family may not understand why a child needs therapy or how the process works. Families tell me this lack of support can seem hurtful, and is one more thing to worry about. Tell friends and family how they can help you, and then keep doing what you need to do.

If you commit it’s worthwhile

I was determined to finish the walk. I had to be flexible and adapt my plan. Due to the extreme heat we took a shortcut one day, but we made it! When families can commit to therapy, and work with a therapist they trust, children make progress. All the hard work pays off when a child is able to express themselves, make relationships and blossom!

Reflecting on 3 months of independence: trying to be myself

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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 →

Parents want a speech and language therapist who has time for them

Post it notes, themes

I’ve been thinking about how parents choose a therapist for their child (I’ve recently set up my private practice). What are they looking for? What do they want? I used feedback I’ve received from parents to make a list, then arranged my ideas into themes.

First there are ‘logistical’ factors. Parents want an SLT who:

  • is punctual,
  • is professional – doesn’t cancel appointments at the last minute,
  • is reliable – does what she says she’ll do,
  • gives appointments at a convenient time,
  • communicates in a convenient way, for example by email,
  • completes reports in a reasonable time frame,
  • has time to listen to them.

Next there are ‘therapist’ factors. Parents want someone who:

  • can build rapport with their child, so therapy is fun & their child likes going,
  • can facilitate progress, so their child develops new skills,
  • is flexible, if something isn’t working she’ll try a different approach,
  • is responsive to changes in the child or family,
  • is experienced,
  • is consistent (this is a big one) they want the same therapist, not a different person every block or visit.

Interpersonal factors are also important. Parents value therapists who:

  • listen to their views and respect them,
  • believe in their child’s ability to make progress and offer hope,
  • can give advice and support around wider issues such as school placements,
  • can work well with the other professionals their child sees,
  • can admit when they don’t know something and ask a colleague,
  • are transparent, with an open, honest, straightforward attitude.

A magic wand and the evidence base

I thought of two more things that don’t really fit in above: the magic wand and the evidence base. Some parents want to find an SLT with a magic wand, someone who can simply make their child’s difficulty disappear. If you find one, let me know, I’d love to interview him or her for my podcast!

Finally, there’s evidence based therapy. I’m not sure how much of factor the evidence base is for parents. Although I’ve never been asked to support my therapy plan with research papers, I have been asked: do you think this will work, how has this approach worked with other children, and which approach will have the quickest result? So some parents are evaluating different therapy options, it’s really encouraging.

When I look over this list, I’m struck by how many of these depend on a therapist having enough time. Perhaps that’s the key, parents want a therapist who they feel, has time for them.

What have I missed? SLTs, what do your families tell you they’re happy with and what do they complain about? Parents, what is most important to you when you’re looking for a therapist? I’d love to hear from you!

 

Organising life is hard for both therapists and parents

 

Rhiannan at sunrise (kind of)

 

London feels different at 6.15am. There’s a sense of opportunity: a new day stretching out ahead. The streets and trains are less crowded, the city feels calmer. Now I’m self employed I bounce out of bed each morning with the sunrise… just kidding! I am doing two early starts a week though, so I can offer therapy sessions before school. Surprisingly, I’ve enjoyed being up earlier than normal. I’m using the change to try out new ways of organising my day. 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 →