Tag Archives: Kate Malcomess

Join the debate: it’s too late to bury your head in the sand

Man burying his head in the sand

Speech and Language Therapy is a tricky place to be at the moment. We’re trying to provide a quality service that satisfies our clients and commissioners—with fewer resources. On a personal level, each day at work brings difficult decisions: as the number of referrals increases and the size of the staff team decreases, something’s got to give. How do we provide a service that’s ‘good enough’? How do we reduce risk, and raise staff morale?

Come and debate these issues

We’re debating these issues and more at the Therapy Ideas Live Debate on 26 June. To get the evening started there’ll be presentations from three featured speakers:

  • Kate Malcomess is an independent consultant best known for developing the Care Aims Model. She facilitates change management programmes – just what we need!
  • Sally Shaw is the manager of Children’s Therapy Services in Hackney, she’ll share how the team there is coping with all the changes.
  • Kim Lewis is an SLT representative for Unite, whose campaigning focuses on maintaining quality.

After these presentations we’ll divide into small groups, discuss what we’ve heard and share our own ideas and challenges. Everyone will have a chance to contribute and be actively involved in planning how to move our teams forward.

Join in the conversation

It’s too late to bury our heads in the sand and hope things will return to the way they were. The golden age of choosing between multiple job offers, endless supplies of money for CPD and resources, and therapy that could continue indefinitely, is in the past. We need to take responsibility and step up to the challenge. Come and listen to our speakers, share ideas with your colleagues & start problem solving: so let’s get this conversation started!

Read all the details and buy your ticket!

Photograph by tropical.pete

Redesigning Service Delivery for a Changing World: Therapy Ideas Live Debate

We’ve now had four sold-out Therapy Ideas Live lightning talk events since July 2011. It’s been great getting to meet and share ideas with such a range of therapists. We’re building a bank of 5 minute videos covering a huge range of topics. Need a quick dose of inspiration? Check them out!

We’re changing the format for the next event, so therapists can discuss their ideas and share their experiences. I’m excited to announce the next Therapy Ideas Live event will be a debate – Redesigning Service Delivery for a Changing World: Taking Responsibility for the Future of Speech & Language Therapy.

The debate will feature Kate Malcomess, Sally Shaw, and Kim Lewis, and is taking place as part of the RCSLT’s Giving Voice Campaign. It’s on 26 June 2012, at The Mermaid Conference Centre, London, 6.00 – 9.30 pm.

Changing Landscape

New commissioning regimes, reduced budgets, and growing caseloads: like it or not, Speech and Language Therapy is changing, and there’s no going back. Let’s tackle this challenge together, by learning from each other, listening to contrasting expert perspectives, and taking an active role in redesigning service delivery for the future of our profession.

We’ll hear from three featured speakers, debate what we’ve heard, and discuss experiences and challenges in small groups. Come along, and meet other therapists who are trying to make positive changes.

Get Your Ticket Now

Tickets are £10 and limited so get yours now. Check out all the details and buy your ticket!

Care Aims in education vs. medical model

Clare Grace raised a great question in response to my post from 2009, Clinical Risk vs. Clinical Need: managing workload and throughput:

My biggest conundrum at the minute, is that the risk assessment tools are very medical model – and don’t seem to reflect anything within the tools/structures of education – and 80% of our caseload is working into an educational setting – any thoughts or ideas would be greatly appreciated.

Although I’m no longer working in the same service, I can remember discussions about how the approach fitted with our work in education.

I’m looking at Malcomess’ “risk” and “clinical risk” grids. The risk assessment requires judgements about functional impact on Activities for Daily Living (ADL) and environmental adaptation. We can consider ADL in the classroom. In terms of environmental adaptation I’ve found a note I wrote on one of the handouts saying: “score environment which is least adaptive (and central.)” So a child in an educational environment which is significantly contributing to risk would score highly on the context column.

In terms of clinical risk we discussed thinking about school staff as well as carers in the first column: motivation for change / carer responsibility. We need to consider who in the child’s life is primary, in relation to impact. A teacher who is unable or unwilling to collaborate in the treatment process would cause a child to score lower in this column (if the SLT service was entirely school based.)

What do you think about using the tools in education settings?

Clinical Risk vs. Clinical Need: managing workload and throughput

At the beginning of the year I attended a two day training course: “Advanced Clinical Reasoning and Effective Clinical Decision Making”, facilitated by Kate Malcomess. It was an intense two days, at the end of which my brain hurt!

Kate talked a lot about risk, which she defines as, “the degree to which harm is foreseeable.” This led us to think about who can best manage a child’s risk, which is linked to the three levels of care: universal, targeted, and specialist. At the universal level—that is, for all children—we should be supporting parents to enable them to manage their child’s risk.

We discussed clinical risk, “the degree to which foreseeable harm can be managed by your intervention,” which you can think of as effectiveness. Then there’s clinical need, “the input needed to reduce risk and achieve predicted outcomes, ” which approximates to the amount of clinical input needed. Kate suggests using a clinical risk vs. clinical need grid, to prioritise workload and increase throughput.

Let’s consider a child who has both high clinical risk and high clinical need. An SLT can effectively reduce risk for this child, but a large amount of input is required. In contrast, a child who has high clinical risk but low clinical need, requires only a small amount of input for risk to be effectively reduced.

If we prioritised these high clinical risk, low clinical need children we would increase throughput: the number of children moving through the system, i.e. the children whose referrals are accepted, are assessed, offered intervention and then discharged. Currently it seems like most children are stuck at the intervention stage—we don’t discharge many, so throughput is small. If we could increase throughput, we would reduce waiting times, which may lead to more cheerful parents (and therapists!).

This way of thinking turns the traditional model, that I’m used to, on its head—there is no mention of using severity to make these types of decisions.

So how do we start? Kate talked about caseload profiling as a first step: looking at where on the risk vs. need grid we would place the children currently on the caseload. Then we can work on throughput, while keeping a record of unmet needs, to show to our commisioners. It’s going to be a lot of work, but I’m looking forward to the challenge, and want to start making some changes… I’ll keep you updated!