Hanen have recently released a revised (5th) edition of their It Takes Two To Talk handbook. I got my first copy 9 years ago, when I trained to lead the program, and I’ve been referring to it regularly ever since.

Parents who are worried about their child’s communication skills want to know what they can do to help, and this book is filled with practical suggestions. It guides parents. The authors state clearly, and multiple times, that they recommend parents consult with a speech and language therapist: this book is not designed to replace having speech and language therapy. However, it provides strategies and techniques that can be used in the meantime, or alongside attending therapy.

I’ve happily recommended this book to friends, whose children have delayed language skills. It is clearly written, with delightful illustrations that add clarity to the text. The tone is supportive, and not at all judgemental.

Changes in this new edition include:

• An updated Stages of Communication Development checklist,
• A section on supporting children who are learning more that one language,
• More ideas about how to integrate communication goals in play.

In the bilingualism section, the authors explain different types of bilingualism and state:

The important thing about choosing home languages is that you should be able to communicate effortlessly with your child. That means being able to talk, sing, read and express love to your child in the language you are most comfortable with.

What a lovely way to say it!

This book shows parents how to use the strategies as they go about their daily lives. During daily routines, such as mealtimes, while playing, reading and singing. Parents aren’t being told that to support their child they need to find more time, instead they are shown how to make the most of what they already do.

It’s an inspiring book; after nearly a decade of using this approach, I know the strategies well. And yet when I flick through the book, a picture always jumps out at me, and I’m inspired to try the game or activity with my own kids.

Thanks to the Hanen Centre for sending me a complimentary copy of the new edition, so I could write about it here. These views are my own.

I feel uneasy talking about money here on the blog and in real life with clients. Kathleen Shannon has some useful advice in her Money Mojo post. Kathleen works with creative entrepreneurs and while that’s not how I’d describe myself, the Braid Creative blog is a wonderful resource. Kathleen encourages readers to “sell your goods with confidence” and talk about money, so here goes.

Prices

People starting their own therapy business ask me how I decided what to charge. I searched online for therapists in London, to see how much other people were charging. Then I calculated each therapist’s hourly rate. There was quite a range! I looked at how experienced each therapist was, and what they specialised in. I estimated my monthly costs, considered how many days I wanted to work and how much money I needed to make.

I want to be transparent about money; I decided on an hourly rate, and I charge the same for everything that I offer: assessments, therapy sessions, report writing, school visits and travel time. I publish this information on my website. I think parents want to know what therapy costs when considering therapy for their child. And it saves me time; if my prices are more than a parent wants to pay, they can see this on my website before they call me – much easier.

Payments

I started out accepting cash, cheques and bank transfers, on a session by session basis or for a half term’s worth of sessions. I’ve gradually changed this, now:

• I require a deposit to confirm the initial booking.
• Parents pay in advance for a block (a half term) of sessions.
• I accept payments by bank transfer, online via Paypal, or in person by credit or debit card.
• I don’t accept cash or cheques.

This is working well for me. It means I deal with “billing” just once every half term, and I’m not going to the bank every week, or chasing late payments. As parents are paying in advance they think about whether they can make all the sessions; the number of cancellations due to clashes with other appointments has decreased. I was apprehensive explaining this new policy to parents who were used to paying in cash after each session. No new clients have questioned it.

PayPal Here Chip and PIN card reader

I bought this card reader (on a special offer of £49.95). PayPal charge a 2.75% fee, I’m happy to pay for the convenience. It’s a great little gizmo, that works via a bluetooth connection to my phone. As long as I remember to charge the device, it’s quick and easy to take payments. It can send a receipt by email or text message.

Accounts

I’m self employed, I got advice from an accountant before I started seeing clients and I pay for support with my taxes each year. I keep a simple spreadsheet to record the money coming in, and going out and have a separate bank account, although it’s not required.

Is there something else you want to know about the money side of setting up my therapy business? Get in touch. Next up: resources, what do you need and what can you manage without?

This blog is part of a series about Becoming Independent.

Several therapists working in the NHS have emailed me to ask my advice about starting their own therapy business. I thought I’d share what I tell them here, in a series of posts. I started working independently about 18 months ago, I’m not claiming to have all the answers! I’ll write about what works (and doesn’t) for me, here in London; you can decide if it’s relevant to you and your situation.

How do potential clients contact you?

I already had an email address I used for work, so I kept using it. My work phone number was more complicated. I see my clients in a rented therapy room (more on that coming soon) and do my admin at home. We don’t have a landline phone, and I didn’t feel happy putting my mobile number on the internet. So I bought a Skype phone number. I selected a London area code, and for £3.35 a month I have a work phone. When someone calls the number, Skype rings on my desktop computer. If I’m out and about and expecting a call, I can open the Skype app on my mobile, and that’ll ring too. The number has an answer phone, and Skype emails me when someone leaves a message.

When a family books a therapy session I give them my mobile number, so I know they can reach me if they’re running late. This set up is working well at the moment.

I only use this number for work so I’ve made my answer phone message specific. I ask callers to tell me where they live and how old their child is. This helps me filter my enquiries. I’m able to call parents of older children straight back and explain I only work with under 7s. As well as check my availability in a particular location (I work in 2 different places) before returning a call.

Short form on the website

I also have a form on my website that parents can fill out to get in touch with me. It’s a free service by Wufoo. One of the questions on the form is: What are you concerned about in terms of your child’s speech, language and communication skills? The way a parent answers this question sometimes gives me an indication of how involved they’d like to be in the therapy process. 

This post is the first in a series about Becoming Independent. I’ll write about how potential clients find my details in the next post.

Photo by Álvaro Ibáñez

The folks at The Hanen Centre kindly sent me a copy of I’m Ready – How to Prepare Your Child for Reading Success and asked me what I thought. Here in the UK advice about how to support literacy skills seems to change frequently, so I was interested to see what Janice Greenberg and Elaine Weitzman suggest.

The book has 6 chapters: Early Literacy, Conversation, Vocabulary, Story Comprehension, Print Knowledge and Sound Awareness. It’s visually appealing; the text is broken up by photographs and drawings. I read it over several days and found it easy to pick up where I’d left off. There’s a comprehensive list of recommended children’s books, coded in terms of how they can be used to support literacy. I think the ‘Try it out!’ checklists and reflection questions look useful.

The book is full of practical examples from real families, so it’s both straight forward to apply and realistic, in terms of what parents can fit into their lives. There are plenty of Hanen’s trademark memory aids, some familiar like OWLing (observe, wait, and listen) and some new (to me) like POP – point out print.

My favourite thing about the book is how clear the authors are about the importance of making reading fun by following the child’s lead. I often worry that parents go in too heavy with the flashcards approach, which can put kids off, so I was relieved that the book stresses reading needs to be fun.

The blurb on the back of the book states that the authors have taken the most current research and broken it down into fun strategies for promoting early literacy. The only thing that frustrated me is that although they’ve provided references for each chapter, these aren’t clearly identified in the text. It simply says: “studies have found….” – so it’s not clear which study they are referring to. I think some parents (and professionals) would like to read more detail from the original research paper, and the format of the book doesn’t support this.

If you’re looking for ideas about how to use books (and conversation!) to prepare a child for reading and writing I’m Ready is packed full of them. It’s easy to read, practical and fun.

If you’re in the UK, the book is currently only available directly from Hanen. Hanen hope their UK distributor will be stocking it soon.

This is the first time I’ve blogged since I had a baby 8 weeks ago. I’m delighted to be sharing my life with this tiny person, although he sure does change the landscape of my days. Spare moments are scarce, when I find them, I hop into bed for a nap!

I’ve been told by parents I’ve worked with that I didn’t understand particular things because I didn’t have children. In my foggy mental state I’ve reflected on a few things I’ve learnt as a new parent.

I’ve realised how dedicated some parents are. I’ve known families come to therapy sessions with their older child when their new baby was just days old. In those first few weeks I called it a successful day if I could shower and comb my hair. These families had a legitimate reason for cancelling sessions but they didn’t: they came along, took part, and supported their older child. Wow. 

I also now understand how difficult it can be to get to appointments on time. I hate being late, but it’s hard getting me and the tiny person out of the house at a set time. I’ve sacrificed the shower and hair combing to make sure we made it. As a therapist, I can’t organise my day so that families can come to their appointments 20 minutes late although I can try and schedule the appointment for a convenient time. 

As a new mother, I’ve been the “patient” or “client” which takes some getting used to. I hadn’t spent a night in hospital since I was born! I’ve struggled with breastfeeding, when I tried to access support I realised: I didn’t know what normal was, and I needed to listen to my gut.

When I started telling the midwives and then the health visitors that feeding was incredibly painful they all said a variation of: “it is at the beginning,” and suggested I give it time. My gut told me something was up, but I’d never done it before and I didn’t know what to expect, I had no idea what “normal” was. It took lots of tears (mine – not the baby’s!) blood, an infection, and me doing my own research before I insisted on a referral to the tongue tie clinic. After 4 weeks I’d found the reason for all the pain and we could begin to move on. 

As a therapist I want to remember that parents may not know what type of communication to expect at their child’s age and although, of course, there is a huge range of “normal” I can provide them with this information. I also want to give parents time to explain to me what their gut is telling them, and really listen to them. I felt frustrated, overwhelmed, and angry when my need to be understood wasn’t met. I knew the professionals I saw didn’t have a magic wand, and couldn’t make the pain disappear, I needed to be understood.

Finally, although I knew no one I spoke to would have that magic wand, I really wanted them to. I know this is how some of the parents I work with feel. My partner gently reminded me we were looking for small improvements, aiming to move in the direction of painless feeding. He encouraged me to record the progress we were making in a notebook, suggested I review it often, and broke out the bubbly when we made it! I want to be this supporter in the therapy process, and bubbly on discharge is an idea I could get behind! 

I came across LessonPix, it’s an online product, there’s no software to install or CD to lose, and I can use it on any computer that has an internet connection. The cost is $36 (USD) per year for an individual subscription, which converted to £22.62 when I paid online with my credit card. It’s less than £2 a month, and as there’s no CD to receive by post you can get started straight away.

I’ve used this resource every week since I bought it, and I recently renewed my subscription for a second year. I’ve made all the usual things, such as symbols for visual timetables using the picture cards template. I’ve also tried out new materials, my clients have enjoyed the games like dominos and board games. I even made a bingo game with s cluster words for a client’s birthday!

To make a resource you simply search for the pictures you want to use and drag each one into your “tray.” You then choose what materials (picture cards, now and next board etc) you want to make, and the site produces a PDF. You can save your trays to easily make different resources with the same pictures later on. As the finished resource is a PDF you can print it from any computer, you don’t need to be signed into the site. I store all my resources in Dropbox, so if I forget to print them, I can always pull them up during sessions on my iPad.

It is so quick to use that it’s easy to personalise the resources for each child, simply putting their name in the title is a detail they appreciate. You can upload your own pictures and photos to the site and then use them to make resources in the same way. If you’re using words with the pictures, you can replace any of the existing labels with your own words – which means the USA / UK English differences aren’t a problem; just search for ‘faucet,’ choose which picture of a ‘tap’ you want, and change the label!

The only thing I’d advise you to watch out for is getting signed out of the site. If I sign in and start filling my tray to build a resource, then get distracted and come back later, the site sometimes automatically signs me out. If I don’t notice I’ve been signed out and finish making the resource, and produce the PDF (when I’m not signed in) the PDF has large watermarks on it and I have to re-do it.

The service was designed and built by Lori and Bill Binko, a husband and wife team in Florida. Bill is an active Twitter user, where he responds to therapists’ queries and lets people know about special offers. It appeals to me that they promote their service by providing useful information and responding to feedback. The gorgeous pictures of Florida sunshine (on Twitter) can be hard to take during winter here in London though! The site has a friendly feel, for example, if you can’t find the picture you need, simply click ‘request an image’ and let them know what you think is missing.

I wasn’t asked to write about LessonPix, (I paid for both of my annual subscriptions) I’m choosing to spread the word about a product I find useful. My subscription to LessonPix has met my needs; I can produce engaging, personalised, visual materials quickly and easily. It’s so affordable and easy to use that I feel happy recommending it to parents. Check it out!

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?

A friend has published a practical resource for developing play and communication skills in children on the Autism Spectrum. Ruth Harris, along with two colleagues, has written Teach Me with Pictures. It’s a book of picture scripts that are ready to use – you can photocopy them or print them from a CD-ROM. Ruth has been working on the book for a while; she spoke about it at the initial Therapy Ideas Live event back in July 2011. Congratulations Ruth, Simone and Linda, it’s wonderful!

The book begins with an introductory chapter, explaining what picture scripts are, their benefits and how to use them.

So what are picture scripts?

You know the picture instructions that come with flat-pack furniture from places like Ikea? They’re picture scripts. You follow the pictures step-by-step, breaking up a complex task into manageable pieces.

Next the book explains why picture scripts work so well for children with Autism. Get the book and read this chapter, it’s insightful, easy to follow and will help you explain the approach to parents and teachers. Many children with Autism are visual learners, who respond well to predictable and achievable activities – picture scripts are perfect. After discussing the skills picture scripts can promote, the book describes in detail how to use the scripts, so you’re ready to get started.

What activities do the scripts target?

The 40 picture scripts are divided into categories:

• Pretend play
• Drawing pictures
• Building and construction games
• Cooking
• Arts and Crafts
• Everyday living

You can see an example of some of the scripts on the publisher’s blog. I can’t wait to try making sandwiches and drawing monsters in therapy, I think the kids will love it!

This book could be used by SLTs, teachers, parents and anyone supporting children with language, learning or social communication difficulties. The activities have been designed to reflect what typically developing children of around 6 years old do, so we can teach our clients the skills they need to take part in the same activities as their peers. That said, a couple of the scripts are a little American, making nachos and ice-cream soda? Still, a good communication opportunity – talk about cultural differences!

This book is an inspiring starting point, use these scripts and then make your own. What does your client or child need to learn how to do? Write your own script and help teach them!

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.

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.