Tag Archives: prioritisation

Being the client: knowing what to expect and listening to my gut

The tiniest member of the Therapy Ideas teamThis 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.  Continue reading

Fiona Douglas: Therapy Ideas Podcast, episode 6

Listen to the 6th episode of the Therapy Ideas Podcast, a series of conversations with therapists from around the world. In this episode I talk to Fiona Douglas in Perth, Australia about working with children with severe speech disorders, prioritisation and the best and worst bits of the Australian and British systems.

Let me know what you think!

Listen now

Download the MP3 file or subscribe in iTunes.



Rebekah Taylor: Therapy Ideas Podcast, episode 4

Listen to the fourth episode of the Therapy Ideas Podcast, a series of conversations with therapists from around the world. In this episode I speak to Rebekah Taylor in Los Angeles, about how she assesses and prioritises in the American school system, life without a waiting list, and the value of supervision and peer support.

Have a listen and let me know what you think!

Listen now

Download the MP3 file or subscribe in iTunes.

Therapy Ideas Live podcast

Therapy Ideas Workshop: Get Control of Your Time and Improve Your Productivity by Prioritising Your Caseload

Woman pulling her hair out

With caseload and waiting list sizes increasing and staff teams shrinking, life for speech and language therapists is tough at the moment. We’re struggling to juggle large numbers of clients and mountains of paperwork while trying to provide a quality service.

If you’re feeling overwhelmed by all of this, you should join me for the Therapy Ideas Workshop in London on 12 October 2012. This full day workshop will help you get control of your time and gain perspective by prioritising your caseload. You’ll improve your productivity, reduce stress, and learn how to negotiate expectations with clients, managers and yourself!

Full-day interactive workshop in Central London

We’ll have interactive presentations, practical activities, round-table discussions, and case studies. We’ll focus on gaining perspective by getting real about our commitments, prioritising, setting boundries and collaborating. I’m excited to be leading this full-day workshop at Sadler’s Wells Theatre in London. It’s a bright, airy space with Internet access and plenty of coffee. Lunch is included, and you even get a discount on tickets to the dance shows!

Get your ticket now

The early bird price of £139 is available until 31 August, so check out the details, including the learning outcomes, and book now.

I’m looking forward to workshopping with you!

Photograph by BrittneyBush

The challenge of discharging children with lisps

Resources are tight in the National Health Service: think one full time therapist with a caseload of around 125 children. So we have to pay close attention during our initial assessments to make sure children meet our criteria for therapy.

For speech sound therapy, children need to have at least 3 processes and reduced intelligibility, as well as age appropriate language and attention skills to qualify. So we give children with lisps, or difficulties with /th/, activities to practise at home, and discharge them. In some cases that’s easier said than done …

I can understand why parents are anxious about lisps; they worry about teasing and bullying. Sometimes I find it hard to reason with them; they’re trying to do the best for their child and I’m trying to manage the needs of a large caseload. We’re in conflict.

I almost want to play them video clips of my pre-verbal child with autism, my dyspraxic child, or my child with a severe stammer and explain that these children are my priority. Not great for confidentiality and probably not effective either!

Empowering parents to support their own child seems like the best strategy. If I can elicit an accurate /s/ in isolation during the session, I can usually convince the parents to agree to discharge. I explain the hierarchy for generalising the sound into conversation and give them written instructions for home practice.

If I can’t prompt the child to produce the correct sound in isolation (I find those lateral lisps tricky!) I tend to go down the ‘your child is not stimulable / ready’ route. I ask the parents to practise discrimination tasks with their child, talk about how the sound is produced and come back in 6 months to a year if the child hasn’t made progress and they’re still concerned.

How do you deal with parents who won’t accept that their child doesn’t meet the criteria for intervention?

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!