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Collaborating for
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if you want to Be more efficient without compromising on effectiveness Improve collaboration with other professionals Combine training with supervised practice
communication
In common with other therapists, Karen Heins and colleagues were looking for an efficient and effective way of managing clients with speech and language difficulties in mainstream schools. The result was the development of the Collaborating for Communication project, which combines practical workshop training for teaching assistants with supervised practice involving groups of real children.
ollaboration is the key to effective speech and language therapy within mainstream schools (RCSLT, 1996; Manz, 2000; Pritchard Dodge et al, 2000). In practice, collaboration often involves assessment of the child, discussion with parents and teachers, followed by a written programme to be carried out by parents and education staff (Portch & Harrison, 2002). Initially, speech and language therapists in the local mainstream school service in Kent were also using this model of service delivery. However, in a survey carried out to evaluate the service, special educational needs co-ordinators emphasised the need for more help from speech and language therapy to train staff and implement therapy programmes. Speech and language therapists had often worked together with individual teaching assistants to demonstrate how to provide therapy for specific children, yet this kind of hands-on supervision was not always possible. The department also offered workshops to teaching assistants on working with children with speech and language difficulties but, despite a very practical focus, it was not feasible for the teaching assistants to immediately practise the ideas with real children under the supervision of a speech and language therapist. The Collaborating for Communication project was developed in 2001 - 2002 to combine practical workshop training with supervised practice in using the therapy techniques with real children. This training supplemented the assessments, reviews and programmes which we continued to provide. I developed and piloted the project while working half time in the schools team with a caseload of ten primary schools. Instead of visiting each school two to three times a term, I targeted two schools at a time, and visited each school for one full day each week for five weeks (roughly a half -term period). The schools not involved in the project during that term continued to receive one visit per term for assessments and reviews. Eight out of the ten schools chose to participate in the project which was structured as follows:
educational needs co-ordinator for the therapy groups to be run over the next four visits. Students with language difficulties were placed together in groups of three to five children of roughly similar ages. Students needing phonology therapy were seen individually or in a small group. One or two teaching assistants were allocated to run each group with me.
2. Language groups
Therapy is much more effective if education staff can see the immediate relevance of language goals to current class work and the broader curriculum (RCSLT, 1996). Each language group therefore focused on a current class topic such as history (for example, Ancient Egypt; Florence Nightingale), geography (Kenya), English (fables) or a time of year (Christmas). A different language area was targeted each week: Week 1 - Understanding stories: Role play helped students understand a story related to the class topic (adapted from Withey, 2000). Week 2 - Building vocabulary: Students described the meaning of words related to the class topic. This area was chosen as many children had semantic difficulties. Week 3 - Listening and following instructions: Activities focused on listening and following instructions while reinforcing vocabulary relevant to the class topic (adapted from Johnson, 1998). Week 4 - Telling stories: Students learned to use a story plan, develop their own story, act it out and retell it in their own words (story plan adapted from Liverpool Speech Pathology Service, Sydney). These particular language areas were chosen as they were relevant for most students with language difficulties, and they fitted easily into current class work. The groups were designed so that teaching assistants could later re-run the same four sessions with the same group of children, but each time they would choose a new topic that the children were currently studying in class. In this way the material was new and relevant to the children, yet the teaching assistants could use the same session plan each time. Each group session ran for 30 minutes, but 45 minutes were allocated to give time to explain the session to the teaching assistants, collect children from class, return them and demonstrate writing up notes. A sample session plan and homework sheet are in
particular language areas were chosen as they were relevant for most students with language difficulties, and they fitted easily into current class work
collaboration
figure 1. Teaching assistants participated fully in the sessions by preparing materials, observing my demonstration of activities, then implementing the activities with the children themselves, and taking notes on the childrens abilities in the different tasks. All schools were provided with a written information package so that they could run the same groups independently in the future.
3. Speech sounds
Children needing phonology therapy were seen either in small groups or individually. A teaching assistant jointly ran each session with me, and brought toys and activities available in school to provide motivation.
6. Reports
At the end of the weekly visits, each child received a report using a standard format to explain the group sessions and provide further ideas for helping children at home and in school. At the end of the programme, special educational needs co-ordinators and the more recently qualified therapists completed a questionnaire to provide feedback about the project. Their comments are summarised in figure 2.
How did they try to FIX the problem? (Think of 2-3 possible solutions) How did the story END?
collaboration
assistants were actively involved in carrying out the activities themselves with the children and taking notes. Each session ran with different children from the school, as using the same group of children all day would have been too tiring for them. One topic was used for all sessions (school), but teaching assistants were encouraged to think how to adapt the activities for current topics in their own classes. A sample timetable is in figure 3, although specific times were adapted for individual schools. Four recently qualified therapists and a speech and language therapy student participated in the training days. The therapists were provided with the session plans beforehand, and chose to run two of the group sessions. It was easier for them to get time away from their regular work for just one day rather than five days. After the training days in the ten schools, 64 questionnaires with completed confidence ratings were returned. Of these, 79 per cent reported increased confidence in working with at least one area of speech or language, while 47 per cent reported increased confidence in three or more areas. One of the speech and language therapists involved volunteered to take on a caseload of mainstream schools, while the others were planning to incorporate the ideas into their current work. The comments were generally very positive, and the perceived benefits were similar to those reported by the schools in the weekly version of the project. The main criticism was from teaching assistants who were only able to attend for one group session; they would have liked to see how the other groups worked, and to have had more practice with the children. Another suggestion was having more advice on other areas of communication, such as social skills development. On a one day training workshop, the special educational needs co-ordinators had to make compromises in deciding how many teaching assistants could be released from classes during the day, and not all areas of speech and language therapy could be covered.
Effective method
The Collaborating for Communication project has been a very effective method of providing handson training with real children so that teaching assistants can run groups for students with speech and language difficulties. It would be valuable to extend the training to other schools in the area, and follow up the schools involved to find out if the groups are still running and if the strategies are being used in class work. A second training programme could also be developed to target other areas of communication difficulty, such as focusing further on speech sounds and phonemic awareness, grammar, voice care for staff and students, and social communication skills. Continuing to develop our collaboration with teachers, teaching assistants and parents will enable us to be much more effective in implementing therapy for students with speech and language difficulties. Karen Heins is a speech and language therapist. Copies of the Collaborating for Communication training manual are available, with all the materials needed to run the project, including notes for presenters, strategies for getting teaching assistants actively involved, session plans for language groups, visual cue sheets, homework, and standard report and letter formats. Please contact Karen at 34 Op der Sterz, Fentange L-5823, Luxembourg, e-mail karen.heins@pt.lu. Manchester Metropolitan University: Manchester. Manz, J. (2000) Positive teamwork. Bulletin of the Royal College of Speech and Language Therapists, March. Portch, A. & Harrison, P. (2002) Clarifying priorities. Bulletin of the Royal College of Speech and Language Therapists, March. Pritchard Dodge, E., Andrews, M. & Andrews, J. (2000) Communication and collaboration. In: Pritchard Dodge, E. (Ed) The survival guide for school-based speech-language pathologists. Singular: San Diego. Withey, C. (2000) Developing language skills through playscripts training course. Riverside Community Health Care, London, 29 June 2000.
Acknowledgements
Many thanks to all the speech and language therapists and schools who participated in the project for their enthusiasm, commitment, advice and suggestions. Thanks in particular to Kat McKeown, speech and language therapist, for her suggestions in the initial development of the project, to Louise Ring, speech and language therapist, for the child report format, to Jackie Charlton, speech and language therapist, for the confidence rating scale, and to Rachel Meinertzhagen, teacher, who developed the story plan bookmark.
Reflections
Do I try to act on feedback received about my service? Do I provide programmes that are meaningful both to those implementing them and to my clients? Do I encourage recently qualified staff into my particular field?
References
RCSLT (1996) Communicating Quality 2. Professional standards for speech and language therapists. Royal College of Speech and Language Therapists: London. Johnson, M. (1998) Functional Language in the Classroom. Clinical Communication Material,