0 évaluation0% ont trouvé ce document utile (0 vote)
191 vues4 pages
Portch A. (2003)
Discussions about clinic or school based therapy can get quite heated. The author warns that, by pulling out of clinics and concentrating on schools, the profession is in danger of getting its fingers burned. Instead we should be grilling ourselves about what combination is right for each individual, and what will enable us to continue giving an appropriate service to all children, irrespective of their age. Five principles are discussed: 1. What is the individual need?; 2. Who is the main focus?; 3. Why are we intervening?; 4. Proper procedures before arranging a school visit; 5.Collaborate and learn. The inclusive agenda for children with special educational needs to be educated in mainstream schools creates a challenge for both teachers and therapists. Success depends not only on selecting the right children but also learning and understanding the educational context, knowledge of the curriculum, and a staged approach to managing special educational needs via the new Code of Practice. Share/joint training is essential. A case example, school visiting example, and programme update are illustrated together with a list of resources for school age children.
Portch A. (2003)
Discussions about clinic or school based therapy can get quite heated. The author warns that, by pulling out of clinics and concentrating on schools, the profession is in danger of getting its fingers burned. Instead we should be grilling ourselves about what combination is right for each individual, and what will enable us to continue giving an appropriate service to all children, irrespective of their age. Five principles are discussed: 1. What is the individual need?; 2. Who is the main focus?; 3. Why are we intervening?; 4. Proper procedures before arranging a school visit; 5.Collaborate and learn. The inclusive agenda for children with special educational needs to be educated in mainstream schools creates a challenge for both teachers and therapists. Success depends not only on selecting the right children but also learning and understanding the educational context, knowledge of the curriculum, and a staged approach to managing special educational needs via the new Code of Practice. Share/joint training is essential. A case example, school visiting example, and programme update are illustrated together with a list of resources for school age children.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
Portch A. (2003)
Discussions about clinic or school based therapy can get quite heated. The author warns that, by pulling out of clinics and concentrating on schools, the profession is in danger of getting its fingers burned. Instead we should be grilling ourselves about what combination is right for each individual, and what will enable us to continue giving an appropriate service to all children, irrespective of their age. Five principles are discussed: 1. What is the individual need?; 2. Who is the main focus?; 3. Why are we intervening?; 4. Proper procedures before arranging a school visit; 5.Collaborate and learn. The inclusive agenda for children with special educational needs to be educated in mainstream schools creates a challenge for both teachers and therapists. Success depends not only on selecting the right children but also learning and understanding the educational context, knowledge of the curriculum, and a staged approach to managing special educational needs via the new Code of Practice. Share/joint training is essential. A case example, school visiting example, and programme update are illustrated together with a list of resources for school age children.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
special educational needs (England) (2000) advocated that the greater part of the provision for school age children with speech and language needs should be embedded within the curriculum and take the childs education con- text into consideration. Since then many speech and language therapy services have reorganised to work within schools, and no longer provide a clinic based service to school age children. I have worked in schools most of my career, am a strong advocate of working collaboratively with teachers, and now manage a large diverse service. I believe it is vital to consider a number of basic principles and, indeed, the purpose of and process for provid- ing a service within schools to avoid leaping from the frying pan into the fire - and inappropriately reor- ganising services to the detriment of all children. Does working in schools ensure that provision is embedded within the curriculum or takes the edu- cation context into consideration? I would argue that it may not, and may even be less effective if a therapist does not have relevant training and / or experience, or consider a few basic principles. My other concern is what happens to preschool children? Given that all speech and language thera- py services suffer a shortfall in resources and that provision into school adds increased demand to a service, are these children getting the intervention they need early enough and at a frequency sufficient to reduce the possibility of severe long-term prob- lems? Principle 1 What is the individual need? First, therapists should always carefully consider the individual childs speech and language needs and whether they have an impact on the childs ability to learn. Difficulties which have the most implications for learning are: Significant language delay Language disorder Some general learning difficulties where there is a verbal / non-verbal skill discrepancy and the aim is to reduce the discrepancy. It may therefore be more effective to work with these children in schools rather than in a clinic. Sometimes a combined approach may be best initially. For example, a child with an expressive language disorder and developmental verbal dyspraxia may be initially best treated by a block of intervention in a clinic setting, followed by a period of consolida- tion when the therapist could take the opportunity T to visit and advise the school. Similarly, if a childs primary presenting problem is a speech difficulty, direct therapy within a clinic can be highly effective, although sound generalisation and phonological awareness may be best achieved at school. School visits may also be necessary to complete assessments in some cases, for example assessment of a child with a possible pragmatic language disorder. Principle 2 Who is the main focus? It is important to then consider who should be the main focus of input. If it is the parents, then a clinic or home setting is likely to be the most effective environment to facilitate change. If the child is the main focus and their needs have implications for learning (for example con- cept work), then the school is the best place to inter- vene. If the difficulties have little impact on learning, then clinic may be the most appropriate setting. Principle 3 Why are we intervening? Why we are intervening at all is an essential question as this establishes the primary purpose, and enables therapists to look ahead to the predicted outcome for the client. Kate Malcomess developed eight care aims, which give us a framework for considering these important questions prior to intervention: Assessment - to determine the nature and impact of the condition Enabling - to maximise use of existing function Supportive - to support the client to cope optimally with their present condition Curative - to facilitate lasting change in function, to within normal limits (chronological age / pre-morbid state) Rehabilitative - to facilitate improvement / lasting change in function Maintaining - to stabilise / maintain / preserve function Palliative - to reduce pain and / or increase comfort when no other change is possible or appropriate Anticipatory - to prevent the development of, or reduce the risk of difficulty These care aims relate to the child not the environ- ment and, once the reason for intervening is estab- lished, therapists can then decide not only what to do but where to do it. School visits must therefore be considered in this context, and should be provided when it is important that the school has a key role in the development of the childs skills because of the impact the childs difficulties have on their learning. The combined effect of a therapist considering the individual childs speech and language need, who is Out of the frying pan, servce management SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2003 + you make decsons about where therapy shoud take pace work wth / through other proessonas have to prortse resources Read ths Discussions about clinic or school based therapy can get quite heated. Alyson Portch warns that, by pulling out of clinics and concentrating on schools, the profession is in danger of getting its fingers burned. Instead she argues we should be grilling ourselves about what combination is right for each individual, and what will enable us to continue giving an appropriate service to all children, irrespective of their age. A big part of the success of working in schools must therefore be not only selecting the right children but also learning to value the specific differences in the roles of teachers and therapists and sharing skills to enable us to work together to help children. From the therapists point of view, this involves learning and understanding the educational context, and a sound knowledge of the curriculum and staged approach to managing special educational needs via the new Code of Practice (2001). It is therefore essential that joint / shared training takes place in local areas to ensure this knowledge base is established and skills developed. On the job training is also highly beneficial as a study by Jannet Wright (1994) highlighted; therapists and teachers who worked together grew to really appreciate what they learnt from each other and increased their knowledge of what each had to offer. This ultimately must influence the successful out- come for children with school based speech and language therapy provi- sion. Our service is piloting a new ser- vice for delivering speech and lan- guage therapy to non-statemented school aged children whose needs would be best met through a col- laborative approach with school staff. The children are identified by speech and language therapists who complete a referral form including current support in school and the rationale for school based input. We have assigned a named therapist to each school for these children, and ensured the school also provides a named contact with protected time for discussion and carrying out activities. Via the Special Educational Needs Co-ordinator (SENCO), we ask the teaching staff to complete a two page ques- tionnaire on each child which covers skills in listen- ing / attention (1:1 and class group), understanding of language (following instructions, answering ques- tions, gleaning information from stories and class discussions), expressive language (telling news, vocabulary, sentences), pronunciation, use of lan- guage (interaction with adults and peers), general academic progress (reading, number work, writing and spelling) and anything else they think is rele- vant. In the questionnaire we also ask for feedback about how useful the school has found our input. In preparing programmes, speech and language therapy staff draw on a list of useful assessments and therapy materials (figure 1). the main focus of intervention and the reason for the proposed intervention should therefore enable therapists to decide where it is best carried out. Principle 4 Proper procedures The procedure you follow is also crucial to your success. My experience suggests that before arranging a school visit it may be helpful to: Send a questionnaire to the school requesting further information On receipt, either telephone the school to discuss the information, or discuss it during the school visit. Then: Arrange a visit and confirm it in writing. This letter should clearly explain the purpose of the visit and the format your visit will take, such as staff you need to see, or observation in class. The letter should also make it explicit that parents will be invited to attend for part of the session if they so wish. A letter should also be written to the parents to inform them of this. During the visit: Make any observations / assessments of the child within class Share findings with staff Listen carefully to teachers concerns and priorities (and if possible the parents / carers) Develop shared / agreed curriculum focused targets with the teacher and discuss and agree ways in which these targets can be implemented at school and monitored Agree roles - therapist, teacher and parent. If it is essential that specific work is undertaken with a child, it is important that school identifies a named adult who will be responsible for working with the child and therapist and implementing the targets. This is more likely to ensure a positive out- come. If this is not available but you consider it to be essential, school visiting may not be beneficial. After the school visit, provide a written record for staff, parents and other professionals which summarises your observations and assessment, your discussion and any agreed plan of action, and identifies agreed targets, strategies for achieving these and how you have agreed these should be implemented and monitored. Principle 5 Collaborate and learn SENDA (2001) has strengthened the rights of children with special educational needs to be educated in mainstream school. This inclusive agenda means more children with difficulties will be educated in mainstream, creating a challenge for teachers and therapists alike. Figure 1 Resources for school-aged children Assessments Bracken (1998) Bracken Test of Concepts Bracken Basic Concept Scale - Revised. Psychological Corporation. Dunn, Dunn, Whetton & Pintilie (1982) British Picture Vocabulary Scales. NFER- Nelson. Harrison & Portch (in preparation) School age screen (SAS). Renfrew (Renfrew Action Picture Test, Test of Word Finding, Bus Story) available from Speechmark. Semel, Wiig & Secord (2000) Clinical Evaluation of Language Fundamentals (CELF-3 UK ). Psychological Corporation. Wiig & Secord (1992) Test of Word Knowledge. Psychological Corporation. Therapy materials From Learning Materials ltd, tel. 01902 454026: Looking and Thinking (books 1-5) Reading for Meaning (books 1-4) Reading for Meaning More (books 1a-4a) Reading and Thinking (books 1-5) New Reading and Thinking (books 1-6) From Winslow, tel. 0845 921 1777 Think it - Say it - improving reasoning and organization skills, by Luanne Martin (1995), 32.95 From Speechmark, www.speechmark.net Working with pragmatics, Lucie Andersen- Wood & Benita Rae Smith From Black Sheep Press www.blacksheep-epress.com First / Last / Next Before / After Time Parts of the Day Days Why / because Facial Expressions Speaking and Listening Through Narrative From The Psychological Corporation, www.tpc-international.com Describe it - games to build descriptive lan- guage skills, by Thomas-Kersting, McCormack & Satin (1998) CLIP Worksheets: Semel & Wiig (1991) 1. Syntax 2. Morphology 3. Pragmatics 4. Semantics From LDA, www.LDAlearning.com Socially Speaking - a pragmatic social skills programme for pupils with mild to moderate learning difficulties, by Alison Shroeder, ISBN 1 85503 252 X From STASS, tel. 01661 822316 Cambridge Language Activity File From ECL www.eclpublications.com Practical Language Activities - Materials for Clinicians and Teachers by JoAnn H. Jeffries & Roger D. Jeffries Auditory Processing Activities - Materials for Clinicians and Teachers by JoAnn H. Jeffries & Roger D. Jeffries From Manchester Metropolitan University, tel. 0161 247 2535 Functional Communication in the Classroom by Maggie Johnson into the fire? SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2003 +; servce management
A big part of the
success of working in schools must therefore be not only selecting the right children but also learning to value the specific differences in the roles of teachers and therapists and sharing skills p.19 servce management SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2003 +8 Figure 2a) Case example Cameron has moderate bilateral sensori-neural hearing impairment (aided) severely disordered expressive skills, profoundly delayed language skills and moderate speech difficulties (some associated with hearing impairment) Early therapy - Clinic based, speech and language intervention with some written correspondence and telephone contact with school. Year 4 - No additional funding. Year 4 Spring term: - Therapist works with school, parents and other professionals to get LEA funding for extra support (at that time 15 minutes per week for 1:1 or small group work with SENCO) - Cameron attends clinic sessions; liaison with school for advice / strategies established. Year 4 Summer term / Year 4 Autumn term: - Extra funding granted on hearing impairment needs. Prioritised by school and parents for specific hearing impairment resources to support Cameron within classroom. - General classroom assistant support, continuation of 1:1 / groups with SENCO for 15 minutes per week. - SENCO becomes named contact - Cameron and parents still attend clinic sessions - Clinic input focuses on speech skills and language work / vocabulary, especially verbs. - Copies of advice / targets given to school via parents after each clinic session. - Input at school limited, focusing on general advice / strategies and support for SENCO and school staff. - SENCO has regular meetings with staff, who then try to support / reinforce advice given, wherever possible within the classroom environment. Figure 2b) School visiting example Write up of visit - Attended school and liaised with SENCO (30mins) - worked alongside Cameron in class (l0mins) - 1:1 work outside the class (20mins). Liaison with SENCO to review previous targets: 1) Cameron will now ask for repetition if not understood but not yet consistent, therefore keep as a target 2) Cameron can now answer 5 concrete questions about a passage he has read but he finds gleaning abstract information difficult i.e. inferencing and prediction, therefore therapist to look at visual information first before written/reading material 3) Cameron has met his 10-vocabulary word target and SENCO has sent more. Therapist stated this would be an ongoing process with new vocabulary but also needs to be filling in gaps of basic vocabulary. Therapist discussed strategies such as word webs and my little book of words to be sent home for discussion/practice and also available to child in classroom to help self help skills and increase independent learning. 4) Regular past tense still difficult for Cameron. Therapist discussed why this was with SENCO, as he has fairly good irregular forms. Due to Hearing Impairment ed quiet sounds at high frequency therefore doesnt I didnt hear as clearly as irregular forms where whole word changes. Discussed two forms of ed past tense endings both spelt the same but pronounced t with quiet word endings and with d in loud word ending e.g. quiet t = walked loud d = heard Therefore will send in picture material to work on loud d past tense (reg) first then will target quiet t past tense (reg). Also advised school to have a recording system to document when input given on each target and if any changes observed in that skill. Agreed with SENCO school visit after half term. Therapist then took Cameron out to try visual inferencing which he managed well with multichoice answers but found difficult with open ended questions B from Looking and Thinking book 1. This is when information is not in the picture at all but high level of inference is to be made therefore target questions B, but complete A as a preparatory activity. Back in the classroom found some vocabulary difficulties therefore dis- cussed with SENCO ways to introduce new vocabulary before and review after a lesson so Cameron has more cues to comprehend les- son and vocabulary. Therapist to write new targets and send new material to home and school. Therapist also to telephone mum. Figure 2c) Update to programme Target 1 Cameron will consistently choose the correct multiple-choice questions / answers, targeting his development of inferencing skills in Looking and Thinking Book 1 activities Rationale Cameron finds it difficult to look at visual material and make an inference from the information he can see. This is due to the fact that the skill requires more abstract thinking. Strategies / activities Please use materials enclosed and answer the appropriate corresponding A/B questions from Looking and Thinking Book 1. In the materials provided, multiple-choice answers are given but Cameron may still require adult prompting to complete the task. In particular give prompts to encourage him to think outside the immediate context and not just how it relates to himself. Encourage Cameron to make his reasoning process explicit eg. prompt with how do you know? type questions. This will help him understand the steps he needs to go through to make an inference / prediction. Continue to encourage Cameron to identify when and what he has not understood. Target 2 Cameron will consistently use a voiced loud regular past ending during structured activities Rationale Cameron has difficulty using regular past tense endings (-ed) because of his hearing impairment. There are two forms of regular past tense endings a) -ed - spoken with a d sound (eg. served) b) -ed - spoken with a t sound (eg. walked) d is a loud sound and t a quiet sound. Due to Camerons hearing impairment, the loud regular past tense endings will be worked on initially as they are easier for him to hear. Strategies / activities Please use materials enclosed from Yesterdays Verbs and follow instructions on each page. Identify and group words with -ed endings (into loud and quiet) and practise in writing tasks. Target 3 Cameron will learn 80 per cent of class topic vocabulary Rationale Cameron has a specific problem learning new vocabulary and relating it to previous knowledge. Strategies / activities Cameron to develop my little book of words noting key vocabulary items and new words which he comes across. Prior to introduction of the topic, new vocabulary will be rehearsed with Cameron and then revised after the lesson. Use topic webs, linking words by association where possible. When explaining what new words mean try to put them into categories and link them to words which he already knows. Rehearse the vocabulary through action, activities and experience at school and at home. Throughout tasks, encourage Cameron to identify any words he has not understood. Year 5 Spring term - 1 hour per day learning support assistant time allocated from funding. Used mainly for general support within classroom (hearing aid maintenance, repeating instructions, explaining tasks / vocabulary meanings, completion of work etc.) - Therapist continues to work with named contact / SENCO and occasionally with class teacher / learning support assistant. - SENCO has regular meetings with learning support assistant and class teacher to plan and discuss action / progress. - Clinic therapy ends, as only language needs remain and all parties feel these needs best met within school environment. - Speech and language therapy school visits 1 per term. - Frequent written correspondence and telephone contact between all parties. Year 5 Summer term - 1 hour per week support not meeting all Camerons hearing impairment needs and only some of speech and language therapy needs. - SENCO and parents feel greatest area of need is speech and language so 1:1 hour per day with learning support assistant focuses on speech and language therapy strategies. - Frequency of speech and language therapy visits to school increases to three per term. - Focus of school visits becomes more specific and target based. - SENCO remains named contact, having regular meetings with class teacher and learning support assistant. - Liaison and support for learning support assistant become primary aim; high level of input demonstrating and advising on tasks and approaches to use during specific 1:1 slots and classroom support. - SENCO continues to meet therapist at each visit to clarify outcomes and maintain overall responsibility. - Statement applied for and finalised to commence in Year 6. We must not let speech and language therapy become just another task that teachers cannot possibly undertake. We dont need another black mark against our profession. If services and each individual therapist consider the principles and procedures listed, then appropriate decisions can be made about where we should be targeting our resources based on what the individual child requires (see case example in figure 2a) - c), p.18). This, coupled with effective training and collabo- ration with school staff, should mean preschool children do not suffer because of inadequate resources and that the greater part (not all) of the provision for school age children ... is really embedded within the curriculum and takes the childs education context into consideration. Alyson Portch is Head of Childrens Speech and Language Therapy Services for Hertfordshire Partnership NHS Trust at St Peters House, 2 Bricket Road, St Albans AL1 3JW, tel. 01727 829415. Acknowledgements Thanks to Cathy Goodbun and Lisa Cookson, speech and language therapists. References DfEE (2000) Provision of speech and language therapy services to children with special educa- tional needs (England): report of the working group (DfEE 0319/2000). Online at www.dfee.gov.uk/sen. DfES (2001) SEN Code of Practice. Department for Education & Skills. (tel publications centre on 0845 602 2260, quoting ref. 581/2001). Malcomess, K. (2001) The reason for care. Bulletin of the Royal College of Speech & Language Therapists 595: 13-14. Portch, A. & Harrison, P. (2002) Clarifying priori- ties. Bulletin of The Royal College of Speech & Language Therapists 599: 7-8. Special Educational Needs & Disability Act (2001) From The Stationery Office or online from the Queens Printer of Acts of Parliament at http://www.hmso.gov.uk/acts/acts2001/20010010. htm). Crown Copyright 2001. Wright, J.A. (1994) Collaboration between speech and language therapists and teachers. Unpublished PhD thesis, University of London. SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2003 +, servce management / revews LEARNING DISABILITIES SOME SUGGESTIONS SIMPLISTIC Themed Activities for People with Learning Difficulties Melinda Hutchinson Speechmark ISBN 0 86388 307 9 34.95 This resource manual has 20 objects as the basis of activities to use with people with profound and complex learning difficulties. It has a very clear, straight- forward layout, is well organised and the activity sheets can be photocopied. Its very easy to read. It provides ideas for group work, using readily available, low cost items (for example, take a coconut). Whilst the book contains some creative ideas, we found some suggestions sim- plistic. It is therefore of limited value to the experienced clinician and not partic- ularly good value for money. It would be a useful tool for teachers or generic sup- port workers who work with people with more moderate learning disabilities. Rafaella Peerutin, Debbie Charles and Louise McMillan are speech and language therapists for adults with learning disabil- ities in Newham Primary Care Trust. LIFE SKILLS OF MOST USE IN A GROUP Skills for Daily Living: Personal Safety ColorCards Speechmark ISBN 086388 474 1 26.95 These cards come with a booklet that lists each situation clearly. Each card is numbered so can be easily cross-refer- enced to the list. The cards are well drawn in colour and would be appro- priate for use with adults, older chil- dren, and adults with mild learning disabilities. Both newly qualified and experienced therapists could use the cards. The basic themes - such as immi- nent danger and everyday situations - are good. However, some of the cards are quite abstract or have complex themes. This may be confusing depending on the individuals own experiences of everyday situations. A useful tool to stimulate discussion, highlighting an individuals level of insight within different situations, the cards could be used with both individ- uals and groups. Overall, my col- leagues and I felt they would be of most use in a group setting. Sue Martin is a speech and language therapist in London. REVlEvS EARLY INTERVENTION OPPORTUNITY TO GENERATE DISCUSSION The Social Toddler (Promoting Positive Behaviour) Helen & Clive Dorman The Childrens Project ISBN 1 903275 38 5 15.99 This is a useful and enjoyable read for both experienced and inexperienced therapists working with toddlers and their par- ents. The authors believe that by showing why children of 2-4 years behave the way they do, their parents and carers will be better able to understand them and respond appropriately. The attractive use of photo pictures showing sequences of toddler behaviour in contexts helps the reader absorb and relate the ideas to real situations, while avoiding telling the parent what to do. The many examples of young childrens behaviour and development at different stages provide the therapist with a real opportunity to generate discussion when used together with parents. At the very least this is a useful reference for parents and therapists seeking to gain insight into the mysteries of toddler thinking. Grainne Hampson is a senior speech and language therapist at the Department of Child and Family Psychiatry, Mater Hospital, Dublin. MULTI-PROFESSIONAL WORKING COVERS BASIC CONCEPTS Teamwork. A Guide to Successful Collaboration in Health & Social Care Sue Hutchings, Judy Hall & Barbara Loveday Speechmark ISBN 0 86388 276 5 25.95 This book covers the basic concepts of collaboration, prerequi- sites for success, benefits, barriers and pitfalls. Each chapter ends with a summary of the key points discussed, and many with an opportunity to reflect, and formulate an action plan of personal or service level goals. The authors are from health backgrounds (occupational therapy, physiotherapy and nursing) although all now work in professional education. Hence some speech and language therapy settings may find it easier to relate to this book than others. However the general principles of collaboration apply to all. This is a useful and practical refer- ence for those embarking on multi-professional working. Judith Anderson is the speech and language therapy coordi- nator (mainstream services), Cotswold and Vale PCT. WORD FINDING DOES WHAT IT SAYS ON THE BOX Find the Link (game) Diana Williams Speechmark ISBN 0 86388 421 0 48.75 This resource does what it says on the box in that it provides an attractive word finding and category game. The 200 good quality Colorcard pictures are useful in themselves and ideas are given for a number of different games. My secondary aged students generally gave it a thumbs up but some of the materials, partic- ularly the clothes category pictures, are aimed at much younger children. Also the insects category includes an earthworm and snail which would upset a lot of science teachers! However this resource will not be staying in the back of my cupboard as it is regularly requested by my students as a fun activity. Karen Kelly is a specialist speech and language therapist at the secondary speech and language base, Twynham School, Christchurch, Dorset. Do l have gudng prncpes to hep me pan and dever my servce' Do l ensure a partes agree on each persons roe' Do l back up conversatons n wrtng' Reectons
Special Educational Needs in Practice (Revised Edition): A step-by-step guide to developing a SEN inclusion policy and delivering the requirements of Early Years Action Plus