Archive for “Inspiration”

The first Therapy Ideas Live event on 5 July 2011 at the Royal College of Speech and Language Therapists in London was fantastic: the speakers were amazing, the format was engaging, and attendees left feeling inspired. The RCSLT bulletin is featuring the event in their September issue, so check it out!

Watch these videos of Gina Davies and Louise Coigley giving their stunning 5-minute lightning talks:

We’ll be publishing more videos of the presentations over the next few weeks, so stay tuned to the blog, or follow us on twitter.

Next Therapy Ideas Live: City University London, 20 Sept. 2011

The second Therapy Ideas Live event takes place on 20 September, hosted by City University, London. Sign up to our email list to be the first to know when we release the tickets. And if you fancy getting up on stage and sharing your experience, send us your talk idea by 23 August 2011. See you there!

I recently connected with Liz Panton via twitter. Liz sent me this comment after reading Clare Chilvers’ idea about using video:

SLTs, clients, students, etc. can have an entirely positive video experience with no tears and nasty surprises using Video Interaction Guidance (VIG) – also knows as SPIN and VEROC (Video Enhanced Reflection on Communication).

There is evidence that the VIG approach, focussing on strengths in interaction, is a very effective way to use video to improve communication.

I have tried it with clients with severe communication problems, eg. no speech at all many years post-stroke, with other health professionals and SLT students. Even the most video-phobic have enjoyed the experience and have improved in confidence as well as communicative competence.

I would recommend the VIG approach to anyone interested in using video as a clinical or reflective practice tool.

Liz Panton MRCSLT
Gateshead PCT (South of Tyne and Wear)

Thanks Liz! That website looks like a really useful resource.

A recent experience gave me a powerful reminder that the children we work with need to feel calm in order to learn and develop their communication skills.

We were about to fly to South America on an evening flight. I’d planned to come home from work and travel to the airport with my partner. But for some technical reason, we couldn’t check in online. Panic! Suddenly the plan needed to change.

When my partner suggested a new plan—going directly from work to the airport—I started mumbling incomprehensibly about not having the right shoes on and my ID badge. I said it was impossible and insisted that the original plan was better. The more anxious and angry I got, the harder it was to think rationally.

Looking back, I realise I needed a visual timetable! If my partner had used symbols to talk me through the sequence of events, it would have reduced both my anxiety and my difficult behaviour. I would have been able to think more clearly, see that the steps were logical, and realise they allowed me to reach my goal: getting to the airport on time.

The same principle applies to the children we work with: they need to feel calm in order to learn and develop their communication skills. We should take the time to prepare a visual timetable for each session, to minimise anxiety and create the right conditions for learning.

In one of her workshops, Gina Davies reminded me that visual support can be quick to produce and low-tech. She demonstrated using an A4 sized whiteboard to produce a “now” and “next” style timetable in front of the children. This can also support the development of early literacy skills if you hold the board so the children can see you drawing and writing.

At the other end of the technology scale there must be visual timetable style apps on the iPhone or iPad. Have you used any? I’d love some recommendations.

I recently went to Paris to eat pastries while my partner attended a conference. Lots of people at the conference were using Twitter. They commented on presentations, shared relevant links, and arranged evening soirées.

Speechies: get with the times

Okay, so it was a content strategy conference for web people, but I think therapists need to try new ways of interacting with each other too. There’s a small community of us using Twitter. You should join us.

Share information

Therapists post links to interesting content, like this information sheet about creating social stories (PDF link) which was shared by several people I follow (e.g. @specialquest).

We also ask questions and share resources. For example @speechreka asked:

Anyone has access to this?: Quick Screen for Voice and Supplementary Documents for Identifying Pediatric Voice Disorders- LSHSS vol 35:308

And then:

I’d really appreciate it if someone can share that article. And anything dealing with paediatric voice disorders. Have an ax tomorrow…lost

Shareka got several responses from around the world, and later on shared what she’d found. Excellent timing. I was expecting a voice client for an initial assessment the next day!

Join the community

Twitter is a place to have an SLT-related chat, to share struggles and successes like this one from @speechbob:

just had the school psych tell me that one of my fluency students was talking up a storm with his strategies, made me smile.

We’re a friendly bunch, so what are you waiting for? Start tweeting and pick the brains of colleagues from all over the world. I’m @RhiannanW. See you there!

I’ve just finished reading Seth Godin’s Linchpin and his message resonated with me. Godin asks readers to make a choice and then share his ideas, so here goes!

Godin describes a linchpin as “an individual who can walk into chaos and create order, someone who can invent, connect, create and make things happen… linchpins are geniuses, artists and givers of gifts.” He says that although we were trained to be cogs in a giant machine, we can choose to re-train ourselves to become indispensable.

Linchpins don’t wait for instructions, they make their own maps. They overcome the resistance (the lizard brain that tells us our ideas will never work and everyone will laugh at us) and get their ideas out into the world.

In a recent team meeting at work, it was easy to see the therapists whose lizard brains were in control; they suggested we stop trying new ways of working and go back to the old way! Fortunately my team also has a linchpin or two; they’re generous with their gifts and keen to make change. I’m trying to be a linchpin too; we’re starting to draw our own map, overcome the resistance, and ship our ideas.

I recommend checking out the Linchpin Manifesto (PDF link) and reading the book. We need more linchpins in the National Health Service! What do you think?

I’m interested in how Speech and Language Therapists (SLTs) use counselling in clinical work. I’m also drafting targets for my Personal Development Plan (PDP) and want to include one about counselling; perhaps writing this will clarify my thinking!

What is counselling?

The British Association for Counselling and Psychotherapy uses this definition:

Counselling takes place when a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having, distress they may be experiencing or perhaps their dissatisfaction with life, or loss of a sense of direction and purpose. It is always at the request of the client as no one can properly be ‘sent’ for counselling.

By listening attentively and patiently the counsellor can begin to perceive the difficulties from the client’s point of view and can help them to see things more clearly, possibly from a different perspective. Counselling is a way of enabling choice or change or of reducing confusion.

Why do SLTs need to use counselling skills?

SLTs work with clients (and their parents or carers) who may be experiencing denial or grief. We might need to use counselling skills if our clients:

• are unable to engage in therapy,
  
• demonstrate strong emotions,
  
• tell us they’re feeling low,
  
• are tearful, or
  
• struggle to adjust to their difficulties.

(List taken from Sparkes and Simpson, see below.) Sometimes we need to address these feelings explicitly before we are able to move forward with therapy.

One particular session with a parent left me feeling uncomfortable: her son had just been diagnosed with autism, and she spent the therapy session in tears. When I reflected on the session, it felt like I’d been unable to support her; so I decided to develop my counselling skills.

Resources and training

I searched Amazon for some books to get me started. I ordered Counselling Skills for Health Professionals by Philip Burnard and Person-Centred Counselling in Action by Dave Mearns and Brian Thorne. I found Counselling Skills for Health Professionals relevant and easy to read; it has practical ideas, short case studies, and an interesting chapter on culture and communication. In contrast, I found the language in Person-Centred Counselling in Action complicated and difficult to follow. Although it contains lots of interesting ideas—and it made me think—SLTs are not really the target audience.

I also attended a one day course called “Feeling out of your depth? Innovative approaches to using counselling skills within speech and language therapy” at University College London. The course was led by Cathy Sparkes and Sam Simpson. It was great! I took away lots of practical ideas for working with clients and families, and learnt more about my own skills and boundaries.

Using “blob people”

One of the ideas Cathy and Sam shared was using the blob people pictures. At work we use the “blob tree” as part of our initial assessment for people who stammer. I liked the list of possible questions that Cathy and Sam discussed: I can easily see how to use them in my clinical work.

The pictures show lots of blob people (who are neither male or female, young or old) in different situations; check out the blob bar! Possible questions to initiate discussion include:

• Which one are you?
• With friends, which one are you?
• Which one would you like to be?

The pictures and questions are a great resource, check them out.

Personal development target

I was prompted to think again about using counselling skills during a recent initial assessment. During the session the parents seemed to move from denial that there was a problem to grief that their son’s language was severely delayed. There was another family waiting, so I couldn’t explore the parents’ distress. Looking at the definition above, I did try to help them see things more clearly, and to reduce their confusion, but maybe I could have done more.

Is there a personal development target here somewhere? How about:

To practise using counselling skills in assessment and therapy sessions, in order to help parents think clearly and be ready to engage with therapy.

What do you think?

I recently left a job in one London borough to start a new one in another part of the city. The aim of the move was to find a job that would allow me to develop my supervision skills, and get involved with service development work, while continuing to progress my clinical skills.

The change made me reflect on the positive aspects of the old job, so I’m jotting them down here.

Positives

It was a large, friendly team of therapists and I was well supported. I worked autonomously: free to manage my own time and workload.

I spent 18 months working with the same caseload, so I was able to get to know the families. When we met in the street, they would stop and chat; I felt a part of the community. I was also able to develop good working relationships with other professionals, such as staff in the Children’s Centres.

The team has a good universal service in place; they are working at the population level to raise awareness and prevent difficulties arising. In this respect they’re ahead of many other boroughs!

We were encouraged to carry out clinical projects, so I developed a drop-in group focussing on parent child interaction strategies, in my patch. With support from the Children’s Centre I was able to grow this group and access hard to reach families.

What I’m looking forward to

I think the new job will also be a positive experience; when I’ve moved through the initial ‘information overload’ phase and begin to find my feet, I hope I will enjoy the new challenge. I’m looking forward to developing the universal service and working with nursery settings.

I find starting in a new team difficult and admire locum therapists, who move from team to team regularly—I wouldn’t cope! If you’ve got any tips about how to make the transition as stress-free as possible, please add a comment!

On Friday I attended a conference: “Intensive Interaction and Play Techniques: encouraging Communication for Children with Autism”. I came back inspired — I can’t wait to try out the ideas!

Here’s a summary of two of the presentations.

Intensive Interaction

The keynote presentation was given by Dave Hewett, who, along with Melanie Nind, developed the Intensive Interaction approach. He pitched his talk at just the right level — making great use of video clips, the talk was both clear and fun.

Dave talked about the fundamentals of communication, such as enjoying being with another person, taking turns in exchanges of behaviour, and using and understanding eye contact. He questioned why most of the approaches we use to teach communication don’t attempt to teach these fundamentals of communication first. It seems obvious: if a child hasn’t acquired the fundamentals, it’s very difficult to learn anything else. So why do we tend to start by teaching symbolic representation?

Dave & co started working on Intensive Interaction because they felt the existing curriculum was inadequate — this was in the 1980s. He asked us to think about whether this is still the case today. We don’t expect babies to follow a timetable, so why do we expect this from children with Autism, some of whom are at the same developmental level?

Dave’s visualisation of communication learning and performance showed how complicated the process is. He suggested that the conventional linear teaching approach probably won’t work for something this complicated. He uses the idea of a spiral to describe learning through Intensive Interaction and play: learning takes off and spirals upwards; repetition means that each activity builds on what has gone before.

Again, this seems obvious to me. However, I often identify a target, and then consider which therapy activities I will use to work on it. Which takes me back to the linear model! I’m going to need to think about this: Dave suggested using video as a progress outcome, but I can’t write that on my goal sheet…

Attention: the Bucket

I also attended a workshop called: “Attention: getting it, building it and sharing it — the Bucket and Beyond”. Gina Davies started her session with a dancing chicken, giving us what she gives the children: “an irresistible invitation to learn.”

Like Dave, Gina also used video clips: she showed us a group of children with autism, before and after her 6 week program of attention work — it was amazing. The children in the ‘after’ clip were able to maintain such good attention that the Teaching Assistants in my group didn’t believe they were autistic.

As I understand it, Gina’s program works like this:

The children sit on chairs in a semi-circle facing the lead adult. The adult has an opaque bucket, with a lid on, containing highly motivating toys. She must be the most interesting thing in the room, so anything more interesting must be put out of sight. Along the same lines, the supporting adults should be boring! When a child gets up out of his chair, he must be slowly and calmly guided back to his seat — without verbal instructions.

The adult at the front takes out a toy from the bucket and demonstrates it to the children. The children’s reward must be intrinsic to the activity: the joy of watching a dancing pig! Gina suggested using 4 or 5 different toys in each session.

When the program begins, the children are only able to cope with sitting in their chairs for around 5 minutes, but after 2 mornings each week for 6 weeks they are able to maintain focussed attention for between 10 and 20 minutes. Each morning session is made up of around 4 cycles of 5 minutes bucket time and then a period of free play. Gina also said that at The Little Group, where she devised the program, they take the children running before they start the bucket time!

Gina was an outstanding presenter — I came home rambling on and on about buckets, and was so excited I had to text a friend, to share the bucket idea with her! I will definitely be giving this a try. I will also use it to support me in my quest to get the child-height sink removed from our therapy room; it’s competing with me as the most exciting thing in the room, so it has to go!

Gina also had lots of great ideas about motivating activities to do with the children once they had integrated attention. I need to email her and ask if I can add the flour castle, spagetti fireworks and lemonade fountain to this site!