Taking a look at the work of speech and language therapists
Each September a number of pupils enter reception classes with identified speech, language and communication needs (SLCN). Some may enter school with a statement and many are already known to the speech and language therapy service from pre-school services. Others may be identified shortly after school entry or later, depending on the type of difficulty they have.
Five to seven per cent of these children have persistent, long-term problems which impact on their learning over several years. Speech and language therapists (SLTs) are available to help pinpoint and explain the nature and severity of the problem and, with school staff and parents, evaluate its impact on both classroom learning and everyday life. There is often much discussion of how speech and language problems affect key learning areas, for example, how some speech sound difficulties affect literacy development. Therapy programmes are then formulated and management strategies devised to tie in with the individual pupil’s needs within their specific environment. These are then evaluated, developed and modified over time. Programmes are carried out by school staff, supported by the SLT.
The range of difficulties that SLTs cover sometimes surprises school staff. If a child has clear problems understanding language, has a speech difficulty or uses a communication aid, the SLT’s involvement is obvious. However, an SLT’s involvement, for example, with a young person with Asperger’s syndrome is often less well understood. After all, such children may have no problem with language and may even have the best vocabulary in their class. However, these children have difficulties in the area of socialisation and interaction and they often need to be explicitly taught skills which most people pick up naturally. This is another aspect of communication covered by SLTs.
Social communication difficulties are not confined to pupils on the autistic spectrum. For some children and young people, difficulties in understanding language, in expressing themselves or in processing information at speed may cause them to have difficulties with social interaction. Elective mutism is a psychologically based difficulty where the person finds it difficult or impossible to express themselves in certain places or with certain people. It is not helpful to try to force or trick them into speaking and a structured programme is required to address the problem.
Another area in which specialised SLTs work is with children who have eating, drinking and swallowing difficulties. Voice and dysfluency (stammering) difficulties are also part of the SLT’s remit.
The way that speech and language therapy services are organised and commissioned varies considerably from area to area. However, most children will be seen first in a clinic, health centre or children’s centre and some may do all their work there. Many areas now have dedicated teams which work with mainstream schools to help pupils who have more severe and long-standing problems. This usually involves working with a named member of staff to devise and guide a programme delivered in school. Special schools and units often have their own therapists who work there for part of their working week.
Training is an integral part of what many SLTs do. This may involve giving general pointers on SLCN, demonstrating strategies and programmes for individuals or providing specific instruction, such as signing training for working with pupils who cannot use verbal language effectively.
SLTs work closely with school staff, such as SENCOs, headteachers class teachers and teaching assistants. Indeed, when seeing a child in school, it is essential to have time to liaise with key staff in order to demonstrate new ideas, ensure the programme is meeting needs and formulate IEP targets. Sometimes a classroom observation can be more useful than working alone with a pupil to evaluate the effects of their difficulties on classroom learning. Parents are also an integral part of the process and, in an ideal world, would come to school for each visit. However, this is often not possible and much liaison work must be done by telephone, backed by written reports.
One common difficulty encountered in an SLT’s work is that of discharge. Some pupils develop their skills to a level similar to their peers, but others will have long-term difficulties and may never learn in quite the same way. However, there does come a time when the environment is adapted as far as is possible or practicable, key staff are well trained in supporting the pupil and they may have mastered a number of coping strategies. At this time, SLTs have nothing extra to add and need to discharge the pupil and focus their resources elsewhere. This is often a major milestone for both the family and the school involved and it requires sensitive planning and implementation.
In addition to liaising with school staff and parents, SLTs also have to work closely with other professionals, including educational psychologists and specialist support teachers. SEN casework officers may also seek advice on specific cases, and SLTs are regularly involved in producing reports which detail a child’s needs for their statement of SEN. In the healthcare sphere, dealings with paediatricians, occupational therapists, physiotherapists and school health advisers are common and there may also be involvement from social services. There can be a large number of professionals involved with any one child and it is imperative that everyone’s roles are clearly defined and respected by all concerned.
An SLT’s working week can vary greatly, but for a school based therapist it is likely to involve:
- several school visits
- writing programmes for schools to deliver
- writing assessment or update reports, including those for statements
- completing essential administrative tasks, such as making appointments and recording statistics for government data
- discussion by telephone about a child with parents, schools or other professionals
- preparing and running training sessions
- updating knowledge of skills and procedures, ranging from new therapy approaches to safeguarding policies and procedures.
Communication is not only an important skill to teach our pupils, it is also one of the key requirements of our role. The worlds of health and education can be very different, and although we work more closely together than in the past, there is still the potential to confuse ideas and terminology. However, there are now more opportunities to develop a joint frame of reference, including the Inclusion Development Programme which has focused on both SLCN and autistic spectrum disorders. This may prove to be a useful starting point for therapists and classroom staff working together.
On a personal note, I find working in schools to be very rewarding and I greatly value my professional relationships with colleagues. It is also a delight to witness the very real progress that many of the young people I work with can make.
Alison Hodson has worked in a wide variety of educational settings and is currently the Highly Specialist Speech and Language Therapist for Children with Autistic Spectrum Disorders for Warrington Primary Care Unit. She is a member of the Royal College of Speech and Language Therapists:
Article first published in SEN Magazine issue 46: May/June 2010.