contents · bulletin thrives on your letters and emails write to the editor, rcslt, 2 white hart...

Dec 2005 • Issue 644

1945-2005

Celebrating 60 years

Looking back at Speech and Language Therapy Week

December 05 cover 25/11/05 12:34 pm

Royal College of Speechand Language Therapists2 White Hart Yard, London SE1 1NX

Telephone: 020 7378 1200email: [email protected]: www.rcslt.org

President George Cox

Senior LifeVice President Sir Sigmund Sternberg

Vice Presidents Simon Hughes MPBaroness JayBaroness Michie

Chair Sue Roulstone

Deputy Chair Rosalind Gray Rogers

Hon Treasurer Gill Stevenson

ProfessionalDirector Kamini Gadhok

Editor Steven Harulow

Deputy Editor Annie Faulkner

Publications Editor Sarah Gentleman

MarketingOfficer Sandra Burke

Publisher TG Scott(A division of McMillan-Scott plc)

Design Courts Design Ltd

Disclaimer:The bulletin is the monthly magazine of the Royal College of Speech and LanguageTherapists.The views expressed in the bulletinare not necessarily the views of the College.

Publication does not imply endorsement.Publication of advertisements in the bulletin isnot an endorsement of the advertiser or of theproducts and services advertised.

C O N T E N T S

COVER STORY:

Looking back atSpeech andLanguageTherapy WeekSee page 14-16

December 2005 • Issue 644

Megan Hide, SLT at Llandough Hospital

4 Editorial and letters

6 News: 2005 RCSLT Honours; Were you affected by HPC de-registration; Royal opening for Marjon SLT facilities; RCSLT welcomes new Head of Professional Development and more

12 Sarah Hulme discusses a pilot scheme offering innovative training for childcare staff

17 Sue Jones focuses on the issues of prioritisation around the management of a clinical voice disorders caseload

18 Mary Riley and Laura Broadstock report on the positive results of collaboration on language groups for children with moderate learning difficulties

20 Professional issues: The RCSLT's revised standards on CPD

22 Reviews: The latest books and products renewed by SLTs

24 Letters extra: A response to Celia Harding's article on functional nutritive sucking

25 Any questions: Your chance to ask your colleagues and share your knowledge

26 Opinion piece: Geraldine Wotton wonders why there is an 'immaturity of thinking' in working with children who have Down syndrome

27 Specific Interest Groups: The latest meeting and events around the UK

Contents December 22/11/05 4:51 pm Page 1

bulletin December 2005 www.rcslt.org4

editor ia l & let ters

L E T T E R S

Life in the fast lane

Long live the CollegeCongratulations on your excellent

diamond jubilee Bulletin. From cover

to cover, it makes for engrossing

reading.

The '60s years are especially

interesting for me, because I became a

student at The Central School of

Speech and Drama during the early

part of that decade.

Some random reminiscences of my

own: it is gratifying to see a photo of

Jennifer Warner conducting a tutorial.

We students learned a great deal from

her seminars. Miss Warner worked

tremendously hard to mould us into

competent (we hope) SLTs.

All of our teachers, staff and

contracted lecturers alike, were

excellent. In later years I heard and met

Betty Byers Brown at an American

Speech-Language-Hearing Association

convention, in Chicago, I think. I was

also Joan van Thal's last student at the

Royal Dental Hospital in Leicester

Square.

Together with brothers Byrne and

Donegan, I helped the College to move

into the St John's Wood premises. At

that time we male students were

conspicuous by our paucity, so they

had to use whomever they could find.

The lecturers were so used to saying

brother, that once Miss Wynter

inadvertently addressed me as Brother

Lawrence. Unfortunately, I fall far short

of the faith of that illustrious person. I

am still searching for God when I am

washing the dishes, for example.

You have provided us with an

excellent historical overview of the life

of the College and our profession. Best

wishes for the next 60 years and

beyond. Long live the College!

Lawrence Fotheringham

Chatham, Ontario, Canada

Advisers pleaIn response to your story on RCSLT

advisers (Bulletin, August 2005, p10-

11), I would like to make a plea for

more SLT paediatric advisers to step

forward in Scotland.

At the Scottish Education

committee, we really need your

expertise and help in responding to the

ever-growing number of papers we are

asked to comment on.

In Scotland, we have a particular

shortage of paediatric advisers in the

following fields: AAC; dyspraxia; head

injury; head/neck oncology and

learning disability.

If you, or a colleague, would like to

become an adviser, more information

on what the role involves and an

application pack are available on the

RCSLT website, visit:

www.rcslt.org/resources/clinicaladvisers

Fiona Whyte

[email protected]

Bulletin thrives on your letters and emails

Write to the editor, RCSLT, 2 White Hart Yard, London SE1 1NX

email: [email protected] include your postal address and telephone number

Letters may be edited for publication (250 words maximum)

As 2005 rapidly draws to a close, it is

time to draw breath, reflect on what has

happened in the past year and look

forward to the next.From an RCSLT point of view, the past 12 months

have simply flown by. The RCSLT’s diamond jubilee

year saw the signing of the Mutual Recognition

Agreement, the appointment of two new country

policy officers, a major manager’s conference in

April, the launch of the Clinical Guidelines in print

and the completion of the new website, the trial of

the online continuing professional development

diary and, of course, the frenetic activity of Speech

and Language Therapy Week in October (see pages

14-16 for details).

Internally, the RCSLT began a process of

structural change to better equip the organisation

to meet the immediate challenges it faces and make

the most of the opportunities as they present

themselves. This major exercise is still ongoing and

details will be unveiled officially when it is

completed in the new year.

Even at this stage, with my fairly clear diary, 2006

promises to be even busier than 2005. There is a

national RCSLT student study day in February, the

rollout of the RCSLT’s online CPD diary in April

and the Realising the Vision conference from 10-12

May in Belfast.

Add to this an enormous amount of

government-led activity in the four UK countries

that will affect the profession and inevitably occupy

the RCSLT policy team. In England, for example,

this includes the inquiry into special educational

needs, the white paper on education, and the

potential implications of the push towards a

patient-led NHS.

So, dear reader, enjoy whatever you do over the

festive period. I look forward to keeping you up to

date on all the latest speech and language therapy

developments in 2006.

Steven Harulow

Bulletin editor

004-005 22/11/05 4:36 pm Page 4

www.rcslt.org December 2005 bulletin 5

editor ia l & let ters

L E T T E R S c o n t i n u e d

Responding to voice concernsI welcome the opportunity to respond to

the comments made by Louise Bass

regarding the effects of laryngectomy

surgery (Bulletin Supplement, October

2005, p3).

I regret that Louise feels that there is a lack

of understanding and support for the

difficulties experienced by people who have

laryngectomy surgery. As a profession, SLTs

are actively engaged in raising both public and

professional awareness of the issues she raises.

In answer to her concerns regarding the

professional acceptance of the term voice

restoration it may be helpful to clarify terms

that we, as professionals, use.

My understanding is that the term voice

restoration refers only to surgical voice

restoration (SVR). This is a specific

technique, in which a valve is inserted into

a surgically created hole to enable air from

the lungs to be used to produce voice.

As far as I am aware the term voice

restoration is not used to describe any other

methods of speech such as oesophageal or

artificial larynx speech. The term pseudo or

alaryngeal voice more accurately describes

any voice not produced by a voice box.

I have worked as an SLT in the field of

laryngectomy for nearly 35 years, long

before SVR became available. When this

technique was pioneered in the early 1980s

it was a great breakthrough and did indeed

enable many people who would previously

have remained voiceless to have their voices

“restored”.

This does not mean that a valve restores

“normal” voice, but that it is the closest to

normal voice of all other methods, given

the loss of the voice box.

For some their voices are actually better

than before surgery when the cancer caused

the loss of normal voice.

Of course, as Louise rightly says, this

technique does not suit everyone and many

people use a range of alternative methods

of voice rehabilitation very successfully. For

women in particular, the change in voicing

can be markedly different. As SLTs we strive

to provide each individual with the best

and most appropriate method for them and

not be too prescriptive.

I would like to thank Louise for

highlighting her concerns and raising this

debate and would welcome views from

others, both professionals and

laryngectomees. We can only improve our

practice by listening and responding to

issues raised by those using our service.

Kaye Radford

RCSLT adviser in head and neck cancer

email [email protected]

Keep the NHS publicI was pleased to see the emphasis that

RCSLT is putting on responding to

Commissioning a Patient-led NHS, both in

the Bulletin (September 2005, p6) and on

the website (www.rcslt.org

/news/news_commissioning).

Members who share my concerns about

these issues may be interested in the

campaign to keep the NHS public. Visit:

www.keepournhspublic.com and register

your support.

Several SLTs have already signed up to it.

Jenny Sheridan

Susan Wallace was a dedicated and skilled

SLT. She qualified in 1978 at Jordanhill

College where she gained a BSc. After

qualifying she worked in a variety of

locations across Scotland, initially working

in Dundee and for the past 17 years in Glasgow.

Much of Susan's work as an SLT was dedicated to adults with

learning disabilities (ALD) and she was an acknowledged expert

and RCSLT adviser in this field. She played a significant role in

shaping the speech and language therapy adult learning disability

service in Glasgow, from Lennox Castle Hospital to the current

community-based teams.

As a clinician, Susan was a great advocate for her clients and was

tireless in her efforts to ensure their communication and dysphagia

needs were addressed. At management level she campaigned to

ensure service managers and planners of strategy were aware of the

communication issues that surround people with learning

disabilities, their environments and within wider communities.

As a highly regarded colleague, Susan shared many long

conversations, exchanging and exploring ideas, always striving to

achieve the best for the clients she worked with. Sound values, a

warm heart, thoughtfulness and a wealth of experience and

knowledge shone through in all aspects of her work.

Susan developed a special interest in learning disability and

hearing impairment, and became very skilled and knowledgeable

in this area. She raised awareness around this unmet need and

together with audiology colleagues campaigned for flexible,

sensitive and responsive services to fill the gap.

More recently, Susan represented Scottish therapists at the ALD

leads group at the RCSLT. Speech and language therapists in

Scotland will recall her for her enquiring mind, always asking the

questions that others were struggling to articulate.

A devoted daughter, wife and mother, Susan would regale her

colleagues with many a story about her family. She was especially

proud of her daughter Sonia who is currently at university

studying psychology.

Sadly, Susan died on 18 September 2005 after a short illness.

Colleagues, family and friends will remember her warmly for her

energetic, enthusiastic and tireless approach to life.

Jill Murray

Susan WallaceMarch 1956 – September 2005

OBITUARY

004-005 22/11/05 4:37 pm Page 5


news

Twenty three years after their first collaborativesuccess, Jayne Comins, Felicity Llewellyn and JudyOffiler have got together again to update theirextremely popular Communication Activities forAdults.

Originally compiled for use with people withdysphasia, this book is also valuable for working witholder and day-centre clients, and can be used forgroup warm-ups.

With more than 100 graded communicationactivities for individuals and groups, this practicalbook is an excellent resource for health professionalsand activity providers.

The first edition, published in 1983, came out at a

time when there were hardly

any therapy materials on the

market, and therapists spent

considerable time putting

together their own resources

when they could have been

spending more time with

clients.

The book became a bestseller,

providing over 100 ideas for

word games and group

activities. Many required little

or no preparation beforehand,

and others needed only a

flipchart, pen and paper.

“We felt that many of the examples in the original

edition had become outdated. Spotted dick has

stopped being a staple of the British diet; ciabatta and

pesto are today’s replacements. Ronald Reagan and

Margaret Thatcher are no longer stalking the

corridors of power; instead, we are governed by the

likes of Tony Blair and Arnie Schwarzenegger,” the

authors say.

“So, as well as dozens of new activities, this edition

includes a completely new set of examples.”

Visit: www.speechmark.net/speechmark/new

Titles.htm

An interprofessional dysphagia framework has now

been developed following consultation with a range of

professionals using interviews, surveys and focus

groups.

The framework informs strategies for developing

the skills, knowledge and ability of SLTs, nurses, other

healthcare professionals and non-registered staff to

contribute more effectively in the identification of

people with, and management of, swallowing

difficulties.

During the process of developing the role

descriptors, draft dysphagia competencies have been

developed in collaboration with Skills for Health and

the Sector Skills Council.

The role descriptors include the content from these

competencies, with additional material to prescribe

professional activities in order to meet the needs of

the professional groups.

Both the role descriptors and Skills for Health

competence models are undergoing field testing to

enable them to be included in the suites of national

workforce competencies (NWCs) that cover the health

workforce. This additional material can be mapped to

other NWCs available from Skills for Health.

Ten sites will test the draft NWC units within falls

and stroke, paediatrics, mental health and adult

learning disabilities client groups.

The role descriptors will be field tested at Sheffield,

Portsmouth, Wales and Derby within stroke,

paediatrics, mental health, head and neck and adult

learning disabilities.

Mary Heritage and Clare Coles represent the

RCSLT on the project’s intercollegiate steering group.

Liz Boaden is on the research team.

The full report will be available following completion

of the project in the 2006. For more information

email: [email protected]

N E W S I N B R I E F

Neuro-diversity voiceIndividuals with autism and related

conditions will have a stronger voice at

the Disability Rights Commission (DRC)

after the formation of a new Autism and

Neuro-diversity Group. Run by people

with autism and neuro-diverse

conditions, such as dyslexia and

dyspraxia, the group will recommend

issues for DRC attention.

Visit: www.drc-gb.org

Delivering patient safetyThe National Patient Safety Agency

(NPSA) has made a new multimedia

pack available to 600 NHS trusts in

England and Wales. Compiled by experts

on health and safety, Delivering Patient

Safety can be customised to suit local

needs and resources.The NPSA has also

launched Seven steps to patient safety for

primary care: a guide explaining how

healthcare staff can improve patient

safety locally.Visit: www.delivering

patientsafety.com and www.npsa.nhs.uk

The HPC in focusThe Health Professions Council (HPC)

launched the first issue of its newsletter

in November, aimed at keeping people

informed about their work. HPC in focus

features articles on renewals, fitness to

practice and CPD.To subscribe, email:

[email protected] or visit:

www.hpc-uk.org

Learning disability portal A new website aims to provide

information on learning disabilities.The

site features frequently asked questions

on learning disability and has an A-Z

resource on common issues.Visit:

www.understandingindividualneeds.com

MS research volunteersUniversity of Wales Institute student SLT

Rhiannon Leach is researching the timing

of multiple sclerosis patient referrals to

speech and language therapy, and the

role MS nurses play in the referral

process. She is seeking volunteers who

work with MS clients to complete a short

anonymous questionnaire on their

patients. Email: [email protected]

Communication activities revisitedTogether again for the first time in 23 years

Dysphagia competencies ready for field testing Mary Heritage and Liz Boaden outline the latest activity in the development ofinterprofessional competencies for management of dysphagia

006-007 24/11/05 3:28 pm Page 1


news

The RCSLT is pleased to welcome Sharon

Woolf as its new Head of Professional

Development.

Sharon commenced her new role on 1

November and has excellent credentials for

the position. Within her remit are pre-

registration education, continuing

professional development (CPD) and

workforce development.

She previously worked as education

manager at the Health Professions Council, a

post that involved visiting universities to

assess their allied health professional

programmes.

Prior to this Sharon worked at City and

Queen Mary’s universities at department level

and in central administration, where she had

a quality assurance remit.

In the short time Sharon has been with the

RCSLT she has already attended a

Department for Education and Skills

stakeholder event to discuss the proposed

integrated qualifications framework and has

spoken to the Royal College of Paediatrics

and Child Health (RCPCH) about the

RCSLT’s online CPD developments.

“Other representatives at the forum from

allied health professions and RCPCH have

been very impressed with the route we are

taking with regard to CPD. We plan to

develop a full CPD profile that will support

SLTs at all stages of their career pathway,”

RCSLT welcomes new Head of Professional Development

RCPCH affiliate schemeIndividual SLTs can take advantage of a new RoyalCollege of Paediatrics and Child Health affiliate schemefor health professionals who work with children.The benefits include:• Receipt of all RCPCH publications (excluding the

handbook)• Membership of the RCPCH book club• Discounted RCPCH spring meeting conference fees

(approx 40%)• Reduced subscription to the Archives of Disease of

Childhood (currently £75 instead of £206 per year)• Use of RCPCH facilities for meetings (subject to

availability. A charge may be made)

Affiliate subscriptions cost £50 per year.Tel: 0207 3075623, email: [email protected] or visit:www.rcpch.ac.uk for details

Were you affected by HPC de-registration?After the completion of this year’s Health

Professions Council (HPC) registration

period for SLTs, the RCSLT became aware of

members who attempted to register well

before the 30 September deadline, but who

were not successful.

While the RCSLT has received anecdotal

evidence that this may have been a

widespread problem, we need to know the

real extent of unsuccessful registration if we

are to act on behalf of members.

If you have been affected, email:

[email protected] and state when and how

you sent off your payment and any other

correspondence, and whether you have had

problems contacting the HPC after finding

out you were not on the Register.

In replying please provide the following

information:

� When did you send your HPC

registration form?

� Did you send a cheque or have you

signed a direct debit form?

� Have you attempted to contact the HPC

(state by what means, eg letter, phone

call, email) and were you successful?

Sharon said.

“ ‘Upskilling’ and ‘portability’ are two key

words that are coming from government in

terms of qualifications. Higher education

institutions have been recording students’

transferable skills for some time. Employers

and employees now need to recognise the

value of transferable skills gained from both

formal qualifications and professional

experience.”

A message from HPC Stakeholder Manager Sarah Dawson:The renewal period for SLTs finished on the 30 September 2005.The HPC has now removed from the Register everyonewho did not return their renewal form on time.The HPC lapsed 972 SLTs.This represents approximately 9% of thenumber of renewal notices sent to registered SLTs. You can check registration on the HPC Register (http://register.hpc-uk.org/lisa/onlineregister/RegistrantSearchInitial.jsp). If your name does not appear on the Register, but you wish to beregistered, then you will have to apply to go back onto it. It is important that if you wish to return to the Register you willneed to complete a readmission form that can be downloaded from the HPC (www.hpc-uk.org/apply/readmission)It is illegal to practise under the protected title speech and language therapist if you are not registered with the HPC.Each individual is responsible for maintaining his or her own registration. If you or your colleagues require any advice orsupport regarding this matter you can contact the HPC registration department on 0845 300 4472 lines are openMonday-Friday, 8am - 6pm.

Fair for All –Disabilityconsultationin ScotlandThe Disability Rights Commission

(DRC) and Scottish Executive Health

Department in Scotland have launched a

consultation on Fair for All – Disability,

offering SLTs and their service users in

Scotland an opportunity to get inclusive

communication and total

communication issues firmly on the

agenda.

We need your input as SLTs, either in

your capacity working for the NHS or as

part of a national level RCSLT response.

Visit: www.rcslt.org/government/

arounduk/scotland

006-007 24/11/05 3:28 pm Page 2


news

2005 RCSLT HonoursThis year's honours were presented at the RCSLT diamond jubilee gala event inLondon on 10 October. The awards recognise the outstanding achievements ofmembers and other individuals in the field of speech and language therapy

RCSLT FELLOWSHIPSHonours for distinguished services to the RCSLT

Honours acknowledge RCSLT members who have contributed outstanding service toCollege and recognises members who have carried out work of special value to theRCSLT

Frances Cook is an expert in the field of stammering. She has worked

in the profession for over 25 years and is manager of the Michael Palin

Centre (MPC) for Stammering Children, developing it into an

internationally recognised centre of excellence. Frances also monitors

the MPC's research programme and presents papers on the

assessment and treatment of stammering in the UK, Europe and

America. She has also been honoured with the 2003 Clinician of the

Year Award from the International Fluency Association.

Yvonne Edels has transformed postgraduate teaching in the area of

laryngectomy and has contributed hugely to the evidence base in

head and neck cancer. She was head of department at the Middlesex

Hospital, which pioneered gastric pull-up reconstruction after

extended laryngectomy surgery. In 1983 she edited Laryngectomy:

Diagnosis to rehabilitation, the only UK textbook on the subject to date.

In 1997, Yvonne took the first MacMillan Cancer Relief funded post for

specialist head and neck cancer rehabilitation at Charing Cross

Hospital.

Roberta Lees became a lecturer in speech and language therapy at

Jordanhill College in 1968. The college merged with Strathclyde

University in 1993 and since then she has held a number of senior

positions, including her current post as reader in the Department of

Education and Professional Studies. She is one of the foremost

international researchers into stammering and has been an RCSLT and

British Stammering Association adviser for many years. Roberta

received an MBE for her work in speech and language therapy research

and teaching in 2005.

Dr Joe Reynolds is a speech and language therapy manager based in

Leeds and is well respected within the profession in the UK, serving as

an RCSLT committee member. He has also been active in European

speech and language activities, serving as the RCSLT representative on

the standing Liaison Committee of Speech and Language Therapists in

the European Union (CPLOL). As honorary treasurer, he contributed to

the success of the 2003 CPLOL international conference and is involved

in planning for the 2006 Berlin conference.

Margaret Oakley has given long and distinguished service to the profession. After qualifying in

1971, she worked as the Isle of Wight's chief therapist, setting up a language unit at St

Catherine's School in 1977. With her enthusiasm and determination the unit flourished and by

1982 had become a residential specialist school for students with primary speech and language

disorders. Margaret's vision was for a further education centre to offer post-16 language

impaired students a two-year study programme. The Grove Hill Further Education centre opened

in 1994, with Margaret as its head.

Fellowships are given to RCSLT members

who have given long-standing distinguished

service to the profession in the context of

research, publishing and teaching. This

award entitles holders to call themselves

'Fellow of the Royal College of Speech and

Language Therapists'

Professor PaulCarding is the

UK's first (and

only) professor of

voice pathology.

As clinical head of

the speech voice

and swallowing

department at

Freeman University Hospital, Newcastle

upon Tyne, he has pioneered multidiscipli-

nary working in voice for specialist voice

therapists. An RCSLT adviser for 15 years

and chair of the research committee for

five, he has also been a voice consultant to

the Royal Shakespeare Company and

associate editor of the International Journal

of Language and Communication Disorders,

and Logopedics, Phoniatrics, Vocology.

Dr StephanieMartin is an

educationalist

with 30 years'

service teaching

on speech

therapy courses

at Central School,

the University of

Ulster and University College London. Her

contribution to the voice syllabus in each

university has been remarkable and her

research work has contributed to the

training of SLT students across the UK.

Stephanie's work in preventative voice care

courses for teachers in training has been

formally commended by groups working in

this field and she was awarded a PhD for

her thesis on this topic.

008-009 22/11/05 4:41 pm Page 1


news

Look out in 2006for details on

how to nominatesomeone for

RCSLT Honours

HONORARY FELLOWSHIPS

Honorary fellowships acknowledge and

honour non- and overseas SLTs who have

contributed distinguished services to speech

and language therapy

Dr HelenMcConachie is a

clinical

psychologist

working with

children who

have

developmental

disabilities and

their families, helping them to function on

their own terms and gain easier access to

services. Helen works closely with SLTs and

has championed their work in her multidis-

ciplinary and clinical research, leading

projects and supervising postgraduate SLTs.

During her time at the Augmentative

Communication Service at Great Ormond

Street's Wolfson Centre, she inspired and

supported the speech and language

therapy team in shaping the direction of

the service.

Colin Whurr has

had a long

association with

speech and

language therapy

publications, in

his role as chair of

Whurr Publishers.

Throughout, he

has encouraged would-be authors and

given much needed support. Colin also

supported the British (and later) European

Journal of Disorders of Communication,

publishing it at a time when the College's

finances were in a difficult position. Colin

has been a stalwart friend of the profession,

offering constructive advice on how to

publish.

The Sternberg Award for Clinical Innovation

This annual £1,000 award is supported by RCSLT Senior Life Vice President Sir Sigmund Sternberg

The joint winners of this award are:

Anne Hurren, chief SLT at Sunderland Royal Hospital, for her work, in

collaboration with a multidisciplinary team, on the development of the

innovative Sunderland Air Pressure Meter. The device measures tracheal air

pressure at the stoma and allows SLTs to assess if a patient is a suitable

candidate for a hands-free tracheostomy valve.

Sean Pert and Carol Stow (pictured with Sir Sigmund), specialist

SLTs at the Baillie Street Health Centre in Rochdale, developed

assessment tools for the Mirpuri, Punjabi and Urdu languages in their

area, working with local bilingual speech and language therapy

assistants. The project produced je zindegi (this life), an early

sentences assessment, and the Bilingual Speech Sound Screen (BiSSS).

The Catherine Renfrew Award

This £500 award celebrates the life and achievements of one of speech and language therapy's

early ambassadors and gives an SLT the opportunity to follow in Catherine's footsteps by

networking internationally

Dr Roshan McClenahan is clinical lead SLT for neurology at the Royal Free

Hampstead NHS Trust. The award enabled her to present a paper on The

development of a short screening test for aphasia at the American Speech-

Language-Hearing Association conference in San Diego in November.

The Speechmark Bursary

The Speechmark Bursary is a £1,000 contribution towards funding research visits or project work

outside the applicant's country of work

Nana Akua Victoria Owusu plans to spend six months in Ghana, researching the situation of

children with communications disabilities, focusing on the perceptions of health and education

workers, and the cultural beliefs that can affect the delivery of speech and language therapy

services. Her research will help to inform UK practice when working with ethnic minority communities.

The RCSLT Student Research PrizeThis aims to encourage consideration of clinical implications of research, by recognising final-

year projects that can demonstrate clear implications for clinical practice

Samantha Hawkesford, formerly of the University of Central England,

wins this award for her project entitled: Children's phonological awareness

abilities since the introduction of the National Literacy Strategy.

The RCSLT Diamond Jubilee Special Recognition Award

Allan Tyrer is honoured for his volunteer work at the British Stammering

Association (BSA). Since 1999, Allan spent two days a week turning the BSA

website into what is now widely acknowledged as the foremost web-based

resource on stammering. As a result of his work, the focus of the BSA's

information service has changed dramatically and over half of information

enquiries now come through the website. Allan has donated an estimated

£50,000 in terms of his time.

008-009 22/11/05 4:41 pm Page 2


news

During the consultation meetings managers have

listened to current developments in workforce

planning and discussed the approach they think the

profession should take to develop workforce planning

guidelines.

For the guidelines to be meaningful and effective, it

is essential to gain approval and consensus from all

departments. Therefore, the consultation has involved

the departments of health and education, and allied

health professional leads in England, Northern

Ireland, Scotland and Wales, and Skills for Health, to

establish the direction workforce planning may be

taking in each country.

Traditionally, workforce planning has been based

either on historical local development, from funding

made available for specific care groups and targets, or

on a ratio of staff per head of population.

This led to the idea of 'notional caseloads' in some

areas of care.

With this approach there has been little ability to

consider the effects of local demography or changes in

practice.

In addition, it has had limited success with

commissioners of services, leading to inequalities in

service provision across the UK.

The present workforce planning direction

encourages us to focus on the needs of the local

population.

This 'planning tools' approach involves assessment

of the needs of the local population and the

workforce skill mix that is available (not only in

speech and language therapy services but in the wider

workforce).

This process may be more complex and time

consuming, but should result in a more effective

involvement of stakeholders and the use of evidence

for best practice.

At present there is little evidence for the efficacy of

either approach. The RCSLT Workforce Planning

Project, therefore, plans to test each approach.

A pilot study is assessing the effectiveness of using a

notional caseloads methodology by collecting data

from SLTs who provide services to people with stroke

and communication and/or swallowing problems

across the UK.

The study aims to ascertain whether meaningful

workforce figures can be reached through consensus

and activity data, and if this approach has currency

with all stakeholders.

A second pilot study will test the planning tools

approach by focusing on children's speech and

language therapy services in Northern Ireland.

This will include stakeholders, from service users

through to those in education and health services, as

well as Skills for Health.

The results of these two pilot studies, and further

consultation with the profession and stakeholders,

will inform recommendations on how to workforce

plan for speech and language therapy services, and

form RCSLT guidelines.

I would be happy to hear your comments, queries

or observations on this project.

Stef Ticehurst

RCSLT Workforce Planning Project Officer

Email: [email protected]

N E W S I N B R I E F

Child health mappingThe Department of Health (DH) is

undertaking its first annual data

collection exercise to find out about child

health service provision across England.

Its primary purpose is to support the

implementation of the child policy

agenda, in particular the National Service

Framework for Children and Young

People.Visit:

www.childhealthmapping.org.uk

Still delays for MNDThe Motor Neurone Disease (MND)

Association says nearly a third of people

diagnosed with the disease are meeting

delays because of inappropriate or late

GP referrals.The Association has

published clinical guidelines on

managing MND in conjunction with a

multidisciplinary team.Visit:

www.mndassociation.org

DNR and stroke recoveryA University of Birmingham research

report says stroke patients with 'do not

resuscitate' (DNR) orders in their medical

notes are seven times more likely to die

in the first 30 days after their stroke than

those without. Published in the

International Journal for Quality in

Healthcare, the report's authors say DNR

stroke patients are less likely to receive

care from a specialist stroke unit or team.

British Medical Journal

CorrectionsThe correct email address in the Liquidise

me article in November's Bulletin

Supplement (p3) is:

[email protected]

In November's Bulletin article on the SLT

and Assistant of the Year (p7), SLT of the

Year Award winner Daniel Hunter is

pictured left, and not right, in the

photograph.

Developing toolsfor effectiveworkforce planningOver the past nine months, the RCSLT Workforce PlanningGuidelines Project has held consultation meetings with SLTmanagers' networks across the UK to ascertain the profession'sworkforce planning concerns. Stef Ticehurst explains the latestdevelopments

010-011 24/11/05 3:27 pm Page 1


news

Speech and language therapy students from the College of St Mark

and St John (Marjon) were delighted to welcome HRH Princess Anne

to open their new speech sciences laboratory on 28 October

The speech sciences laboratory is one of the many facilities provided

within the multi-million pound Peninsula Allied Health Centre (PAHC)

on the Marjon campus in Plymouth and represents collaboration

between the Universities of Plymouth and Exeter, and Marjon.

The facility provides opportunities for students from a range of

healthcare disciplines to learn together. Speech and language therapy

staff and students enjoy an attractive clinical suite and modern office

facilities.

During the opening, Drs Sally Bates and Lucy Ellis demonstrated

the learning resources available for students. The Princess met Gillie

Stoneham and a group of third year students working with actor

Anthony Richards, who took the role of a patient recovering from

CVE, and was particularly interested in electropalatography and its

potential teaching, clinical and research application.

The students demonstrated the use of actor simulation in clinical

skills development, a technique that has been developed for use with

second and third year students, and also with clinicians participating

in clinical educator training programmes.

Course head Anne Ayre was pleased to demonstrate the filming and

editing equipment used to capture clinical activities, and described its

application for teaching and research purposes to the Princess.

Royal opening for Marjon SLT facilities

Core standards for care pathways in stammering

Care pathways potentially offer many benefits

for clients, clinicians and services, particularly

in the light of the anticipated changes in the

NHS and the way services are to be

commissioned, provided and 'chosen'.

Care pathways should be transparent

systems that ensure a client's journey through

therapy is properly and effectively charted

and reviewed. They should include clear

guidelines and criteria for clinical decisions

from referral through to discharge and

indicate when alternative referrals (eg

specialist) are required.

The client or carer will be key partners in

decision making, the clinician will be clear

about the services they can and cannot

provide and the manager will have evidence

for service development and planning.

The core standards agreed at the Leeds

meeting, following a broad range of

presentations from participants working in a

variety of settings, were:

� Evidence based assessments

� Comprehensive therapy options tailored

to individual need

� Access to specialist support/alternative

clinical route

� Protocols and guidance for

each step on the care pathway

� Clear criteria for moving

through each stage of care

pathway, discharge and

follow up or re-referral

With clear support mechanisms:

� Health education in terms of

information and advice

leaflets, accessing services and

typical care pathways

� Clinical governance

� Continuing professional

development of clinician

including regular supervision

� SLTs should offer therapy

programmes that are within

their own competencies and

supported by appropriate

training

It has been very satisfying to see

the increasing number of services across the

UK that have now established local care

pathways for at least one section of their

dysfluency service, most commonly for the

pre-school population.

We would welcome your comments or

feedback in relation to these core standards

and the prototype care pathway.

Frances Cook – Michael Palin Centre for

Stammering Children

Email: [email protected]

Specialist SLTs in disorders of fluency have been working on core standards for carepathways in stammering since 2002. Following a meeting at St James Hospital, Leeds, inMay 2005, participants achieved a consensus on the core standards required

(from left ) Students Debbie Jones, Julie Jutsum, Alex Kirk.(Far right) Dr Sally Bates

010-011 22/11/05 4:43 pm Page 2


feature TRAINING CHILDCARE STAFF

ACT!: Innovative trainingfor childcare staff

Our early years speech and language therapy

service has been running adult-child

interaction (ACI) training for nursery staff in

the London boroughs of Camden and

Islington for some years. The theory and

effectiveness of ACI and parent-child

interaction (PCI) therapy is well documented

(Cummins and Hulme, 1997).

We offered our original training

programme to staff in the two local

education authorities' (LEAs') maintained

nurseries. PCI therapy has a high profile

across the two boroughs, and staff in the

maintained nurseries are often already

familiar with its principles.

The training programme encompassed a

one-day nursery-based staff inset session,

followed by a course of four weekly small

group tutorial sessions. The inset session

covered the theory and practical techniques

of ACI. The tutorial sessions allowed for

more detailed and experiential learning; staff

brought videos of themselves playing with a

child to each tutorial, and analysed their own

interaction using the self-rating scale.

We modelled these practical sessions on

our ongoing work with speech and language

therapy students (Parker and Cummins,

1997), and it has proved very successful over

the past eight years. Staff feedback has always

been very positive and the programme has

been replicated within many other PCTs. One

participant was inspired enough to later train

as an SLT.

In 2001, however, changes within the LEAs

meant all childcare settings in the boroughs

became registered with the new Early Years

Development and Childcare Partnerships

(EYDCPs). In order to be in line with the

LEAs' central offer of training to all members

of the EYDCPs, we were faced with the

prospect of offering training to over 200

childcare settings - a huge increase on the 18

we had so far targeted.

The potential to increase our profile and

impact on staff interaction styles in a wide

range of non-maintained settings was very

exciting, but presented us with a range of

challenges:

� a huge increase in the number of

childcare settings we could now

potentially target for training

� many staff have little or no experience of

speech and language therapy

� staff are often not familiar with the

principles of PCI

� private nurseries do not have inset days

designated for training

To meet this challenge we developed a one-

day training programme that can be offered

centrally or to individual nurseries. It

encompasses both theory and practical in an

accessible way for child care staff. As a pre-

requisite to the training day, we ask each staff

member to bring a video of themselves

playing with a child that they are willing to

show to their peers.

The day's programme is as follows:

� introduction/expectations

� overview of common speech and

language difficulties

� facts and myths about speech and

language development

� principles of ACI with video examples

� video analysis in small groups - using the

ACI tally count (ACT!)

� aims and objective setting

� play ideas

� evaluation/questions

The most innovative aspect of this session is

the use of an adapted self-rating scale, known

as ACT! This was devised because the original

parent/carer self-rating scale (SRS)

(Cummins and Hulme, 1997) can take up to

30 minutes to explain to adults.

The SRS was devised and is used within

Islington's early years SLT service as a

discussion document for parents and SLTs

analysing parents' interactions with children

with complex language disorders. It was

considered to be too cumbersome and

detailed to use in a single day training

session.

ACT! is a simple and practical tool that is

accessible enough for staff to effectively and

independently analyse their own skills in

relation to their interaction with a child. It

looks at the adult's balance between

initiating/directing, and responding/

reinforcing (see table one). We know children

with language disorders need more practice

but, in reality, often receive less in childcare

settings where staff are more directive, use

more complex language and provide fewer

contingent models (Girolametto and

Weitzman, 2002). In this context developing

these skills continues to be a priority.

Tally counting enables staff to make

independent judgements about their

interaction strengths and weaknesses in

relation to a particular child, without the

need for extensive explanations of

terminology.

On the training day the staff analyse their

videos in small groups without the SLT being

part of their group. Since many of the staff

have little or no experience of speech and

language therapy and PCI, we wanted to

make the video analysis as unthreatening as

possible. The SLT is available for support and

guidance, and to answer questions, but we

encourage staff to work together and support

each other.

During the practical session the staff are

given the following instructions to complete

their copy of ACT! When the group

reconvenes, they are asked to identify one

target for developing their own interaction.

We initially trialled the programme in one

private nursery and have since run it in

several of the local children's centres and LEA

nurseries, with great success. It has become

Sarah Hulme discusses a pilot scheme offering innovative training for childcarestaff using a simple self-rating tool

012-013 22/11/05 4:44 pm Page 2


an integral part of the care package for

nursery key-workers of children attending

our pre-school language unit in Islington and

is part of the core training offered to Sure

Start local programmes and children's

centres.

We are seeking funding to help us to

analyse the initial and post-training videos

made. However, initial analysis is very

positive. At initial video, most staff were very

directive with the children, as shown in the

samples (table two). This is reflected by the

research, which suggests that larger groups of

children receive language input that expresses

management functions concerned with group

safety or task compliance, as opposed to the

more responsive language input that we

would like children to receive (Palermus, 1996).

On follow-up, three months after the

training session, staff who were very directive

featureTRAINING CHILDCARE STAFF

at the initial training session had reduced

their use of questions and directions, allowing

the children more time to initiate.

All video analysis was carried out on three-

minute samples of video.

Interestingly, the staff 's use of comments,

praise and repetition remained stable. This

indicates they were allowing more silence at

follow-up, but would benefit from further

input to increase their use of facilitative

language in response to the child.

In response to this finding we have added a

follow up half-day session, which gives the

trainers the opportunity to discuss and advise

on the type of more facilitative strategies that

staff might use in place of the directives they

have discontinued.

In the feedback, all of the staff identifiedSarah Hulme – Principal SLT, early yearsservice, Hunter Street Health Centre,Londonemail: [email protected]

References:Cummins K, Hulme S.Video – a reflective tool. Speech andLanguage Therapy in Practice, Autumn 1997; 4-7.Girolametto L,Weitzman E. Language facilitation inchildcare settings: a social interactionist perspective.Enhancing caregiver language facilitation in childcaresettings. Hanen Centre Publication. Proceedings fromsymposium, 18 October, 2002.Palermus K. Child-caregiver ratios in daycare centregroups: impact on verbal interactions. Early ChildDevelopment and Care 1996; 118, 45-57.Parker A, Cummins K. A service resource – new venturesin group placements for students. Speech and LanguageTherapy in Practice,Winter 1997; 13-15.

Acknowledgements:Thanks to Busy Bees Nursery, Perivale, for taking part inthe pilot, and to Deirdra Leahy, specialist SLT, IslingtonPCT, for the video analysis.

table one: ACT! ACI tally count

ACT! looks at the adult's balance between initiating/directing and responding/reinforcing

the practical session and usefulness of theory

as excellent or very good, and all have stated

that it was highly relevant to their workplace.

Staff comments about what they had learnt

from the day include, “... that silence is very

important in encouraging children to talk,”

and “... that not asking so many questions and

sitting back and observing encourages the

child's speech.”

All staff said they would recommend the

course to other nursery staff, and one stated,

“It was a brilliant course!”

In summary, ACT! is a simple, effective

tool for use in a combined theory/practical

day training session. A follow-up session would

be helpful to further develop staff skills.

Asking questions Directing child/ Repeat or copy Say something suggestions child/praise child about what child

is doing

Number of times

Instructions given to staffIn your small group please watch your video twice1. The first time observe your general impressions.2. The second time count the number of times you use

each of the following types of utterance:• asking questions• directing the child/making suggestions• repeating what the child says/copying the

child/praising the child• saying something about what the child is doing

Count up your scores, and with the help of yourcolleagues decide:• what would you do more of next time?• what would you try to do less of next time?

table two: sample showing staff intervention in the trainingsession and the follow-up video

Staff A Staff B Staff C

training follow-up training follow-up training follow-upsession video session video session video

number of questions asked 61 11 26 3 32 13

number of directions or commands used 5 0 10 2 9 3

012-013 22/11/05 4:45 pm Page 3

London

The RCSLT held its diamond jubilee

celebrations at the Scotland Office on 10

October. At the event, RCSLT President Sir

George Cox gave out this year's honours,

fellowships and special achievement awards,

including the Diamond Jubilee SLT and

Assistant of the Year Awards. The evening was

also an opportunity for SLTs, assistants,

RCSLT council members and officers to meet

politicians and civil servants from health and

education across the four UK countries.


feature SPEECH AND LANGUAGE THERAPY WEEK

Guernsey

Guernsey SLTs were the main topic of press,

radio and TV coverage during Speech and

Language Therapy Week.

According to department head Barbara

Evans, the Guernsey public were,

“bombarded with coverage about

communication impairment and how to

help… that's great for our patients and also

for the profession as well”.

During the week, the speech and language

therapy department opened its doors to

many different age groups. Individuals with

communication problems attended a

consultation event aimed at raising awareness

of how people can help to break down

communication barriers.

Local secondary school students also

undertook Breaking down the barriers to

communication workshops, and pre-schoolers

and their parents were treated to a party,

including a bouncy castle and language-based

games.

Health Minister Peter Roffey opened the

new department at the Princess Elizabeth

Hospital on 11 October.

Northern Ireland

Therapists and support workers across

Northern Ireland took part in Speech and

Language Therapy Week events in hospitals,

schools, shopping centres and many other

public places across the Province.

For example, Craigavon and Banbridge

Community HSS Trust hosted a speech and

language therapy exhibition in Craigavon

Civic Centre; St Gerard's Educational

Resource Centre opened its new speech and

language therapy suite, and Patricia McKenna

at the Clogher Valley Sure Start team ran a

Snappy sounds music and rhyme workshop.

Among the VIP visits planned during the

week, George Russell, assistant director at the

Department of Health, Social Services and

Public Safety, met SLTs at Homefirst

Community Trust. Writing to RCSLT

Speech and LanguageTherapy Week 2005Thank you to the many RCSLT members who requested and used their Speech and LanguageTherapy Week packs and information literature. From the responses we've had, you clearlyenjoyed taking part in the activities you put together and feel that the week was veryworthwhile. Here, we look back at the events of Speech and Language Therapy Week, 10-14October 2005, using your images

The 2005 award winners at the RCSLT diamondjubilee event in London on 10 October

Phot

o:G

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RCSLT vice president Baroness Michie with chairProfessor Sue Roulstone

Phot

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Barbara Evans gives instructions on how to play alanguage-based game

Phot

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Pres

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SLT Michelle Habgood shows students some of hervisual aids

Phot

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14-16 22/11/05 4:46 pm Page 2


Northern Ireland Policy Officer Alison

McCullough after the event, George said, “I

gained a valuable insight into the work of

SLTs in school settings, which is beneficial for

my own work in this area of learning

disability.”

Clare McGartland, Western Health and

Social Services Board Allied Health

Professions Commissioning Officer, visited

the Royal Belfast Hospital to see its cleft

palate services and videofluoroscopy clinic.

After the event she commented, “I found the

day very worthwhile and indeed, learned a

lot. I know that the insight gained will help

me in my role of AHP commissioner.”

Llandough Hospital

The Llandough Hospital adult speech and

language therapy department ran an excellent

campaign during the week. Department

members threw a party for their past and

present clients to acknowledge their hard

work in making “our jobs easier through your

determination and enthusiasm”.

They also organised information boards

with members of the paediatric team in the

hospital front entrance, day centre, canteen

and stroke rehabilitation unit. An observer's

day on 7 October provided an opportunity to

discuss the role of SLTs with people

interested in the profession as a

career.

During the week, the Welsh

Assembly Government's

Dominic Worsey (from the

Department of Healthcare

Standards, Quality Standards

and Safety Improvement

Directorate) spent a

morning shadowing SLT

Claire Helme on the wards. As a result of

his visit, Dominic wrote an article for his

directorate bulletin. In this he acknowledges

that, “my visit will certainly stay with me for

a long time and I won't forget the staff and

patients that I met and the warmth with

which they welcomed me.”

Bexhill and Rother PCT

Bexhill and Rother PCT paediatric speech

and language therapy team decided to

concentrate on making the public more

aware of Makaton signs and symbols during

their Speech and Language Therapy Week.

They organised a host of events, including

a special session at the Arthur Blackman

Clinic, where senior specialist SLT Sarah

Norman runs a baby signing group.

A sponsored Makaton sing/sign-along

fundraising event involving teachers and SLTs

from Torfield School, supported children in a

Gambian school. Children collected

sponsorship for learning the signs and songs.

The team also transformed the paediatric

speech and language therapy department at

Eversfield Centre with a large display

featuring information on baby signing and

speech and language therapy, and ran

activities for children.

The week also coincided with the launch of

the team's new Makaton Users Group

(MUGS), which offers parents a forum to

exchange ideas, practice signs and learn new

ones. The team plans to build up a lending

library of Makaton resources in the near

future.

Airdrie Health Centre

The speech and language therapy team at

Airdrie Health Centre in North Lanarkshire

raised awareness of their work by setting up

display boards at clinics in Adam Avenue,

featureSPEECH AND LANGUAGE THERAPY WEEK

Northern Ireland Policy Officer Alison McCullough(centre front) with the St Gerard’s team

Orla Connolly (right) and Carol Hunterat the dysphasia awareness day

SLT Megan Hide welcomes guests to the Llandough party

Gerald (client and guest at the party) draws thelottery winner

Mums and babies at a Makaton signing session

Phot

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and

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14-16 24/11/05 3:26 pm Page 3


feature SPEECH AND LANGUAGE THERAPY WEEK

Airdrie Health Centre and Monklands

Hospital.

Alison Tait, SLT, said “The purpose of the

week was to highlight the work we do and

give people the chance to get information on

the services provided in the area. We were

also keen to promote speech and language

therapy as a career path.”

They succeeded getting a news story and

photograph in their local paper, the

Coatbridge and Airdrie Advertiser, which lead

to positive feedback from the public, as well

as coverage in the North Lanarkshire NHS

magazine, the Pulse.

North Devon NHSPCT

Staff at the North Devon NHS PCT

organised an open day event for the week at

Barnstaple Health Centre. Angela Grant, head

of speech and language therapy said, “The

As well as having stalls in St Peter's

Hospital and Ashford Hospital foyers, they

manned a stand at the Brooklands Shopping

Centre to catch unsuspecting shoppers. The

stalls featured events with AAC company

representatives demonstrating products from

Toby Churchill Ltd and Possum Ltd.

They succeeded in getting an article and

photographs in the Surrey Herald, featuring

the work of SLT Debbie Thomas from St

Peter's Hospital with a dysphagia client. The

Eagle radio station interviewed Ashford

Hospital SLT Afshan Siddique and Nicola

Murray SLT appeared on the BBC's Southern

Counties radio breakfast show.

The department also gave out RCSLT A

career in speech and language therapy leaflets,

information on paediatrics, stammering and

voice services leaflets, and speech and

language therapy department information.

Staff also got the public to fill out a mini-quiz

to learn more about speech and language

therapy.

Staff considered that their hard work on

the week paid off, as they feel they have

demystified some of the myths the public

have about speech and language therapy and

noticed an increased level of enquiries to

their service. They also think the events

helped to raise team moral.

open day is a good opportunity for the public

to meet members of the team, ask questions

and find out if we can help.”

The event included a drop-in session with

senior SLTs Annarella Prime and Erica

Sturdy. The team also set up a stand at the

North Devon library in Barnstaple, featuring

RCSLT balloons and provided information

leaflets on speech and language therapy to the

public.

Ashford and StPeter's NHS Trust &

North Surrey PCT

The speech and language therapy department

at Ashford and St Peter's NHS Trust and

North Surrey PCT decided to head out into

their local community to promote speech and

language therapy during the week and to

raise awareness of stroke and related disorders.

SLTs from the paediatric team in Airdrie with their display

Phot

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Ad

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Annarella Prime and Erica Sturdy, senior SLTs atBarnstaple Health Centre

SLTs on the stand at the St Peter's Hospitalpostgraduate centre

£500 Speech andLanguage TherapyWeek competitionSome of you have commented that

you didn’t have time to collate allyour media clips before the 1

November deadline.

We’re pleased to say that we’veextended the closing date to 10

December.

Send your entries to: Speech andLanguage Therapy Week

competition, 2 White Hart Yard,London SE1 1NX.

14-16 22/11/05 4:47 pm Page 4


Prioritising clinicalvoice disorders

Voice specialists, in common with SLTs

working in other clinical fields, are under

growing pressure to assess and treat ever-

increasing numbers of patients.

The profession is successfully developing

its assessment and diagnostic role both in

multidisciplinary and in SLT-led parallel

voice clinics.

This, together with other health service

pressures, may lead to resource implications

for patients who require ongoing therapy.

Resource pressures, in turn, may force

many clinicians to consider prioritising their

patients. But what criteria do they use to

make these judgements, and on what

evidence do they base their decisions?

Voice disorders are complex and reports

show patients vary widely in how their voice

problems affect their quality of life, including

social, emotional, work and lifestyle issues

(Scott et al, 1997; Wilson et al, 2002).

Many clinicians have found discrepancies

between how severely dysphonic a patient's

voice may sound in the clinic and how it is

affecting them on a day-to-day basis.

Patients with severe dysphonia owing to

laryngeal cancer may view their voice quality

as secondary to curing the disease.

A professional singer with a normal

speaking voice, however, may worry more

about losing part of their singing range as it

could affect his/her career.

Clinicians routinely use perceptual

evaluation, patient self-report scales, case

history information and laryngeal

examination to inform diagnosis and

management decisions and therapy planning.

These tools are also used to gain baseline

measures and outcome information.

The most common formal perceptual

analyses used in the UK are the Grade,

Roughness, Breathiness, Asthenia, Strain

(GRBAS) scale (Hirano, 1981) and the Vocal

Profile Analysis (VPA) scheme (Laver, 1980).

Patients' self-report scales include the Voice

Handicap Index (Jacobson et al, 1997), Voice-

Related Quality of Life Scale (Hogikyan et al,

1999) and the Voice Symptom Scale (VoiSS)

(Deary et al, 2003), all of which have been

validated and used in research. Some

clinicians also use their own informal

assessments.

However, there may be inherent problems

with both types of assessments. They often

only reflect how the patient presents on the

day of clinic attendance, which may not be

truly representative of the patient's voice

disorder.

Studies (Jacobson et al, 1997; Speyer et al,

2004; Murry et al, 2004) indicate that there is

a moderate relationship between clinicians'

rating of voice quality on a perceptual scale,

patients' self-rating of voice quality and

patient self-report quality-of-life scales.

None of these studies addresses consistency

of the voice from day to day or week to week,

yet this is a common problem in voice

disorders. It may affect quality of life and

possibly motivation for therapy.

As clinicians dealing with substantial

caseloads, should we use the information

from perceptual analysis and patient self-

report scales to aid our prioritisation

decisions? And, if so, how?

Patients are commonly seen strictly in

order of referral, but should they perhaps be

prioritised according to who has the 'greater

need'?

Prioritisation could be based on the

severity of dysphonia, how it affects their

quality of life or a combination of both.

This would require the same measures to

be taken routinely at the first assessment so

patients' responses can be compared.

Consistency would also be of value.

This might help clinicians prioritise

caseloads where the resource pressures

cannot be met and where prioritisation

methods need to be based, as far as possible,

on objective data.

Sue Jones discusses issues of prioritisation around the management of a clinicalvoice disorders caseload

featureCLINICAL VOICE DISORDERS

Sue Jones – Head of SLT ServicesWythenshawe Hospital, Manchester email: [email protected]

References:Deary I, et al.VoiSS: a patient derived symptom scale.Journal of Psychosomatic Research 2003; 54: 483-489.Hirano M. Clinical Examination of Voice. (1st Ed.) Springer-Verlag, 1981.Hogikyan N, Sethuraman G.Validation of an instrument tomeasure voice-related quality of life (V-RQOL). Journal ofVoice 1999; 13: 557-569.Jacobson B, et al.The Voice Handicap Index (VHI):development and validation. American Journal of Speech-Language Pathology 1997; 6(3): 66-70.Laver J. The Phonetic Description of Voice Quality.TheCambridge University Press, 1980.Murry T, et al.The relationship between ratings of voicequality and quality of life measures. Journal of Voice2004;18(2):183-192.Scott S, et al. Patient-reported problems associated withdysphonia. Clinical Otolaryngology 1997; 22: 37-40.Speyer R,Wieneke G, Dejonckere P. Self-assessment of voicetherapy for chronic dysphonia. Clinical Otolaryngology2004; 29:66-74.Wilson I, et al.The quality of life impact of dysphonia.Clinical Otolaryngology 2002; 27, 179-182.

017 22/11/05 4:47 pm Page 3


feature COLLABORATIVE WORKING

But we can’t do that...

Burnley's former Calder View Community

(now Holly Grove) School catered for

children with moderate learning difficulties

(MLD). The school had primary and

secondary departments on one site. In 2003

we found ourselves, like many of our

colleagues, sinking under an increasing

speech and language therapy caseload. Over

seven years, the SLT caseload had doubled to

90 children and their language needs had

become more specific and complex.

We spent most of our time on annual

review assessments and reports. The school

had only eight sessions of speech and

language therapy input, and the funding for

an SLT assistant, who was previously carrying

out therapy, had stopped. She had been

seeing up to 18 children a week, under our

management.

We put various strategies into place to try

and manage the caseload. This included

giving practical ideas to classroom staff, ideas

at annual review to integrate specific aims

into class activities, training for teaching

assistants (TAs), signing and symbol training,

and the discharge of children whose language

was in line with other skills and could be

managed in the classroom (11 children were

discharged during the previous year).

Although we did see some children for

therapy, the waiting list was increasing and

despite our efforts we felt we were not

meeting children's specific needs.

Traditionally, many SLTs deliver therapy in

groups according to language aims. There are

several drawbacks to SLTs-only running

groups. For example, withdrawing children

from mainstream classes reinforces the

perception that only SLTs can deliver therapy,

it can stop children from accessing a valuable

lesson, and it is not collaborative working.

We felt we could continue to assess,

formulate aims and offer strategies, but could

also train others to deliver the input. For

example we could:

� use the skills of experienced TAs who had

delivered speech and language therapy

programmes or helped in groups

� timetable the primary department to run

language groups at the same time so no

lessons were missed

� allocate children to groups based on

language targets from their annual review

– not on age

� train all primary department staff to run

the groups

These strategies would empower teaching

staff, and make them more aware of language

difficulties and specific strategies. We would

also be complying with government advice, as

government literature strongly advises

working with other agencies (Every Child

Matters, 2003; The National Service

Framework for Children, 2004).

We discussed our ideas with the head

teacher who supported the principle of

language groups. There was initial resistance

at taking children out of their peer groups.

Class one was already running streamed

language groups two-three times a week and

we felt this to be appropriate. The rest of the

primary school, however, was to participate.

We faced many problems: room and staff

availability, training, attitudes to the role of

the SLT and the teacher regarding language

stimulation, timetabling, allocation to groups

according to annual review aims, number and

size of groups, allocation of children not on

caseloads, and resources. We tackled and

overcame each problem.

We proposed that 45 children be allocated

to one of seven groups. Two of the groups

would focus on different areas of grammar

and two on semantics. One group would

focus on social skills and verbal reasoning,

one on sounds and another on listening

skills. Two members of staff, either a teacher

and a TA or two more experienced TAs,

would run each group.

We presented the proposal at a school staff

meeting. Staff gave feedback on the

groupings, and made suggestions, such as

which children should not sit together. We

gave each group a resource box, with the aims

written on each box, and demonstrated

activities. We also identified equipment that

would benefit the groups. This was funded at

the start of the next financial year, with the

school buying over £300 worth of equipment.

The groups ran from October 2003 until

June 2004, once a week in a 45-minute slot.

All groups ran simultaneously on Thursday

afternoons during the first lesson.

We supported the groups on a rotational

basis, offering demonstration, advice and

recommendations as needed.

Initially the staff were unsure of their

capabilities, but as the year progressed they

became more confident and actively sought

our advice. They were proud to demonstrate

different activities they had implemented and

the children's progress, and over time,

accepted ownership of the groups.

The general format of the groups was:

� timetable

� social rules and game to target one social

rule

� activity one, targeting one of the groups'

aims

� activity two, targeting another of the

groups' aims

� fun game to finish - targeting another

aim, eg marble run

We audited the effectiveness of these groups

by giving questionnaires to 14 staff and 45

children.

Of the nine staff (64%) who responded, all

thought the language groups were a useful

addition. Typical comments included,

“Targets are specific to each child”; “Children

have a chance to talk, gives lower ability

children chance to shine; progress is easier to

assess” and “A chance to use my knowledge

and qualification as a nursery nurse”.

All respondents thought the language

Collaboration with teachers on language groups for children with moderatelearning difficulties has had positive results for staff and pupils. Mary Riley andLaura Broadstock report

018-019 22/11/05 4:48 pm Page 2


groups should continue. Additional

comments were all positive reflecting the

staff 's enjoyment of running groups and

teamwork. Some simply said, “Thank you”.

The comments from the acting head are

shown in the box above.

Improvements suggested included more

training for staff who need it; demonstration

of equipment and resources; more on-site

speech and language therapy; more help for

children with complex needs; and a formal

plan sheet in education format.

The children's questionnaires were in

pictorial format. We received 41 children's

questionnaires (33 children were on the

caseload and eight were not). Twenty-six

children (79%) on the SLT caseload said they

liked their language group; 29 (88%) of these

rating the groups from 'great' to 'OK'. Half of

children not on the caseload found the group

boring - perhaps indicating that the groups

were not meeting their needs. Most of the

children liked the games best, not realising

they were linked to language targets.

Several changes were suggested after the

audit (see table one).

Our job satisfaction has increased by

working in this way. We all value the teachers'

role and they have seen children's language

skills improve.

There has been carryover of strategies used

in the groups to the classroom. The teachers

and TAs are more aware of the complexities

featureCOLLABORATIVE WORKING

of language and how to target specific aims.

Working together has also increased our

profile.

Our school has suggested introducing

language groups in the secondary

department. We feel that by working together

mainstream settings could also benefit.

At annual review there has been a marked

increase in children achieving their targets,

directly linked to the group they were in. For

example, one child in the grammar group

improved by 18 months on his grammar

score in a 12-month period.

True collaboration only works through true

commitment from both the school and

speech and language therapy service. We, as a

schools team, aim to investigate this approach

in different settings.

Mary Riley, specialist SLTLaura Broadstock, SLTHolly Grove School, Burnley, Pendle andRossendale PCT email: [email protected]

References:Department for Education and Skills. Every Child Matters.DfES Green Paper (CM 5860), 2003.Department for Education and Skills. National ServiceFramework for Children, Young People and MaternityServices. DfES, December 2004.

Note:Calder View School no longer exists. Children with MLD, SLDand physical difficulties from three schools now attend twogeneric learning difficulty schools. One is for primarychildren, the other for secondary.We will let the languagegroups settle in and plan for 2006 to take in the children'swider communication difficulties. Staff appear to be keento do this.

Strategies aimed to empower teaching staff and make them more aware of language difficultiesand specific strategies

suggestions actions

to continue language groups these have been running all year and continue to be successful

to offer further training general training and individual sessions for staff of each group, plus equipment resource-sharing session

to review timetabling changed to first session in the afternoonbut we face continuing problems with number of rooms available

SLTs to advise on rotation (every six weeks) achieved and advice is given on request

school to review the needs of those not on SLT caseload

to create a resource file with aims and higher level activities now in their activities groups

to re-audit to be arranged this academic year

Jackie Poxon, acting head teacherstated:“The SLTs used their knowledge of thepupils on their caseload to designprogrammes based on their needs withclearly defined targets.The impact of the groups has been

clearly visible. Targets were met, moreresources were requested and ideasflowed.It was noted that on summative

assessments (eg British PictureVocabulary Scale) a high proportion ofthe pupils had raised scores, some ofover a year.The structure and focus of the groups,

together with the staffing and supportfrom the SLTs led to overallimprovement in pupil performance,both in formal assessments andgenerally across a wider range ofcurriculum areas.” table one: changes suggested after audit

018-019 22/11/05 4:48 pm Page 3


profess ional i ssues

Although CPD has been an aspect of speech

and language therapy professional practice

for many years, there is now a greater level of

external interest and scrutiny. The Health

Professions Council (HPC) has introduced

CPD requirements for re-registration for

SLTs, and the NHS has brought in the

Knowledge Skills Framework (KSF),

making an explicit link between CPD

and career progression. These

developments mean SLTs and support

workers will be required to keep more,

and different, records of their CPD

activities.

The RCSLT's role in CPD is to

enhance professional practice. It must

make its systems fit for purpose by

providing appropriate tools to support

members in maintaining their CPD. The

new RCSLT CPD scheme will provide the

mechanism for maintaining HPC registration

and professional certification at the same

time.

The new scheme, which comes into effect

in April 2006, will replace the current RCSLT

log. It includes a revised set of CPD standards

(see table one); an online CPD diary,

allowing members to record their ongoing

CPD activities and receive regular updates on

relevant courses; and a CPD toolkit

containing guidance and formats for

undertaking a range of CPD activities.

Certified RCSLT membership equates to

full, practising members who have agreed to

meet the RCSLT standards on professional

conduct and CPD. All practising UK

therapists must comply with this, and

Streamlining CPDprocesses for SLTs

overseas therapists can opt in, if appropriate.

Support workers are not required to adhere

to the standards, but choosing to do so will

contribute to their professional development.

The new approach is as relevant to support

workers as it is to qualified therapists.

The CPD online diaryThis is a simple electronic way of recording

your ongoing CPD activities and reflections

on learning. Accessed via the RCSLT website

(see figure one), the diary will provide the

mechanism for recording compliance with

the standards and enable the RCSLT to audit

your CPD records. It will make the need for

the log and a counter signature on renewal

forms redundant and will ultimately lead to

online membership renewal.

The system aims to align the RCSLT

requirements with the HPC's and the KSF

and to minimise paperwork. It uses HPC

CPD categories, so you will be able to see

what your range of CPD activities looks like

in relation to these. You will also be able to

collate and print out reflective commentaries

on each activity, cut and paste them into a

word document and reference your CPD

activities to KSF dimensions and levels, if

required.

The diary will be able to send you email

alerts on short courses relevant to your

location and clinical interest, provide a forum

for discussion on CPD matters and generate

reports on all CPD activities. Data will be

backed up every 15 minutes and stored on a

secure computer server, so there will be

minimal risk of your records being lost.

A paper-based version of the CPD record

will be available for those who do not have

access to the online system.

The CPD 'portfolio of evidence'In addition to recording CPD activity in the

online diary, the new scheme requires

members to keep a CPD 'portfolio of

evidence'. This must include an annual

personal development plan (PDP), and

evidence of your CPD activity during the

year. It must also include a range of different

CPD activities (eg peer review, significant

event analysis, audit, etc). It can include all

forms of CPD evidence accepted by the HPC

(see table one in November's Bulletin article,

p21).

The RCSLT has produced a toolkit,

containing guidance and forms on work-

based CPD activities, to help you. In addition

to a PDP template, the toolkit includes

sections on undertaking peer review,

reflective writing, significant event analysis,

In November's Bulletin (pp 20-21) Anna van der Gaag outlined how the HPC's newrules on continuing professional development (CPD) will affect SLTs. This monthAnna and Sharon Woolf, describe the RCSLT's revised standards on CPD and itsplans for supporting members with the broader range of CPD activities theregulator now requires

Figure one. The

RCSLT's CPD online diary page

020-021 22/11/05 4:49 pm Page 22

Anna van der Gaag is consultant to the

RCSLT CPD Project and an HPC Council

Member. She was on the HPC's CPD

Professional Liaison Group, 2003-2004.

Sharon Woolf is the RCSLT's new Head

of Professional Development.


profess ional i ssues

mentoring and audit. All members must

complete a PDP annually using either the

RCSLT form or a locally devised template.

RCSLT audit of CPDThe RCSLT will begin random audits of the

online diary from April 2007. The audit will

look at the amount and range of CPD, as well

as records of the impact of learning. Requests

for evidence of CPD activities from your

portfolio may be sought if the diary has a

shortfall in activity. The RCSLT will support

members who are not meeting RCSLT and

HPC requirements, and help get them on

track before the HPC audit starts via the

diary, email alerts and feedback from audits.

Complying with the standards� You must meet the RCSLT standards to

maintain certification status as a full

practising member

� If you do not meet the standards, this

may affect your ability to re-certify.

Falsification of information, or a lack of

evidence of CPD activity, will be subject

to scrutiny by the RCSLT

� If the standards are not met, you will be

given feedback and support, and a further

year before being re-assessed. If you are

still not meeting the standards, you will

not be able to continue as a certified

RCSLT member.

The new scheme aims to minimise

Standard 1: Amount of CPD Undertake a minimum of 30 hours CPD per year (for full-time SLTs) (excluding mandatory training)

Standard 2: Type of CPD Undertake a mix of CPD activities (work-based, formal, self directed, professional activity)

Standard 3: Record of CPD Maintain an up-to-date record and 'portfolio' of activitiesactivities

Standard 4: Reflective account Maintain an up-to-date record of the outcome of of impact of CPD learning (impact on practice)

Standards 2, 3 and 4 mirror the HPC's CPD standards. The RCSLT's Standard 1 shows the minimumamount of CPD required. Information on requirements for part-time and extended leave cases isdetailed above

What type of evidence should be in your portfolio?

CPD activity Purpose/example Number of Type of evidence kept in your CPD portfoliohours 2006/7

Attendance at a lecture or Update on new research in a clinical area 3 Certificate of attendance, course evaluation, reflection onseminar impact of learning in diary

Peer review or significant To review a challenging clinical case 2 Peer review or significant event analysis recordevent analysis

Presentation at a specific Present to colleagues on a new 4 Copy of programme with evidence of your interest group approach to therapy presentation

Developing a new service Improve communication between 4 Service protocol and reflection on your contributionprotocol team members

Review of paper Review paper on a specialist clinical area 4 Letter of invitation to review

Poster presentation at Present findings from a case study 5 Letter of acceptance for posterconference

Attendance at committee* Planning for a local AHP conference 4 Minutes of meetings showing record of attendancemeeting

Audit activity Reviewing waiting times in my clinic 4 Audit record form, minutes of meetings

e-learning module Update knowledge on disability 1 Certificate of completiondiscrimination legislation

Postgraduate degree course Gain higher qualification/undertake Accounts for Degree certificate, evidence of module completionresearch total hours

There will be exemptions and pro rata arrangements in place from the start of the new scheme forpart-time workers and those on extended leave.

For exemptions on RCSLT Standard 1 (see table one), part-time workers employed for fivesessions or less will only need to complete 15 hours per year (50%) of the total CPD requirement.

For those on extended leave, if you are working less than six months in a year, you will need tocomplete a minimum of 10 hours of CPD per year. If you take leave for six to 12 months, you willneed to complete a minimum of five hours per year (eg reading, e-learning). If you are on extendedleave you will be exempt from the audit during the year in which your leave occurs. The onlinediary allows you to log periods of extended leave at any time.

Those in full-time study (eg MSc or PhD) can claim exemption from Standard 2 (see table one)within a specified period. You must inform the RCSLT of your studies via the online diary and let usknow once the study ends. This will then be flagged-up if you are selected for the audit process.Other exemptions will be agreed on an individual basis.

paperwork and maximise the efficiency of

recording CPD for the RCSLT, the HPC and

the KSF. It will require a major shift in the

way CPD is recorded, but is designed to make

it easier for you to maintain both your

RCSLT certification and your HPC

registration.

*Committee meetings need to contribute to your development - if there is no significant new learning as a consequence of attending, you cannot credit the meeting in the CPD scheme

Table one: RCSLT CPD standards from April 2006

Part-time and extended leave requirements

020-021 24/11/05 3:24 pm Page 23


book reviews

B O O K O F T H E M O N T H

Book ReviewsSpeaking for Myself PLUS! Earlyyears software for developingcommunication, cognitive andreading skillsTOPOLOGIKA SOFTWARE LTD, 2004Single-user licence £39;five-user licence £79;home-user licence £17(ex-VAT)

This software package isworth exploring,particularly forchildren who respondpositively to signing. Signing support isprovided for individual words, shortsentences and some nursery rhymes – greatfor extending parents' and staff 's signing.

The package provides a good range ofinteractive activities targeting basic wordmeaning, listening, comprehension, simplesentence construction and early literacy.These are presented in easy-to-navigatescreens, colourful, but not too busy. Thespeech is very clear, and delivered by bothadult male and female voices.

The signing appears in an overlaid window,presented by an adult actor and accompaniedby speech. The CD also provides resourcesfor printing out material from the

programme.The manual is excellent and includes

simple but sensible suggestions for usersunfamiliar with 'the teaching of reading andthe links between reading and spokenlanguage'.

We recommend this inexpensive package,especially for young signing children ininclusive educational settings and also forclasses in schools and units for children withadditional support needs. Interested parentswill welcome the cheaper version for homeuse.

JENNIFER REID, JANE DONNELLY

SLTs NHS Fife

Motor Speech Disorders, 2ndedition – Substrates, DifferentialDiagnosis and ManagementJOSEPH R DUFFYMosby, 2005 £31.99ISBN 0-32302-452-1

This is an expanded andupdated version of thehighly respected firstedition. As before, it coversin fine detail the neurological andpathological layers of different motor speech

disorders, their recognition and differentialdiagnosis.

The authors have revised sections to reflectdevelopments of the past decade. Newillustrations, diagrams and tables support thetext, and the authors have addedrepresentative clinical case summaries to eachof the main disorder chapters.

Hailing from the Mayo Clinic, the bookretains a strongly medical model bias. Itsstrength lies in the exhaustive detail of theneuropathological underpinnings of thedysarthrias and apraxia of speech, andreference to perceptual and acoustic studiesof these conditions.

It is one of few works to deal with thehyperkinetic and rarer forms of motor speechdisturbance, and contains probably the mostthorough consideration of psychogenicspeech disturbances in the general literature.

Extensive citing of sources makes this afirst-class reference work. Some readers maybe disappointed that only about 115 of the578 pages are directly devoted tomanagement. Nevertheless, this is more thanin most books.

The price represents astonishingly goodvalue for a hardback work of this size.

NICK MILLER

RCSLT adviser – motor speech disorders

Speech language sciences, University of Newcastle

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People with Autism Behaving BadlyJOHN CLEMENTS Jessica Kingsley, 2005 £13.95 ISBN 1-84310-765-1

The author has many years' practical experience of working with people with autism whose behaviours

are of concern. However, there are other ample reasons for reading this book.

It is not primarily for professionals, but is designed carefully for parents and carers. Its construction and

content are interesting, and various ways of using the book are outlined at the beginning.

The book encourages parents to carry out specific exercises enabling them to look at their child's

problem behaviour objectively. It also helps them to take a professional's viewpoint and apply it to their

child.

The author's clear perspective on why behaviours might occur is refreshing and straightforward. Parents

sometimes 'can't see the wood for the trees' when it comes to their child's behaviour. Clements' explanations are illuminating in an area

often fraught with emotion. He then supplies a range of tried and trusted strategies to address the problem behaviour.

Clements introduces excellent 'think pieces' on the topics of medication and relationship styles, and the appendices include useful

checklists.

This is a sound and innovative book for parents but it also has much to interest SLTs.

JANE NEIL-MACLACHLANAdult autism coordinator, RCSLT adviser


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book reviews


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Assessment and Intervention inAphasia – A Clinician's Guide ANNE WHITWORTH, JANETWEBSTER, DAVID HOWARDPsychology Press, 2005 £29.95ISBN 1-84169-345-6

This book provides abridge between theoryand practice in theunderstanding and management of aphasiclanguage impairment.

The first section examines the theory andprinciples of a cognitive neuropsychologicalapproach. The second illustrates how themodel described can be used to identify thenature of impaired and retained single word(but not sentence) processing. The finalsection considers the therapy literature.

This is not a dry, exhaustive literaturereview of research. The authors havetranslated key studies into a format that busyclinicians will be able to absorb and use. Iwill definitely use it to help my own clinicaldecision making.

Case studies illustrate deficit patterns. Thetreatment studies are systematic and detailedenough to allow the clinician to replicatethem.

The authors raise issues about how andwhy therapies work. They argue persuasivelythat there is no contradiction betweenfunctional, social aims, and therapy directedat reducing impairments. They advocate thatthe cognitive neuropsychological approachshould not be used in isolation and mustinvolve the person with aphasia.

This book is essential reading for thosewishing to familiarise themselves with theknowledge and resources to undertake acomprehensive analysis of single wordprocessing and to support evidence-basedtherapy.

SARAH ROSS

Stroke specialist SLT, Sheffield

Focus on Solutions: A HealthProfessional's GuideKIDGE BURNSWhurr, 2005ISBN 1-86156-479-1£17.50

The book has a readable style with plenty ofreal case examples and accounts oftherapist/client dialogue. Although the theory

is well covered, the general tone is verypractical. There are 'key points' boxes atregular intervals in the text to help the readerassimilate information.

Although the author explains that SolutionFocused Brief Therapy (SFBT) can be used ina range of healthcare and non-healthcaresettings, most examples are from an adultspeech and language therapy caseload.

In a well-referenced first chapter, theauthor outlines how SFBT has evolved andincludes several theoretical approaches. Insubsequent chapters she demonstratessuccessful use of the approach with, amongothers, stammering, dysphasic andParkinson's clients in individual, group,domiciliary and acute settings. The finalchapter examines audit and efficacy.

I highly recommend this book to anyonenew to SFBT, or to those who have alreadycome across the theory but would like moreconfidence in using it.

EMMA OSEI-MENSAH

Chair, SIG counselling and therapeutic skills

The Impact of Genetic HearingImpairmentDAFYDD STEPHENS, LESLEY JONES (eds)Whurr, 2005£37.50ISBN 1-86156-437-6

This book examines the social andpsychological effects of genetic deafness, andthe genetic interventions associated withthem.

The initial chapters focus on the historyand growth of genetic interventions,including the responses and attitudes of thedeaf community and hearing parents towardsuch interventions.

The authors then use the World HealthOrganisation international classification offunctioning, disability and health to examinethe impact of genetic hearing impairment.This model is used as the framework insubsequent chapters, which focus onchildhood deafness, adults of working ageand the elderly population, and the impact ofspecific conditions such as deafblindness,neurofibromatosis and otosclerosis.

The book concludes with two movingpersonal accounts about what it is like to livewith these conditions.

This thought-provoking book provides acomprehensive review of the literature on thepsychosocial aspects of deafness.

Its title, however, is somewhat misleadingwith less emphasis on genetics than Iexpected. There is simply not enoughevidence to comment on the impact ofgenetic hearing impairment alone, and theauthors had to include research on theimpact of hearing loss in general. The book,therefore, lost some of its focus.

It would appeal to those interested in thepsychosocial effects of deafness and thoseintending to undertake research.

SUZANNE HARRIGANSpecialist adviser childhood deafness

The Ear Foundation, Nottingham

VIP: Voice ImpactProfileSTEPHANIE MARTIN,MYRA LOCKHARTSpeechmark, 2005£39.95ISBN 0-86388-527-6

This evaluation tool is foruse by SLTs working with clients with voicedisorders. It offers a visual profile of specificareas that require change. It can also be usedafter therapy to reflect and reinforce visuallyany change achieved.

It includes a CD-Rom that is very easy touse and the questionnaire is printed in thebook, which can be photocopied.

The 10 sections include topics such asgeneral health, vocal history andenvironment. Each section consists of 10 yesor no questions. The yes responses areconverted to a graph and recorded on the VIPsheet. It takes approximately 15 minutes tocomplete the 100 questions, but the client canfill it in on their own to save time.

Guidelines on how to carry out thequestionnaire are included as well as sixworked examples.

The profile is not designed to be asubstitute for the normal informationgathering process but to complement datacollected from objective sources to build amore complete picture of the client.

It would be most useful to SLTs new toworking in the area of voice.

LINZI HATCHSpecialist SLT Adult neurology and voice,

North & West Belfast HSST


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let ters

We were interested to read Celia Harding's

article in Bulletin. We take issue with her

implied statement that functional nutritive

sucking skills can only be developed through

the use of finger sucking or the use of a

dummy.

Aside from the small size of the study

(seven pairs of babies) and the lack of detail

given, eg it is not possible to determine at

what gestational age the intervention was

started, it is not clear what the desired goal of

the intervention is as only “full oral feeds”

and “neonatal feeding development” is cited.

Worryingly, there is no mention of these

babies transferring to full breastfeeding. We

assume that most of the babies were bottle

fed since there is a high correlation between

dummy use and lack of success with

breastfeeding.

The author identifies there is no clear link

between intervention and outcomes. She

Functional nutritive suckingand breastfeedingBulletin received this letter in response to Celia Harding's article, Developingfunctional nutritive sucking skills in premature infants, (Bulletin, August 2005, p14-15)

Celia Harding replies:Therapists who work with neonates are

receiving increasing numbers of referrals to

assess infants who have complex feeding

needs. We believe early intervention carried

out in collaboration with parents and

significant others promotes the best

outcomes. One approach is non-nutritive

sucking using a pacifier, finger or empty

breast when preparing an infant for

positive oral experiences and oral feeding

(evidence quoted in article).

As in my study, not all mothers are able

to or want to breastfeed due to a range of

cultural, personal and/or health needs. It is

known that organisations such as the WHO

and UNCF state that use of pacifiers should

be discouraged due to the supposed adverse

effect on breastfeeding. Worryingly, this is

in conflict with the evidence base (Kramer

et al, 2001; Collins et al; 2004) that states

pacifier use has no effect on the

development of breastfeeding.

My aim was not to reduce the

importance of breastfeeding, but to reflect

on the rationale behind an established

intervention, as it is the responsibility of all

practitioners to be rigorous in

understanding the interventions we are

promoting.

References:Collins CT, Ryan P, Crowther CA, McPhee AJ, PatersonS, Hiller JE. Effect of bottles, cups, and dummies onbreastfeeding in preterm infants: a randomisedcontrolled trial. British Medical Journal 2004: 329;193-198.Kramer MS, Barr RG, Dagenais S,Yang H, Jones P,Ciofani L, Jane F. Pacifier use, early weaning, andcry/fuss behaviour: A randomized controlled trial.Journal of the American Medical Association 2001:

286; 322-6.

acknowledges that tactile feedback during

handling has an influence. Indeed, Kangaroo

Mother Care programmes have already

proven the benefits of good physiological

stability and breastfeeding outcomes for very

premature infants.

The underlying premise is that this

intervention is based on babies learning to

bottle feed. For babies who are going to

breastfeed, it is well researched that even

premature infants can develop their suckling

skills if given the opportunity, by being close

to their mother's breast as much as possible.

For instance, a premature baby lying at his

mother's softened breast while receiving a

tube feed does not show “defensive feeding

behaviours”, instead he is having a positive

feeding experience.

Babies do not “learn” to breastfeed, they

need to practise at the breast, while

continuing to receive tube and cup feeds to

help them to maintain their nutrition.

Elizabeth Mayo

International Board Certified Lactation

Consultant (IBCLC) NCT breastfeeding

counsellor, infant feeding specialist,

Cheltenham General Hospital

Co-signed by Sandra Lang (Author of Breastfeeding special

care babies); Sally Inch (infant feeding

specialist, Oxford Breastfeeding Clinic,

Oxford Radcliffe NHS Trust); Clare Meynell

(IBCLC, infant feeding specialist, Chichester);

Irene Ridgers (IBCLC, infant feeding

specialist, Frimley Park Hospital); Gail Cruise

(breastfeeding coordinator, Derriford

Hospital); Hilary Myers (IBCLC, midwife,

West Wiltshire PCT); Anne Tompkins

(neonatal nurse, North Devon District

Hospital, Barnstaple); Sarah Hunt

RCSLT_dec_p24 24/11/05 3:23 pm Page 4

Any Questions?Want some information? Why not ask your colleagues?

Email your brief query to [email protected]. RCSLT also holds a database of clinical adviserswho may be able to help. Contact the information department, tel: 0207 378 3012.

Evaluating storytellingHas anyone found a good way of evaluating the

effectiveness of storytelling groups?

Anita Goveas

T E L : 0207 771 3372

E M A I L : [email protected]

Paediatric dysfluencyWhat do other SLT services do regarding care-pathways for

children who stammer, particularly concerning service

delivery and discharge criteria?

Charis Jennings, Kim Bates


Juvenile metachromatic leukodystrophyWhat is your experience of language loss in a child with

juvenile metachromatic leukodystrophy? What is your

success with AAC, implemented early while planning ahead

for further deterioration?

Joanna Thompson


Laryngectomee careWhat out-of-hours service do you provide for

laryngectomee care?

Sarah Eli


ALD dysphagiaRecently appointed lead SLT for ALD dysphagia wants to

contact others in similar roles.

Karen Bonar

T E L : 02890 552577


Bilingual co-workers I would like to contact other bilingual co-workers to share

their experiences about AfC banding.

Hassan Karolia

T E L : 07771 772794


Learning disability Any ideas on transition clients, ie from school to adult

learning disability?

Fran Virden

T E L : 01743 261181


Children with SLIAre any particular phonics packages useful for children with

specific language impairments?

Jennifer Thoms


Oral hygiene Do you know of any research or have policies on oral

hygiene for people nil by mouth?

Julie Lynn

T E L : 01928 753424


Teacher trainingHave you developed a CD/DVD training package for

teachers, including video of children in schools?

Helen Baugh

T E L : 01423 555869


Dysphagia dietMultidisciplinary group, researching need for user-friendly

recipe book for clients who require a thick purée, seek ideas

to share.

Linda Blackie, Mandi Hodgson


VideofluoroscopyInformation wanted on equipping a videofluoroscopy suite.

Gill Hood

T E L : 01604 545737


Russian phonological developmentDo you have any information on normative data for Russian

phonological development?

Amanda Baxter


Feeder cupsDo you know of published materials on the disadvantages of

parents using feeder cups after six months, especially those

with valves?

Jo Bishop



ask your co l leagues

RCSLT-dec-any Qs p25 22/11/05 4:52 pm Page 20


Opinion p iece

I have been working with children and young

people with Down syndrome for almost 12

years. What never ceases to surprise me is the

enormous potential these children possess,

despite all the problems they experience, and

there is now no doubt in my mind that with

the correct input they are capable of learning,

and learning quickly.

I am not alone in this opinion. Sue

Buckley, Director of Research at the Down

Syndrome Educational Trust, and the Down

Syndrome Association have long since argued

that children with Down syndrome respond

well to therapeutic input, supporting this

supposition with research and coherent

debate.

However, despite this there persists an

unerring pessimism among many

professionals, including our own, as to

whether such ongoing input can really make

a significant difference to these children's

long-term language and cognitive needs.

Contrast this with the enthusiasm

demonstrated for children at any end of the

autistic spectrum. Look through the job

pages in our speech therapy journals and

there are countless advertisements for therapy

posts as autism advisors/specialists.

Yet there have been no equivalent posts for

therapists working with people or children

with Down syndrome. This is odd, given

there is no evidence to suggest that children

with this condition are less deserving.

Equally perplexing is that, despite our

advances our perception of these children in

many ways, little has moved on from when I

began my training over 20 years ago. Witness

the terminology still used when we talk about

these children. They are said to be visual

learners and are very loving. Most telling of

all is the use of the word 'stubborn'. Yes, there

is something to these terms but they are

Seeing the child withDown syndrome

superficial and tell us little.

So, I wonder, why does this 'immaturity' of

thinking persist despite the evidence? What

clouds our vision of these children's potential

and why do I have a sense that despite the

evidence we have not moved on? This is a

complex issue and one I feel I may not

satisfactorily address here, but I feel it is a

debate worth beginning.

First and foremost, as pointed out to me by

a mum of one of the children I work with,

babies in-utero suspected of having Down

syndrome are recommended for termination.

Those that are with us now are here because

their parents refused to be pressurised into

terminating the pregnancy or were

undetected in the womb, and so effectively

slipped through the surveillance net. It seems

to me that such profound societal

ambivalence to the existence of a group of

people will do much to harm the way we see

them.

Secondly, there is also no question that the

physical manifestation of a child with Down

syndrome adds to the sense of strangeness

and difference in a negative and non-

productive way. Children with autism, on the

other hand, despite their strangeness and

difference are perceived, interestingly, as

beautiful and enigmatic.

No such positive associations seem to be

made universally with reference to children

with Down syndrome. In reality they, like

children on the autistic continuum, fall all

the way along the attractiveness spectrum.

Thirdly, negative social attitudes towards

disabilities undoubtedly become encapsulated

within the language we use. Nowhere is this

better demonstrated than in the use of the

word 'stubborn' when describing these

children's renowned resistance. Such a catch

all term implies a rather mindless bottom-to-

ground fixing and an erroneous and

annoying by product of the child's

'condition'.

Given the enormous challenges these

children face, such a robust emotional

response is natural and to be expected. Not

just because of their processing difficulties

and the plethora of health problems they

experience but, most importantly, because of

the shortfall of expectations they encounter

due to the prejudices we all hold and which

inevitably underpin and pervade our

intervention.

It seems to me, therefore, that these

underlying prejudices contribute powerfully

to the unerring sense of pessimism that still

prevails - simply because they so disfigure

our outlook as far as these children are

concerned.

Only by becoming aware of the potency of

these beliefs will we be able to free ourselves

to make more coherent clinical judgements as

to the real potential of these children. We

need to recognise the value of our input to

the development of these children and

maximise the use of the data available to us

already.

In my experience, when I manage this with

the children I work with, they rise to the

therapeutic challenge and do very well

indeed.

Geraldine Wotton wonders why there is an 'immaturity of thinking' in working withchildren who have Down syndrome

Geraldine WottonIndependent SLTemail: [email protected]

Acknowledgements:I would like to thank the children and their parentswho gave me inspiration to write this article and toMargaret Wright and Annabel Bosanquet for theiradvice and support.

RCSLT-nov- opinion p26 22/11/05 4:53 pm Page 22

Speci f i c Interest Group not ices

Northern Research SIG (N30)

6 December, 9.30am - 12.30pm

Research Governance: An essential guide for

SLT researchers in the NHS. Guest speaker Dr

Léonie Walker, R&D manager, North

Tyneside PCT. Practical session will enable

potential researchers to navigate NHS trust

research systems and Caldicott approvals,

research ethics committees, compliance with

the Data Protection Act and the Trust

Intellectual Property Rights policy.

University of Newcastle upon Tyne, Room

2.22, The Research Beehive

Members free/non-members £10 (inc SIG

membership for 2005-2006)

Contact Dr Helen Stringer, email:

[email protected]

South Wales SIG Learning

Disabilities (W2)

7 December, 9.30am - 4pm

Current knowledge and research on the

communication and people with Down's

Syndrome – Learning styles, motivational

issues and intervention, Helen Connelley,

SLT, Symbol Trust Kent

Sandfields Young Business Centre, Port

Talbot

Members £15 (£10 membership)/non-

members £20 (including food)

Contact Sian Jones or Katrina McLaughlin,

tel: 01792 614100, email:

[email protected]

Adult Learning Disability Central Region

SIG (C12)

12 January, 10am - 4pm

Visual impairment, Rachael Skinner,

practitioner/lecturer – sensory and learning

disability.

CREST Training Room, Woodfield House,

Bewdley Road, Kidderminster DY11 6RL

Members free/non-members £10

Contact Jackie Hartley, email:

[email protected], tel: 01562 746947

SIG in AAC – Central Region (C16)

19 January, 9.30am - 3.30pm

AAC in a medical setting: children and adults:

Helen Cockerill, Guy's Hospital; Janet

Nicholson, Bristol Children's Hospital; Julie

Atkinson, ACT Birmingham; Anne Williams,

Learning Disabilities Service, Cornwall, plus

others.

Oxford Centre for Enablement, Nuffield

Orthopaedic Hospital, Oxford

Members £5/non-members £10 (includes

lunch)

Contact Sally Chan, PCAS, Claremont

School, Bristol. Tel: 0117 9247527, email:

[email protected]

Head and Neck Oncology SIG (North)

(UKRI 10)

20 January, 9.30am - 4.00pm

Current issues in dysphagia for head and neck

cancer patients. Topics include: Evaluating

dysphagia – FEES and videofluoroscopy,

Annette Kelly, UCLH; Functional sequelae of

chemo-radiation, Jo Patterson, City Hospitals,

Sunderland; Dysphagia after total/partial

laryngectomy, Helen Rust, Christie Hospital,

Manchester.

Postgraduate Education Centre, QMC,

Nottingham

Members free/non-members £10

Contact Katherine Behenna/Jackie Farmer,

tel: 0115 970 9221, email:

[email protected]

Yorkshire Paediatric Dysphagia SIG (N16)

23 January, 1.30pm

Ethical issues: Professor Jois Stansfield. This

will be an afternoon of presentation and

workshop. Please bring real problems for

discussion.

Tadcaster Health Centre, West Yorkshire

Contact Angela Hunter, secretary, tel: 01924

483909 or Sue Craig, chair, tel: 01274

365461

For SLTs Working in Child Development

Centres (UKRI03)

24 January, 10am - 3.30pm

Videofluoroscopy, special care pre-term babies,

neuro-disability and cerebral palsy.

Dysphagia specialists Annie Bagnall and

Helen Cockerill will run the day. Only those

enclosing an A5 SAE with apologies, prior to

the meeting, will receive minutes and notices.

Room C318, Cox Building, Perry Barr

Campus, UCE. Visit: www.uce.ac.uk

Members £25/non members £30. Places

limited so book early

Contact Fiona Wilson, Therapies Office,

Children's Hospital, Doncaster Royal

Infirmary, Armthorp Road, Doncaster DN2

5LT. Tel: 01302 366666 ext 3854

SIG Adult Acquired Dysphagia (L4)

25 January, 1 - 4pm

Dysphagia research – feedback from MScs.

Pharyngeal residue: How do FEES and VFS

compare? Annette Kelly; The added value of

FEES in trache care, Pippa Hales; Assessment

of swallowing in ITU, Sue McGowan

Gilliatt Lecture Theatre, Institute of

Neurology, Queen Square, London

WC1N 3BG

Members and students £5/non-members £10

Contact Laura Hobbs, 4 Balfour Road,

Chatham, Kent ME4 6QT, tel: 01634 830000

ext 3225, email:

[email protected] or

[email protected]

Managers SIG (C22)

20 March, 9.30am - 4pm

Speech and language therapy managers and

the law

Room B702, Baker Building, University

Central England, Perry Barr, Birmingham

Cost: £20 includes membership. Cheques

payable to 'Speech and Language Therapy

Managers SIG'.

Contact Helen Anderson, SLT Department,

Residence III, North Staffs Maternity

Hospital, Hilton Road, Stoke on Trent, ST4

6SD. Tel 01782 552485/6, email:

[email protected]

To advertise your RCSLT-registered SIG

event for free send your notice by email

only in the following format:

Name of group and registration number,

Date and time of event, Address of event,

Title of event and speakers, costs, contact

details

Details may be edited

Send to: [email protected] by the

beginning of the month before

publication. For example, by Monday 5

December 2005 for the January Bulletin.


RCSLT-dec-SIG p27 22/11/05 4:52 pm Page 21

2006 Bulletin Supplement advertising schedule

To advertise in the Bulletin contact Katie Eggleton, tel: 0207 878 2344

Issue Date Booking and copy Expected to reach SLTs on:by midday on:

Jan 2006 12 Dec 2005 1 Jan 2006mid-Jan 2006 3 Jan 2006 15 Jan 2006

Feb 2006 16 Jan 2006 1 Feb 2006mid-Feb 2006 2 Feb 2006 15 Feb 2006

March 2006 14 Feb 2006 1 Mar 2006mid-Mar 2006 2 Mar 2006 15 Mar 2006

April 2006 16 Mar 2006 1 Apr 2006mid-Apr 2006 31 Mar 2006 15 Apr 2006

May 2006 19 Apr 2006 30 Apr 2006mid-May 2006 3 May 2006 14 May 2006

June 2006 16 May 2006 1 Jun 2006mid-Jun 2006 1 Jun 2006 15 Jun 2006

July 2006 15 Jun 2006 1 Jul 2006mid-Jul 2006 3 Jul 2006 15 Jul 2006

August 2006 17 Jul 2006 1 Aug 2006mid-Aug 2006 2 Aug 2006 15 Aug 2006

September 2006 14 Aug 2006 1 Sept 2006mid-Sept 2006 4 Sept 2006 15 Sept 2006

October 2006 18 Sept 2006 1 Oct 2006mid-Oct 2006 4 Oct 2006 15 Oct 2006

November 2006 18 Oct 2006 1 Nov 2006mid-Nov 2006 3 Nov 2006 15 Nov 2006

December 2006 17 Nov 2006 1 Dec 2006mid-Dec 2006 2 Dec 2006 15 Dec 2006

Please note New ad rates for 2006:Recruitment £23 per single column centimetre. Courses £21 per single column centimetreFull page discounted to £2,10010% Surcharge on all 3-column adverts. Agency Commission 10%We only accept digital copy. Bromides are not accepted

Column Sizes 1=42mm 2=90mm 3=136mm 4=188mm

To make a Supplement booking or for further information please call Sophie Duffin, tel: 020 7878 2312

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