Giving Voice: What is the role of the Speech & Language Therapist in Forensic Learning Disability

Services?

Yasmin SimpsonSpeech & Language Therapist NHS Fife Forensic Learning Disability Service

Communication Context There are over 10 million people in the UK

today who are described as having a disability

0.2% of the population will have a diagnosis of Autistic Spectrum Disorder

1.5 million people in the UK have a learning disability

27% of adults in Scotland have difficulties with reading and writing

4% of these adults cannot read at all

What is the main aim of speech & language therapy? To work with staff and service users to

achieve effective communication strategies and environments

To build the capacity of staff and service users to understand the impact of learning disability on communication

To work with staff and service users in order to develop a shared understanding of the relationship between behaviour and communication difficulties

How are these main aims achieved? Assessment of functional communication skills Assessment of level of comprehension Basic assessment of literacy skills Provision of information to support the development

of an appropriate communication environment Development and implementation of accessible

communication strategies and resources Building the capacity of others to effectively manage

communication support needs

What can speech & language therapists bring to the care planning process? A broad understanding of the most effective

interaction styles

Advice and support in implementing appropriate language levels

Skills in the development and implementation of visual communication strategies and resources

Formal, informal and observational assessments Understanding of use of grammar and syntax Understanding and use of simple and

complex vocabulary Assessment of auditory memory and

language processing skills Provide information not only about what the

person understands but also how they use their language skills to respond to questions

What can the speech & language therapist do to support staff and service users? Jointly develop strategies and resources to

support the person’s communication environment in terms of Expectations, guidance and protocols Legal status and rights and responsibilities Offence related interventions in terms of modifying

language level, addition of visual supports Provision of visual strategies to engage with the

person around decision making, e.g. mind maps, talking mats

Communication context

The Foundation for people with Learning Disabilities (2000) notes that:

Up to 90% of people with learning disabilities have communication difficulties

About 60% have some skills in symbolic communication, such as speech, signs or picture symbols

Communication Channels

Content Actual words & Sentences

?%

Visual

Tone, pitch, volume, pace

Non-verbal data- body language,gestures, facial expression

Auditory

?%

?%

100%

Communication Channels

Content Actual words & Sentences

38%

Visual

Tone, pitch, volume, pace

Non-verbal data- body language,gestures, facial expression

Auditory

7%

55%

100%

Communication Channels?

If only 7% of our messages are received via the actual words and sentences that we use why is so much of our communication with service users often through written and verbal means?

Is there more we can do to try and ensure that we use more non-verbal means to communicate important information?

Why make information accessible? Many people with LD have literacy difficulties…what do they

do with written information?

“If I don’t understand I rip it up… I thought it was rubbish...I feel rotten but what can you do?”

Lady with a learning disability, Leven

“I get staff to read the letter, I’m not good at reading”

Man with a learning disability, Dunfermline

Big words…take me a wee while to figure them out

Man with a learning disability, Dunfermline

Why make information accessible?

For service users accessible information helps: engagement understanding expression decision making

For staff accessible information helps you: to be person-centred to provide a good quality service to demonstrate competence and understanding of

your service users

Accessible information context

• Population

– broad spectrum of partial or non readers – will support people either significantly or in part

• Personalised – designed around needs of a specific individual – takes communication needs into account

Even when information is made easier to understand, many people with LD will still need to support to use it.

Examples of good and bad

Care Programme Approach Pathway

Working well

Not working well

Support

Keeping safe

Relationships

Health & Wellbeing

Activities

What’s important to me? How do I want

my life to be? ActionPlan

Care Programme Approach Pathway

Working well

Not working well

Support

Keeping safeRelationships

Health & Wellbeing

Activities

What’s important to me? How do I want

my life to be? ActionPlan

Family.Animals – dogs.Looking into thefuture.

A house in thecommunity.A better future.Driving lessons.A job looking after animals.

Trying to make progress.

Talking to people.

Keeping myself clean.

Knackering things up, everything I’m working towards.Not seeing other family.Support to talk to other

people.Support keeping a job.Support to keep me outof trouble.

Watching what I’mdoing. Not gettinginto trouble with thePolice.Not mix with the wrongpeople.

Have a goodrelationship withStaff and family.Not to play up withthem.

Take up a sport.Walking and cycling.Watching what I eat.Say what I should besaying. Good behaviour.

Helping old people.Gardening.Going to work.Playing football.Therapet.

People with Learning Disabilities and the Criminal Justice System SLT brief was to

Participate in the development of the guide and provide information about the communication support needs of people with LD

Make the various sections more accessible for people with LD

Ensure that the guide was accessible to a wide range of people who may have communication and/or literacy difficulties

Structure of the accessible guides Introduction:

Information about the guides and why they were developed

The Same as You? principles A brief explanation of the criminal justice system Where to get further information

Information about the Police Information about Prosecution and Defence

Structure of the accessible guides Information about Court Information about Criminal Justice Social

Work Information about Prison Information about Health and Social Work

Services

How have the guides been made accessible? Use of simple language to describe what

happens when someone with a learning disability comes into contact with criminal justice services

Use of appropriate visual imagery to support understanding of the text

Involvement of a wide range of service providers and users during the development

Pitfalls? Very difficult to write something suitable for

everyone! Some information is simply too complex to simplify

without losing some of the message Initially attempted just to make sure that what was in

the written guide was made accessible in the easy read guides

Clear that this is not what was wanted Need to go back to the guides to check that the

information is sufficiently detailed Further input from service users needs to be sought

to ensure that the information is sufficiently detailed and at an appropriate level for the majority

What next?

Lots of feedback received already Hopefully more feedback still to come Some actions identified with regard to some

of the guides Further review of the content before the end

of the year Sustainability issues – guides will need

updating periodically to reflect any changes

Accessible Information Database

www.nhsfife.scot.nhs.uk/easyread

Accessible Information Database

www.nhsfife.scot.nhs.uk/easyread