I am an NHS speech and language therapist AMA

[starbrightstar]

Inspired by a similar-ish thread. AMA

@starbrightstar examples are particular letter sounds, whether it is at the start of the word or within the word , 'v' 'l' "f" Also paired letter sounds like "gr" "pl" "cr" etc...

He hasn't had a referral. I have spoken to staff when at nursery and now in reception.

My son saw an amazing NHS speech therapist aged 6-7, she really improved his speech sounds production (he has verbal dyspraxia). The therapist was
limited with the number of hours she was able to provide but managed to find a way round it and gave him the time he needed.

Do you feel you are able to give the amount of direct therapy needed?

He’ll be 5 in November.

What about in terms of practice though? For example, using metrics/assessments where the baseline is white, neurotypical etc?

Definitely. More so for children/adults who are bilingual or grew up within a bilingual caseload. We would not sue standardised assessments for these kiddos.

There is a push towards more dynamic assessments too (I.e. we do lots of practices and give cues during testing).

In terms of general standardised assessments- I think we do have a long way to go but we are getting there.

Thank you.
I wondered if it was a different discipline. My DF had a stroke and was given two session which worked well.

I think it's one of the most fascinating careers but I am biased! I learn from my parents and my students everyday. I love the research and the science behind SLT.

I think the salary is ok- you start off with roughly £24,000-26,000 per year and pay goes up in terms of banding- also including London weighting etc.

Do you ever feel pressure to not specify reports or reduce the provision you would recommend for the nhs due to the lack of capacity?

My son was discharged and we used the fact that the ehcp was specified to get the LA to fund independent therapy. He has made huge progress with the independent, I feel partly because they don't have to consider the impact on service levels etc

What did you think of the film 'The kings Speech'? Are any of the tactics used by Lionel Logue still used today- or are they all considered very much old school now?

Thank you.
I wondered if it was a different discipline. My DF had a stroke and was given two session which worked well

Salt is a vast profession which makes it very interesting and tricky if you want to specialise but can't choose.

We work with people who have dysphasia (eating and swallowing), adults with learning difficulties, adults who have had a stroke and traumatic brain injuries, head and neck cancer, degenerative disorders, including Alzheimer's. The profession is very vast!

My DD is in Reception and still has a ‘th’/sticking tongue forward lisp. Her speech is understandable and she isn’t having any issues at school from speaking to her teachers. Is this something that would warrant referral or could she still grow out of it?

I have not seen the Kings speech funny enough. What practices did you see the therapist use? I'm not so experienced in stammering. I only work with a couple of students who have stammering but they are of high school age.

My mother is 89 and has Parkinson’s and a stroke . Her voice is very faint and now even harder to understand . She has been referred several times but no help is forthcoming and it is so frustrating for her. Is there anything that can help ?

Do you feel pressure to discharge children early?
My son was discharged at 7 from NHS salt. At 13 we started lodged an appeal with SENDIST and as part of our evidence commissioned as private salt report. The NHS salt services became involved again (after being asked many times by school for the previous three years) and recommended 20 hours of involve the per year. His needs haven’t got worse the only
difference is we were going to tribunal!

I'm quite different. I did some IPSEA training prior to becoming an SALT and worked in an independent school which some of the children had very specific, detailed and quantified reports.

My honest answer is that SALT's- including managers, just do not know- we are not taught how write reports/provisions which are aligned to the SEN code of Practice and plus SLT's are stretched with huge caseloads and their thinking is that- well, we just don't have the time.

I do write my reports very specific, detailed and quantified, which did raise a few managers eyebrows. I was also told that in our service, we had to align with the way the council writes their format for EHCP (?). But I kindly but firmly directed them to the SEN code of Practice and told them that I would be aligning my provision and reports to the SEN code of Practice. But this is very rare and I actually had to jump through hoops and challenge managers who have had many years as an SLT to undergo these changes. Initially, this did put me off and I considered working privately.

Thank you for your reply. You sound very brave to challenge your managers like that.

Lisps wouldn't warrant an SLT referral in my service. You can try but, unless there are any other concerns, it is very unlikely. It's funny as my DS has a frontal lisp which is frustrating.

Going back to your DD, is she unable to use the /s/ sound and is replacing this with /th/?
In any case, I would start off with minimal contrast therapy, so find target sounds containing s vs th. As an example, miss vs myth and see if you DD can spot the word from your verbal model. I would also include articulation therapy- as lisps are more an articulation in nature than phonological. So I would work on saying the /s/ sound within vowels, and then within single words and sentences etc.

Thank you for this. My son is 2 years and four months. He has been referred for speech therapy as he doesn’t yet speak any words. He babbles away happily but no actual words. He has a hearing test booked for next week. What happens at the first few sessions, please? Also, nursery starts at 2.8 years in Scotland but due to his January birthday, he isn’t eligible to start until he is 3.4 years. If he is under speech therapy, can they request he starts nursery earlier than 3.4 years to help with his speech? Thank you very much.

Thank you for your reply. You sound very brave to challenge your managers like that

Thank you. I always put the children and my families at the frontline of my work. It would be unethical for me to not write reports/provisions to a particular standard- especially since I am aware of the law! The issue is not with the SLT, it's more to do with the managers and the service leads.

if someone has a diagnosis of severe ilo what is it that would make it severe?

I am looking for some advice for my son (non verbal, autistic and adhd). He had been struggling with pecs for a long time and I have asked about an aac device but am constantly being told he needs to learn pecs first. He has taught himself many things on an ipad and I believe an aac device would be a much better way for him to learn communication. He had no real interest in pecs. Why are speech and language so against trying this? Is this normal practice?

This is a tricky question. In my service, I personally do not feel pressured to discharge children early. In fact, you can say, (if you had a good reason!) we are more likely to reduce EHCP hours than discharge. But discharge is primary down to the treating therapist (wholly dependent on the service as many are different).

Another point is that, depending on the child's needs, we receive many SALT referrals from schools, which, in some cases, the child's needs could be met if the school just put in the provision or made modifications. Most schools feel that SALT is the magic wand and we can help solve all their students difficulties. A huge amount of schools and I mean huge, are not willing or "don't have them time" to do the extra leg work to support their students or make changes to their environments. So we are encouraged to ask school lots of questions (I.e. what provisions are they putting in place already) before accepting a child for a referral (but of course this depends on the child's needs).

This is so frustrating!! I'm sorry. A child does not need to learn PECS before going onto an AAC device. Can you child recognise a McDonald's sign? Can your child recognise his favourite game app and pick these out when bombarded with other apps. If you answer yes to any of these questions, then your son is ready to move onto an AAC device.

This is what I find frustrating about the field. The quality of therapy lies solely upon the individual therapists. Not many therapists research the latest evidence based approaches and some are still stuck in their mindsets.

I would make a self application and refer your son to the assistive technology service hub, there are many scattered around the UK. The issue you may have when going down this route, is if your son qualifies for a referral - more due to funding restrictions. But please try.

I would also be tempted to purchase or trial an AAC app, like proloquo2go, grid for iplayer and see how your son gets on.

What is ilo?

Hello! You are doing all the right steps. He will have an initial assessment session when the SALT takes down a case history, conducts an assessment (typically through play- with your child and assess her overall communication and attention skills. After this, the SALT may warrant additional referrals or services that he/she feel may benefit your child and/or see your child for individual/group sessions with an SLT.

You can get some voice amplification devices which can assist with her levels of voice. Can you tell me which area you are in and I can direct you to somewhere? Feel free to PM.