Question for Speech and Language Therpists

[QueenStarlight]

AIBU to request that targets set focus on improving the scores directly in the CELF assessment?

Otherwise, what is the point of a CELF assessment?

Yabu but the clinician should be able to answer and justify the targets they have chosen.

The Celf is generally used as a diagnostic tool that highlights specific areas of difficulty and areas of strength. This information is used to inform therapy. Targets are usually selected because they represent the most significant impairment functionally or developmentally. If targets were set to improve the Celf then the learning from therapy may not generalise to everyday functional situations and while scores on assessment would improved this would not reflect a child's true ability. There are also limitations on how often assessments such as Celf can be used.

If you are unhappy with the targets set, please talk to the therapist.

Thank you for your response.

I feel the targets set are selected because they represent the common denominator of the children for whom therapy is provided and to justify group therapy over 1:1, rather than targeted towards a specific and severe impairment.

I feel he would benefit from the targets set as they are areas of difficulty, but nowhere nears the challenges he faces with his language disorder which is separate from the ASD which appears to be targeted.

I've been told that weekly group therapy to include 1:1 as deemed appropriate is the maximum offer available to any child and is only going to be given this term reduced from then on. This is because the group therapy skills can be delivered by trained school staff.

I don't object to this for the ASD stuff. In fact it makes sense to me. I object strongly for the language disorder stuff however because I feel disordered language is beyond the capability of most TAs and class teachers, regardless of training (which won't happen anyway because the focus will be on social communication rather than grammar etc.).

Yes to all of the above but also went a SALT is assessing a child, particularly on something like the CELF, we would also be looking at things like auditory memory and attention skills. These are not always the things being tested but will have an impact on the child performance on assessment and in the classroom.

Thank you shoe. Attention skills are fantastic 1:1, but terrible in a group. Another reason why I think though the group targets are appropriate (to help in attend in that context), the actual grammar stuff needs to be delivered 1:1, when he definitely IS attending.

It's so frustrating. I'm feeling that ds is being massively short-changed, especially as he is the type of child for whom impact is massive when he gets the right provision.

Therapist seemed genuinely shocked that I didn't consider once a week group therapy a high level package. Is it really?

It seems somewhat diluted to me.

The celf assessment is one assessment tool and should be used in conjunction with other types of assessment such as observation and informal assessment and listening to what parent and teacher concerns are to get a pIcure of overall need. Setting targets directly off the celf may make your child improve at that assessment or maybe not. The question is why would you want your child to score better on the celf - this doesn't really have an impact on your childs day to day communication In the classroom and ability to learn - it only teaches the child to pass that particular assessment. It is one assessment tool that might highlight areas of difficulty but i'd never set a target directly off it to improve scores. Changing a child's skills with communication usually involvs making environmental changes and modifying teaching to help he child learn in a style suitable for them mixed with some individual targeted stuff if required which school staff can be trained to do.

I would second talking to he therapist if you are unhappy and maybe highlighting what your main communication priorities are. With the families I work with. We usually set one target around what the family consider important to them and one around what has been identified
from assessment that is going to have the most impact on learning and communication.

I can't comment on how much therapy is offered in your area as it differs slightly area to area.

If you feel that you are not being listened too and your concerns are not being answered then it may be worth raising a complaint. All targets should be measurable and your therapist should be able to provide evidence of whether the targets were meet after the therapy block. As you feel the therapy is general and targeting social communication it is worth asking multiple people (therapist/senco) what strategies and intervention is going to be put into place to target x, y and z.

Something has broken down and you are concerned enough to ask on a public forum so please don't leave it. I'm sorry I've not been more useful.

Thanks flamingo, I'll try and talk to the therapist but feel that is so difficult because I genuinely think that what she is offering is such outrageous robbery for my son that I am finding it difficult to judge her as anything but nasty.

I can't rationalise my thoughts at all. I'm completely outraged. I don't want to make what already is dire, worse.

Thanks for your help Ejay. Why isn't therapy based on need rather than area?

That also makes me uncomfortable and feeling robbed if I'm honest, but I'll try and sleep on it for a few days and see if I can figure out how to approach it in a more constructive way with the therapist.

I've been told that weekly group therapy to include 1:1 as deemed appropriate is the maximum offer available to any child and is only going to be given this term reduced from then on

She's not "nasty". If that's the maximum offer available in her service, she won't be able to offer any more, however many complaints you make about her.
Can you afford to hire a private SLT?

I can't afford to hire privately, but more significantly, we're a big family and struggling with the afterschool/weekend time demands without additional tutoring.

I understand that provision must meet educational need, and that blanket policies such as 'maximum quotas' are illegal.

I am not a SALT just a parent with a DS (ASD). I too find it difficult to understand why targets are set that don't seem to be addressing the main concern. We were given a chart when he was a little younger that explained what needed to take place before language would develop which was very useful at the time. However since then everything suggested and resources provided to the school always seem to be 6 months out of date. We have a CAF meeting, school staff and myself explain where he is up to now, e.g. starting to understand today and tomorrow and then months later receive a resource that is reminiscent of the 70s with lots of Velcro. DS verbally understands today tomorrow by then and SALT asks us if there are any other resources she could provide. We just want specific professional advice on what to target next and how to go about it as we go along, but it always seems that when a report comes through it reads as tho SALT put it in place, but actually just clarifies what school and home have achieved already and told her that in previous mtg. Our senco is good in terms of organising ehcp but seriously hasn't really observed our DS. Every mtg he mentions ASD children needing routine and every mtg I explain that he doesn't mind, in fact very much likes, breaks in the routine. DS has a great sense of humour and likes change. Last mtg was the worst, long story. My DS is sociable, happy with others, can take him anywhere as they say. It seems to me school and professionals involved have been trained in ASD and have categorised him. In the case of my DS I personally think it would be better if they had no training at all as they seem fixed on sensory issues. At home he can use a pen to practice in handwriting skills books, at school they've had him trying to make marks in sand or glitter to develop fine motor skills when he can already hold a pen correctly (with prompts). I understand he is supposed to be more engaged as sand is sensory, he doesn't care for sand much tho. As it goes on I seriously wonder who in the room has the speech n language communication disorder lol
BTW very early on we booked a session with a private SALT expecting regular sessions. She more or less said exactly the same as the NHS and sent us on our way to practice with a 'come back if you want once he is verbal'!

Op sorry for whining on, once I got started I couldn't stop. You sound like a really good mum making sure your lo is getting the best as deserved. Good luck

We have had a nightmare getting adequate SALT provision for our child who has language disorder. She was getting one session every 3 months! I went to the GP and asked to be referred to the Nuffield Centre in London. They did a full day assessment of her and were absolutely fantastic. They wrote a report saying she needed at least once a week one to one support. Armed with this I applied for an Educationand Health Care Plan (which all the local professionals said I'd never get). I'd heard off the record that it is difficult for local authorities to go against the recommendations of the Nuffield as they are seen as the centre of excellence for speech problems and that the parent would then usually win an appeal.

It worked! She got the EHCP and low and behold they offered her a place in a speech nursery for 6 hours a week- I never knew the nursery existed. It was almost like it was a secret. She has thrived there and is being discharged tomorrow with speech of a 'normal' 4 year old.

We were referred to Nuffield free on the NHS. We just paid the train fares there and back.

Thank you everyone.

I suppose I need to figure out whether the provision is even worth fighting for. Is even 1 hour a week 1:1 too diluted to make a difference?

Is upsetting the school and relations going to get ds what he needs?

Does the SALT actually even know what to do about his language disorder? When I researched there was 'good practice' but little actual evidence of impact.

Where can I, do I go to find out if I am right about ds being shafted? Are parents so isolated wrt this that provision can be patchy and lack accountability?

I don't think ds will get referred to Nuffield as he's had quite a number of SALT assessments over his lifetime.

The picture of difficulties is quite clear. What is not clear is what he should be entitled to versus what is being offered, in terms of projected outcomes.

Have you tried contacting the parent partnership? I think the service may have changed its name but if you look it up you should be able to find it under its new guise. I have heard they are very good. They provide advice on entitlements and what is reasonable to request and push for. I think they would be able to tell you if they thought your lo is not getting what they should and the best way to make it happen whilst maintaining a good sch relationship.

I'm an SLT. I used to work with kids in the NHS. When I first began work (20 years ago) we used to have the freedom to treat the kids however we saw fit. We had freedom to be creative and offer treatment that we thought would make a difference.

Over the course of my career, the emphasis shifted to give the responsibility to schools to provide 'therapy.' It didn't work. School staff are not trained to do language therapy.

There are other issues - language must be acquired and not taught. For that reason, parents are often asked to do X,Y, Z at home in order to generalise skills. Parents often complained about this because they thought they would bring their child to clinic and the SLT would sort out the difficulty.

I now work with adults and in private diagnosis. I stopped being effective with children a long time ago due to the system. They are cutting children's services further and virtually every experienced SLT I know is shifting into private work. That probably tells you everything!

Thank you Vanilla and mmm

I don't mind doing work at home. I do it anyway so having something more focussed and specific under the guidance of a SALT would be more efficient than me trying to guess.

DS is in a unit, which I rate fairly highly. I think the staff there could well be able to deliver the ASD-related stuff under the SALTs training, particularly the attention stuff, but not the language disorder stuff.

He needs someone who can apply their knowledge and learning minute by minute to the feedback he produces in order to spot difficulties along the way and change therapy regularly being able to research and network amongst colleagues for ideas and support.

Yep. And that doesn't exist, but it used to.

Vanilla pls help. I have been on the more than words course as a parent and fully understand when you say salt now expects parents and school to provide the input. We do this at home as best we can. We also provide my ds's LSA with a detailed weekend book featuring lots of pics for her to use when trying to develop his communication. I once worked with an amazing salt prior to the birth of my DS and I witnessed in awe how skilled she was at bringing children on in a very short space of time. I don't know if any of this transferred beyond the session but it was amazing to see. I also paid privately for a salt but was disappointed, this was when DS was prediagnosis and it was the same advice as NHS, i.e. He might need help at school. I don't want to be mean to anyone that should be helping but they are always way off the mark. Way too late in terms of his development and bizarrely obsessed with creating Velcro resources. Hello it's 2015 and people have access to real pictures on tablets. Our current salt is very young and that is not meant as a slur but she sent us a ridiculous resource in the post, one for us n school. School recognised it as pointless (better than when in nursery my DS had a sore finger and LSA thought she should take a picture of it to ask how he was - clearly misunderstood the training session - it was there in front of her- but she just remembered the take pictures bit) arrgh she was off laminating ffs. Surely the point of pictures is to attempt to talk about what isn't there but she simply did not understand that argggh

Sorry Queen yet again I am hogging your post! I'm pleased for you that you have faith in the unit your lo is in. I also truly feel your frustration at the lack of priority when it comes to addressing individual specific needs. Think this is my main issue. I want to keep relations good with school but often feel like they haven't heard a word I've said. It's almost like what I say dawns on them 2 terms later and I am left feeling dub I already told you this