SALT indirect or direct therapy

[debs40]

OK. We're going through SA process and we have a dispute between NHS SALT and our SALT about whether DS needs direct or indirect (i.e. consultative) S&LT.

I had to argue very hard with the SALT who compiled the report (they work jointly for NHS and LA) about the need for any further involvement as their default positon is to leave AS chidlren to school if there are no language problems.

She has proposed a consultative role - setting targets and three yearly visits.

Our SALT says this is standard mainstream package and would not secure statement.

Obviously, there are other issues (sensory, coordination, hypermobility etc) and school are alreday saying they do not have the reosurces to meet needs.

I'm just completing my parental statement. How should I play this? Just stick to what our SALT says?

How is your ds Debs with communicating?

Had some great advice on here about 'functional' communication. Sod the tests and how he performs in test environment, can he communicate clearly and effectively?

bollocks. DS gets 30mins weekly by a senior SALT experienced in ASDs which is watched by a TA with 8 years experience working on a SALT base who indirectly works with ds another 3 lots of 30mins as well as incorporating the targets into his general learning.

His verbal comprehension is on the 92 percentile.

It depends where he is with his language, but we argued that ds' expressive language is exploding and has the potential for getting quite disordered if not guided by regular monitoring and control. The fact that he has language and is using it, gives much more potential for using it wrongly given his difficulties caused by ASD.

Keep your expectations very high indeed. Don't be fobbed off. Ours was VERY hard won, but it shows what is possible.

No, he has great anxieties about communicating his needs (or at all with those he doesn't know). The best way to describe it is that it is like (it isn't) but it's like a kind of selective mutism.

If he is with someone he knows and trusts - fine. If not, you won't get a word out of him, or if you do, it will be reduced language, baby voice etc.

Everyone agrees on the needs - our SALT, LA SALT, EP. They don't agree on provision but then, as I understand it, once you confirm a child needs direct and regular SALT, it is game over as far as statementing application goes. It can only be secured via a statement.

...."She has proposed a consultative role - setting targets and three yearly visits.

Our SALT says this is standard mainstream package and would not secure statement."...

Absolutely. My DS gets this same type of consultative (didn't know that's what it was called) SALT now at school. And he is only on Action+.

If he ever has a statement, i'd expect better SALT provision.

Thanks. I will pursue the SALT provision angle. He also needs OT and physio and has a massive list of recommendations from the EP so the lack of 1:1 SALT will not necessarily mean no statement. However, clearly, if this is what he needs, I must pursue it.

Their argument is of course that you don't need a trained SALT to deliver this SALT provision. Perhaps, we don't need doctors to prescribe either or physios or OTs or anything that costs money!

debs I agree that you don't need a trained SALT to deliver ALL SALT provision, but you need the person who is delivering it to be trained and not as a monkey but as someone who is able to spot difficulties and progress and access the SALT on an ad hoc basis whenever your ds has spurts or plateaus.

So, IF the SALT is suggesting this, get them to WRITE that he will need a Higher Level TA support with at least 4 years experience of delivering SALT or something, and at least 2 days training in the last 12 months, as well as weekly access to the SALT for any problems etc.

Do you see? What she is saying is right in theory, but you need to nail it in concrete terms.

Starky!! Thanks. She is suggesting this:

"These programmes will be delivered by school staff with the appropriate level of training, support and monitoring as advised by a Speech and Language Therapist. In the first year DS will require three visits to support staff to be able implement targets, strategies, and to be able to support problem solving whilst the staff are suitably trained to carry this out on their own and with the support of the ASD team and Social Communication Toolkit".

What do you think?

Our NHS SALT said she had written the maximum she was allowed half termly to termly SALT visits to nursery. The Salt would set and teach programme to nursery staff so indirect therapy. DS has severe Lang delay. The tribunal where we asked for aba said they were very concerned there was no direct speech therapy and was factor in us getting aba. Yet I am sure the NHS has blanket policy locally of no direct salt for ASD I don't think they even have any Salts with sufficient ASD experience. They don't actually think they can help and only give direct salt for minor phonoligical disorders where they can help. So as with anything it's about their resources. Go for what you think he needs and don't believe the NHS.

Thanks Agnes, I think you are right and it's useful to see resources in both ways - available SALT resources and actual SALT expertise.

You see, I'm not so keen on the direct SALT for us. Ds won't work well with new/ outside people. He regresses and asks me/ TA to speak for him. He becomes very disruptive and does what he can to end the sessions.

His true ability is masked in SALT sessions. His comprehension scores are low but that is affected by the ADHD/ concentration aspect and I think his comprehension when focused is actually very good; he's even able to pick up on subtleties like sarcasm/ puns. His vocabulary is excellent but he has severe problems with the typical ASD stuff like following, initiating and sustaining a conversation.

In his head, all that matters is him. He's very engaged if he initiates questions e.g. about how something works, but can't respond to others' ideas/ thoughts/ questions effectively; he'll go off on a tangent back to what he wants to talk about or just ignore the speaker. This isn't helped by an extremely poor short-term memory or the ADHD.

So, for me, the half-termly half-day SALT visits (to observe and talk to ds and train the TA and give her resources and ideas for how to run her 1:1 sessions with ds and how to run her SALT group sessions with ds and the other 3 children) are far better than the direct SALT he used to get.

ds's TA is with him all the time at school so she can generalise the targets much better and I think this is the best use of time. I could have got more SALT for him because CAMHS's report was very clear about his need for help with pragmatic use/ conversation rules of language, but this works best for him right now.

That is really interesting but I suppose it is reliant on there being TA provision and without a statement there is no guarantee that he will get that.

It is whether he will gte a statement too without the need for SALT.

Definitely. It's another argument for TA support. That doesn't have to be instead of SALT but I would question the value of stand-alone SALT without adult support to then generalise it into real life.

Our independent SALT suggested both - indirect and direct.

Fat chance of that I suppose!

No, not at all. Most people with more intensive packages would have both. Might as well ask for both if evidence backs the need.

Thanks. Our SALT got back to me yesterday (independent not the NHS one) to say she strongly believes he needs both direct and indirect therapy.

Her view, and she's been doing this for 25 years, is that some NHS therapists are giving the level of input that is usual for their service and they feel dictated by the premise that the service should be equitable. This is stated in NHS legislation.

However, within education we are talking about individual need. The real question should be what, in a professional?s opinion is necessary in order to secure adequate progress? The question is not what is usually given to children with a similar profile. If you never give more than what they are suggesting then you may not have the belief that anything different works.

Makes sense. But not sure how successful we'll be pursuing it.