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Moondog can I pick you brain to 2 mins ?

20 replies

TheArsenicCupCake · 09/01/2011 18:23

Ds does an out of class speech and communication group session a couple of times a week at school.
Most of the children attending ( school have informed me) have speech problems .. Ds however has more functional communication issues ( turn taking, the way he says things to others, monologuing (sp), understanding what is being said to him.. Etc etc

I have a general progress meeting and an annual review coming up... I'd like to know how much progress he has made.. Especially because he is having a lot of social problems with peers ( no shocker tbh.. But the group is supposed to be helping him.. That was the thought behind doing it.)
anyway.. How would progress be measured? And should they measure how effectively he his transferring the skills he is learning?

Also any suggestions I could go in to the meeting with?

Thank you

OP posts:
tryingtokeepintune · 09/01/2011 22:02

bump - because I am interested too.

moondog · 09/01/2011 22:25

I can't answer for other SALTs I'm afraid.

They are however perfectly valid questions and ones that you need to ask. They could be taking data at intervals throughout the day on how often he initiates conversations, or approaches someone for example. They could be providing him with a salient cue which signals that he needs to initiate conversation. (I love the Motivaider for this purpose. You just set it to vibrate at intervals and teach the person wearing it to carry out an action when it vibrates.)

Those are the sort of ways I personally think when designing and evaluating intervention to target these areas but everyone has their own way of doing it.

It's a recognised fact that SALT in general has been very poor at monitoring and measuring outcomes to evaluate effectivenemss (or otherwise) of intervention. We are all under increased pressure (quite rightly so) to prove that what we are doing is making a difference.

Just doing it isn't enough. It has to work.

Hope that helps a bit.

linksandsmileys · 10/01/2011 00:16

This is an interesting topic as DS is in the same situation but, at present, there is no active SALT intervention (although school were apparently sent SALT targets three months ago).

I don't know if it is the same for you Arsenic, but, with us the social skills groups are run by school without SALT involvement. So how do schools measure these things on their own?

We have a meeting with a SALT this week (hopefully) to discuss what school have been doing so any questions to ask school about how they measure progress would be welcome.

tryingtokeepintune · 10/01/2011 00:27

What sort of social skills groups do they do?

Our Autism Outreach suggested Socially Speaking by A. Shroeder but school decided not to do it. That was recommended 12 months ago. I found out they did not have the book so I bought it and lent it to them. In Sept, the CT said it was really helpful and asked the Senco if they could buy their own book; Senco said yes and so they returned mine. In Dec, Autism Outreach recommended that they use Socially Speaking again.

Am really irritated because that's 12 months of a recommended programme of Social Skills class that ds has missed out.

linksandsmileys · 10/01/2011 00:32

I don't know.They haven't told me much about the social skills group and what they do. It's taken by a supply teacher with some previous specialism in EBD. DS does not have EBD.

I have asked her before about Socially Speaking but she says head wouldn't buy it/

You've given me another question!

TheArsenicCupCake · 10/01/2011 17:27

Thank you moondog :) ( you want to be our SALT!)

and I love that gadget! .. Ran it past my mum ( psych).. Who said she thinks ( completely as a grandma and totally off the record lol) .. That I should be nudging ds2s SALT to be using one.. As it would benefit ds a lot!

I understand how difficult it is for you when answering these questions.. But I really appreciate it :)

I wasn't sure if there was a bog standard policy for record keeping.

OP posts:
TheArsenicCupCake · 10/01/2011 17:30

And if I find out anything useful folks about all of this I'll post :)

OP posts:
working9while5 · 11/01/2011 21:25

"It's a recognised fact that SALT in general has been very poor at monitoring and measuring outcomes to evaluate effectivenemss (or otherwise) of intervention."

Do you think we are worse than others suggesting "interventions" in schools in reports following assessments?

It's also dependent on role, this. If you work in a language unit with a small caseload, actually you do huge amounts of monitoring. You monitor and adjust everything you do continually. Do you mean that there is limited gold standard research within the profession? That, of course, is a bit different to monitoring or measuring outcomes related to individual students.

I have only worked in one trust, I'll be honest, so it surprises me when I hear that people don't keep data. What about Nuffield progress charts, or Lidcombe or the adjustments made on a continuing basis in any direct speech sound therapy? Confused
I assumed that SALTs doing direct therapy kept quite a lot of target-specific data?

To my mind, there is limited outcome measurement on consultative work.. but that's a bit different IMO as so much of the time, half the battle is even getting staff to realise that a child is not just naughty and in need of discipline. To my mind, those therapists who see a child for 45 minutes once a half term (and I have been that therapist) often have a very specific "outcome": see child, assess and write report. This is very carefully documented, of course, in statistical analyses. I am highly sceptical that there can be particularly effective "intervention" in any discipline based on a 45 minute once-half termly visit. The goals shift when provision is that dilute, don't they? Isn't the goal in this type of service delivery more likely to be related to information sharing and training others on SLCN?

I am as harsh a critic of SALT as any, but I don't think that we are particularly any worse than most other professions in the NHS/educational system as is, except in so far that we target some areas that are quite difficult to operationalise.

Social skills "programmes" are one obvious example of this. Social interaction encompasses so many different levels of human experience and development and so many, many variables that it requires not only tremendous skill, experience, creativity and initiative to design a truly effective intervention proramme, but quite a lot of time and a very dedicated consistent treatment team. Knock one cog out of the wheel and you can have a very weak programme indeed.

Typically, "social skills" programmes in schools introduce students to the idea of social convention. Usually, students who have participated in these programmes can tell you a bit more about the mechanics of social interaction at the end of a programme e.g. you need to look at someone, not get n their space etc. Sometimes, this can help them understand the feedback teachers and other adults give them about their behaviour but only rarely is this, in and of itself, going to effect behavioural change. It's a bit like learning about, say, Greek myth. It doesn't make you sprout wings and fly too close to the sun.

If a child is experiencing social difficulties, what is needed is some sort of analysis of what is happening and why, with a strategy related specifically to that.

So, for example, we had a student a number of years ago who would not speak or interact on the playground. So stage 1 of intervention was getting her to actually stand near her peers. Stage 2 was playing alongside her peers in a preferred, nonverbal activity (skipping). Stage 3 was copying her friends in skipping activities. Stage 4 was learning things she could say to her friends when skipping. Stage 5 was saying some of these things to earn rewards.
How did we know when we'd achieved our outcome? Well, simple. She spoke to her friends on the playground. Did this miraculously cure all her social difficulties? Not a chance. It required a huge amount of careful teamwork and planning to do this much, and we were lucky that it generalised into other settings spontaneously. However, as simple as that sounds, it really isn't.. when you consider that even in many language units, SALT time is maybe one hour per child per week (or even less). Unless the team will play ball and there is sufficient time to observe, work out what makes a kid tick and what will enthuse and motivate them without overwhelming them AND sufficient time is given to enable a student to do this again and again many many times day in and day out, it's not likely to happen.

With a speech sound, you can do hundreds of trials in an hour. Social skills are harder to target intensively and peers, in particular, are harder to control as variables. Little buggers.

This doesn't mean that therapists and school personnel shouldn't try. It is a huge bugbear of mine to see ill-defined social targets... but it is a hard, hard thing to do without a hell of a lot of time. Tracking data consistently would be easy peasy if there were adequate resources and data were prioritised, but the reality is schools are frenetic places with many competing priorities and SALTs are usually outsiders whose targets can easily be pushed to one side. Unless the target is very much defined, appropriate, works quickly and the school is 100% on board to carry it out, it can be hard to see change and all too easy to find a dusty programme on a shelf somewhere.

Like moondog, I usually look at frequency of desired behaviour over a set interval. However, that only applies to wholly behavioural targets. With my students, many of whom are verbal and able, I am also looking for signs of cognitive change e.g. developing understanding of why something needs to be done, showing they can recognise complex and abstract behaviour in a structured setting with lots of support long before they are expected to show it with peers. I want them to be able to tell me that they are "getting it" by showing awareness of really quite complex social phenomena as much as be able to do it.. there is so much frustration and anxiety in not understanding the actions of others even after the event that needs to be dealt with as well as actual behaviour. I find it important in my provision that the kids have a chance to talk through all the stuff that stresses them out about the neurotypical too e.g. a student today who wanted to talk about a change in his family circumstance that was distressing him but couldn't understand it unless thoughts and feelings were visually represented.
What is the outcome when we act as "critical friends" for students who are struggling socially due to an inability to navigate the minefield of social relationships? Will it prevent them struggling socially? Not necessarily.. at all.. but it can reduce stress within the school day, particularly at secondary and they do learn vocabulary and ways of talking about these things that may hopefully help them in the future if they need to discuss and destress about these things out with someone (as my AS cousin does online). As well as the behavioural level, there are social and emotional considerations.. I have posted this before, but this reflects my thinking a lot.

You need both IMO..

moondog · 11/01/2011 21:52

No, not any worse than anyone else.

I could only dream of doing such intensive work as you obviously do with so few children who seem to have quite high level communication difficulties.

I work with hundreds so have to think in terms of what can be achieved in that time.
It would be nice to think there will be a time when SALTs have a tiny caseload but in the main, it won't happen, at least not in public serivce.

My principle aim is to transfer osme of what I know into the heads of the people who are with these kids daily. It's of no use if it only stays in my head. That means most of my time is taken up by training people in the rational, design and measurement of interventions and then letting then get on with it while I monitor (often electronically as I cover a vast geographical area.)

It's by no means a perfect model but it works better than how I used to work before i became a behaviourist.

linksandsmileys · 11/01/2011 23:41

Wow, 9-5, your post is incredibly helpful and explaining the importance of direct therapy.

It is very easy to dismiss the functional language problems of children who have AS and are intellectually able. However, they have a massive impact on education, their ability to stay in education, school refusal, exclusion and mental health.

My son still cannot say hello to his teacher and yet the only SALT support has been through school with him being offered occasional social skills groups where he has chatted about his favourite food etc.

Does he like the groups? Yes

Have they helped him speak to adults? No

Have they made it easier for him to go to school? No

Have they helped him to improve his ability to manage socially? No

I went on a course a year ago with Michelle Garcia Winner and Carol Gray and they made alot of sense.

Thank you again for your efforts and time in posting all that.

tryingtokeepintune · 12/01/2011 03:59

Thanks working. Very helpful post.

working9while5 · 12/01/2011 13:38

I have worked with 100's too (have reduced caseload following mat leave as am now working half-time) and I found that the commitment to the type of data tracking you describe was extremely low. The system I used to use was a behavioural one (based on APs) where you assigned each student a rating of 1, 2, 3 or 4 to indicate their progress against the target on a given day. These were supposed to be filled out each time a programme was carried out. There were guidelines for each target e.g. communication temptations, with levels of success e.g. if the student was quickly achieving 4's, they could "move up one". They were supposed to submit these electronically to me each half-term. I must have trained hundreds on how to use these sheets (it's a bit of a no brainer - do the work, say whether a student achieved 0-25, 25-50, 50-75 or 75-100) and write it in a box). I can count the amount of times I got these sheets back filled in on one hand. I gave up using that system after a year of soul-destroying failure to implement this tracking system. I used data sheets that were quite similar to yours. Certainly, within our LEA, the majority of schools wanted nothing to do with them...

I want to make it clear that I work in public service, in an LEA-commissioned but NHS role. It is not a private post. It is in the same LEA where schools demonstrated so little interest in the tracking forms above.

There are still places in the country where highly specialist roles are associated with small caseloads. I know a few colleagues in other LEAs with caseloads like mine who are also working in NHS or LEA-funded roles. Unfortunately, these are being rationalised with each year. Last year, for a .5 post, I had 6 students with SLI or aphasia and a full-time HLTA who not only could work directly with me in sessions, but could monitor the work of other support staff in the school. This year, that time has been reduced to .4 and the caseload has increased to 17. Next year, I suspect similar will happen..

The whole point is that we have given the impression that all these kids need is some support person who can go to a training session and then deliver the programme we are too specialist to waste our time on Hmm. The HLTA I work with in my SLI setting is absolutely brilliant. A parent of a child with severe communication difficulties herself, she absorbs information and uses creativity and initiative to adapt it. Yet she is quite, quite clear that she needs SLT input and would find her job impossible to do without it. She has had about as much training as anyone can have and does a very capable job.. she can differentiate for particular students in the main but when we have a new student with a different profile, or new problems arise, she needs professional support to continue to work at that level. This involves doing joint sessions, not just telling her what to do.

We need to be proud of our profession and appalled at how it has been diluted. I am working in this particular role because frankly, I had had enough of providing ineffective therapy for the masses while students with pervasive, life-altering levels of difficulty had limited support when kids with speech sound delay who would questionably resolve spontaneously had more time in hours.

As for the kids on my caseload having high level communication difficulties? What is a "high level communication difficulty" anyway? It is often used to describe the communication of young people whose pervasive difficulties in understanding and relating to other people have the potential sometimes to leave them, in adulthood, friendless, jobless and dependent on the state. Verbal children are seen as less disabled, when often, in some respects, they are more so. There are virtually no adult services for adults with significant language impairments who are considered "able" by virtue of being verbal.
This is particularly true for individuals with SLI.

My students have pervasive language and/or communication difficulties that have a tremendous social and academic impact in their day to day lives and there is huge variation in their presentation. Some of my students with SLI have extremely severe syntactic and semantic impairments but high level pragmatic impairments. Some of my students on the spectrum have extremely severe semantic and pragmatic impairments but low level (or no) syntactic impairments. They all have significant and severe communication impairment. I wouldn't play top trumps as to who is more disabled, but I would say it's often an even mix. Both groups are, by any stretch of the imagination, quite substantially disabled.
I really don't know if, at secondary, we can "fix" it.. but we can help them get the most they can out of their education and assist with the transition to post-16 etc, ensuring they have developed an understanding of their disability and, where at all possible, some self-advocacy skills.

Training others is crucial, yes. There is no point in the information being in one person's head.. But how do you train someone to do something you have never done intensively yourself? Especially when there is such variety in what needs to be done with one select group of students within one school? (Asking generally re: consultative work, not implying you particularly!) At the moment I have two challenges - I find it challenging to adequately differentiate the majority of Science key words and I need to support a group of students in understanding key words for a core topic (characteristics of living things again - movement, growth, respiration, reproduction, excretion, nutrition and sensitivity). This year, many of the strategies that worked with our last cohort of students are only working with about half the cohort. The other half, it's back to the drawing board. We need to find a level that is just right for each student, so we are having to split the group in two and work in stations to "hit" different targets for different ability levels.
My other challenge is a student with ASD who is absconding from lessons and is posing a health and safety risk to himself. We are working at the moment on getting him to express some sort of preference and/or rate things as preferred/non-preferred as we really need to work out what's underpinning the escape behaviour and while we can observe and make guesses, as he nears adulthood, it would be obviously good if he could also express these things himself! There are another 10 kids who are presenting differently again that deserve and require thought and planning and individualisation of their curriculum. As a behaviourist, you know that the key is appropriate and correct functional analysis of the behaviour that requires change. Giving them an appropriately designed intervention requires the advantages a small caseload allows: time to find THE target, the one that will make the difference. Even then, it's not always easy as I'm sure it isn't on any team - somedays you get it wrong and spend your intervention time trying to coax a distressed student out from behind a chair.

However, it should not be beyond any professional's dreams to provide appropriate therapeutic intervention.

StartingAfresh · 12/01/2011 13:39

Are you going for a record length Working?

Damn it. You're posts are always so blimmin good I never feel I can ignore them, but they're looooooooooooong! Wink

working9while5 · 12/01/2011 13:42

I know, sorry! I think it's because I have an audience lol

I spend most of my working life speaking in short, simple and clear sentences. When I get on a roll about these things, I just can't help myself.

I have two degrees. One is in English lit. The other should be obvious. I guess I miss being wordy sometimes and MN is my release! Grin

justaboutmaintainingorder · 12/01/2011 13:48

This reply has been deleted

Message withdrawn at poster's request.

linksandsmileys · 12/01/2011 14:05

Working makes me want her as my son's speech therapist!

Your posts are so helpful and explain fully what I suspected was the case about the type of indirect therapy my son is being offered.

StartingAfresh · 12/01/2011 14:13

God, I would love working as my ds' speech therapist, but she'd never be able to do her job as I'd be quizzing her every second and demanding that she explain in detail what she was doing and why.

She'd resign within a week I reckon! Grin

moondog · 12/01/2011 18:11

Yes 9-5, you write superb posts which are a real pleasure to read and which always provoke thought.

Re data collection
'I can count the amount of times I got these sheets back filled in on one hand. I gave up using that system after a year of soul-destroying failure to implement this tracking system. I used data sheets that were quite similar to yours. Certainly, within our LEA, the majority of schools wanted nothing to do with them... '

That's very sad. All I can say (I'm due in aerobics in a hour!) is that thnaks to PT we have hit upon something that works and works better than any of us would ever have imagined.

Re caseloads
'because frankly, I had had enough of providing ineffective therapy for the masses while students with pervasive, life-altering levels of difficulty had limited support when kids with speech sound delay who would questionably resolve spontaneously had more time in hours.'

I couldn't agree more. It makes my blood boil. I can't see how hourly 1:1 appointments with a SALT for kids with these sort of issues still occur, especially in today's financial climate. It's a bloody scandal.

Re SLI and older people
There are virtually no adult services for 'adults with significant language impairments who are considered "able" by virtue of being verbal.
This is particularly true for individuals with SLI.'

Yes again. I have my doubts about the sort of 'awareness raising' (albeit well intentioned) that is going on this year especially with the whole Communication Year thing. The outcomes from the kinds of activities recommended by RCSLT are not going to be great.

Re your two challenges, yes indeed.
With the first, i do it not only every day in work but with my own child who has comm. difficulties. I spent last night rewriting a short story they are doing in class in a way she will understand, with a view to (having mastered this) then moving onto the story itself in original form. I go thrrough everything she does in school daily to eliminate/adjust for comprehension issues. It works great but it is hard work. I probably spend 12-15 hours a week working for her or with her.

With the second, yes again.SALTs talka lot about the meaning of behaviour and what a person with CB is communicating but they don't really get it, not like behaviour analysts too.

Yet again, great post.
Now I'm off to do some star jumps. Smile

justaboutmaintainingorder · 12/01/2011 18:56

This reply has been deleted

Message withdrawn at poster's request.

mariamagdalena · 13/01/2011 16:16

Not hijacking, just bookmarking the thread!

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