Moondog and working - narrative therapy

[appropriatelyemployed]

We saw the new NHS SLT today. Managed to persuade her to implement one target with ABA methodology. She is very attached to Black Sheep Press' narrative therapy and wants to set up social skills groups for this.

I hate social skills groups and we have found them pretty useless thus far.

She says this is different.

What are your experiences with it?

Marking place.
My dd2 doing this in a small group. I'll have a more informed opinion on it's value after Wednesdays iep meeting...(I hope)

Black Sheep Press could be a UK library extension of Picture Exchange Communication System (PECS)

I don't think it is the resource that's as important as how you use it tbh.

I don't find the black sheep pictures very clear, especially when badly photocopied, but I think they are popular (and cheap). But the issue I suppose is HOW they are used to promote language/social skills.

Haven't used their stuff for years (there are many different materials available and for the bog standard s/lt like me, much depends on what is in the office cupboard). Their stuff has a good reputation though.

If you can

1. operationalise (ie break down/task analyse) what you want
2. mesasure progress
3. harness motivation and reinforcement to get what you want

then anything is efffective, be it a ripped old binbag or a flashy new computer programe worth thousands.

Thanks. This seemed to be a specific programme to follow so I wasn't sure.

If it's SMART then it should be good.
I wnt to an s/lt 'roadshow' recently and picked up whatl ooked like a great little programme at one booth. I asked the woman manning (womanning?) the desk how the child's progress through it was measured.

Here brow furrowed
'Oh you don't measure anything' she said 'You just do it.'

Then I went to another stall and saw a book called 'Yoga for Autistic Children'.
I left shortly afterwards.

Ha!

Well I asked about this and her answer was that, for now, having DS sit in the group away from his TA would be a sufficiently measurable objective.

Yet, what does that have to do with measuring the effectiveness of the programme?

Oh, I tire of it all I really do.

Why don't they all go away and get off my son's statement.

Really?
Well how will she measure it, track it and decide on a criteria for success?
This is not an attack on this woman but rather a comment on how so called education has quite literally disappeared into its own fundament.

I sympathise.
It is positively Orwellian.

It is a pile of poo isn't it?

That's why we're doing what we're doing now with DS. Do I think it is the most appropriate place for him? No. I don't.

But at least he'll not be harmed there and their set up makes them marginally more accountable to parents not to mention available.

It's stupid that I'm fighting a tribunal for anything other than the right provision, but so what if it is all written in his statement? It can mean very little in terms of quality if provision and Outcomes. He had an amazing statement. Probably one of the best in the country for someone of his profile, and yet independent experts coukd find no evidence of progress as a result of it.

DS did a narrative SALT group a few years back,(run by 2 SALT) when he was 5 (was youngest in the group). I was v pleased with it, as there was a v useful focus on question words,in forming, narrative which helped his receptive language. (his weaknesses were more receptive wise than with sequencing and inferencing). So this sort of therapy can work well within a group format but I would be concerned as to the training/experience of non-SALT qualified staff.

Ha ha our new NHS SALT attached to SALT recommended this first time she saw DS. I looked it up and it seemed to include lots of concepts he didn't know yet like pronouns. It seems more about language than social.

Given DS has a full ABA programme I couldn't understand the logic of replacing a highly specialist individualised programme with something like this (apart from the obvious zero work for SALT), but to humour her we agreed to use the resources but not the format. (she wasn't that amused)

School have now presented me with 2 lever arch files of the stuff dusted off from the last child she recommended it for 5 years ago.

The pictures actually look similar to the Derbyshire language tests SALTs do so i think the resources can be made into something ABA like and useful but we will probably use them in 1:1 and carry on with his far more interesting and motivating social programmes.

The trouble with these social skills groups is that they never seem to be social, fun or measured. Trying to recruit peers to sit at a table doing language work is not going to be nearly as easy as it is to play fun, social games in the hall instead of lessons.

We are having far more social success with running around games than with anything like this.

I really wish we didn't have the SLT on our statement now so we could do what we wanted. It is just a constant battle to get targets anywhere near appropriate and I hate watching them churning out packages of crap which they dump on school. They are always so keen to say 'progress' has been made and so willing to lie in reports, I see no benefit in their intervention at all.

AE You NEED SALT on the statement, regardless of whether it is any good. At least you need it as a NEED, if not provision.

I am in a similar position in many ways. If we weren't going the route we were then Herts declaration that ds no longer had any SALT needs and was being discharged would have had me whooping for joy. Not because they aren't lying their heads off, but because I would never have to deal with such a shitty service again.

BUT, then I'd have trouble getting other provision, or being taken seriously, or getting across my point to a school that there might be a better way of doing things due to his langauge problems etc.

As hard as it is, you need to try bloody hard to make friends with this SALT. If you can 'steer' her, she can influence the school and the rest. Perhaps a private SALT can help you as in their code of conduct independents and NHS are supposed to work together.

I know you're tired of it, and it shouldn't be up to you to get the SALT to do something worthwhile, but do read their quality standards. It is all about being open to new ideas, contributing to research and publications, working in partnership with parents, keeping up-to-date with research etc.

BUY her the bloody resources if you have to.

Yes, you are right - as usual!

I will try and let her get on with social skills groups which may be fun even if they are pointless and I will sort out other interventions!

Well it doesn't seem to be helpful for dd, in fact it has been decided that she's better working 1:1 because the others in the group are quicker at responding than dd who needs time to process what to say, and because they are young they often jump in to answer before she can which upsets her.
The work on W- words looks likely to be continued indefinitely as the senco has "hit a brick wall". Dd has quickly memorised the expected answers to questions (through vgd memory and echoalia) but when asked out of context of the material she is lost.
It's a conundrum. 6 of us sat around that table today and lots of scratching heads. I have a feeling that they weren't saying what they were thinking and I can't help but feel it's either because they are as equally clueless as me or that they see dds problems as massively huge and are trying not to overwhelm me.

KF I think its that they are as utterly clueless.

ABA have helped us with wh questions and while its still early stages when they do it they make it look easy
So for e.g. to teach the difference between 'who is it' and 'what is it' we had photos of people and objects and initially he had to match them to the right word (who or what) and we prompted it lots of times until he got the idea.
then we had photos of people stuck to chairs and tables and went round the room asking who or what is it and he had to pick the right answer e.g. the name of the person on the photo or the name of the object it was stuck to (again prompting first then fading out prompts)

It makes me wonder how many SALTs actually have been taught how to teach language
I think many only know how to teach speech e.g. the actual sounds that come out, but not how to put them together into words!

Most of these schemes and groups in mainstream are designed for children who are just behind or have language poverty (parents who don't speak to them at home). They are not designed for children who do not learn language in a typical way / have a language disorder. But its so much easier to get the school to buy a pack and leave them to get on with it.

Ask them for their evidence it works for children like yours e.g. is there research showing success for children with language disorders

If the senco has hit a brick wall then its time to insist on regular direct speech therapy as your child's needs cannot be met from the ordinary resources of the school

As our LA is a SEN Pathfinder we have asked under the new law / pilot to have SALT as direct payments so we can swap the NHS SALT to a private one. Needless to say the LA are not geared up for DP despite the law coming in in Jan and seem to think being a pathfinder means trialling 2 very small projects in a very limited geographical area. But as there is this new law for pathfinder areas we intend to try and use it to get some decent SALT in place.

If they do say yes, and given the way the law has been drafted it will be hard to say no, no doubt they will tell us DS needs hardly any SALT and the hourly rate is tiny so any DP is miniscule so it won't cover private SALT!

Being able to get direct payments for SALT is one of the few areas where I think the SEN green paper has got it right, I am not a big fan of free market competition but I think SALT and autism outreach services are areas where the quality is often so poor that being able to go private will be a good thing in pushing up quality. No parent in their right mind would actually choose to buy these services if they had a choice.

Most of these schemes and groups in mainstream are designed for children who are just behind or have language poverty (parents who don't speak to them at home). They are not designed for children who do not learn language in a typical way / have a language disorder.

Yes

Ask them for their evidence it works for children like yours e.g. is there research showing success for children with language disorders

Yes again

I think SALT and autism outreach services are areas where the quality is often so poor that being able to go private will be a good thing in pushing up quality. No parent in their right mind would actually choose to buy these services if they had a choice.

YES

Spot on post there Agnes.

That's a very helpful post Agnes, thanks.

We are asking for DPs too with the help of our advocate as I don't see this service has anything to offer DS but I imagine that they will get away with refusing it on the basis that it costs them more to provide DPs because of their job lot contract.

When we made it known that we were 'opting out' and wanting to spend the money ourselves, the SALT department updated their recommendations to 'no SALT needed'.

But I don't suppose any of you here are even slightly surprised.

No not in the least. But disgraceful nonetheless.

Agnes that is exactly the impression I have got of our SALT - speech sounds yes (not dds issue) but language no. I know she is uncomfortable at the multidisciplinary meetings. She never says much.
Yes, the school was asked to buy the pack and left to get on with it, exactly as you say.

In all my reading on language impairment the closest explanation I have come across is semantic pragmatic disorder. She may have some APD but as she's mildly HI with language ability

AT I read that the £150k each pathfinder was getting was in recognition of the fact the LAs were tied into contracts and would in effect be having to pay twice until the contracts ran out.
I don't think that was an official view but you could try saying thats what the £150k is there for.
I hope I do get the chance to say just that on the basis I am fed up with the SEN officer saying 'thats what DLA is for' every time we ask for anything.
I imagine by the time they work out how to do DP the pilot will have finished
I am equally sure as no doubt every parent on the pilot has to give feedback they will do anything they can to make sure we are not able to give any feedback!
Star I am not in the least surprised but our last SALT write in her AR report that DS needed every language structure taught individually so even they might struggle to turn round 6 months later and say he doesn't need SALT anymore.
KF if you look at ICAN assessments on ICAN website then I think someone blogs about her child with SPD which you might find interesting

Thanks Agnes that is helpful. I have FS on it so we will be raising it and the AR.

I think these pathfinder authorities will be monitored so I am sure we can feed refusals back to the relevant government department.

Which reminds me, I did email the DoE about this a couple of weeks back but have had no response. I will chase.