If you had 2 minutes to "pitch" what was needed for people with Autism to NHS commissioners, what would you say?

[working9while5]

Hello all

Long time.

To cut a long story short, I have to do a 2 minute "elevator pitch" for commissioners on ASD in my area for a job.

If I get this job, I will actually FINALLY have the opportunity to make some real changes to speech and language therapy provision in my area, but I'm really not expecting that I will be successful. I am actually surprised I got an interview because I banged on SO much about the efficacy of behavioural interventions and tracking/monitoring of progress in my application. I figured I wouldn't get an interview so I wanted to just write what I wanted to, have my voice heard...

But an interview I have, and I would value the reality and candour of the MN SN community on where the money should REALLY go, what should REALLY be said.

I'm not prepared to play much politics on this one because if that's what I have to do to get the job, the chances are I won't have a chance of actually making the changes I want to see made - if that makes sense? I have to go into this being candid about what's needed but in a way that someone who had no vested interest in Autism services can "get" almost instantly and feels ready to put money behind.

Any thoughts?

PS I will be 38 weeks pregnant on the day of the interview! So not a lot of time to prepare right now as am so slow and lumbering...

If its for a job interview i would say the NHS are already doing a fine job!

NHS SALT provision problems i have encountered, they work on formal assessments and not functional ability, even when the child has no previous difficulties with formal assessments, just functional ability and this is well documented. I suspect to lighten their work load.

They should provide SALT 'programmes' to school, they supply DIY work sheets.

They should attend termly meetings, and monitor progress and help to set targets. They dont.

How about a "Communicating with people with ASD" course to run on INSET days in every school in the area?

Have already covered the worksheet issue in my application... and I wonder would an NHS commissioner "get it".

NHS commissioners are (predictably) all about the money... so they want to know that what is being offered is effective, efficient and does the job. Facts and figures.

I think you are dead right.. but how do you sell that to someone who doesn't know anything about the processes or practices that work or don't work and perhaps doesn't even know the first thing about Autism or why they should care about it? They want to know: a) what's the problem, b) how much does it cost? c) how you're going to fix it without much money to do so..

So, the problem might be: long term, kids with ASD are costly to health and social care...

The solution might be...
early intervention can make a difference if it's effective... we know that communication and social skills are THE major features that differentiate whether a person with ASD will gain employment and find relationships and this has nothing to do with performance on IQ or language tests.. so effective intervention needs to be based on observational assessment and treatment of those skills that is adequately monitored and tracked...

Which can be achieved by (facts/figures proving that it is feasble to do with current resources if you just do it differently).

There is definitely the possibility to push functional assessment here... but it just has to be cleverly done. Very cleverly done.

Say what you have already said but with costings.......

And show your up to date knowledge about potentially having to win back funding from personalised budgets!

And mention Moondogs interactive diary backed with research and decent group training jointly for TAs/teachers and parents to set up systems where therapy is ACTUALLY happening with accountability and motivation built in that is not purely down to the SALT.

Yes, Starlight! Need to trawl through the Health and Social Care bill.. it's the costings are hard, because I'd like to access the data for the area but as you know, that ain't going to happen while I am on mat leave and through the lumbering, clunking system... I've talked a lot about that sort of system and the need to invest in training people in accountable trackable systems too. I am on it like a car bonnet.

This personalised budget thing, is there anything really good on it that you know of? Or any good national data... I used to know this stuff before I worked more in schools but have lost my touch a bit..

How is bump?

No. It's all pie in the sky promises and sound bytes. Agnes is usually better at keeping up with these things though so perhaps ask her if she knows what is going on.

However, it might be a bit cheeky but I bet your interviewers will have no clue yet as to what is happening either so to some extent you may also get away with 'dreams' particularly if you can show you might have some solutions to their worst fears should they come about.

My daughter has complex speech problems. She started school with a TA (who was the school nurse). DD had a cleft repair with no soft palate, a trachy, recovering from first Jaw Distraction, oral sensory issues, hyper nasal speech, dreadful back sounds and she couldn't really articulate properly. This TA had two mornings training, prior to DD starting school. The specialist Cleft SALT came in twice a week for the first half of the term and then it became once a month, and over time every half term. DD did fantastically well, down mainly to the TA being so receptive to what was expected of her. She certainly earned her wages!!

Seven years on the TA is now working for my local NHS SLT dept. assisting adults recovering from strokes and brain injured youngsters out in the community.

With the right sort of training, and with the SALT coming in to check speech targets once a month, both DD and the TA flourished.

Oh and Agnes has been good with costings before now too.

And don't scare any caring carrot advocates/leads into thinking you'll be the demise of their empire. Show them how they can better justify their existance and jobs with a bit of EBP.

Bump fine thanks. Back to back now! Silly silly baby!

I think the SALT therapy provided by the NHS is useless for several reasons : they are simply trying to graft onto autistic kids the types of therapy which work with normal children. They fundamentally miss the point because they miss 2 key deficits of autism: lack of imitation and lack of any social desire or willingness tp please. Only with behavioural techniques such as ABA can you overcome these, and teach speech by using reinforcements or rewards to encourage the child to talk. Plus ABA will teach the child HOW TO IMITATE so that they know how to copy first sounds, then words. The irony is that there is not enough SALT to go round, so us poor autism mums languish on waiting lists for months. But when we finally and joyfully reach the top of the list, the SALT will often quickly give up altogether on the child learning words and shift to Makaton (meaning they are, effectively, not acting as speech therapists at all, perhaps they should be renamed Speech Prevention therapists!). Or they will recommend PECS, which they more often than not use wrongly: as an alternative rather than a precursor to words.

For my money, you need to retrain an elite cadre of SALTs in ABA or VB: such a course was actually featured in the Dept of Education's handbook on SEN launched by Sarah Teather earlier this month.

Get this select group of SALTs together, get Moondog in, send them on the BeyondAitism course, and refer all autism speech problems through them. It could make a vast difference to outcomes in autism speech problems.

Early intensive behavioural intervention offered to preschool and EYFS age children.

It will save NHS money in the long term (eg avoiding SS, mainstream inclusion etc).

So SALTs already know something about ABA and the enlightened ones can see how it's good practice. EIBI should be essential part of SALT training and CPD.

Treating parents as genuine partners in the process of support for their children - the proposed changes should back that up in theory in some way.

In my ideal world, support and care of ASD children wouldn't be divided between NHS and Dep of Education, butwould come under a single SEN body. But that's too nebulous and idealistic to say!

Good luck!

2 minutes you say?

Yy to saving money in long-term.

To be honest, NHS commissioners will have no vested interest in the survival or demise of SLT for these kids.. if they thought they could get rid of it and replace it with nothing it would be a happy day for them, so I don't think they will worry about the demise of any empires.

Also, in our area there is 1 WTE cover (half time senior/half time junior) for specialist autism SLT so anything to do with training or engaging others is always going to be seen as a good thing, also anything trackable/accountable not likely to be sneered at. The bulk of the money, as I said before, is put into diagnosis not intervention.. so I suppose one of the challenges is to say, well, that's great, diagnose these kids but then what? Diagnosis is not everything, how can it be made more efficient etc?

Functional assessment definitely the way forward.. real skills, functional skills. I need to show how all our mainstream Band 5/6 therapists (non-specialists) can easily be trained to do all of this and in a short period of time can train others.... Particularly joint attention/imitation/initiation/manding/early concepts and vocab/Teach me Language stuff... I would like to see all this stuff being the bread and butter stuff... properly trackable, properly accountable, properly evaluated.

I don't think that will be necessarily something I talk in detail to commissioners about other than showing a cascading effect e.g. how training all of these speech therapists to train school staff etc in basic behavioural principles/choosing right target/data recording can result in better, faster, more comprehensive evidence based intervention for all... they will want details of potential outcome, not process if you know what I mean.

Yes

A whole TWO minutes. Woop woop.

What about:

'Give me the job and I will improve the outcomes for twice as many ASD children on half the budget and will be able to provide the evidence. I will need full engagement and support from you. It will take two years and upon delivery of the evidence you can double my salary!'

And I need 6 months maternity leave......

and I'll be breastfeeding at work.....

lol Starlight.. that is just about perfect from my point of view! Though I suspect wouldn't go down well with my manager (though at least on the plus side did breastfeed herself AND have a homebirth back when no one did it).

That is the crux of it though, isn't it.

I just have to say
You're very worried about your budgets
Your're very worried about the health and social care costs incurred as a result of long term disability
Social communicaiton, not language or IQ, predicts how much you will have to shell out
Long term costs of current system = already unspeakably high
Costs increasing all the time
Current interventions not touching this need - no evidence, not working
This can change everything and will improve outcomes... (insert proof)
You will thank me for all of this
You can't afford not to employ me actually

Where do I put in the bit about diagnosis? That's the thorn in my side in this. Keep thinking, but how do I change it so that diagnosis doesn't take up SO MUCH TIME?

I need facts and figures. Now!

Well diagnosis and need are not the same thing are they?

And technically not dependent on each other. Not in terms of formal labels certainly.

Assessment is of course essential, but that can be a part of the intervention surely, and 'some' of it can be outsourced provided TA's/teachers/parents are trained and have the tools.

How does the dx role fit into the whole newly proposed single assessment process?

It sounds to me like it is going to be outsourced to a private company anyway in the near future. The recent news has been priming the public for such a move similar to the DLA assessors. Too many SEN children apparently, due to lazy teachers and parents.

Mmmmmmmm, yes, that's interesting about private companies.. yes, because there's that "arm's length" bit, isn't there? So diagnosis may not be as central. To be honest it is the bulk of the current role to the extent that really it has almost been the entirety of it. It's one of the reasons I got out of that when I came back off last mat leave. The "process" consisted of 2 x 1hr assessments (minimum) plus report plus attendanace at a MDT, and that was just me.. other members doing obs in schools, ADI etc.

I am sort of with Moondog on the too many SEN kids though..too much desire to label children with a "need" that would be best met by standard adjustments to teaching or environment that could be done instantly or for free, creating endless paperwork for these kids and taking time away from those with persistent lifelong communication disability (in our field). I am always ranting about it to people at work. To anyone who'll listen, mainly!

In terms of assessment, I agree. Anyway proper ongoing data tracking IS assessment and suggests when things need to change.

I just feel a bit out of the loop this year in comparison to how I would normally be, was very pregnancy-sick for a LONG time so feeling a bit as though I just don't have my finger on the pulse in terms of all these new changes. On the plus side, baby flipped out of Breech on Monday so no cs.. but I suspect back to back again from all the kicks up front..