Speech and Language Therapy....or lack of

[donkeyderby]

Can anyone tell me what is the minimum amount of Speech and Language Therapy I should expect for my DS (12) who has SLD and is at a special school?

I have only recently found out that DS has not had SLT for one year and 3 months. No direct SLT contact and no programme in place for the teachers/TA's to implement. He has SLT in his statement, but not a specified amount of hours, (I know that so few children get this, that I would not consider fighting for it).

I finally got a reply from the therapist yesterday. She said she had assessed him in October '07 and found that his speech had improved so much that she didn't need to see him or do a programme for him. His needs 'could be met through the curriculum', which means in reality, SLT was being withdrawn.

I'm don't think I'm demanding when it comes to SLT, (I have other battles that take priority). I know that other kids need more than he does despite his SLD. His language IS improving, though it is unclear, obsessive and random. But I do think that he should be seen once a year at the very minimum and some sort of programme put in place, if only to measure his progress.

It seems unreasonable to have so little input, but the therapist made me feel unreasonable for questioning her.

Am I being unreasonable? Any SLT's out there got an opinion as well?

My daughter is 10, has SLD and her speech is unclear and immature. Our SALT was seeing her once a term with a programme in place (3 times a year) and after lots of letter writing finally to the trust chief exec. this was increased to each half term (6 visits).

I stll feel this is totally inadequate and it should be weekly and we are trying to get our LEA to pay for a school where we will get this.

In my LEA, in the special secondary schools, children get a year 7 assessment and then very little SALT so similar to you. We did get the amount of SALT in part 3 of her statement by getting it amended at an anual review and it may be worth trying this. I do understand that you may have bigger fish to fry!

Thanks for your replies. It seems provision is a complete lottery, and a lot depends on how much you are prepared to push for it. I would really like to know if there is some sort of guidelines on frequency of SALT when it is not quantified on the statement. The IPSEA website suggests that it is good practice for provision to be quantified, but doesn't say it HAS to be. I will ask the local parents organisation about my child's rights and how to push for more. The more parents feel they have to get SALT quantified on the statement to avoid the situation I am in, the less SALT there is for everyone else, because they never employ enough therapists to go round do they? I am beginning to think that locally that you are more likely to get intensive SALT in mainstream school than special schools. Or if your child has a diagnosis like autism, specific speech and language delay, or CP. The others just seem to slip through the net, despite their language delays, especially as they get older.

Also, considering their business is communication, SALT's seem hopelessly bad at ommunicating with parents! I have never got any feedback/programmes without having to seek them out.

I mean Communicating!

I'm no expert but it sounds unreasonable to me, particularly the lack of communication with parents.

Ds2 is in m/s and not statemented so probably not a great comparison there but whenever the SALT goes in to see him (every 6mths or so) she sends a letter to say she's going to see him, phones afterwards within a week or so to discuss her findings and ask how he is at home, and then sends me a written report.

I'm a salt in this field. Off out but will return.

Look forward to it moondog! Thanks

Ok, issue is as follow

-not enough salts
-big caseloads (nay, huge caseloads)
-drowning in irrelevant paperwork like all public sector workers
-difficulty discerning who really will read/act on a report and who couldn't give a hoot (last category worryingly large)

Doesn't make for a great service for anyone.
I find it physically impssible to keep in regular touch with all parents/carers of the 80-100 people I have on my caseload but i always tell them to contact me as and when they need me and always get back.

Report writing is tricky-the more of it people do,the less time they spend in the classroom/workplace. I use lots of different systems but come to the conclusion that them most important place for me to be is in the classroom with staff and children working with them and communicating verbally with staff. So many people never look at a report. Ever.

I think because of the factors MD has mentioned it's easy to fall into the trap of thinking that other groups of kids are getting the SALT at the expense of your child. I remember saying to one lady on a course about how I couldn't even get DS on the list before he was 3 because he had some speech - turns out her non-verbal child also wasn't referred till 3. IME as a parent to a child with speech/language delay as a "diagnosis" does not open the floodgates to help.

As an avid reader of the reports I get given - I don't tend to find them all that useful for my purposes- as they tend to be more a snapshot of DS's abilities than focus on future work. I think the problem is that because SALT don't have the resources for regular ongoing contact, they need to have a lot on file (for CYA purposes and to have some sort of resource to look back on if apppointments are several months apart). As a parent - I would far rather have SALT spend 1/2 hour on direct work with DS, with me watching, so I can do similar work at home, than spend that time on reports.

Yes TC.Reports often merely set out what we all already know anyway.I know many professionals in this filed who churn out lovely reports but don't really practice intervention.

I will fight to bitter end to make dissmeination of useful information to staff and parents (and working side by side with them) my top priority.

I have to say I find it so hard when I read all these posts. I dont know how you all cope trying to battle getting the things for you kids.

Im quite new to all this but the support I have from DDs team is fantastic.

Her SALT is the most amazing woman she goes beyond her proffessional demands, has phoned when on holiday, has come in to the hospital to make sure DD was ok.(same as her Physio and consultant)Even the OT who we only saw once before Xmas came running across the supermarket to see how she was.

She comes into my house kicks off her shoes and rolls about the floor with my DD, DD is just 7months and loves SALT so much, it helps she knows the voice and thinks of food lol.

I hope you manage to get answeres and the help you need.

Thanks for more replies. Josey, I have to say that when DS was tiny, there was a lot more SALT...and physio...and OT...and Portage...life was Appointments City Central. I was overwhelmed by reports from professionals. I had to buy a 4 drawer filing cabinet for the paperwork! It has just petered out as he has got older. Good! But NOT when it ceases altogether without notification!

TotalChaos, I know lots of other children do not get the SALT they need. But I absolutely don't begrudge those who get more, and I don't blame any parent for fighting for the provision their kids need and getting it quantified in statements. My argument is not and never will be with those parents. I have fought social services for respite tooth and nail and have got it, at the expense of other kids (as social workers just can't stop themselves telling you)!

Moondog, I acknowledged right from the beginning that there are not enough SALT's, hence the lottery of provision. I worked as a nurse for years, I know how the system works, (or doesn't work). I just don't feel that no SALT at all for my son is acceptable. I don't think I ever said I wanted reports - I just want a couple of lines in his home/school book, telling me the name and contact details of the SALT (I had no idea for a year that a new one had taken over), and a photocopy of his programme once, maybe twice a year. Is this asking too much?

To get back to my first question, in your experience, is it reasonable for a child with SLD and global developmental delay, to receive no direct SALT, no assessment and no SALT programme delivered by classroom staff for nearly a year and a half? Once a year, I would like him to be seen and a programme put in place. To me, this seems to be asking of the SALT, the very bare minimum of a service.

Donkey, no what you are asking for is perfectly reasonable.Chase up-with a letter to head of dept, copied to relevant folk (eg. head of relevant directorate)
I more or less guarantee things will move fasat

donkey - as an aside - do you know that cerebra have a scheme where if your child with SN/neurological condition hasn't seen SALT in I think 6 months, they may give you £500 towards private SALT?

www.cerebra.org.uk/parent_support/support/speech_therapy.htm

Blimey TC, never heard of that!
It seems a worrying step in a way, to plug the gap left by statutory services!

The biggest problem is not really lack of SALT but finding a way to disseminate info between all relevant people quickly and efficiently.
I always maintain the communication diffs. lie with us (relevant adults) and not with the child/service user.

This was gonig to be my MSc topic.

The cerebra thing is agreat idea; we were about to apply when DS3 was finally seen.

DS3 is younger and I have no idea what he will receive at 12 but ATM he has a SALT visit weekly. please don't think we came by that easily- I am the annoying bitch that nobody at the LEA wants to speak to. However I have never had to complain about a SALT now I come to think about it- have had problems with staff turnovers etc but that's just bad luck, and the main issues were about getting anybody to make the referrals initially (or act on them- they kept re-prioritising the list we weren't on; at pre-school lvel they were focussing on school ages and vice versa- that's a management issue though).

I would ask the relevant agencies- school Paed etc- what they have actually asked SALT for help with as a start off; if SALT are not being approached by people stating that he needs X and Y then that will be a problem.

Agree that you need to now centiles etc- here there seems to be a blanket of 'if you reach centile X in so many areas then you lose provision'; its a low level also- 6th centile IIRC, I dead that tbh as he's close in nly one area, will be interesting to see what happends when ds (if?) reaches that although he is plateauing nw and I don't think we'll see much mroe progress (he has a big lexicon now, but doesn't have the motivation to communicate verbally- but as he only just got his ASD dx we haven't been able to get anyone to focus ont hat yet)

Clarissimo and Moondog, I know zilch about SALT centiles. Are they measured against NT children of the same age, or are they measuring relative improvement of the individual child?

Just on a point of priciple, I wouldn't go for private funding. I think the current SALT and classroom assistants can cope with the workload I am asking of them. That's good to know for others who need more intensive help though.

I will see what is said in the annual review coming up soon, then maybe I'll do what you suggest Moondog, and start gently kicking ass.

Funnily enough, despite having been a nurse, I could be seen as anti-therapy (any therapy). I am not, but I am rather anti intensive one-to-one therapies delivered in strange environments by therapists who don't take into account the 'patient's' targets or emotions around their illness/impairment and treatment. Take physios who don't stop when a child is in pain or who allow sessions to be boring. An LD child will not want to do physio if it feels like torture, so why not incorporate physio into physical play and games and make it fun and do it in a fun environment the child knows? Same for the idea of putting a whole bunch of non-verbal children in a special school where only the staff speak, then giving them all intensive SALT. Surely being around verbal active peers is much more stimulating to speech?...My own theories of course...not scientifically tested!

I digress. Thanks for all replies. It's given more confidence to ask for what I want.

I used to work in a SN school and the secondary part got virtually nothing as the SALT worked on the theory that if it hadn't happened by then it wouldn't improve, we used to rant about this but they wouldn't budge and there was such a limited amount to go round.

My son is now 13 and has Down's syndrome and regarded as having SLD. He has very little speech is still at the one word stage , and these words tend to be very unclear . We no longer have a speech therapist ,as of last summer, when he had a review, when she said ," This is all the speech he will ever amount too , so there is no point me contining to work with him", , "His school will continue to help him with his communication" , but that as far as i can go with him". We work at home with him , but apart from going to see a very expensive private ST , we are stuck .
The school is most unhelpful and so my poor son is just being left , with no help at all .
Sorry this probably is just a rant and not helpful too the conversation.

45nanny, rant on! I don't mind!

I was given the opposite excuse - that my son wasn't getting SALT because he was doing so well (spelling?)! I suspect it's like nymphadora says, as they get older services just drop away, and any old excuse will do for culling some of the non-quantified support. Maybe it's the importance attached to early intervention that concentrates resources into the infant/primary ages?

I await feedback from my local parent group, so I'll get back to this thread with my findings if it is any help to you. An initial conversation with them was encouraging in that they said it was perfectly possible to get his provision quantified if you go about it the right way.

As an SLT I'll add that it is impossible for anyone on mumsnet to make a judgement of whether it's appropriate for your child to be seeing an SLT.

We can only comment on what is/isn't appropriate if we actually know your child, have assessed them, spoken to parents and staff and looked at their history.

It is important that children can benefit from therapy. Sometimes children reach a plateau (or a temporary one) in which case therapy can be of little benefit (or needs to be re-visited later). I have never known a child be actively discharged where there was a real identified need, though in many cases the need is inadequately met through school programmes designed to offer intervention to as many children for as little cost as possible.

It does concern me that parents often have expectations of SLT (and what it can achieve) that simply don't match what we know as professionals. This is a problem of communication, of course, but given that we are rarely allowed to be honest in our dealings with parents (to the extent that even our reports have to play up the positives and play down the difficulties), it isn't surprising that parents feel lost or confused or that their child's therapist isn't offering a service. We live in a nanny state where parents (apparently) cannot deal with being told the truth and must instead be spun some line about their child.

We can't even write honest reports expressing concerns to other professionals anymore so we do it on the phone instead.

When I worked in special schools the staff were always outraged that we worked with some children who were verbal when we "didn't see those kids who can't speak". They never really understood how we made clinical judgements because we didn't have the time to properly explain to them and even when we did try to explain, many of them had already decided our service was "no good" and weren't prepared to listen (you could see them switching off).

We also have no time to see parents, particularly when their children are being seen in school rather than clinic (ie not accompanied by a parent).

Schools will always re-refer to SLT if they feel something has changed or the child has had a development spurt. In this case the SLT will reassess the situation and decide whether therapy can now help.

I am sorry you feel that your child isn't receiving the right help (and you may well be right) but perhaps you need to have an honest discussion with the therapist involved to find out WHY they haven't prioritised your child at this time. Given the time to explain this honestly it might make more sense to you and you might feel less angry.

And yes, if you still feel the reason isn't good enough (or honest enough) then take it further, but bear in mind that even a second opinion may agree with the first.

Good post Mogwai.

mogwai , having read through your message , i have to disagree with you ,schools dont always re-refer ,MY SON'S DIDNT .
I had to get intouch (with the SLT) a couple of years back and request they paid a visit to my son at school , as he had made great progress with his speech ( after us attending a private SLT for 6 months ),but as i ran out of money to continue with the private SLT and so tried to get help both from the school and from our own SLT .The school wasnt recoginisng the improvement or if it did refused to do any thing about it, so i had to go to the SLT myself. Whilst he did continue to improve with her , there came a time when as i said in the previous post , she had said , as he would go no futher ,with his speech and that the school would be able to give him what he needed and so she would no longer need to see him.How does she know he would never get any futher.We havn't seen her for over a year now and he hasnt been seen by any one at school either .
I have almost given up the fight to get my son seen again by any SLT , the school isnt meeting his needs. They havn't even sorted out his communication book out for him yet , dispite me having sent back his two old ones back four months ago, i have made my own at home , one that they dont want to use because its isn't how they do it in school, not the right type of pictures, but i will continue to use it as they have still to offered me anything else and as he still has very poor communication skills how on earth do they excpect him to tell us what he wants. I understand that he is never going to chat away like other children ,but i know he is being let down badly. I know ,that the help should have been there when he was younger, again he didnt get it ,just seemed to get left behind, i have always been fighting for him to been seen regularly by SLT but , same old story ,not enough to go around.
I now have no choice but to try to find the money to go private agin , if only for him to be re- assesed and give me some ideas on how best to help him .

45, how very distressing for you.
Have you gone though SNAP/Parent Partnership?
Have you written to head of directorate/Chief Exec?
Have you visited your Community Health Council (brilliantly helpful)
It isn't good for anyone when paretns are at loggerheads with a school like this. Nothing can be done effectively unless there are clear nad honest channels of communication.

Thanks moondog for the ideas,will start letter writting Im always at loggerheads with his school , im sure they dread it when i call. If i had i choice i'd move him , but i dont and he love going.