what would you like your slt provision to look like?

[littlemisschatalot]

i am an slt, currently trying to redesign a service that is failing parents and children.
wwhat would you value?
we are thinking along the lines of continuity of a named therapist,regular provisions tailored to meet needs, rather than provisions that your child "fits" into, but never does really, school/nursery liason with parental involvment, locally placed drop ins/assessments/therapy provisions.....
this isnt meant as a flame your slt thread, just trying to get a handle on what parents want in an ideal world.
thanks

Tbh, the thing that is failing us totally at the present is "in school" provision. It's a black box. We have no idea who sees her or how often, if at all. We have no explanation of her IEP and what inputs are SALT based. We have no, repeat NO feedback for what we could be doing at home.

Afaik, the whole thing is a MASSIVE con. SALTs are hard-pressed and in-county at present the solution is to push as much provision as possible into SN schools and then - just not turn up. . School won't "get involved" for fear of being made responsible for provision, so fail to report how very little provision is actually delivered. Net result - kids in most need get zero provision, or as near to zero as makes no difference.

I think the most productive change would be if they had the guts to say to me: "actually, we cba to give your child (who has as near to zero communication as makes no difference) any provision at all, so either buy some or write her off. Your call; we don't give a toss.

Sorry. Yes, this is ranty. But SALT is a very sore subject here.

yes i realize that it is a sore subject, but i have the opportunity to potentially make a difference to the 3000 children currently on our caseload. often if we ask parents thay say ita all fine as they fear a confrontation with us will make us give their child less, or push them to the bottom of the list.
i agree we are hard pressed, and there is no one model fits all ideal, but if i could just have a few ideas of what we should be changing, that would be great.
thank for your input.

Abandon the "Wait and See" approach whilst being realistic about the number of SALTS there are and focussing on parent training in the first instance.

The Government should instead do a deal with Hanen to have a version of "It Takes Two to Talk" available free of charge online with video clips to provide examples and the facility for parents to record their own clips and submit them for feedback on a secure forum not unlike this one (why reinvent the wheel? - this works).

Health visitors should mention the availability of such a programme at the 18 month stage then follow up at 2 years. There should be a leaflet on it in the labour ward instead of "Emma's diary" or whatever that silly booklet is.

Parents following the programme but finding their child not progressing should then be fasttracked.

transparency when discussing with parents. if resources don't allow appropriate salt time, then to admit it, rather than imply a child is getting top notch services. also drop-ins for the "worried well" - as a % of the worried well parents will have a child who is actually in desperate need of input, but may slip through HV tick boxes.

I haven't found lack of continuity a problem TBH - others may of course feel differently - I think it's more important that any SALT has the right skills for a child's difficulties (e.g. SALT who primarily specialised in child phonology may not be best placed to deal with a child with very delayed receptive language).

In terms of general approach - I wonder if some sort of Hanen type approach might work for some parents - i.e. a more collaborative approach. Also if e-mail could be harnessed as well to allow quick questions/answers between parents and SALT.

better communication ,My son is about to switch to school team and all ofa suddern after working dam hard the last 2 years ,I am meant to take a back seat and let the school deal with it , no way

And to be honest and say sorry we just don`t have the resources or anyone with the skills that your son requires .as I heard thehorror in salt voice when had a conversation with her on the phone

our salt is pretty good, but only sees him once a term, ok now he is improving but very frustrating when he wasnt, id like more regular input, or at least a phone chat more often to ask how its going so you can request new targets or ask questions etc

'we are thinking along the lines of continuity of a named therapist,regular provisions tailored to meet needs, rather than provisions that your child "fits" into, but never does really, school/nursery liason with parental involvment, locally placed drop ins/assessments/therapy provisions.....
this isnt meant as a flame your slt thread, just trying to get a handle on what parents want in an ideal world.'

oh gosh. Continuity of named therapist who does pass the case over if he or she is going on long term sick or leaving. SLT trained in AAC. Completly non-verbal children not abandoned because they cant show 'improvment' in speech. Its about communication!
And more. Obviously.

yep we get the sam eproblem here Riven wrse the problem is less salt you get

which is a bit bizarre

It's to do with NHS targets, isn't it. The way they work in most areas is you are measured based on turnover - a very crude measurement of "cure rate". There is huge pressure to discharge, either by treating the kids with easily fixed problems first or by creatively redefining the problems of the long-term patients so they don't exist. . In practice, the therapists know full well where the real problems are and most try to give as much attention as they can where it is needed - but the targets don't leave them that much room for manoeuvre.

LMC, in all seriousness, the thing that would help us most (SLD 5yo, near zero communication) would be using the limited SALT resource to train and advise us as parents as well as the school, and manage out a 24-hour programme which we all work on together. We are all happy to do the legwork for her, but we need a PLAN. With hard targets and timescales so we know where we are supposed to be on it. Currently SALT is giving school vague and general advice; they are working on this (but because it is so unfocussed I think what they are doing is pulling in 3 or 4 directions at once) without anyone involving us at all so we can't follow through at home and when your child doesn't generalise naturally that's a HUGE problem. I don't want SALT to do more work with DD1, I appreciate her time is limited. I want her to do the equivalent of designing an ABA programme; give us a book list or whatever and then let us and the school between us work out how to achieve the thing. So I'd like her work to be at a higher level, I guess.

for my 2.10yo with severe delay & poss ASD

• home based (he's phobic about hospitals)
• specialist staff - SALT we've seen is clueless about his complex issues ---> drop ins/community staff are not able to address his needs
• no wait & see - even 2 months ago we were told 'there's a wide range of normal at his age' & 'wait until he is three'
• email contact - I have 3 small kids to care for on top of ds' sn I cannot spend the day on the 'phone
• specific goals set out & regularly reassessed
• parental involvement/training/agreement - I am v. cross that PECS is still being pushed at me WITH NO EXPLANATION when ds is flying with makaton.

I think the most helpful thing ( with limited resources)would be to assess all children with language difficulties as quickly as possible ( no waiting 18 months then saying he cannot have salt till he can say 3 word sentances). Then 2 things. Parents ( and later teachers) need skilled guidance - shown how to interact specifically to develop language in their children or webbased courses, taylored to their childs needs. Then regular reviews preferably with parent or excellent feedback. The showing us is so important! I realise not all parents have time for this, but most of us worry and struggle to do our best - and would prefer to channel what time and energy we have into the important stuff. If the early was there hopefully less 1:1 school based salt would be needed.

I meant reveiws of the child with parent present oops!

I'm quite happy with the services so far but would definitely second:

• specialized SALTs catering differently to different problems
• e-mail contact
• continuity, including continuity of a small team who know your child and viceversa
• Hanen courses run at times compatible with having a job and other family commitments
• ABOVE ALL, working with schools because that's where children end up spending most of their time. It's all very good for parents to do their bit, but again we're not there for many hours a day. This probably brings us to statementing and I don't know if we want to go there. The SALT should work with the school/nursery on a regular basis, and 6-week reviews of IEPs should be taken seriously. I think ALL nursery staff should have some awareness and ideally some training (Hanen would be great, and useful for ALL children) in speech and language issues.

many thanks for your comments so far.
we are a very pro hanen area, offering to all children from 18 mths on our caseloads. we offer hanen in the evenings as well as day for parents who work. we do a drop in, and have an e drop facility where parents can contact us by email. i hear the comments about slts having the necessary skills to deal with complex communication needs, and are thinking of having area based skill mix pods, so less experienced therapists have direct access to specialist therapists.
lingle we did talk yesterday about going to post baby groups to promote hanen strategies. in areas with sure starts/childrens centres this already happens. our problem seems to be that we assess people and offer them provsions, which they cant attend/dont meet their specific childs needs/are wrongly timed/in the wrong location/and then they get "lost" in the system.
i hear also about honesty being the best popolicy.
keep it coming! thanks everyone.

Littlemisschatalot
maybe one should have added, ideally there would be more consistency in services throughout the country.
As I said, we're actually happy with the SALT provisions we've got so far (bar perhaps the school thing), but what I get from MN is that we have lucked out. Your area sounds utopic; the problem is that a lot of areas aren't

Hanen is fantastic so pleased to hear that is part of your plan/review. I think the most important thing would be to spend more time assessing the individual child at the beginning rather than looking at the diagnosis and making a quick decision about what to offer. We were given PECS although imo it was not appropriate for DS1 at that stage and I do wonder if it was just a case of 'Autistic child = PECS' and certainly no one had spent any time with him to find out what he could or could not say.

it sounds utopic but sadly isnt. we have a recruitment/retention issues and its hard to get everyone to do the same thing/have the same ethos.unfortunatly, some in our profession still think half an hour a week doing mouth exercises is the best way forward.

transparency from the very beginning about waiting list times, likely provision, the relevant NHS targets and how they are working towards them. salt being upfront with parents about educational implications of language problems. expectation management - so that HVs/GPs referring explain the nature of NHS SALT in terms of possible medium to long term nature of working with a child and amount of work parents need to do.

oh and also a real choice of AAC, rather than a child being pigeoned into whichever of sign/PECs an area seems to prefer.

I'm a SALT and a regular poster and in despair about provision.
It's a nightmare and as a parent with a child with language difficulties,I see it from the other side.

I think 'worried well' drop in clinics are a great idea. So many community clinics are clogged up with middle class kids who have slight speech difficulties. It's unacceptable that so much time and emrgy is expended on them when kids with severe communication difficulties are out there. However, it's the only way these people can access even a 'yes he's absolutely fine, so go away and don't worry'. Worried weell clinic would give the chance for the paretn to be reasuured and the child to never even enter the system which involves more bloody paperwork than you would dream of in your worst nightmare.

I would like to be able to give parents a credit card sized card with a website address on it from which they can access advice, tips, activities and further info to help their child. Content could be monitored and vetted according to RCSLT criteria.

We massively underestimate how much parents want and can and should be involved in helping their children so more Hanen type stuff would be invaluable.I would go so far as to making further input contingent on parents completing a course. From the other side of the fence, people need to know how much time is wasted by people using the S/LT service. We regulalry have people wanting to cancel for ballet or football or often not even bothering to turn up and offering no apology. It can happen three or four times in a row and again the paprework setting up new appointments costs time and ££££££.

Same for stuff like Makaton training. People need to turn up and be committed. I have to say that on the whole, parents seem to think that schools and therapists can and should do all the owrk. It isn';t possible. With a caseload of between 70-100 people, we are a limited resource.

I would devolve responsibiltiy for kids with ASD to ABA providers. Most sl/ts have no idea what to do with kids with ASD and it is a waste of everyone's time and money. S/lts would be better of using their not inconsiderable skills with other people.

Also more high quality training for 1:1 school assistants supporting kids with comm. difficulties. Did you know there are over 24 000 in England alone doing this highly complex and responsible job with no additional training whatsoever? Everyone is obsessed with 1:1 but nonone stops to think of the quality of that support. I venture to sugg est most of it actually prevents better communication as the 1:1 person tends to do too much for the child.

We have a "worried well" clinic here in the Bradford area which seems to work very well. It's once a month.

Another suggestion would be for audiologists to be briefed wherever there is a suspicion of receptive language delay. My audiology appointments were wasted because the audiologist kept giving DS2 detailed instructions he didn't understand.

work on the barriers preventing parents accessing courses/appointments/group salt - as an sahm with one child and a partner at home in the evenings it was very easy for me to up sticks and cross the city as required for group SALT/Hanen etc - but say for a working single parent with more than one child accessing things could be very difficult indeed. Could Children's Centres support the SALT department by offering creche places for Hanen courses?

also would if some form of choose and book system would be feasible in reducing no shows etc, if people were able to book more convenient times. group courses can be particularly frustrating if you are on the list for several months, then get notification a few weeks beforehand and have booked a holiday in the meantime!

I find it really frustrating that DD#1 gets 5-6 weekly sessions then ends up waiting for months at a time before she sees the NHS SALT again. It is my understanding that this is done so that boxes can be ticked to say that targets are being met to provide therapy within a specific period of time. No priority is given to the more severe cases over the mild cases re amounts of therapy received. I have also found that until this last block of therapy that they have ended up using one of the sessions to reasses each time to ensure they are up to date with where DD is at. I pay for weekly private SALT help in between times, which both parties have been made aware of from the start. Inevitably though DD is not where the NHS therapists "expect" when they next see her as we have undertaken lots of work in between.
What would I like - I'd like to be able to see the NHS SALT on a regular basis. I know weekly might be pushing it even with a nicely redesigned service as there is a limit to how many children can be seen, but certainly every 2-3 weeks rather than a block followed by months of no contact. As I understand it at least for this area, when DD starts reception I will still take her to the SALT appointment during that year, but after that they will see her in school now and again - I would like to be able to attend those if possible, or have the option to still take her myself so that I can continue to stay up to date with her progress and ways in which I can help her.

Good luck with the reorganisation of your area SLT.