SALT advice needed please

[anonandlikeit]

Could anyone help with some SALT advice please.
DS2's (CP&ASD) latest SALT report says to discharge him from their service.

Before I agree I want to check that there isn't more they could offer him, but I don't know exactly what I need to ask for, or even if it is the sort of thing SALT can help with.

His most recent understanding of language assessments all fall within normal limits BUT at the lowest end, just scraping in to be within limits. The SALT feedback also said his processing time is extremely slow, taking over 60seconds to respond, she has added advice to school to give him time to respond.
Also to get the answers, he needed the Q's repeated several times & further prompts etc, so a painful process.
He produced NO spontaneous speech, was difficult to focus, lots of rocking etc.

What would you do?
What should I be asking for?
Can/should SALT help with procvessing time, social use of language etc

Not sure about processing time, but certainly social use of language should be within SALT remit. I wouldn't want DS to be discharged ,as I think that it could give the false impression to school etc that the language issues are all fixed iyswim, whereas being under SALT does I think flag up there being a problem in this area. Do they do any salt groups in your area - last year DS did a "narrative group" - which is to do with putting together events/sequencing into little stories, and focuses on "wh" words and the answers to them - something like that could be helpful to your DS.

Thanks for your help,
school don't want him discharged either, we just need to eb sure about what we want before we ask for it IYKWIM.

we & the school have been working on a SALT programme for structure & recall.
She said that problem appears to of resolved

just a little bump!

I'm an SLT

I think you need to be more specific about what you want and you need more specific infomration about reason for discharge.

As a mum, I understand your wanting him to reamin on the caseload but as an SLT I also understand that we don't have the resources to keep children on the caseload unless we feel they can make better progress (not just spontaneous progress) with our input.

If your SLT feels she can make a difference, he needs to stay on the books but there's no real sense on having him on the books simply to highlight his needs.

I had this recently with J. Expressive language and vocabulary etc. all way above average and so she wants to discharge him BUT his social skills and use of language are well below what they should be and CAMHS did recommend ongoing SALT so I said please don't. She didn't but wants to next year. So I am asking LA to tighten up the Statement, which states severe defecits in social interaction and communication and provides for some SALT in Part 3, but not how often she should visit etc.

TBH, am going to ask for a second opinion from a SALT who is more experienced with autism as there is a good one locally.
HTH

Thanks for your input.

MissEmilyDavis, thats what i need to know really. Can a SALT help with processing time/speed etc or is this just a developmental thing that will either improve or it won't.
I don't want him on the books unless there is any value in it, he has enough appnt's & you are right, she will, i'm sure have a huge caseload. BUT equally I don't want him discharged IF they can offer him more.

In a 1 to 1 assessment with allowing 60+ seconds for him to respond, repeating instructions & Q's, offering further info, he can just about give the correct answers to scrape a "within normal limits"
But the real world isn't like that is it.

If he were your son what would you be asking for with the benifit of your expert knowledge

It's diffiecult without seeing him myself, anon.

I have seen a few children who had issues with processing time but I've never (personally) been able to improve this, only to make others aware of it.

The processing time you describe is quite exceptional, however. I've never come across that sort of length of time myself.

Has this always been an issue or did it develop gradually?

My personal feeling is that I would have an independent assessment (which will cost in the region of £120 - £150) with the aim of determining whether SLT can be of further benefit.

I would imagine (TBH) that your lovely boy will always have some degree of difficulty in the areas you describe; the challenge for the SLT is to determine if he has reached a plateau. This doesn't mean he wouldn't make more progress, just that SLT can't improve things above and beyond the rate of spontaneous progress.

Thanks Missemily, I appreciate your honesty.

He was born at 28 wks has mild CP & Autism, language has always been delayed.
His ability to follow instructions has always been OK & his vocab is good too now.

The SALT was giving advice & a programme to work on word retreval & sentance structure but she feels this has now resolved.
But I don't know if his slow response is due to processing or retreval or a bit of both.

I'm sure he will plod along & gradually improve in his own way, its just difficult to know honestly if there is more they could offer or if its all down to budget constraints.
Is it worth me fighting for more from them, I suppose is the Q.
Maybe an independant assessment may eb the way to go.
Thanks again

sorry, I typed out a long reply and lost it when the PC crashed so this is a shorter version!

I would begin by phoning the SLT who is discharging your son and approaching it from an "I'm concerned" point of view rather than approaching it as though you are expecting to have to fight for what your son needs. There's nothing worse than answering the phone to an irate parent who has already decided that you are trying to deny their child the help they require (I'm not saying this is how you would approach it, it's just my opinion).

Sometimes we discharge children becasue they have reached a plateau, however, yes, in my experience, we are doing less for children than we did in the past, simply because we have huge numbers and fewer staff.

At the moment we have particular problems in PCTs because many of them are in serious financial trouble and have frozen budgets and frozen vacancies. In the department where I work, there are five vacancies and we are not allowed to recruit, which means the people left behind are under a lot of stress. It is often the fault of the system and rarely the fault of the individual SLT, most of whom graduate from university wanting to help people and find themselves frustrated at the constraints under which they are required to work. In my own case, I often wonder if I'm being even 10% effective.

I have often discussed the "discharge" issue with parents and found that their anxiety comes down to the fact that they have a long history of SLT and feel they have to fight for anything their child has ever had. To let go of that service can be hard (and so can an admission that things may have reached a plateau). Many parents don't realise that they can refer their child back to the service at any point if they feel there has been a significant change in their child;s skills or in how they are communicating/coping. It's not a very final thing and perhaps this is what you need to hear?

Ask the SLT for an explanation. If you are not happy with what she says then go down the independent route but try to be as objective as possible and work out exactly what it is you'd like help with.

Thanks again MissEmily, i have a good (i hope) relationship with all of ds2's prfessionals, so certainly would never be that irate parent, if ind it gets you further to be calm & polite!

I can't imagine anyone puts themselves through, study, uni & all the training if they don't actually want to help the people they treat.

I think all parents know its the system at fault but I suppose its like anything, if your the person dealing with the end user you are the one thats going to feel the full force of worried parents frustrated by the system.

I was discussing it with ds's SENCO, the school at the moment say with allowances & support he is coping. But they don't want him discharged because of the difficulty & waiting times of getting back in to the SALT system.

I guess its a vicious circle, if there were shorter wait times & easier access to SALT us parents (&the schools)would be happy to eb discharged without a fight, but then again if more of us were happy to be discharged there may be shorter wait times.

TBH I knwo very few children who are actually receiving therapy from a SALT, many have assessments & reviews every 3 or 6 months. Any actual therapy is done by the school TA's & the parents, who certainly are not trained profs.
Maybe more therpay would get kids discharged quicker?

Thanks again for your help.

anon- when DS was discharged I was told that if me/school had concerns and wanted him seen again, we would not have to go on the waiting list again. may be worth checking with your local SALT department.

in terms of the processing -not something I know much about - there have been discussions on here about auditory processing disorder/and or the Listening programme or AIT or Johansen therapy. I think people's experience of these therapies has been somewhat mixed.

We got discharged from SALT on the basis that school cover all the social skills/communication stuff and SALT didn't need to be involved.

I checked this with community paediatrician and it seems to be the protocol for the area.

Trouble is if school didn't pick uip these things in the first place, how are they best fixed with part-time TAs to develop social skills/communication on an individual basis?

Thanks TC & Debs
I'll discuss it with the SALT tomorrow