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SALT advice - More than Words

13 replies

StarlightWonderStarlightBright · 04/01/2010 00:00

Is this the right level for my ds. Have been offered a place on a course run by the SALT dept (At last they're doing something) but SALT therapy will be suspended in the meantime.

My ds is 3 and is verbal. Receptive at around 18months and Expressive at around 2yrs 4months.

Would 'It takes two to talk' be more appropriate?

Given that the course is 'based' on Hanen and the apalling service so far I am inclined to believe that it will be as much use as their imposed 'PECS' but was wondering if anyone has any thoughts.

Many tia

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FanjoForTheMankySocks · 04/01/2010 07:22

We are doing this course. My Dd prob has less speech than your son but the course is geared to all levels.
We have found it quite good although it's terrible SALT is stopped during it, we were told that was because 'you'd be overwhelmed by too many people around'

cyberseraphim · 04/01/2010 09:01

I thought Hanen was great - it is definitely suitable for a verbal child - it is much more open and flexible than PECS. Of course a lot depends on who is running the course - I was lucky in that both SALTS leading the course were very good.

StarlightWonderStarlightBright · 04/01/2010 10:00

I think I'll skip it. It would be exremely difficult to organise, I need SALT to not be suspended but targetted on our home programme.

After a year of no sensible salt and my own research (plus bought-in support) I reckon I know more about how to progress my ds than they do and I've probably got a range of Hanan techniques I use on a daily basis quite by accident.

Also DH and I are at last doing an Early Bird course (out of county coz they don't do them here) and with that and the appeal it would be hard to fit in. Plus given the course offered is an hour drive away I think I can make a case for it being unsuitable for our needs as the reason for turning it down.

No harm in getting the books though or perhaps doing it privately (or out of county) in the future though.

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TotalChaos · 04/01/2010 19:10

I did It takes Two to Talk - not More than Words. But my experience of Hanen was very positive - by far the best NHS help we got. The two SALT doing it were very good - one was US trained (and an ASD specialist SALT) so had a great pro-active attitude, the other one was very experienced, her day to day work was dealing with high school aged pupils with language problems, and had a grandchild with language disorder, so could see the family's perspective well. My DS was ahead of the other kids on ITT - this isn't a problem, as the focus is very much on setting appropriate individual goals for each child, and bringing the individual child on to the next stage. I felt that the goal setting was a hell of a lot more thoughtful than the usual identikit dull set of exercises received after usual SALT sessions.

TotalChaos · 04/01/2010 19:12

PS - apparently the parent sticking through the course rate was much higher for More than Words than It Takes Two To Talk in my area (and the SLT running ITT it in my area were good), which would suggest that it is a valuable course?

waitingforgodot · 06/01/2010 17:46

Hi Starlight, I have a copy of It takes two to talk if you want to borrow it?

StarlightWonderStarlightBright · 06/01/2010 17:50

Thank you TC, that is really helpful.

waiting That's kind, but I'm currently drowning in books and information that is so far unread so I'll pass for the moment, but thank you for the offer.

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waitingforgodot · 06/01/2010 20:16

thats ok! happy reading!

grumpyoldeeyore · 06/01/2010 20:30

I haven't been on any Hanen courses but have been on Earlybird. I doubt you will learn anything on EB given how well read you are already - its definitely not geared to those doing ABA - ours was run by Autism Outreach Teachers who took the line that all children would be fine in mainstream under their watchful eye - but then came out over the 12 weeks with horror stories of situations where it wasn't going so wonderfully in mainstream. Were very restricted by the Local Authority line - discouraged people from applying for statements even though we were on course to get one and other children in the group were at least as severe as DS and if he needs one so did the others, also discouraged people from looking at special school. It was nice to meet other parents but I think if I had the choice I would choose Hanen over EB. I think EB is based on Hanen (I think Hanen tried to sue the NAS for stealing big chunks of the course) but I suspect a good Hanen trained SALT would be better than EB which will just be peddling a TEACCH / SPELL line. Just a thought. I didn't learn anything on it but enjoyed it socially. Also you need to think whether turning down help will be problematic at tribunal eg they might say you have not exhausted the options available and can't say that ABA would work any better than their (cheaper) approaches. EB is very basic eg what is the triad etc. There is a book which accompanied EB which if you could see it would indicate what the course will involve. We spent a lot of time biting our tongue not to disagree with the line they were coming out with. It would have been useful if we had done it 6 months earlier when DS just diagnosed, but we have read so far beyond EB level now it wasn't useful for us. They present a lot of stuff as fact eg all ASD children are mindblind, highly anxious etc. Between DH and I we went to all EB sessions except one but for several only one of us could go and it didn't make any difference, we didn't miss much. We didn't get anything specific and new to use on DS out of it.

waitingforgodot · 06/01/2010 20:38

Hi Grumpy, thats a dangerous thing presenting stuff as fact as not everyone has the capacity to question things. Makes me shudder!

StarlightWonderStarlightBright · 06/01/2010 22:19

Grumpy Thank you for that. We've made our decision now and attended our first Earlybird on Tuesday. It is out of county and run by a retired Advisory Teacher in conjunction with Bernardos. She visited to video ds and turned up halfway through an ABA session and didn't seem too bothered. She appears to be sympathetic to the struggles for a statement of the others in the class (all have or nearly have).

I did have to bite my tongue though. We're encouraged to share experiences, but the minute I mention something that works for us that includes the devil word 'reinforcement' we were swiftly moved on. I suspect I'm going to disagree with 'routine', and 'visual support' when we get there, but the others in the class are brilliant positive parents and it was a relief to meet people who knew exactly how to react to us having a child with asd.

wrt the hanan course. I will be writing to them to express my disappointment at providing yet another inaccessible service. I don't drive (and even if I did it would be over an hour away so problems with childcare due to early start), there is no practical public transport there and ds can't afford to have his slt suspended given that it never really got going.

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TotalChaos · 06/01/2010 23:00

they weren't meant to suspend DS's SALT while we did Hanen but they did but as it was much better than his usual SALT I wasn't that upset. the Hanen course involved 4 home visits from SALT over the ten weeks.

StarlightWonderStarlightBright · 06/01/2010 23:38

TC I hear what you say, - but it isn't the Hanan they are doing. It is a course 'based' on Hanan.

I have a meeting tomorrow with no less than 3 SLTs, - LOL to tell them exactly what I want and a phonecall booked with and extremely senior person in the PCT afterwards to feed back.

I have a list of 30 complaints and have created this to back-up what I am saying. It didn't take very long and I bet I could add a million more quotes:

But puting it here for anyone to nick..........

Evidence and research to support what we are saying we need to happen, but which has not been happening to date (a year under the SLT service):

  1. Targeted support based on need rather than assumptions about asd

? The child?s needs to be viewed holistically, rather than being defined by a diagnosis (Together from the start)

  1. Parents having a significant role in the therapy

? For professionals to work in partnership with families with parents fully involved in decision making processes affecting the provision of support to their child (Together from the start)

? Engaging parents in the process of children?s learning is integral to them
making good progress. (Lamb Report)

? Positive attitudes to parents, user-friendly information and procedures and awareness of support needs are important. There should be no presumption about what parents can or cannot do to support their children?s learning. (CofP)

? If your child is attending nursery or pre-reception school, the priority of the speech and language therapy is to work with you and your children. This is because your child?s family is the main focus of your child?s life. (Hertsdirect)

? Parents and caregivers are involved from the beginning and are key to the management so they can be supported and have the opportunity to acquire skills and strategies for managing children and adults with ASD. Specialist programmes may be devised targeting areas of need. (RCSLT Resource Manual for Commissioning and Planning services for SLCN 2009 asds)

? Acknowledgement and drawing on parental knowledge and expertise in relation to their child. (TftS)

  1. Communication with parents

? Good, honest and open communication is key to the development of positive working relationships and requires practitioners who listen to parents and are trusted by them. Parents? confidence in the SEN system and in schools and local authorities in particular, is significantly coloured by the quality of communication with them (Lamb report)

? Good communication is not just better for parents and professionals, it is better for children. In the most successful schools, the effective engagement of parents has an impact on children?s progress (Lamb report)

? Open communication and a culture that values listening to parents are vital. Everyone working with parents of disabled children and children with SEN needs to be prepared to be part of that culture. (Lamb report)

? The speech and language therapist will always discuss and agree with you the aims for your child. (Hertsdirect)

  1. Availability of information

? To respect the right of the parents to receive comprehensive, accurate information about their child and service provision options(Together from the start) Providing information to families is a key function of service provision. Good information enables families to remain in control as they take decisions about what to do. Difficulty accessing relevant information is positively disempowering in a situation that is often already very stressful (Together from the start).

? A public service, funded to meet public objectives must share, publicly, information on how it goes about its work. (Lamb report)

? Information provision is central to government policy in health and social care. (TftS)

? clarify intended purpose of intervention (CQ3 Section 9.2)

? Parents should be able to access the information that they need, when they need it, in ways that are convenient to them. (Lamb report)

  1. Therapy given by an appropriately trained therapist with relevant experience and monitoring

? They should demonstrate commitment towards keeping their professional knowledge and skills up to date (Together from the start)

? If a child receives the right help early on, he or she has a better chance of tackling problems, communicating well and making progress. If a child does not benefit from early intervention, there are multiple risks which may become evident over a period of years ? of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects, of challenges to mental health and, in some cases, of a descent into criminality. (Bercow)

? The development of clinical expertise is essential in order to ensure that clinical practice is developed and delivered on the basis of evidence of efficacy. Specialist SLTs are responsible for the appropriate clinical support, education and training to more junior (Bercow 3.46)

  1. To receive a service that uses data-driven evidence-based practice to inform intervention

? (Service standard 23 CQ3) The service has a strategic and systematic approach to establish and evidence-based resource as the basis for provision. (CQ3)

? There also needs to be a tighter focus on outcomes for children and value for money. This needs to be informed by what is known about the most effective approaches in securing children?s progress. (Lamb report)

? (Service standard 56 CQ3)Clinical care standards are linked to the published research evidence base and consensus views on best practice (CQ3)

? Speech and language goals should be: SMART, formulated in conjunction with the carer; discussed, agreed and evaluated with carers; evidenced based, needs based, take into account the skills and knowledge of the agent of change; measured. (CQ3 Section 9.2.3)

? We have highlighted the importance of designing and planning provision around a clear set of outcomes for children and young people. It is also important that provision is based on sound evidence of what works. We have highlighted the need for a stronger evidence base and the challenges of gathering evidence in this area. (Bercow 3.76)

? Establishment of an evidence-based resource as the basis for provision of clinical care, organisation of services and service development (RCSLT 2006:116)

? Evidence-based practice contributes to an improvement in clinics services, makes clinicians more accountable, decreases the gap between research and practice and reduces the variation of services provided to clients (International Journal of Language and Communication Disorders)

  1. To have a service that works with other key deliverers, particularly those who work with Ross on a daily or weekly basis.

? Advice from the therapist should be incorporated into your child?s Individual Education Plan (IEP) which is tailored to meet your child?s needs. (Hertsdirect website)

? As ASD and atypical autism are lifelong conditions, an individual?s behaviours need to be continually assessed throughout their life, especially at transition points between pre-school, primary and secondary school transitions and out into life, (National Service Framework for Children, Every Child Matters 2003, Children Act 2004, National Service Framework for Children 2005).

? Once a child?s SLCN has been identified, we recommend that a range of information, advice and support should be readily available to families, particularly at key stages in a child?s life, including in the early years, at the time of a diagnosis, when starting preschool, nursery, primary etc (Bercow 1.25)

  1. To have acknowledged the parents research and preference for the method of intervention and have written recommendations for the statement on that basis, particularly as that intervention has shown to have positive outcomes and is reported as such by the SLT professional organisation.

? One good controlled clinical trial in the USA compared the effects of three treatments for 61 preschool children with ASD (Howard et al, 2005). The children were assigned to treatment groups according to their parents? preference. Twenty-nine children in the intensive behaviour analytic intervention group received 25-40 hours per week of treatment on a 1:1 adult:child ratio. Sixteen children received an intensive ?eclectic? intervention which used a combination of methods for 30 hours per week in 1:1 or 1:2 adult::child ratio. Another group of 16 children attended a non-intensive early intervention programme which consisted of a combination of methods for 15 hours per week in small groups. At follow-up the behaviour group had higher mean standard scores in all skills than the other two groups. The differences for all skills were statistically significant apart from for motor skills. At follow-up learning rates were also considerably higher in the behaviour group than the other groups. There were no significant differences between the mean scores of the eclectic and small groups group. (RCSLT Resource Manual for Commissioning and Planning Services for SLCN)

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