Speech & Language Therapists..... Exactly What Do They Do?

IntroductionIn order for professionals from any field to work together well, it is vitally important that each one has at least a working knowledge of the others role and ideally a little about their background. They need to understand what each can bring to the situation to help whatever task is on the table. There have been many studies and many projects on this topic. The author wrote ‘Exactly what do they do’ for Special Children Magazine in 1994 which focussed on the results of a questionnaire. This really pointed to the fact that teachers didn’t really know what to expect from the Speech & Language Therapist. Having been out of the profession and working in industry for ten years, I assumed that the situation would have changed radically and improved beyond belief. However, in my day to day clinical work in schools, I found the opposite to be true. The general opinion, I gathered, was that teachers do not realise what speech & language therapists do and how they can work together I decided, therefore, to look at the current situation in more depth.The 2008 SurveyThe original 1994 questionnaire was again sent out to 200 mainstream primary schools chosen randomly by an external administrator who had no knowledge of why she had been asked to select the list. The schools were from across several speech & language therapy (SLT) regions within the Midlands areas. The response rate was 88% which immediately hi-lights the perceived importance of the topic.  The results showed that Teachers had little idea of the training of speech and language therapists. All knew that SLTs saw speech problems but 65% were unsure about what their role in language problems and a frightening 85% didn’t realise that they had a role in social use of language problems or Autistic Spectrum Disorder. 55% did not know how to refer, 89% did not feel confident working on programmes left by the Therapist.Why is it important for the teachers to know about the role of the SLT and how they can work together?The recent Bercow report highlighted the fact that 7% of any class might not have the necessary spoken language skills to begin to access the curriculum. This confirms the Lock study in 1994 which stated ‘any primary school class will have at least 2 or 3 children whose speech development is a source of concern and significantly more who do not listen or talk as well as their peers’. Bercow found that this figure increases to 50% in areas of social deprivation. Obviously, without a certain level of understanding, use of language and general communicative ability, almost every educational task will be affected. Spoken language skills are, quite simply, the building blocks for written language and educational development. The new government directive places the responsibility on children’s services to know about the services and provision available. What is the training?All Speech & Language Therapists study for 3 or 4 years at University to obtain a BSc Honours degree or equivalent. The RCSLT and Health Professional Council insist on proof of continuing professional development so that initial knowledge is continually extended and developed.  Topics studied include phonetics and linguistics, acoustics of speech & hearing, audiology, speech perception, psychology, anatomy, physiology and neurology, speech and language development and pathology, speech and language assessment, and therapy.They work in health centres, schools, nurseries, hospitals, day centres and in the clients own home. There is no lower age limit so that babies with feeding and swallowing difficulties may be seen from birth and no upper age limit e.g. clients who have had a stroke.What types of communication problem can they help with in school?In very simplistic terms, Speech & Language Therapists see children with problems in 3 main areas:·         Speech·         Language·         Social use of communication   Speech ProblemsIt is very easy to identify problems with a child’s speech and Teachers usually feel much more confident when recognising and referring these types of difficulty. The problems may be delayed processes or more seriously disorded i.e. not following normal trends.Language DifficultiesLanguage problems will include both understanding (receptive language) and what the child says (expression).a)      Receptive Language/Verbal comprehensionUnderstanding what is said to them is a problem for some children. This can be related to hearing difficulties or the fact that English is not the native language, but it can be specific problem. The normal rate of development may be delayed or disordered i.e. not following the developmental stages. Children may have problems with listening & attention, auditory memory and understanding of grammatical concepts. They will probably understand concrete ‘here& now’ rather than that which requires simple reasoning skills. These children with receptive language difficulties may be difficult to detect. They can often become skilled at disguising their problems particularly if they are quiet and well behaved. Warning signs may be simply inappropriate responses to requests or not carrying out/responding to the task at all.  They may follow other children and be the last to respond to instruction even in non language activities such as PE. Poor attention span at story time may be another indication (over and above the typical wrigglyness of the 4 – 5 year old!).Some children with receptive language problems will have diversion tactics which could include verbal ploys i.e. changing the subject or going off at a tangent, while others may employ physical diversions! Behaviour problems will therefore be associated with poor comprehension of language.Understanding spoken language is not the same as situational understanding. Situational understanding is the same concept as if adult was placed in the middle of Russia; he would understand routine, gesture and such things as facial expression which would enable him to function in some way. However, children with poor receptive language skills may often have problems with this too.b)     Expressive languageObviously if a child does not understand language there will be problems producing it, so that if a child is not grasping certain vocabulary or concepts, he is hardly likely to be using them correctly. Expressive language difficulties are easier to detect and may well indicate receptive difficulties. Some children have difficulty accessing vocabulary, so that although and they may know a word they either give an alternative or talk around it. If a child is missing out words from sentences or using incorrect sequences within sentences it could be a cause for concern.Social Use of LanguageIf a child has problems with social use of language they are likely to have problems with appropriateness of language, discourse & conversational skills and using language for interaction.  Many children with language difficulties have problems keeping their language relevant to the situation and contexts or may be inappropriate to the situation and people to whom they are speaking. They may give too much information or have little truth value. In discourse they may have problems with eye contact, initiating or responding, taking turns and establishing a referent. Use of language includes expressing needs and feelings, asking for help, greeting people, terminating conversations appropriately.Social use of language involves being able to ‘put yourself into another’s shoes’. ‘Poor conversational skills can be interpreted as stemming from a lack of understanding that other people have access to different information or knowledge, and that communication occurs through the exchange of information’. (Alex Kelly). Hale et al (2005) says that this lack of understanding, or theory of mind deficit, will result in difficulty engaging in reciprocal social discourse. These children may present as ‘unusual characters’ or the class teacher may suspect that the child is on the autistic continuum. These children need suitably experienced professionals to specifically identify the way forwards.How can they assist the class teacher or SENCO?The SLT can assess the child’s communication to determine the nature of the problem and draw up targets for remediation. They are trained to use many, many different formal and informal assessments. They will also look at the environment to see what opportunities are available. It is vitally important that targets for communication are built in to the child’s everyday life at home and at school. The Slt will usually draw up a programme of work which can be built into the IEP. She/he will then monitor the programme and revise accordingly. Different PCTs have different services available, so that some areas have specific teams to work within mainstream schools, while others have to be managed from the local community clinic. The funding for children with speech, language and communication varies massively cross the country as does the priority status.  Last years IDP focussed on Speech, Language and Communication but has now moved away to Autistc Spectrum Disorder.Confidence is a very important factor in determining the success or failure of any venture. Therefore, the SENCOs and class teachers need training to:·         help identify SLAC difficulties·         understand the difficulties faced by the child·         be able to use general strategies for the classroom and specific techniques to helpIt is vitally important that the Speech & Language Therapists are able to do this. If the local authority cannot provide access to such training, there are independent training courses available, which can be tailored to individual area need e.g. www.private-speech-therapy.co.uk or www.speakclearly.co.uk.Conclusion          ‘The ability to communicate is central to all that we do, to who we are, how we learn and how we relate to others’ (Ross, Leeds Metropolitan University, 2007). Communication problems of any kind, however mild, will certainly lead to isolation, frustration and an inability to fully integrate into society. Children will have a harder time making friends and fitting into school. It is our joint responsibility to find the best way to work together to achieve the best for each child. Understanding what each other does is an important first step.Libby Hill BSc (Hons), MRCSLT, LRCSLT, MASLTIIP, HPC Reg.Consultant/Specialist Speech & Language Therapistwww.private-speech-therapy.co.uk