Professional Documents
Culture Documents
tranng
SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2003 +o
Do l seek out exstng o-the-
she packages beore spendng
tme deveopng my own'
Do l network wth other speech
and anguage therapsts to
compare methods and resuts'
Do l pan how l w assess
reabty, vadty and ong-term
eectveness o a project'
Reectons
Response to the project varied among the care
homes and the hospital (see table 1). Two baseline
measures were taken at the control home but two
planned training days were cancelled by this home
because of staffing problems; staff shortage was
given as the reason at the community hospital too.
The referral rate to speech and language thera-
py and dietetics did not increase post-training.
Resident profiles (describing swallowing prob-
lems and their management) pre- and post-train-
ing depended on the member of staff reporting -
there was little reliability. Swallowing environ-
ments in the residential homes were very positive.
In the nursing homes, post-training improvement
was seen in one (NH1) but not the other (NH2,
whose commitment to the project appeared to
peter out). In the control home, no change was
noted from the first baseline measure to the sec-
ond. Satisfaction among a sample of residents
varied among the homes. Participants at the
training day showed a significant improvement in
knowledge immediately post-training. This
improvement was sustained over six months by
the staff who attended the follow-up half-day
(several of the participants had left by then).
There are several implications for the use of
SOAP in care homes:
This package can promote increased knowledge
about dysphagia and change in working practice
and should be rolled out on an ongoing basis to
other homes in the Local Health and Social Care
Co-operative.
Small changes are needed to reflect UK
circumstances (for example, food items and
vocabulary).
Responses among the homes varied. Perhaps in
future homes that are willing to commit to change
(if necessary) and able to give staff protected
time should be targeted.
Another way forward would be the development
of a dedicated team of allied health professionals
for residential and nursing homes. The remit of
this team would include both ongoing training
and assessment / management of residents
chronic problems. A model for this exists in
Glasgow (Scott, 1999).
Used quite differently
SOAP was used quite differently in the two pro-
jects (see summary in table 2). The composition of
project staff in the two areas shows that either
one person or a team can run a training project.
There was also variation in planning time, with
protracted discussions required in Renfrewshire
and a much shorter lead-in time in Tayside. In
both projects we trained staff looking after older
people in institutions where turnover of clients /
residents is likely to be slow, but where the same
cannot necessarily be said for staff turnover. The
number of staff trained was very different. The
model used in Renfrewshire is our preferred one,
in which all staff received training. In Tayside the
range of staff grades and experience was prob-
lematic in terms of generalisation of the training
to the homes. Training time was longer in Tayside
than in Renfrewshire but the model of care in
Renfrewshire was introduced in the continuing
care hospital rather than in any care homes.
The Tayside project included a wider range of
outcome measures, most of which were developed
specifically, for example customer satisfaction ratings
and quality and rate of referrals. Three of the
homes changed working practice after their train-
ing as measured by observation of swallowing
environment and feeding practices at mealtimes;
however the changes were much less widespread
than those achieved by the blanket training in the
continuing care hospital. There it was noted that
length and quality of mealtimes had improved,
and that appropriateness of feeding strategies had
improved significantly. Importantly, the speech and
language therapist was able to monitor clients reg-
ularly and thus, we feel, provided a more effective
speech and language therapy service as a result of
implementing the SOAP model.
So, would we use the SOAP training package
again? YES.
And do we recommend it for use either in care
homes or long stay hospitals? YES.
Linda Armstrong is a speech and language therapist
working for Perth & Kinross LHSCC, NHS Tayside,
e-mail linda.armstrong.slt@tpct.scot.nhs.uk and Alison
Bain a speech and language therapist with NHS Argyll
and Clyde at New Sneddon Street, Paisley (contact via
e-mail Wendy.Toner@renver-pct.scot.nhs.uk).
References
Bain, A. (2003) Swallowing on a plate. Bulletin of
the Royal College of Speech and Language
Therapists. May.