collaboration

Collaborating for
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if you want to Be more efficient without compromising on effectiveness Improve collaboration with other professionals Combine training with supervised practice

communication

In common with other therapists, Karen Heins and colleagues were looking for an efficient and effective way of managing clients with speech and language difficulties in mainstream schools. The result was the development of the Collaborating for Communication project, which combines practical workshop training for teaching assistants with supervised practice involving groups of real children.

ollaboration is the key to effective speech and language therapy within mainstream schools (RCSLT, 1996; Manz, 2000; Pritchard Dodge et al, 2000). In practice, collaboration often involves assessment of the child, discussion with parents and teachers, followed by a written programme to be carried out by parents and education staff (Portch & Harrison, 2002). Initially, speech and language therapists in the local mainstream school service in Kent were also using this model of service delivery. However, in a survey carried out to evaluate the service, special educational needs co-ordinators emphasised the need for more help from speech and language therapy to train staff and implement therapy programmes. Speech and language therapists had often worked together with individual teaching assistants to demonstrate how to provide therapy for specific children, yet this kind of hands-on supervision was not always possible. The department also offered workshops to teaching assistants on working with children with speech and language difficulties but, despite a very practical focus, it was not feasible for the teaching assistants to immediately practise the ideas with real children under the supervision of a speech and language therapist. The Collaborating for Communication project was developed in 2001 - 2002 to combine practical workshop training with supervised practice in using the therapy techniques with real children. This training supplemented the assessments, reviews and programmes which we continued to provide. I developed and piloted the project while working half time in the schools team with a caseload of ten primary schools. Instead of visiting each school two to three times a term, I targeted two schools at a time, and visited each school for one full day each week for five weeks (roughly a half -term period). The schools not involved in the project during that term continued to receive one visit per term for assessments and reviews. Eight out of the ten schools chose to participate in the project which was structured as follows:

educational needs co-ordinator for the therapy groups to be run over the next four visits. Students with language difficulties were placed together in groups of three to five children of roughly similar ages. Students needing phonology therapy were seen individually or in a small group. One or two teaching assistants were allocated to run each group with me.

2. Language groups
Therapy is much more effective if education staff can see the immediate relevance of language goals to current class work and the broader curriculum (RCSLT, 1996). Each language group therefore focused on a current class topic such as history (for example, Ancient Egypt; Florence Nightingale), geography (Kenya), English (fables) or a time of year (Christmas). A different language area was targeted each week: Week 1 - Understanding stories: Role play helped students understand a story related to the class topic (adapted from Withey, 2000). Week 2 - Building vocabulary: Students described the meaning of words related to the class topic. This area was chosen as many children had semantic difficulties. Week 3 - Listening and following instructions: Activities focused on listening and following instructions while reinforcing vocabulary relevant to the class topic (adapted from Johnson, 1998). Week 4 - Telling stories: Students learned to use a story plan, develop their own story, act it out and retell it in their own words (story plan adapted from Liverpool Speech Pathology Service, Sydney). These particular language areas were chosen as they were relevant for most students with language difficulties, and they fitted easily into current class work. The groups were designed so that teaching assistants could later re-run the same four sessions with the same group of children, but each time they would choose a new topic that the children were currently studying in class. In this way the material was new and relevant to the children, yet the teaching assistants could use the same session plan each time. Each group session ran for 30 minutes, but 45 minutes were allocated to give time to explain the session to the teaching assistants, collect children from class, return them and demonstrate writing up notes. A sample session plan and homework sheet are in

particular language areas were chosen as they were relevant for most students with language difficulties, and they fitted easily into current class work

1. Assessment and planning day

The first visit involved carrying out three to four assessments / reviews and planning with the special

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Figure 1 Sample session plan and homework sheet

Session 4: Telling Stories

Preparation: You will need pictures of scenes (such as a family at the beach; children going shopping) and problems (for example a child who has lost something or fallen over). You will also need the picture cues for the different stages in the story plan. Session Plan: Revise Homework: Ask students what are the three things they need to remember to follow instructions (look, listen, repeat). (1 min) Setting/Beginning: Revise that when questions are about time (have a picture of a clock), who questions are about people (have a picture of people) and, where questions are about place (have a picture of a house). Show the pictures of different scenes, and ask the children to make up when, who and where (for example, One hot day, mum, dad and Sam were at the beach.) If when is not clear, then just use One day. For the first 1-2 pictures, think up the setting as a group. Then give each child a picture of a scene, and ask them to make up the setting (when, who and where). (5 mins) Problem and Ending: Show the children pictures of different problems, and ask them to explain what the problem is, think how the characters would feel in these situations, and two or three things that they could do to solve the problem. For younger children it is fine if they can only think of one solution, but older children should be able to think of at least two possible solutions. As above, do the first 1-2 pictures as a group, and then give each of the children a different picture to discuss the problem. If the child can only think of one solution to the problem, ask the rest of the group if they can think of any other ideas. Once a number of solutions have been suggested, ask the child to choose one as the ending, and then explain how the characters would have felt in the end. (8 mins). Children make up a story to do with the class topic: Ask the children to think of a story that fits in with the class topic. Use the same prompts as above to generate a setting, problem and ending. For example, if the topic is Ancient Egypt, the setting could be Thousands of years ago, a pharaoh and his slaves were living in Egypt, and then the children can continue the story by thinking of a problem that the pharaoh could have. Sometimes the children need to be led through the different solutions by the adult saying First the pharaoh tried...., but...., then the pharaoh tried ....., but ..... In the end...... (6 mins). Children act out the story: Give each child a different role in the story, and they can act it out. If there is time, you can switch the roles over and act it out again. (5 mins) Children retell the story in their own words: Use the picture cues to help them remember all the important stages in the story; perhaps each child could take a section (e.g. first child setting, second child problem etc.). (5 mins) (Note: Story plan is adapted from Speech Pathology, Liverpool Health Service, Sydney).

figure 1. Teaching assistants participated fully in the sessions by preparing materials, observing my demonstration of activities, then implementing the activities with the children themselves, and taking notes on the childrens abilities in the different tasks. All schools were provided with a written information package so that they could run the same groups independently in the future.

3. Speech sounds
Children needing phonology therapy were seen either in small groups or individually. A teaching assistant jointly ran each session with me, and brought toys and activities available in school to provide motivation.

4. Workshops for teachers, teaching assistants and parents

School staff and parents were invited to attend a one hour workshop on working with children with speech and language difficulties. Five out of the eight schools chose to hold workshops. Some schools preferred joint parent and staff training, while the others decided to have separate sessions for parents and staff. The number of participants in each workshop ranged from about six to more than twenty.

5. Providing experience for more recently qualified therapists

The mainstream school team was keen to encourage more recently qualified therapists to consider working in schools. Therapists were therefore invited to spend five days working on the project in one school, and three chose to participate. An information package included advice on assessing school-aged children, writing reports and preparing programmes. A resource file contained information on expected speech and language development in school-aged children, programmes for different areas of language, speech and fluency, and pre-prepared training packages for delivering workshops to school staff and parents.

Language Group Homework Session 4: Telling Stories

Today we have been working on telling stories. Here is a story plan to help your child tell stories with you at home, or if they have to prepare a story in class. If your child has difficulty with writing stories, then they can start by just putting 1-2 key words in each of the boxes. If necessary, later they can expand these key words to make full sentences. WHEN did the story happen?

6. Reports
At the end of the weekly visits, each child received a report using a standard format to explain the group sessions and provide further ideas for helping children at home and in school. At the end of the programme, special educational needs co-ordinators and the more recently qualified therapists completed a questionnaire to provide feedback about the project. Their comments are summarised in figure 2.

WHO was in the story?

WHERE were they?

What was the PROBLEM?

One day hands-on workshop

After the success of the first two terms of the pilot project, we decided to extend the training to other schools in the area. To involve as many schools as possible, the training was condensed to a one day hands-on workshop held at each participating school. Ten schools chose to be involved. All schools identified at least one teaching assistant who would attend all day, so that they could understand how the programme worked as a whole. Some schools then chose to send different teaching assistants to each session, or else to have three to four teaching assistants who attended all sessions. After initially observing the therapist, the teaching

How did they FEEL?

How did they try to FIX the problem? (Think of 2-3 possible solutions) How did the story END?

How did they FEEL?

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assistants were actively involved in carrying out the activities themselves with the children and taking notes. Each session ran with different children from the school, as using the same group of children all day would have been too tiring for them. One topic was used for all sessions (school), but teaching assistants were encouraged to think how to adapt the activities for current topics in their own classes. A sample timetable is in figure 3, although specific times were adapted for individual schools. Four recently qualified therapists and a speech and language therapy student participated in the training days. The therapists were provided with the session plans beforehand, and chose to run two of the group sessions. It was easier for them to get time away from their regular work for just one day rather than five days. After the training days in the ten schools, 64 questionnaires with completed confidence ratings were returned. Of these, 79 per cent reported increased confidence in working with at least one area of speech or language, while 47 per cent reported increased confidence in three or more areas. One of the speech and language therapists involved volunteered to take on a caseload of mainstream schools, while the others were planning to incorporate the ideas into their current work. The comments were generally very positive, and the perceived benefits were similar to those reported by the schools in the weekly version of the project. The main criticism was from teaching assistants who were only able to attend for one group session; they would have liked to see how the other groups worked, and to have had more practice with the children. Another suggestion was having more advice on other areas of communication, such as social skills development. On a one day training workshop, the special educational needs co-ordinators had to make compromises in deciding how many teaching assistants could be released from classes during the day, and not all areas of speech and language therapy could be covered.

Figure 2 Comments about Collaborating for Communication

Key benefits reported by schools: Practical demonstrations and participation made more sense than on paper. Improved confidence and skills in supporting students with speech and language needs. Children enjoyed sessions and groups allowed all children on the caseload to be included. Closer links with the speech and language therapy department. Strategies used in groups were extended to the classroom. Main disadvantages and suggested improvements from the schools: Timetabling and grouping children, withdrawing teaching assistant support from classrooms and finding space in the school to run the groups. Teachers would have liked to be more involved. Less time for assessments of children, and the concentrated support of a day a week over a five week period reduced visits from speech and language therapy for the rest of the year. Perhaps children could attend language groups during the holidays as they had in the past. Future plans of the schools: 6/8 schools plan to continue the language groups, as well as incorporating the ideas into class work. The other schools plan to use the strategies within existing class work. One school was creating an advice file for working with speech and language difficulties. A bookmark with the story plan was devised for all students to keep with their reading books. Key benefits reported by the more recently qualified therapists: Developed confidence in training teaching assistants. Many therapy ideas and useful resources. Seeing how language therapy can encompass National Curriculum areas, and be adapted for future use by schools. Useful for coping with large numbers on the caseload. Main disadvantages and suggested improvements from the more recently qualified therapists: Reduced time for therapists usual area of work, and stretched them in another direction. Project was general, with limited opportunity to focus on more specific issues. Teaching assistants would benefit from a briefing meeting before the groups and then another meeting in the last week for questions and adapting the project for their own use. A rating scale could measure the teaching assistants confidence in working with children with speech and language difficulties before and after the project. Future plans of the more recently qualified therapists: One therapist has decided to increase the amount of school-based work in her caseload. Another therapist was planning to run similar groups in the schools she visits. The third therapist will use the programmes and advice when preparing reports for school-aged students.

Figure 3 Sample timetable

9.10 9.30 10.15 10.30 11.15 12.00 1.00 1.45 2.15 Introduction: Expectations, confidence rating scale for working with speech and language difficulties. Explanation of the days sessions, and how to run the groups with weekly sessions. Language Group 1: Understanding stories Break Language Group 2: Building vocabulary Language Group 3: Listening and following instructions Lunch Language Group 4: Telling stories Working with speech sounds: Therapy activities for one child with a phonology programme. Question and answer session: Adapting groups for future use, confidence ratings after the day, feedback.

Effective method
The Collaborating for Communication project has been a very effective method of providing handson training with real children so that teaching assistants can run groups for students with speech and language difficulties. It would be valuable to extend the training to other schools in the area, and follow up the schools involved to find out if the groups are still running and if the strategies are being used in class work. A second training programme could also be developed to target other areas of communication difficulty, such as focusing further on speech sounds and phonemic awareness, grammar, voice care for staff and students, and social communication skills. Continuing to develop our collaboration with teachers, teaching assistants and parents will enable us to be much more effective in implementing therapy for students with speech and language difficulties. Karen Heins is a speech and language therapist. Copies of the Collaborating for Communication training manual are available, with all the materials needed to run the project, including notes for presenters, strategies for getting teaching assistants actively involved, session plans for language groups, visual cue sheets, homework, and standard report and letter formats. Please contact Karen at 34 Op der Sterz, Fentange L-5823, Luxembourg, e-mail karen.heins@pt.lu. Manchester Metropolitan University: Manchester. Manz, J. (2000) Positive teamwork. Bulletin of the Royal College of Speech and Language Therapists, March. Portch, A. & Harrison, P. (2002) Clarifying priorities. Bulletin of the Royal College of Speech and Language Therapists, March. Pritchard Dodge, E., Andrews, M. & Andrews, J. (2000) Communication and collaboration. In: Pritchard Dodge, E. (Ed) The survival guide for school-based speech-language pathologists. Singular: San Diego. Withey, C. (2000) Developing language skills through playscripts training course. Riverside Community Health Care, London, 29 June 2000.

Acknowledgements
Many thanks to all the speech and language therapists and schools who participated in the project for their enthusiasm, commitment, advice and suggestions. Thanks in particular to Kat McKeown, speech and language therapist, for her suggestions in the initial development of the project, to Louise Ring, speech and language therapist, for the child report format, to Jackie Charlton, speech and language therapist, for the confidence rating scale, and to Rachel Meinertzhagen, teacher, who developed the story plan bookmark.

Reflections
Do I try to act on feedback received about my service? Do I provide programmes that are meaningful both to those implementing them and to my clients? Do I encourage recently qualified staff into my particular field?

References
RCSLT (1996) Communicating Quality 2. Professional standards for speech and language therapists. Royal College of Speech and Language Therapists: London. Johnson, M. (1998) Functional Language in the Classroom. Clinical Communication Material,

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