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Tracey Marsh and Clair Brookes are speech and language therapists for Barnsley (NHS) Primary Care

Trust Both work within the community paediatric team in clinics homes and educational settings seeing children with a wide range of communication difficulties Dealing with such an unpredictable caseload demands that they are creative and flexible and work closely with other early years professionals

1. Health promotion Health promotion is becoming increasingly recognised as an effective method of collaboration. In Barnsley we take pride in working closely with Bookstart and Sure Start, in addition supporting other local health initiatives such as bottle to cup exchange. Invitations to represent speech and language therapy at health promotion events - for example Baby Day, Early Years Exhibition - are received with enthusiasm. We have produced displays to educate others about early communication development. In addition we felt it was useful to give information about who we are, what we do and our level of training. These displays, including Talking Tips, Caring about Communication and Come on Lets Play rotate around our community clinics, a new one being created every three months. 3. Joint Visits Joint visits with both a range of multidisciplinary professionals and our own team members form a central part of our collaborative working. We find working alongside health visitors, nursery nurses, teachers, Portage workers, psychology services, the sensory impaired team, physiotherapy and occupational therapy particularly valuable. Multidisciplinary visits provide opportunities for liaison but also offer insight into roles and working practices. Further benefits are in generating a holistic view of the child and the impact of their needs on the family which is useful for setting our own aims. Joint visits with colleagues give us the opportunity to gain new ideas and second opinions and to problem solve, which can offer reassurance and improve productivity. 5. Screening Tool An audit of new referrals discovered that we werent always receiving all the children who would benefit from our input at the appropriate age. A working party of speech and language therapists and health visitors met to develop a screening tool and a training package. The screening tool is used at the health visitor 18-month assessment. This enables the health visitor to make appropriate referrals or give advice to parents. The training package, run by the health visitors and speech and language therapists, comprises information about the rationale and use of the screening tool, developmental norms and advice leaflets. The screening tool is being piloted by the health visitors and is undergoing audit. If proven to be useful and effective, we will extend its use to cover other health visitor assessment stages. Community Practitioners and Health Visitors Association, see 2. Team Meetings Having the opportunity to meet with other professionals at team meetings (such as Annual Reviews) on a regular basis is something we enjoy, and the most effective way of ensuring all professionals are singing from the same song sheet. We find the most useful outcome is in the joint goal setting. It is also a useful arena to inform others of the nature and extent of a childs communication needs and help them to have appropriate expectations. For example we encounter a lot of children with poor attention skills alongside their communication difficulties. Informing school staff that a child may need time out between tasks facilitates a happier and more cooperative child for all concerned. 4. Newsletter Our team has recently started a quarterly newsletter, Lets Talk, to inform the public and a wide range of professionals (including health visitors, school staff and paediatricians) about our service and topical projects. So far we have included an overview of the role of the speech and language therapist and our department, our innovative new therapy groups in clinics and changes in our school service, where we have moved from a needs based to a location based caseload to help with consistency of therapists in schools, and are offering a group social skills package in secondary schools rather than one to one therapy or programmes. In future we aim to cover resources useful to other professionals and book reviews. 7. Spotlight on Special Educational Needs - Speech and Language Difficulties We both find this book helpful in promoting collaborative working in an educational context. Written by a teacher, psychologist and speech and language therapist, it offers insight into the roles of the various professionals. Although it acknowledges there can be difficulties, collaborative working is nevertheless strongly advised as essential. The book provides practical suggestions to support children with communication difficulties in the classroom. These strategies can then be managed collaboratively with joint planning. We have recommended it to many schools and it has already appeared in our newsletter Lets Talk (see no. 4). Spotlight on SEN - Speech and Language Difficulties by Bob Daines, Pam Fleming & Carol Miller, ISBN 0 906730872, published by NASEN, has been reduced to 4.50. From 10. Time / Organisation / Communication For collaborative working to take place, time is essential. We feel recently there has been a shift towards greater recognition that collaborative working is effective. In Barnsley we have seen an increase in joint working practices including the multidisciplinary projects mentioned previously and a stroke unit. To create time for collaborative working we decided that the numbers of direct client contacts had to decrease. In addition to time, organisation and communication is paramount. For us letters and telephone calls are our primary means of communication. We look forward to a time when there is more widespread use of e-mail. Our team is lucky to have full-time clerical support. We would be lost without Julia and, without her efficiency, would find collaborative working impossible to achieve.

6. Early Listening and Early Communication Skills These photocopiable books are very popular amongst the whole team and we find them user friendly and full of good ideas. The activities can be given to other professionals to reinforce communication development. The Early Listening Skills book provides suggestions specific to different settings such as nursery or the home, whilst Early Communication Skills remains more general. Activities to enhance pre-verbal skills, listening, vocalisations, discrimination, memory and early words are covered in developmental sequence. They allow the child to generalise skills in different environments and can easily be integrated into the educational curriculum which we find is effective and rewarding for the teachers and children. Early Communication Skills by Charlotte Lynch & Julia Kidd, ISBN 0 86388 223 4 is 33.45 and Early Listening Skills by Diana Williams, ISBN 0 86388 142 4 is 35.45. Both from Speechmark, tel. 01869 244644.

Clair Brookes

Tracey Marsh

8. Hanen - Learning Language and Loving It (LLLI) This programme is new to us in Barnsley and is running as part of a Sure Start project. Having a regular opportunity to work closely with and train early childhood educators seems to be collaborative working at its best. The fundamental principles of LLLI are derived from the It Takes Two To Talk programme, which we also enjoy running here. We try to foster links between LLLI and Sure Start by empowering the nursery staff to encourage language stimulation, intervention and enrichment. In addition we are running weekly speech and language groups in a project nursery. Session plans and materials are provided for the nursery so they can continue the groups on a daily basis. For Learning Language and Loving It: A Guide Promoting Childrens Social and Language Development in Early Childhood Settings resources see the Winslow catalogue (freephone 0845 921 1777) or contact Anne McDade, Hanen UK/Ireland Co-ordinator, tel. 0141 946 5433, e-mail

9. Advice Sheets In Barnsley, we have created a number of advice sheets for a range of needs. Those we use most frequently are Talking Tips primarily for language delay, Two Word Toy Time to encourage language modelling through play and Let Your Child be in Charge reflecting Hanens allow your child to lead. All have minimal language and are presented with graphics, as we find information presented in this way the most accessible and likely to be taken on board. These advice sheets are useful for parents and for other professionals. Talking Tips was produced for health visitors to distribute at the 18 month assessment. Clipart from Corel Gallery Magic CD Rom, see Leaflets available for a small charge from Barnsley (NHS) Primary Care Trust, Speech and Language Therapy Department, New Street Health Centre, Upper New Street, Barnsley, South Yorks S70 1LP.

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