Commentary:-

Hi welcome back and I hope you enjoyed our last session. Today I have been asked to talk to you
about the role of the SLT and our relationship with the SNAs we work with in schools. I currently
work as a private and HSE SLT but have good friends and colleagues who were deployed to the
Demonstration model, a forerunner of the School Inclusion Model, I also have extensive experience
of working within primary and secondary schools both here and abroad prior to my return in 2006 to
Ireland. I can say this to you especially - that in my experience - my favourite person to work with in
educational settings has been the SNA. why? Because when I am focusing on the needs of a
particular child it is the SNA who typically spends the most time with that child directly engaging
and supporting them and the great thing about speech therapy is that everything we do with that
child that involves any form of communication is ”therapy”.
There are two parts to today's session that I hope you will find useful – we are going to talk about
the context of the speech therapist and their relationship with the SNA in the school environment
and supporting children and their families outside of school. And what does an SLT do?
All of us working in education to support children with complex needs are doing so under the SIM.
This is a description to refresh of what the SIM aims to achieve
My first session covers an introduction to overall understanding……….. And the cycle of language
development with a brief mention to the power of your positive interactions with all children that
will support communication development.
In terms of understanding the nature and purpose of interventions , I will cover some of this in the
next few slides I tend to describe the specific skill of the SLT as when we meet a child and through a
variety of means determine where the child’s SLCN are in line with the “normal” pattern of
development - Then our job is to assist anyone communicating with the child/children to
understand what the implications are for this child of their language difficulties, how to increase the
chances of successful communication by showing those in the child’s environment how to adapt to
the child’s needs and finally to determine what is the next appropriate stage of development/need
for the child. I would not assess a child in 2 nd class, determine that their language skills were on a par
with a child in senior infants and pick as my therapy goals second class curriculum activities. My goal
would be to build on the child’s current abilities to the next appropriate stage.
Behaviour is a form of communication – nonverbal and verbal and we tend to work with challenging
behaviour through language and discussion. This is obviously much more challenging for a child with
SLCN than a child who has not communication difficulties.
As SNAs and part of the school team you will most likely hear from parents if their child isattending
an SLT. From my experience of the Demonstration project, I know our HSE team always checked if a
child attending the HSE was in a demonstration/pilot school and that would be our first point of
contact with the school. In schools where there were no demonstration SLTs, our point of contact
was usually the class teacher or resource teacher who would cascade the information through the
school. I am going to briefly talk through the three levels of this pyramid and how the SLT fits in and
how the SNA is a key worker with the SLT – not to deliver therapy but to support the child’s
communication needs. I will talk through each level and refer to both our roles.
The role of the SLT is to create “ a communication friendly environment” for all pupils but especially
for those with SLCN. The universal training is for all in a child’s environment so that they understand
what is “typical” development,/How children who do not develop “typically” can be identified and
how we can meet their needs by having ”adaptable” adults and environments. We cannot expect
children to compensate for their challenges, just as you could not blame an airhostess for not being
able to fly a plane in a “ crisis” so we as the “component” and informed adults must adapt to
children who do not have age appropriate communication skills. Information/Knowledge is power –
as the steve covey quote goes – “Seek first to understand, then to be understood.” – this is so
important in speech and language therapy as the core challenge is the ability to communicate so we
need to be sure we are “sharing the Moment” and maximising the chances of a successful
interaction.
 This level seeks to identify children presenting with SLCN and to meet their needs in a more specific
way via interventions. I have been the SLT who administered the assessments, but I have also
delivered training programmes to schools that empower the teachers to deliver the assessment
process to identify at risk/struggling children. Typically, this is done by the SLT and the teachers –
class or resource and they cascade it down to the SNAs. I personally have worked directly with SNAs
who were “willing and able” to run these groups in a very successful manner, in addition to
class/school wide interventions.
From the research we know that approximately 10% of preschoolers will present with SLCN but this
decreases with maturity
Around 7% of children and young people are expected to have specific speech, language and
communication needs (primary SLCN) – Primary SLCN is where the only presenting difficulty is with
their communication so children with complex presentations often have SLCN in addition to other
areas of need – ASD/learning difficulties
In areas of social disadvantage, often more than 50% of children are likely to have delayed speech,
language and communication skills .
The number increases when we consider children where there are additional needs to SLCN. In
general, there is evidence that all children with primary SLCN are not being identified in school, in
fact less that 50% of them are being diagnosed. This is why the target universal and targeted school
support tiers are so important as they increase the identification of children with communication
difficulties and supports their learning in the environment and in targeted interventions.
“Despite internationally accepted prevalence figures of 7%, only 3% of the school population is ever
identified as having SLCN. Children are being missed. (ref Communication trust uk
(https://www.thecommunicationtrust.org.uk/media/267241/1_4_national_prevalence_final_pdf.pd
f )”

the intensive school support ifs for the most severe /top 1% of children with SLCN.. As you can see
the SLT is the primary provider of the intervention, but they work with the whole school team as a
child in need of this service will struggle with all areas of the curriculum and will need understanding
and support in all their interactions with adults and peers in school and at home.
These children do not often have associated learning difficulties and the impact of their SLCN is
profound.
This is just a sample of the services that provide SLT support to primary and post primary
schools in Ireland and any one school could have several therapists from several services
involved. A child/adolescent could come from these services for a variety of reasons – for
example
the majority of children with SLCN come from the primary care service and attend their
local clinic.
There is a new structure evolving for children presenting with complex needs and this is
called “ progressing disabilities” – these children tend to be more likely to have an SNA
involvement as their complex needs require additional supports to access a mainstream
setting – this was previously a split service between the HSE and Private /state funded
sector, e.g. Beechpark/Enable Ireland but the new structure aims to integrate all these
services.
Children such as those cochlear implants, cleft palate, complex medical conditions may
come thought a hospital SLT paediatric dept
CAMHS employs SLTS directly to work with children accepted to this service
A lot of parents despairing of waiting times for any publicly funded SLT service will – if they
can afford to – supplement or replace the state service with a private relationship.
From the tree of language, we describe the skills required to become a competent
communicator. The above areas are in the roots and we contribute as SLTs to the
tx to support children presenting with challenges in these areas –
1. ASD – we offer training to enhance communicating with children on the spectrum.
 – “how to get in on the act” as this is the greatest challenge for these children.
They struggle to share interactions with us. So the more competent we are at
interpreting and responding to their messages the greater the oppertunities for
learning to occur – the goal of education
2. We work with schools and visiting teachers for children who are deaf to
understand the impact their hearing loss has on the language and general learning
and we support schools and families to work on their understanding, expression
and clarity of speech. The understanding and expression of language therapy can
be shared via whole and targeted level supports but their speech work may require
individual and specialized support.
3. We work with children who struggle to attend and listen to language and this
often, but not always, has an impact on ability to learn language. Again, as this is in
the “roots” it is often essential to work on a child’s ability to attend and listen
before we can expect then to engage in learning through language. My favourite
advice is to find something the child is interested in/enjoys and encourage them to
do “one more turn” that they would like so we increases their attention one turn at
a time. We don’t increase attention by the length of the task – e.g., if a child cannot
stay to complete a 24-piece jigsaw. Instead of always putting out the 24 pieces and
struggling or failing to complete the jigsaw/task every time. We do the first 12
pieces and let the child do the second 12/6/4/1 so that they get the sense of
completion.
4. We don’t group children in by their ability level but rather by their age in our
education system. This works well for the majority of children. I often use a train
analogy for this. The wexford to Dublin train takes over 3 hours. Most of the
children in the classroom will get to their destination/learning level on time..
Children with general learning difficulties will be taking a longer time to get to the
same destination, , they will go on the same journey, but the pace is individual to
their ability. . So, there is no use waving at them from Dublin to come join you, you
have to go to Arklow, and sign post them to Rathdrum – to Wicklow – to
Greystone's – to bray at their pace. The role of the SLT is to tell you where they are
on their journey at any one time and what is the appropriate station/goal to be
aiming for next. They also need environments that understand and support their
individual journey at their pace.

1. Receptive Language difficulties are often called “invisible” – we tend to assume

that we are easy to understand. But as we know from lecture 1 – learning to
understand the meaning behind the sounds we make is a journey and lots of
children struggle with that journey. We often think they are being disobedient and
not listening when they don’t do as we ask. But how can they if they don’t
understand what we are saying? We all know the feeling of being in a foreign
country and not understanding others – we just need to remember that this is
happening for a lot of our children with their first language. It also often is the case
when a child has more than one language that their difficulty understanding us
occurs also when their other languages are spoken to them. As SLTS we determine
what level a child is understanding at and then we work through games and
activities that are fun/interesting/motivating to increase the key words/concepts
and reasoning tasks to support their development of better understanding of – in
the case of most SLT in ireland– English. We do train others with the other
languages to duplicate our games in their language – gael scoil/native speakers of
the other language
2. Expression of Language – the development of vocabulary and grammar is often 6
mths behind the development of understanding of language. We know from
 research how important a good vocabulary is for learning so work on supporting
the learning of new words by giving children a “map” of the meaning and sounds
associated with the new word to make it “more secure” and easily accessible in
their memory. We know that a child has to hear a word 9 nine times to grasp and
retain its meaning – that’s not just repeating it nine times but saying in sentences
that share the meaning of the word and its associated words. Do you all also know
that if a child is to retain and say that word again, we have to give them three
oppertunities to use the word themselves. Its not enough to talk to them about the
word, we have to listen and give them an opportunity to show that they are
learning with us. We also work on grammar so using personal pronouns –
she/he/i/me/him, tenses – saw/walked and generating more mature sentences.
We do this again via fun games and motivating activities as when children “buy
in” /engage with interest they learn quicker. We both get bored if the activity is not
working. A good chat/laugh is one of the most enjoyable experiences we share
with others and this is often done via story telling/narrative – lots of children we
see struggle to tell us their news in a coherent way and we end up getting by
almost playing “20 questions” SLTs support you and others to help children
understand how to construct a ”story” and also follow others stories.
3. Speech Clarity – this is where the child knows what s/he want to say and is saying it
- but you don’t understand. This can be due to “mislearning” the sounds of English
or a physical imparitment that makes speech unclear such as a cleft palate/cerebral
palsy/mssing teeth!. Most children present with the mislearning type of speech
difficulty ,which is why for most children this is no longer present as they get
older.When you have a physical limitation that is life long the effects on your
speech may also be lifelong. We work differently with both types of speech
difficulty. It is an area of communication development that requires the specialized
skills of an SLT to help others support a child through “relearning” how the sounds
of English work and in the case of a physical limitation in adapting to make as close
an approximation to the sound we want as possible. Again this is done in a fun,
positive and engaging way to get the best outcome.
4. To make this even more complicated any one child can have any combination
almost of the 7 above. If they are presenting with challenges in 1 – 4 - the roots,
this has an impact on how well the rest of the tree will grow so we expect to see
some difficulty with 5 – 7. a child with a difficulty in understanding English is
unlikely to be able to speak it in an age appropriate way. Children with 5 and 6 may
or may not have clear speech but as SLTs we would work on all areas of need with
your support at anyone time.