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pers ectlves
from ersonal
Construct
Psychology
Sasha Bemrose and
Malcolm Cross
outline techniques
of Personal
Construct
Psychology using
case examples from
their innovative
work with parents
of deaf children.
n our work with parents of young deaf children, therapy
often focuses on the interaction between the parent and
the child to develop a language rich environment. Before
this can take place, it is important to discover how par
ents see things, if and why there is a need for change and
within what parameters this change can come about.
Without this understanding, any intervention focusing
on change is likely to fail.
Personal Construct Psychology (PCP) values the parents' ways of
thinking and, s n approach, can challenge and libel'ate them. It
provi des tools for explorati on and can offer expl anations for the
ways we behave which al'e personal or unique 0 t he individual.
The therapist can help the parent discover and test the validity of
t hew personal construct system and, where nece sary, work
t oward change (Bannister & Fransella, 1986) .
A unique view
pCP IS based on George Kelly's notion of Const ructive
Aiternativism. Essentially his philosophical positJon remInds us the
pe specti ve we take of events i JUst one of an infinite range of
interpretations available t us. Therefore, ever yone IS responsible
for constructing a unique view of the wOI'ld. Construction and
Reconstruction are hemes cenlral Lo PCP The human capacity
to revise heir view of their ci rcumstances IS based on the under,
standing that events do not possess inherent or unvarYing mean
Ings. Instead, we make meanings or place intel'pretations upon
events (Kelly, 199 I ). I the language of PCP these interpretations
are called constructs and have a range of qual ities.
Our constructs are vali d ted by observing at' experiencing their
repl ications: we collect eVidence ba ed on OlW antiCipation o '
events. If a constnlct ha helped us under and a situatJon III the
past, t hen we will see this as a lid Interpreta Ion anci It '111 help
us predict rutul'e events. I . tor examp!e. we have ac ieved success
SPEECH & LA CUACF THERAPY IN PRACfICE SPRI'\oG 199 9
ISSN (online) 2045-6174 www.speechmag.com
COUNSELLING
Carol has a one
an.d a half year
old daughter
This method was used
with Sarah who has a three year
old son with a profound hearing loss. She
had vague concerns about herself as a parent
and triadic elicitation helped explore the dimensions
she used to make sense of parenting. This was achieved
by asking Sarah to think of a number of parents she knew.
These parent figures included herself as she is now, as she was
before she became a parent, as she w ould like to be as a parent,
her parents, parents she admires and does not admire and so forth.
The therapist asked Sarah to choose three names at random and say
how two of them were similar (circled below) and different from the third.
Elements/People ~ Me ~ My Mum
Construct
. ,
'need to be
In control'
vs 'relaxed'
who has a mod
erate hearing
loss. Carol said
she felt her
daughter did not
talk and there
fore she was not
able to interact
with her. In this
nstance 'does not
One of the dimensions Sarah identified which she used to make sense of par
enting was 'in control' versus 'relaxed'. She felt she needed to be in control
but would like to be more easy going. The articulation of this construct
helped Sarah discover she did not have to be only 'in control' or 'relaxed'
but rather that different poles of the construct could apply at different
times. It enabled her to see ways of being more like the kind of parent
she wished to be. She identtfied aspects of parenting where she could
be more easy going (during play sessions with her son) and some
times where It was helpful for her to continue to be in control
(when disciplining h e l ~ son). After a few weeks Sarah reported
she felt more confident as a parent and was enjoying the time
she spent with hpr:... cl}n, attributi ng this to her new insights.
talk' was the emer
gent pole. She felt the
opposite of not talking
was 'saying words'. From
this elicitation the therapist
and Carol discussed non
verbal aspects of her
daughters communication,
ego pointing, vocalising, eye
contact. Following this dis
cussion she became more
aware of her daughter's
attempts at communicating
and began to accept these
as 'talking'. From this
reconstruction she was
then able to begin the
process of more effectively
Interacting with her child.
in the past by being pushy. then we are likel y to use this strategy again
in t he future. Constructs are unique and therefore we expect peo
ple to make sense of the same events differently Personal ConslnJct
Theory suggests we use particular constructs to make sense of a
finite range of events. Most importantly, personal construas are hiel-
archical, that is, some are More important than others.
Exploration
When uSing PCP with parent s of deaf children, the personal con
structs chosen for exploration are t hose defined by the parent as
problematic or collaboratlvely identi fi ed by all part ies as Inhibiting
change in the desired directi on. Constructs may be eli crted in a vari
ety of ways including informal and tri adic. Further techniques of lad
dering cl.nd pyramiding can be used t o probe personal perspecti ves.
10 SPEECH & U\ NGUt\GE TH ERAPY IN PRACfICE SPRING 1998
I )Informol Eliciting (Dolton & Dunnett, 1992) (Case I)
By listeni ng to the way the parent tal ks about particular issues, the
therapist can build up a picture of how they view their situat ion.
For example, the pal-ent may say "rt's hard work looking after a
deaf dllld" . We can infer the parent has a construct about looking
after their- child; 'hard work' versus something el se. In this instance
'hard work' is tne emergent pole. The therapist can t hen ask what
It would be li ke looking after t he chi ld if It was not 'hard work' . We
mar Lhen find the construct is 'hard work' vel-sus 'enioyable'.
2) Iriodic Elicitation (Dolton &Dunnett, 1992) (Case 2)
ThiS is a more formal method of el iciti ng constructs. It explores a
person's di mensions 01- constl-ucts rn some detail and is particu
larly useful when a person fi nds it difficult to identi fy or express
their constructs.
ISSN (online) 2045-6174 www.speechmag.com
COUNSELLING
Case three
a) Laddering
Frances has a two year old son who has a mild hearing 10ss.The therapist had observed
Frances tended to control any interactions with her son.This was not helpful in facilitat
ing his communication development as it did not allow any chance for him to initiate or
respond.This in tum minimised opportunities and incentives for him to learn for himself.
Many sessions had been spent discussing this wit h Frances but a change in her interac
t ion style had not been evident. She reported it was important for her to do everything
for her son. Using laddering we wet-e able to ident ify why t his was so. The tick repre
sents the pole of the new superordinate construct which Frances prefers .
.I 'good parent' vs 'bad parent'
A
.I 'feel competent' vs feol I.l_ less'
A
.I 'it's myI role' vs ''la.'e n roe
A
.I 'do evel-ythi ng for vs '!etting my d do
my child' things for h
(
Frances identified the opposite of doing for her son was 'letting my child do
things for himsel f .The preferTed pole is 'do everything for my child' and thi S as Impor
tant for her because it gave het- a role. She preferred to have 'a role' because she need
ed to 'feel competent' as this made her a 'good parent' (superordinate construct). If she.........
let her son do things on his own, she would no longer have a role and feel useless and,
by implication, a bad pat-ent.
It was therefot-e vital to understand why this construct was important for Frances as,
when therapy focused on encouraging Frances to let her child become more indepen
dent she was resistant to change because this meant, for her, being a 'bad parent'.
b) Pyramiding
Frances was asked to think of different ways she could be a good parent.
..------- 'good parent' ---------..
'meet child's needs' 'teach * ew skills' 'provide opportunities to learn'
Frances identified she could be a good parent in a number of ways; by helping her son
develop and leam, by teaching him new skill s and by looking after his needs. From this,
we discussed how being a good parent could mean letting her son be more indepen
dent as it enabled him to grow and learn new skills. O nce Frances recognised she was
still a good pat-ent if she let her son experiment with new skills, she was able to change
in a way which increased het- child's learning opportunities whil e still enabling her to act
as she felt a 'good pat-ent' should.
3. Loddering (Cose 30)
Laddenng can be used to explore w hy people make certain choic
es, why they I-esi st change or are greatly upset by what appear. from
o r'perspective. t o be 'minor event s' The technique is based on t he
Idea that some personal constructs are more Important (superor
dinate) t han other constructs (subordinate). Thi s procedure begins
by identifying a construct of interest and it s opposite pole ( I st level).
The parent identifies which of the two poles they prefer and why
this is important for t hem (2nd level). The opposite of t his second
pole is Identified and the preferred pole chosen. ThiS process is
repeated until the parent can no longer t hink of a new constnuct.
4. Pyramiding (Cose 3b)
This is t he reverse of laddering. Once superordinate const ructs
have been discovered we can use pyramidi ng to make the impl i
cations of a part icular construct concrete. Pyramiding is facil itated
by asking "how)" questions.
Facilitatin2 change
The techniques <iliove are formal and informal ways of eliciting
and explOring personal constructsThrough their use,the therapi st
may assist the parent t o examine 'their constructs, determine
whether these are helpful or unhelpful and look t owards person
ally acceptabl e ways t o change. Therapy may be achieved t hrough
simply helping the parent see new paths. They can be helped to
visual ise what the change is t o be, enact the goal (behave 'as I t
were) and subsequently experience and make sense of this ne '
real it y. When Frances (case 3) thought about letting her son be
more independent. she behaved in a way which allowed hIm 1
SPEECH & LANGUAGETHERAPV IN PRACTICE SPRING 1998 11
ISSN (online) 2045-6174 www.speechmag.com
COUNSELUNC
leam for himself and in doing so he became mOI-e Independent
The out come of her child being more independent was examined
in terms of our predicti ons (the child is more communicative). In
this example our pred ict ions were correct, which reinforces the
change the parent has brought about.
PCP can be used by therapists to work effectively with parents of
deaf children and also a variety of other client groups. We feel it is
essential to have an understanding of the philosophy and theory
behind PCP and have only provided a rudimentary introduction. If
the speech and language therapist, like George Kelly, is not inter
ested in the truth or falsehood of a person's view but simply in the
ways in which they view themselves and their relationship with
others, then they may be freer In their interpretations.
Sosha 8emrose is 0 Specialist Speech & Language Therapist ,',11 m
Camden & islington Community Health Services NHS Trust. Malcolm
C Cross is bosed In the Department of Psychology, School of Sociol
Sciences, City University.
I
I
I
I
Any correspondence should be addressed to Sasha o[ 464 A Homsey
Rood. London N 19 'lEE (tel. 0 171 281 2562 evenings).
References
Bannistec D. & Fransella, F. (1986) Enquiring Man (3rd Edil lon).
London: Croom Helm.
Dalton, P & Dunnett, G. (1992) A psychology for living: Personal
construct theory for professionals and cli ents. Chichester: John
Wiley & Sons.
Kelly, GA (1955/1 99 I) The psychology of personal construct.
Volumes One & Two: Norton. Reprinted in London by Routledge
in 1991.
For the purposes of r.his ortlcle the parents' nomes hove been changed,
PCP Training Courses
Counsel ling Psychology Research & Training Centre
12 Onsl ow Gardens, South Croyden, Surrey CR2 9AB
Tel 0181 239 6947
This article is the second in a short series looking at how speech and language therapists have used training in other
fields to assist their work. Neuro Linguistic Programming - A speech & language therapist's guide was in Winter 97.
A personal view of counselling by Christina Shewell and FamilyTherapy will feature in future issues.
Questions
What is the basis of PCP holds that each individual has a unique view of
Personal Construct he world, under constant revision in response to
Psychology? received and their interpretation of it.
Why might intervention Because change is dependent on the unique view of
M.lMtII he individual concerned, barriers to change may be
of a parent / child
interaction model fail? missed if a therapist makes assumptions about how
parent sees the situation.
How can a speech and .. rough PCP a parent can see one view does not nec
preclude another, and that a range of options language therapist use
PCP? is open to them.
RESOURCE UPDATE. ..RESOURCE UPDATE. _.RESOURCE UPDATE.
AAC development
A new speech output device is available from Liberator,
combining pawerful language with dynamic screen tech
nology.
Vanguard gives simultaneous access ta everyday words as
Helping teachers
A speech and language therapy service to mainstream schools has
published two practical guides to running language groups in schools.
The West Sussex team responded to requests for more practical
advice to help teachers meet the needs of the increasing numbers of
weI! as those needed in speCific situations. Using icons and J........
Single-meaning pictures, most words can be selected with
two activations. Pre-loaded words, songs, books and
activities reduce the need for programming, but this can
children in mainstream schools with a
speech and language impairment. The
guides are intended to provide teachers
. be accomplished quickly.
The synthesised and digitised speech can be accessed by
tOUCh, headpointing or switch-activated scanning. Built-in
infrared capabilities provide cantrol Of appliances such as
a television or video recorder.
The Prentke Romich Company device uses Unity and
Language Learning and Living vocabulary programs.
Details: Liberator, tel. 08004582288.
,_ and teaching assistants with a frame
work to run language groups.
(Note: The guides will be reviewed in a
later issue of the magazine.)
Practical Guide to Running Language
Groups in Schools - Key Stage 1 a 2
and Key Stage 2 a 3 are available
from The Speech a Language
Therapy Service, Worthing Priority
Care NHS Trust, The Satellite Centre,
Shoreham First School, Victoria
Road, Shoreham, West Sussex
BN43 5WR. 15.00 piUS 1 pap
each.
12 SPEECf-1 & LANGUACE THERAPY IN PRACTICE SPRINC 1998
ISSN (online) 2045-6174 www.speechmag.com
APHASIA
Group . ~ r a p y
-
apOSItIve
outcome
--NHS TRUST -
In recent years, larger
caseloads and time
limitations have
made group therapy
a popular choice in
aphasia treatment
However to some
therapists it is still
controversial, with
many using it only
as an adjunct to
individual treatment
Caroline Davidson
and Carol Nelson ask
if a group approach
can be effective in its
own right
s members of a busy department in an acute
general hospitaL we felt a group treatment
approach for people with aphasia had a lot to
offer and was not being used to its full poten
tial. Although clients seemed to have benefit
ed from previous groups, we had never for
mally evaluated outcomes. We therefore con
ducted a small study using clients attending individual therapy
who had plateaued. We asked if they would be interested in attend
ing a group to see if any further gains could be made. The five,
whose ages ranged from 54 to 60, had suffered a cerebrovascular
accident between four months and one year previously. All had
non-fluent type difficulties, from problems at a single word level to
word-finding difficulties within phrases.
Assessment
In our earlier groups, some of the tasks were at times unstructured,
and emphasis was often placed on social skills. For this project, we
aimed to develop more structured activities in keeping with the
cJients' specific linguistic difficulties. To identify these, a broad
selection of PALPA assessments (Kay et aL 1996)(TabJe 1) was
administered to each client before and after the group therapy pro
gramme by a therapist who had not previously worked with the
client, but who was involved in the therapy group.
Whilst we felt it important to measure individual linguistic gains,
we were also aware of the need to assess interactive aspects of com
munication. We videotaped conversations between client and
speech and language therapy assistant before and after group ther
apy. A functional communication profile (Table 2) adapted from
the 'Adult Communication Analysis', published by the Centre for
Independent Living in Ohio (Florance, 1981) was used to grade
clients on a five point scale, where 1 indicates a very poor and 5 a
very good score in four different areas.
An analysis of verbal picture description ('Cookie Theft' picture,
Goodglass and Kaplan, 1983) was also used, following research by
Mackenzie et al (1997) into right hemisphere deficiL The system,
based on original research by Yorkston and Beukelman (1980) and
Myers (1979), examines the interpretative and literal units in clienLS'
descriptions. Figure 1 is an example of the analysis technique
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998 13
ISSN (online) 2045-6174 www.speechmag.com
APH ASI A
TABLE 1: Pre-Treatment Programme Assessment scores and percentage of change after.
PALPA no. R.G. P.M. R.K. E.C. J.I.
initial %change initial i'.change initial i'.change initial i'.change initial %change
score after score after score after score after score after
2:Same-Dlfferent 55172
=
69172 +3i'. 63172 +9% 72172
=
72172 -11.
Discrimination
-
4:Minimal Pair 29/40 +4% 39/40
=
81140 +101. 39/40 +2i'. 39/40 +1%
Discrimination
- -
47:Spoken word 24/40 +10% 39/40 +2% 39/40
=
40/40
=
38/40 +51.
Picture Matching
48:Written Word 25/40 -5% 40/40
=
38/40
+3"
38/40 +3% 39/40 -3%
Picture Matching
-
53:Spoken 18/40 +7% 29/40 +15i'. 24/40 +10% 26/40 +27% 13/40 +331.
Picture naming
-
r
53:Repeating 36/40 -3% 39/40 +21. 28/40 +30% 36/40
=
31140 +1Oi'.
Picture Names
53:Wrltten 0/40
=
22/40 +7'" 0/40
=
1/40 +38% 0/40
=
Picture Naming
55:Sentence-Pic. 28/60 +1% 54/60 -51. 84/60 +61. 46/60 +6% 39/60 +20%
Matching (aud.)
I
56:5entence-Pic. 27/60 -8% 45/60 +1Oi'. 24/60 +20% 29/60 +9% 43/60 +111.
......
unication Profile
IABLE 2 functional Com
m
_--..---,-'-1
\ \
Therapy
\
\
-,
communicative Success:
, message acroSs
Ability to get one s
Intelligibility:
h
orcl correctly
Ability to say eac W
Appropriateness:
te
ancl contextually
Accura es
appropriate respons
Efficiency:
2
r
\
1
2
r
1
\
2
3
4
\
\
3
4
\
\
3
4
5
\
5
\
5
The group ra n weekly for two hour sessions over twelve
weeks with two therapists. The clients did not receive
any addit ional individual peech and language therapy.
On assessment, all cl ients had problems both at a cen
tral semantic level and at the Ie eI of the phonol ogica l
output lex icon. Tasks were designed to target these
areas and three examples are detailed in Figure 2.
These therapeutic activities were designed to work
primarily on input and only at the end stages of the
12 week block did we try any verbal output tasks.
We were aware that. although there is a great deal of
information wri tten on the benefits of group trea t
ment, there is minimal discussion of therapy proce
dures. Thus many group tasks are employed from
individual thera py and there is a risk that each
client is treated sequentially within the group, with
little interaction between group members and the
therapist. What occurs then is not good group
hich are neither therapy but inefficient individual therapy within a
Responses W strictecl in length group setting. The tasks we used were taken from
abnormally con ________ therapy tas ks
revIews
COUNSElLING
A valiant attempt
NLP Counselling
Roy Bailey
Wrnslow
ISBN 0 87388- 157-2 0 395
Neurolingulsti c Programming emel-ged in America
f!"Om observati on of the work of three t herapists
who were also superb con)municators: Satl r: Perls
and Er'i ckson. Gnnder, ? Professor of lingUisti cs, and
Bandler: who studied psychotherapy and comput ,
er s, analysed and descri bed t he ingredients of effec
tive communicat ion demonstrated by the t hree
therapists. ;)s it is now known, has since
become widely recognised as a I resource of
psychotherape bc t ool s for change by counsell ors,
d ents and speech nd language erapists ali ke.
Roy Bcu ley's introductory book is a useful addition
t o the book shel f for those familiar wit h NLP and
t hose new to the subject.
The book covers all aspects of communication; it
traces the orIgins of LP. gives a .I ossar y and
description of t he t erms used and ouLii nes tech
niques empl oyed for en co raging pOSiti ve hera
peutic outcomes. Speech nd language therapists
dealing with all dient groups will be pal-ti culariy
i 'erest ed In patterns of language used by clrents
which indicate the preferred sense 'lith which they
construct an I dividual realrty. be it vIsual. audrtory,
gustator y. olfactory or tacti le. Body language, eye
movements and their pi ce In communICation.
breatn and tone of voice and the ntpli cati ons of
these for conveying meaning are described in detail.
as 15 the nature of r apport - an essential first step in
buil ding rust and a secure wor king relationship.
Cl ear VI ual ch rts illu tr t e step by step the tech
niques covered. from re ramrng t o the constructi on
of therape tic met aphors. Tlle over-all impression is
of a vali ant attempt to cover a vast amount of
matenal in an organi sed. clear and approachable
way Roy Bai ley empl oys appmpi-iate case histor- y
dial ogue to good effect t o highlight the processes
he descri bes.
This t ext offers bot h a start mo poim for those newly
Interest ed In the subject and a I-eference h- ndbook
for those who have attended experiential work,
shops ,.nd who air-cady h ve a worki ng knowledge
of NLP Because the model used by LP practitJon
ers involves clos observation of communication
stril tegles dnd pmvi des opportunities for change
towar-ds rnor' e positive and effective intel- ctl on,
NLP is particuldrly useful for speech dnd langua e
t herClpists in e areas of voi ce and Duency therapy
and where there are learning difficulties. LP also
offel-s echniques for enhancmg and maintaining r-ap
pon . for probl em solvi g, for increaSi ng confidence
and accessing resource I slates of mind. all of which
skills are needed by both cirent and therapist to n
nbute t o i! sci ccessful outcome. This is a valuable
book for therapists who ill'e Interested in using '.his
type of approach in their practl e.
Jennrfer Bell, a member 0 rhe ASsoCllitron or Speech :?
Language Therapists in Irdependent Prf)ctICf: i.>
speech and languoge lheroplsr in Devon
(NLP - A Speech & Language Therapist's Guide by
C;Jrollne Skelton feiltured In the Inter 97 ISSile - .
Speech & Language Therapy in Practice
SPEECH & LANGUAGE TIfFRAPY 1"1 PRACIiCE 19' 17
ISSN (online) 2045-6174 www.speechmag.com
REVIEWS
AUTISM
Many ideas will be used
Autism - P.D.D. More Creative Ideas From
Age Eight to Early Adulthood
janice I. Adams
Available (rom Winslow
Orderre{: 163-3635 97 06.95
This is a very practical book ror parents. carers
and professlonills. I contains theory bout
autIsm and POD and assumes readers are famil
Iar wIth the ImpaIrments present In these co d"
tions. There IS some 0 erlap with the uthor's
prev ous book. Autism - PDD. Creaave Ideas dUring
rhe School Years. Th,s book how vel" contaIns
mOl'e suggestions relatIng t o teenage years an
adulthood an area less well rep esented In the ht
erat re on utism.
The author IdentIfies he develop ent of a pro
p,iilte SOCi al and communICation skills 1S a strand
that should run t hrough pr grammes for every
alea of defiot. She suggests that we hdve to gaIn
InSights into the orid o f an utistic person to be
able t o help them. and modIfy the curncl/lum
accordingly.
The book IS dIVIded int four secons - 'SoClabfil:y
and Commun'catton: 'Benavlour, Feelings a- d
Emotions'. Relationships. Sex rty and the FaMily'
and 'Bri dging the Gap' (inclusIon of the autiStIc
person in society) .
Eilch sectJon begins WIth quotatJons from pe pi e
With autism including Donna WIlliams and Temp e
Grandin and ends wit h anecdotal examples and
case studies, These al-e very pow rful and emo
jive. The suggesti on ru-e a co plla 1011 of ideas
from profes lonals. families and caregivers and are
very practIcal. The sectio about sexuahty or
example 0 Llines ways of he p' ng the parents and
Siblings cop With the changes occumng in
puberty and gives practical suggesl10ns for copin
with senSItIve Issues such as masturbation nd
-n ns rua lon,
Throughout the b ok here 15 an emph sis on the
development of fundi nal con municatlon. The
Jse of ymbol 5 stems is seen as a way of givlllg
the autistic person access to communic ti on in a
Wider community There are many useful Ideas
about developin symbo use. br ex mple to
support behaviour programmes and to help
pup"s to become aware of heir own emotio s.
There are very clear illustrall ns of symbol sys
tems and suggestlon- fOI ' making these flexible
nd portable.
The au hor stresses hat many young people With
autism have lives contro led by others and sug
gests ways in w hich they can be helped to make
choices and decisions about their own hves. She
also describes ways of developino self monnonng.
th, Stext descnbes an American system of educa
tion and care in which there is greate emphasis
on Ineiuslon than t here is currentl y in this (Quntr y.
The layout is inconSIstent: although some check
li sts are very other sections are confusing. It
can be dIfficult to find specific informati on as
there is no index. W hen an activ' y is outli ned the
lack of detail is someti mes frustrating: however,
there cl re many references t o books and journals.
I found many Ideas I will use with our pupils. We
WIll certainly include thiS book in our staff library
and would recommend it to parents and carers.
especially t hose with children who are approach
ing adolescence.
Sue Allison, Speech and longuage Therapist. IS
Deputy Head at Ins ope House, Cheadle, Cheshire,
a school (or chIldren With autism.
PRAGMATICS
Skilful weaving of theory and
practice
Working with Pragmatics
lUCie A dersen-Wood & B nita Roe
Smith
Winslow
IS8 0 86388 /68 8 2 7_50
WorkIng With Pragmati cs is not a
tome. It IS however an excellent,
well-researched and logically w ntten
book. As practical. down t o earth
therapist I like books at answer
simp e like w at? hy?
'lOd. most Importanty. howl This
book does exactly that.
The fi rst two chapt ers ex pi In an
define pragm ICS. There IS also an
outline of heorelical approaches to
pragmatics. ThIS means the I-eade!"
can ge a qUIck. comprehensive con
cept 01 the commonest theories.TI1e
res of the book I devoted 10 prag
matIc developmen assessmen and
therapy Students will love this book
- as a student. I well ,-emember ask
Ing the perennIal question. HOW?
The chapters on assessment e cour
age clinrcians 0 be thorough in both
Ion al and informal analysis of prag
ma ic disability. Thel'e IS a useful
overvIew of formal assessments
avadabl and some helpful 5U es
lions, The pragmatic rating scale
could be used t o priol'itlse cases Th,s
means one can be confident In plan
ning th ne essar y Intel' enli on.
making h,- book acceSSible 0 1- chni
Clans and students ahke. H Ing read
about theory and assessmen we
al-e dil-eaed to hlnk about pr ven
tlon of problems and trainmg of
other professionals. famtl y nd care
givers. Th,s book reminds us we
should be shari ng stra egies with
caregl 'er5 and enabling them to
effect change in their pproacn to
cli ents With pra matlc dlsabil y, i
school and at homeThrough ut this
book he au hors skIlfully weave the
theory and pl-ac Ice t ogether; c arify
Ing and formaiislng orking with
prrtgmatlCs. As a therapist worklng
primari: y In the classroom, I am sure
th,S book WIll incl-ease my abilIty to
wOI-k With cileills, parents and other
profess:onal colleagues more effec
tI vely
WorkIng with Pragmatics ay be
more appropriate for the paediatric
clinl ian but I feel It woul d Inform he
practice of both teachers and st .
dents. It co tams facts relevant fOI- all
profeSSionals workIng " i h Individu
al s who have dIffi culty Interacting
with others. Fi nally. for those who
become "hooked on pragmiltlcs".
there IS an annotated bibli ography
al lowing the reader t o select areas of
research they migh like to Investi
gate further
Carole E.. HIgginbottom IS a speec
and language therapist at Stam]
House School.
DYSLEXIA
Interesting, but no surprises
Degree Students with Dyslexia
Growing up with a Specific Learning
Difficulty
Barbara Rldc.h Manon Farmer &
01ristophf" St erling
Whu(r
ISBN 1-86156041 9 {/9.50
Part of a wldel ' research st dy. this book
has been published to draw attention t o
th need to identify and support st dents
with dyslexi a who are in highel' education,
The main bulk of the book IS gIven over to
in-depth interviews with nIne dyslexi stu
de'1ts whose ag s ranged from 18 - 42
ye I-S. They came from a wide r"nge of
socia-economic backgrounds and were
studymg for a var iety of degrees. The stu
dents volunteered to t ke part and may
ot therefol-e be r'epresentat,ve sample.
Full data was collected on I 6 dysl exic and
16 control students. Only the dyslexic stu
dents w I inl rviewed. the ,ntervlews
being carried out by a research assist nt.
himself dyslexic
The A ult Dyslexic Checkhsl (Vlnegl-ad) was
used to olscnminate from non
dyslexic students I had t o track thi dow
on he Intemet as only three of the twenty
questions wCl 'e quoted. The highest ranking
question indicating dl'slex;a was" he1
wntlng cheques co you frequentl y find
youl'Self makIng mistakes?"The least Impor
tant was "When you have to say a long
word do you 0 e ,mes fi d It dimeul to
get ali the sounds In the right order?" Hmm!
The nter'"iews make Intel-estlng readino
w hile not producing any surpnses. 0 Iy
one student had been diagnosed befc re his
teens and several were no as essed until
their mid-twenties There IS grea vanation
in the type and seventy of difficulties both
practical and emotional as
described by J1e students.. Almost all the
students ,-velcomed h" ng a label 0 attach
to heir problems.
Sev ral of the students felt they had
e celled at talking and preferred oral pre
sentation while others lacked confi dence
and found It hard 0 order their thought
and xpress t hemselves. I searched the
book for any reference to speech and lan
guage disorders nd found one paragraph
near the end o f the book: S ckhouse &
Wells (1991) were quoted - dysleXIa has
been called "a hidden speech and lilnguage
disorder" and Snowling I-eports that dyslex
IC chil dren often have a history of Idte or
troublesome speech and language develop
me t. ot one of the dents was asked
about any early d,fficulties in the interViews,
If thIS book goes some w y t o improVing
support services for such students th t (an
only be a good thing. The author felt
dyslexIC children. their famIl ies and pnmary
and secondary teachers would find this
book useful. H ving read the inter views. I
would have I ci uded university lecturers on
that list. I wou d recommend this book t o
the above and for rncl usion in coll ege
li braries.
Sheila Gunn Is speech and language therapIst
at Derwen College. Osw try. Shropshire.
18 SPEECH & I.ANCLJAGFTH ERJ\PY IN PRACII CE SPRING 1998
ISSN (online) 2045-6174 www.speechmag.com
REVIE'NS
CONVERSATION ANALYSIS
Interpretation needs skill
CAPPA I CAPPC/
Ann Whitworth. Lise Perkms, Ruth Lesser
Whurr
55 00 each
In recent years, I'esearch concemlng Conversati on
Analysis (CA) and its clinical applicati on has beCll
accruing at a rapidly Increasmg I-at e. The CAPPA
(Conversati on Anal ysi s Profil e For Peopl e With
Aphasia) and CAPPCI (Conversa Ion AnalysIs Profrl e
For People W it h Cog'1ltlve Impairments) have been
developed as resources for speech and language t her
apists t o help Incorpor-ate pnncipl es of CA into assess
ment for people with general ised cognitive Impair
ment - as in dement"l or fol lowing head inlur y - and
people wi th aphaSia. Tl,ese dSsessmenls JI-e t o be
used in close collaborati on with the cl ient's conversa
ti onal partners and as an adjunct t o li nguisti c measures
of language disabili ty.
Both assessments ale well presented and clearly IclJd
out In a formal t h;:!.t is eaSily accessible. They are pre,
sented using a slm.lar deSi gn and compnse:
., a structured mt el-Vlew to be conducted with the key
conversati onal partrer (and also for the person wrth
ilphasia in the C APPA)
, an analysis procedure fo r use with a ,en minute sam
pl e of conversation between the client and his I her
conversational partner
'" a summary profile that contains InfOI-matl on gath
ered from the Ilterview and conversat ion sample
allOWing companson of the two sources of informa
ti on and establishing a baseli ne for analysis.
Both the CAPPA and CAPPCI take a long t ime to
administer and scoring requil-es much intel-pretation,
agalO extremel y time consumi ng.
The structured interviews pr-ovlde a useful format for
eliciting Information on the clr ent's cur l'ent conver sa
ti onal ilbil ities, interacti on style and any changes that
have occun-ed. The questions included in the inter
views cover il wide range of areas and allow for dis
cussion on any cUI Tenl strat egies in use, the cli ent's
response to such st rategies and the seventy of the
behaViour
I feel such a detailed intel"view for-mat IS not approprr
Jt e for use with some clients and carers. In par-tlCular;
I found the int erview wiLh the person wi t h aphasia In
the CAPPA onl y surtable f,) r a restricted number of
clients With relatively well preserved functi onal lan
guage comprehenSion Jnd expl"essi on.
PrOVided a suitabl e conversati on sample can be
obtained, thiS analYSIS can p"'ovide usefUl informatIon
t o help clini CI ans deVise highly Individualised therapy
pmgrammes, and carer training programmes. The
analysis procedure rollows a detailed and at ti mes
system. which demands an In"
depth knowledge of 1he assessments. Tllis procedul'e
IS again extremely time consuming.
Both the CAPPA and the CAPPCI successfully aSSimi
late and consolidate the many stl-ands or Informati on
and pnnCl ples of CA into Lwo useful assessments.
Ill fol"lllatlon gamed fr'Om uSing these assessments IS
undoubtedl y extremely valuabl e, although Inter-preta
tloii r-el:es heaVi ly on the skill of the cl ini Cian: there 15 a
deal'th of gUidelines prOVided vvithi n the assessment
on appropriat e therapy goal s.
The detail included within these assessment s is funda
mental 10 the prr ncipl es of CA. however, gi ven [he
gr-e<lt deal of ti me needed to compl ete the assessment
pr'Ocedure, the CAPPA and CA PPCI may not be the
most pl"actrcal resources for use within a busy com
munity dinlC.
( 1010 Robertson IS 0 speech and language therupis t in
Aberdeen Vllth Gmmpian Healthco re
VOICE
Plenty to draw from
Creative Relaxation in Groupwork
irene Tubbs
Wmslow
ISBN 0-86388-143-2 E23 95
Irene Tubbs is a physical education spe
ciaJlst with expenence of working With
cl ients of aJl ages and abilities. As well as a
leachrng degree, she has dipl omas in
counselling, Illulti-modal psychotherapy,
stress counselling and management.
The book IS diVi ded into four sections,
col our coded for ease of reference. The
first sections, roughl y one third of
the book's content conSider the benefits
of relaxatlor] , how to chieve it and how
to organise and present workshops, Her
methodology Includes familiar themes
such as posture. oody IclJIguage, breathing
and oice. and also explores dance, usi c.
exencise, art and alternative ecaples,
Reaoers already persuaded 0 the bene
fits of alternatwe therapies will find little
t o cntlcise: others will be sceptical of the
unsupported cl ai ms couched in non-sci
entific language. The style IS r eadable and
informati ve and is focused t o proVIde a
t heoret ical basis for most of the "'1ork
shop ideas which foll ow. I found It easy 1.0
identi fy With many of the concl usi ons she
draws from hel- own experrence in obser
vati on and counselling. However; in such a
subj ecti ve cont ext. more academicall y
presented I-eferences descnbing expen
mental methods and resul ts would gi ve
hel' work greatel- cri tical credibility.
The 'PI"acti cal Workshop Ideas' are well
defined and easy t o follow.They compnse
wal-m-ups, main themes and I"elax down
sessi ons. ac1Jvity is defined by its ai m.
appropri ate age level , time and equip
ment requirements. The themes of relax
ation, t ension release, bneathing, voice and
use or wOI-ds are pal"tlcularly relevant to
my own area of work. and I found pl enty
here to draw from . some or the
thirteen stress-management exencises
demand consi derabl e confidence and
experr ence of handling emotions in a
group context. Ms Tubbs recommends
trainmg In Rational Emotive Therapy and
Cognitive Behavioural Therapy for two of
her exerci ses, and gives a general diS
claimer thift "we should never' use a spe
cialist skill tha we have not been lr 'alned
for ' However I felt there had been insuf
ficient di scussi on of the danger-s of self
discl osure and the need for IndIVI dual
support which may well ari se, both for
the gmup members and for the therapi st
or practrLJ oner
The book prOVides an Intm duction to
relaxat ion theor-y and practi ce which
would be a useful gUide t o a thelaplst set
ti ng up groups for adults or adolescents in
speCial needs, mental heal h. VOice, nuen
cy or neurology. It is presented in an AS
I-ing-bound format which makes the exel-
CiSes easil y accessible. T nel-e IS a bibliogra
phy and a bl'i ef desCll ptJon of some alter
native t herapies wrth contact addresses.
)0 Ponon BSc RegNI RCSLT is 0 Voice
Specralist With South Bucks {\IHS Trust
GENERAL
Too wide ranging
Treatment Resource Manual for
Speech-Language Pathology
Fromo P Roth & Colleen K. Worthington
Singular
ISBN 1-56593 636- / 0 000
Ah, is thi S lust what I wdnt) One book
for all treatment. This all Singing, all
danCi ng publi cation comes fium the
USA, so thel'e are sectiOns on US law
I-equirements and ethics. ThiS may
make Interesting leadi ng. My first
impreSSion ,",vas that thiS is a smail
book pnnt ed on big papec 1he prrnt
being large and spread out. An ad'/an
t age of thiS is that thel'e al'e many large
t abl es, such as developmen tal cha(ts
and glossil r ies.
The blurb on the I-ear makes J
of claims Including both comprehen
sive and basic information FOI" t reat
ment. I does Indeed cover many
aspects of our wo'"k. from '!:ssentlal
Ingredients for good t herapy' (for
example, adapti ng communication to
cl ients). through speCific therapy Ideas,
to ;In example of writing a nereml let
ter to other profeSSionals.
It IS my ImpreSSion that the alillS of thi s
book are too Wide ranging. Many
chapters end In a dlscialmer descnbing
the chapter as basic Information at an
intr'Oduaory level and fur her reading
is recommended As a I-esull of the
vaned tOpICS, many items are given a
mention onl y, for example collabora
tive wOI-king with teachers. Much of
what is in the book will be found on
speech and language t herapy quallfiea"
tion courses
At tempts are made to apply theol' y Lo
pract,ce. Often, different approaches
are introduced and each disorder is
defined and descnbed III stralghtfol-
wil.-d erms. The chap tel's vary in how
comprehenSively they cover a topiC.
For exarnpl e, the chaptel- on dysnuen
cy hardl y ment ol's Involvlllg cal-e
givers, w hi lst the one on child language
covers many aspects rrom tw o Lo eigh
teen years In sections. There are also
specifi c activiti es IIlcludlng ideas to elic
It drfferent pragmatic functions. Other
areas necessaril y have limited activities,
for exampl e word finding. There IS a
good balance of activities and hll1ts
acmss the book, such as al,leulatlon
therapy ror- difficult to elicit phones
One big hole is the absence of infor
malion proceSSing based therapy,
especially noticeable In the section on
adult aphasld.
Overall the book docs have uses, espe
cially for newly qualified c!rnrcians. I did
dip Into t and take Ideas and principles.
There are many practical Ideas but
are spread quite thinly acros'S dlsor
The book may Jlso prompt look
Ing at our job With a Wide perspective .
I did not get my all all danong
therapy book, but I p(obably wrll.
James Storey is u speech and language
therap.st wtUl Sandwe/l NHS TrUSL
SPeECH & LANGUAGE TIIERAPY IN PRACTICE SPRING [998 19
ISSN (online) 2045-6174 www.speechmag.com
each, al
so
in . d DO"
in a The "Say anavailable
'best worksheets . t k.
coO\bina
tiOll
to reoders are. p, '
z,ch, l.
and sticker charts.
READER O FF ER
couJJesy
Winslow
Books t om a valiety of publishers and
co en g he 'ange of speech and
language erapy work are
rs:
d
'de Evaluation of
Be Sl
DysphagIa
B.E.D.
Introducing Strategies fo r
Parents and
Professionals
Janice I. Adams
This author 110s also
written Autism-P.D.D.
Creative Ideas DUring
The Mighty M
Anita Robbins & Game
jackson arah
fi
For two to six Players Order
rom three to seven reference
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game is a {u 29.99 +
Work on VAT
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Includes game ideas manual
reprod 'bl ' a
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descriPtions ,etter,
the motor PIctures o{ al/
P
h rC/ses alld a
Iw ys a aila blefo r re ie ; the
reviewergets to keep the
Dok. As a special 0 er, on a
Order Edward Hardy
reference The BED. ThI alms
1sn89,91 to be a com pre-
the School Years and
More Creative Ideas From
Age Eight to Early Adu lthood. Bath
otocOpiable paperba
PUPPet pattern H d 'g
are also mirrors
the exercises. or teaching
)6.9S + hensive but easy
VAT bedside dysPhagia
fi rst come, first servedoasis,
readers offeringto do a review
\ ill also be given the choice of
one of the products bel ow.
Phone Avri Nicoll on 0I569
740348 or write to her at:
Speech &Language TherapyIn
Practice, FREEPOSTSC02255,
STONEHAVEN AB39 3ZL,
or e-mail avrilnicoll@rsc.co.uk to find
ou what books ' re avai lable fOl'
review and to take advantage of this
offer: Guidelines for writing a review
II> ill be pro ded,
The products below, new to the 1998
Winslowcata ogue, are being made
available free by thecompany to readers
o Speech and a guage Therapy in
Practice. Winslow doesnot publish
these prod cts b distnbutes them
In he UK
In 1998, inslow is publishing JUst one
ma in ca a ogue Ith fou rteen extra
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Educatio ,Heal h, Elderly and Soc'al
Cal'e. For a freecopy,contact L n
Smith on 01869 244644or write to
Winslow Press Limited, Freepost 327,
BICESTE Oxon OX6 OBR, UK.
20 SPEECH & U\:--JC LJ ACE T H ERAPY IN PRAcn
use I
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assessm
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includes a screen, :eo;rol
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00"
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dot to dot. ssWord
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the latter is reviewed m this issue
of the magazine, This book aims
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Order
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Written by a
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place In
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Suitable for
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Photocopiable worksheets
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ReaderOf{E
ISSN (online) 2045-6174 www.speechmag.com
COVER STORY
I
......earnln
rou
number of recent changes
and developments in high
er education, clinical edu
cation and adult learning
theories prompted tutors
on the BSc Speech
Pathology and Therapy
coul-se at the Unive(sity of Manchester to
consider ways of developing the clinical
education offered to their students, The
most infiuential of these factors are:
Developments In univer sity teaching and
adult learning in general, highlighting the
value of
a) experiential learning, as opposed to
Julie Marshall and
Catherine Aldred
observe that a
supplementary
learn ing package
using video can
be a valuable
way of
supporting
clinical
education
in spite of the
initial time and
costs involved,
didactic classroom based teaching
b) Problem Based Learning, aimed at
developing analytic and broad based prob
lem-solving skil ls
c) self directed learning, in which students
take greater responsibility for their own
learning needs and processes,
Increased availability 0 t eaching temnol
ogy, such as video, computer-s and multi
media,
Pressures on university teaching time
and dr nlca! pl acements, These pressl1res
Include inadequat e time for Ol1e-to-one
cli nical educ t ion within the university set
ti g, i sufficient eli ical placements, partle-
SrEEGI & LANGUAGETHERAry IN rRAcnCE SPRING 19!J 21
ISSN (online) 2045-6174 www.speechmag.com
COVER STORY
Figure I: Example of written tutorial
questions and sample answers:
Voice assessment video
I, What are the main factors
causing vocal abuse (for this
client)?
Shouting at children,
occasional throat cleal'ing
and high volume,
2. Why does the therapist
physically examine her neck
and shoulders?
To look for ' signs of tension,
asymmetry and to assess
discomfort and tenderness,
J How will the therapist's
explanations help the patient?
Decrease anxi ety about
cause of problem, 91ve
patient positive things that
she can do to impro e
her voice, understandi ng of
how natural acti ons
and her own anxiety have
caused her symptoms.
4, Are there any additions you
would make to the end of the
session?
Ask patient if she has
questions, has she
understood, how does she
feel about what the
therapist has said, has she
thought of any other
facto rs while the assessment
has gone on?
ularly with certain cl ient groups, an inabili
t y t o provide every student with opportu
nities to work with every cl ient group and
speech and language therapy managers'
concerns about the limitati ons on clinical
experience for students' cl inical develop
ment and future employability
An increasing awareness that there are a
number of core clinical compet encies
applying across as well as Wi thin cli nical
fields, and that students' increased aware
ness of the transferability of these skills
may improve their clinical confidence and
effectiveness.
Project
desln
A number of projects to support cl inical
education and learning were consi dered
and implemented in light of these factors.
One such project consisted of creating a
set of vi deos t o support the cl inical edu
cation of final year students. It was antici
pated it would
a) be relatively easy to implement
b) provide a permanent resource and
c) be virtuall y free of both material costs
and time commitments in the long-term,
although time consuming and expensi ve
for both NHS clinicians and university staff
in the short-term.
Enterpri se in Higher Education (EHE) was
a partl y government funded initiative to
encourage innovative developments to
Improve the employabi lity of university
graduates. This project appeared to meet
EHE funding criteria and a proposal sub
mitted in Apri l 1994 was subsequently
awarded.
We planned to produce ten videos, each
of 20-40 minutes with the focus on a
client with a specific type of communica
t ion The disorders selected
reftected areas in which it had recently
been difficult to obtain sufficient clinical
experience for all students. These included
cl ients with voice disorders, acquired
dysarthria, acquired expressi ve and recep
tive dysphasia, Pervasive Communi cation
Disorder, hearing impairment and users of
Augmentati ve or Alternative
Communication. The number of Ideas
was restricted to elghl by the funding
available. W ritten tutorials would accom
pany each vi deo.
Implementation
Foll owing the successflll bid. an expen
enced thel'apist was appointed to co-ordi
nat e the project for 40 days between
October 1994 and June 1995. Speech
and language therapy managers were
sked for suggesti ons of appropriate staff,
cl ients and locati ons. Indivi dual therapists
were then contacted and, if suit able clients
were available and agreed to be involved.
filming t ook place within their usual clinical
setting. The videos were made and edited
by the project co-ordinator and a video
technician. Speech and language therapists
gave their time and energy will ingly,
despite heavy workloads and were gener
all y very supportive of the project.
FollOWing filming. the videos were edited
to focus on specific aspects of the clinical
sessions. Written tutorial quest ions were
added to the videos and sample answers
provided by teaching staff Figure I pro
vides an examp le from the voice assess
ment video. Questi ons rel ated t o specific
aspects of the cli nical session and were
modelled on typic I observation, practi cal
and theoretical tasks given t o students
during live cliniC observation sessions.
Seven videos were ready for use by
October 1995 and the final one was ready
by October 1996.
Student s are expected to watch all eight
videos at ti mes of their choice dUring the
fi nal academiC year, but only have to com
plete the tutorials on a minimum of four
of the videos, selecting t hose relating to
the cl ient groups with which they have
least clinical experience. Completed tuto
nals are not assessed. but the students
evaluate their own performance against
the sample answers. if necessary watching
the vi deo again. Viewing facilities are avail
able within the department and they are
not permitted to take videos home, to
preserve client confident iality
Evaluation
The video learning package has so far
been used by two groups of year
speech and language therapy students.
Thei feedback. both verbal and written,
has been 0 erwhelmingly positive.
The most reqt;ently watched videos were
dysarthrta and dysphonia. both used by
I 8 per cent of -r e students. foll owed by
MC and e aphasia. studied by
I 4 per cent arc -:: per cent respectively
The least -rec;uefi - otched VIdeo was
on hear 0 :Jill e 11. Evaluation was
carned : :;clore the end of the acade
mic vear, :o rr ore may have watched them
at c laier oate.
S ..cents' ere asked to rate the videos on
a scale of one t o five for their usefulness
fIVe bei ng "most useful" and one being
"least useful"). Twenty nine per cent of the
videos were rated as five, 64 per cent as
four and seven per cenl as one. Examples
of the comments made by the students
included:
The tutonals focused my thoughts and
view ing
Helped impmve my observation skills
Inspired discussi on between friends If
wat ched in a group
Some of t he treatment procedures
helped me both t o supplement and reject
some of my own approaches
Gives a credible source of therapy Ideas.
Most students wanted more videos on a
wider range of client groups. Negative
comment s were !I1d.i nly rel ated to the
need to improve the written tutOl' ials and
the viewing arrangements.
Clinicians have not been asked formall y to
22 SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998
ISSN (online) 2045-6174 www.speechmag.com
evaluate the project, but al l t hose who are
aware of it. erther through direct involve
ment or through t heir students, have com
mented favourably on rt.
Uni versity staff involved have found it use
ful to have vi deo m terial using therapi sts
j.
other t han themselv s and to have a prac
,
ti al supplement to lectures. It has been a
very positive development to work close
ly with colleagues in the NHS and has fos
tered the view that clinical education is a
JOint endeavour shared between those
who are predominantly cli niCians and
t hose who work predomlnan Iy in educa
tional institutions. Although the project
was t ime-consuming and expensive to
develop, now that it is complete the time
investment is minimal. Staff have devel
oped skills in implementing such a project
and have been encouraged to use more
frequent videolng of their own clinical
work, thus making it available t o larger
groups of students.
PriOrities
The client groups shown in the videos
were selected for two reason s: those
where it has been difficult to obtain suffi
cient experience for all students, and
those with particularly complex difficulties.
It was interesting t hat for one of t he orig
inal groups chosen - cl ients w rth cquil"ed
receptl e aphasi a - no video was made as
no surtable client s were available. The rea
sons given by therapists were that they are
no longer being referred such di ents but
are much more likely to be seeing clients
with global aphasia or those wit h dyspha
gia. It IS not clear whether this IS a com
mon situation but it may refiect increased
cont racts for acute hospital based as
opposed to community services. This issue
Questions
I'aises questions about the client groups of
which student s are expected to gain
experience, and the need to monitor the
changing treat ment priorities in the NHS
and adapt ed cational courses accordingly.
Future
Developments
The success of the project and feedback
from students has generated ideas for fur
ther developments Including
I. Development of videos involving a
wi der range of client roups. These could
be used both to supplement current cl ini
cal experience and to precede it.
2. Use of some of the material s by groups
of students, such as those studying com
munication, linguistiCS and communicat ion
disorders and also by applicants to speech
and language therapy courses (only with
permission of clients and therapists, as
their original permission did not extend to
this usage).
3. Development of a larger bank of video
materials, some of which could be edited
from the original videos, to demonstrate a
wide range of core clinical skills.
Unfortunately these plans cannot go
ahead until further funding is available.
Useful
Supplement
This project has provided the university
with a means of supplementing students'
clinical experience without putting
increased pressure on already overbur
dened cl inicians and educators. The use of
structured video teaching materials can
never replace hands-on clinical experience
but appears to be a useful supplement.
pal"tlcularl y at times when students would
normall y be carrying out substant ial
amounts of observation.
Answers
COVER STORY
Julie Marshall is a Lecturer
in Speech Pathology at the
Centre for Audiology,
Education of the Deaf and
Speech Pathology,
The University of
Manchester;
Oxford Road,
Manchester
M 13 9PL.
Fax:
+44 (0) 161 275 3373
Phone:
+44 (0)16/275
3376/3389
Email:
Julie,Marshall@man.ac.uk
Catherine Aldred is a
Lecturer in Speech
Pathology at The University
of Manchester and a
Specialist Speech and
Language Therapist with
Stockport Healthcare Trust.
Why are new waY5
rMMI Development5 in adult learning theory,
of learni ng beinq technology, core competencie5 and pre55ure5
on teaching time and placement5 need to
be accommodated.
What do 5tudent5
IIIfII!nI di5cu55ion and therapy idea5.
1iMt.. The video5 can facilitate ob5ervation 5ki1l5,
like a bout the video
package?
Have there been The U5e of video ha5 been extended a5 a
benefit5 for 5taff? practical tool and the joint nature of clinical
education empha5i5ed through the work
with NHS clinlcian5.
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 1998 23
l
ISSN (online) 2045-6174 www.speechmag.com
How l
language therapy team leaders for Fosse Health
Trust in Leicestershire. Both specialise In workfng
with adults with learning dlsabfittles.
The adult neuro team with South Downs Health NHS
Trust is Helen Garratt, Val Fam, Sharon Qarlc, MaryrCJS(t
McKay, Joe Osmond and Usa Cox.
Ann Adams is the Oinic (o-ordinator of a team of
speech and language therapists based at East Surrey
Hospital, Redhlll.
(aseload .
management IS a
skill of any
soeech and language
therapist, whatever
the numbers or dient
grQup involved.
Balancing available
resources with .
developments In the
profesSion and the
wishes of clients
brings man
P
ressures. ree
conbibutions
demonstrate the
reaJi!y of good
caseload
management :
solution to
be found but an
ongoing, e\(oMng
team exerase.
24 SPEI'C I1 & lANC: UAGU 11-l [ RAJlY I I'RAC' f1CE SPRING 1998
ISSN (online) 2045-6174 www.speechmag.com
HOWl. ..
, AduH Leamin Disabi
Fromq
toqu
~
,. South Down Health
U l llUII
Iy and demand
Teresa catdleside andJ fdcIestone
explain hcMttheir tmm is worldng
toMm1s ptrJVicb;Jamorejlexliesmtb?
The invitation to write this arrived at an
interesting time. Like other departments,
we have found ourselves subject to many
changes over the past few years. We have
been reviewing our service as a whole,
looking at our ways of working and identi
fying how we could improve and make
limited resources more effedive. Caseload
management is a major consideration.
The team
We form part of the speech and language
therapy learning disabilities team compris
ing a full-time manager, three team lead
ers, a specialist in profound and multiple
handicap (PMLD), a specialist and a chief
post in working with individuals who chal
lenge services, seven generalist therapists
whose caseloads include adults with learn
ing disabilities (based in Day Centres) and
three whole time equivalent assistants.
We are divided into three teams, North,
South and City, based on geographical and
social services / hea.lth care divisions cover
ing a population of 2785 individuals with
identifled learning disabilities
(Leicestershire Register of individuals with
Learning Disabilities). Although not all
known to our service, most will be seen for
assessment and / or therapy at some time.
Problems facing us include:
1. Numbers Although a comparatively
large department. the sheer number
already on our caseloads makes it very dif
ficult to manage the caseload successfully
and maintain a consistently high standard
of therapy. [n some ways we are victims of
our own success as development work with
other professionals has raised awareness of
our role. From these successes, particul arly
in working with PM LD clients, those who
challenge, and those with eating and
drinking difficulties, we are receiving
increasing referrals with an expectation we
will respond almost immediately and pro
vide input and liai son at an intensive level.
2. Contract Currency Perhaps the most
significant factor is that the speech and
language therapy contract with the pur
chasing authorities (most importantly
with the local Health Authority) is based
on the numbers of clients we see on a face-
to face basis. There is therefore always the
pressure to see large numbers, with the
ensuing difficulties in terms of quality for
the cI ient and stress for the therapist. There
are strong arguments against this basis for
contracting; see Communicating Quality 2
p.134, no. 9, also Money, 1997.
3. Consultative proiects We are increas
ingly involved with communication based
projects, such as making information more
accessible to clients with learning disabili
ties, ego health leaflets and videos. These
are very exciting and our expertise is often
essential for success. Problems arise in
that. again, time spent on this develop
ment work is not available for direct work
and, indeed, under the present system is
not acknowledged.
4. Audit, developing policies and proce
dures, research and development, out
come measures All are essential duties for
our team, but of course require adequate
time for meetings and planning. We also
feel strongly there should be development
of formal systems for support and mentor
ing of therapists new to or inexperienced
in learning disability work. Presently, to
cope with the numbers, all therapists need
to work alone, carrying their own caseload.
We see this as a major negative effect of
unmanageable caseloads.
5. Open ended versus episodes of therapy
Our way of working can be described as
'open ended' in that we see a client for ther
apy for a particular communicative need,
ego developing more appropriate ways of
greeting others, then, when that aim is
realised, another communicati on goal is
identified, ego working with signs/symbols
to make simple choices. This encourages
the therapist to keep the client's case 'open'
thereby continuing very high numbers and
causing ever-increasing problems main
taining casenote / caseload standards, man
aging revi evv procedures etc.
So, there seemed to be nothing for it but to
clear three days from our diaries and get
together as a team to thrash things out.
Planning renegotiation
We agreed the only way fOlward is to rene
gotiate the contract currency allowing us
flexibility for consultative and develop
ment work.
Over the next year we are going to work as a
team to develop a projed focusing our input
away from direct work towards changing
and adapting a client's communicative envi
ronment. We will then have 'permission' to
take time to work alongside a colleague and
be able to pool skills. There will be the
opportunity to develop effective and sensi
tive outcome measures, essential in any
negotiations to change the contract currency.
We have agreed a system of prioritisation
for new referrals, based on guidelines in
Communicating Quality 2.
We will carry out case studies from referral
to discharge to distinguish more effective
ways of working episodically. Through
these, we will identify the time needed for
assessment, goal planning, liaison, therapy
planning, face to face therapy, recording,
report writing, follow up work and review.
Differing methods of intervention and
management can then be compared and
changes in working practices made.
We need this period of informati on gather
ing so we have sufficient data to present to
managers and purchasers specifICally
regarding what constitutes an ideal model
of intervention in terms of length of input
/ episode, and the content or focus of our
intervention - from the individual to envi
ronmental. At the same time, our solutions
need to embrace quality measures and
continuing professional development.
Active team
These major service issues cannot be
add ressed overnight. It would also be
impossible to address them as an individ
ual therapist. We feel very fortunate to be
part of an active, forward looking team,
itself part of a large department (38.1
whole time equivalent). Working cohesive
ly gives us a voice and therefore the oppor
tunity to be proactive in initiating changes
to help us move from a quantitative
towards qualitative and, we are sure, very
effective model of input.
References
RCSLT (1996) Communicating Quality 2.
London: Roya I College of Speech and
Language Therapists.
tvloney, D. (1997) A comparison of three
approaches to delivering a speech and lan
guage therapy service to people with learn
ing disabilities. Euro.pean jOllrnai of
Diso.rders o.f Communicatio.n 32 (4).
The South Downs Adult Neuro
outstrips our ability to supply it. Issues relat the caseload to achieve an equita b le e rvicp
team values working with carers
ed to demand are response time to referral, across different sites and to adlieve fl exi
and voluntary organisations to how to <lddress the needs of carers and what bility of service so we can respo nd lO ari
help supply meet demands, is available to support people after their dis ations in demand. This is in :lddi tio n to
As many speech and language therapists charge from speech and language therapy. the aim of providing a qua lity, approp riate,
find, the demand for the service generally Challenges for our team include managing accessible service.
SPEECH & LANGUAGE THERArY IN PRi\ClI CE SPRINC 1998 25
ISSN (online) 2045-6174 www.speechmag.com
HOWl..
The service
South Downs Health Trust is a community
trust providing se rvi ces to 300 000 people.
It is a mLxed urban / rural area with a large
proportion of people over 65 years. The
5.5 whole time equivalent speech and lan
guage therapy Adult Neurology team is
based in Brighton. It provides a service to
inpatients in two acu te hospita ls, outpa
tients in a variety of sellings across the
trust, two rehabilitati on units, an elderly
physical and mental healt h day resource
centre and a limited domiciliary service,
Management strategies
The strategies we have implemented to
improve caseload management include:
1. Administration
A central wa iting li st is held, Thi s ensures
no referrals go "missing" and that it is pos
sible to get an overall picture of the service,
Each week an adult neurology team meet
ing is held, one of the functi ons being to
discuss the waiting li st and to prioritise
and allocate patients to therapists, There is
secretarial support to regi ster the new refer
rals on to the computer system, create
records and deal with acknowledgement
lellers,
2, Location
Outpatients are seen at five sites across the
Trust area , Sessions are allocated to the dif
ferent sites but a certain amount of fl exi
bility is possible. The advantages of work
ing from different sites are that the patients
do no t have to travel too far and it facili
tat es eas ier liaison with ot her professionals
based in that locality.
3. Liaison with other organisations
We have links with a number of loca l
organisations for people who have had a
stroke, The Stroke Association's Dysphasic
Support Service runs two groups and does
"one to one" visits; we meet regul arly wi th
the local organiser to di scuss the people
involved in the scheme, The department
was instrumental in selling up the loca l
ADA (Action for Dysphasic Adu lts) self
help group which we still have some
Voluntary sector contacts
Action for Dysphasic Adults
1 Royal Street,
London SEl 7LL
tel. 0171 261 9572
The Stroke Association
Stroke House,
Whitecross Street
London Eel Y 8JJ
tel. 0171 490 7999
Parkinson's Disease Society
22 Upper Woburn Place
London wel H ORA
tel. 0171 383 3513
Alzheimer's Disease Society
Gordon House,
10 Greencoat Place
London SWl P 1PH
tel . 0171 306 0606
Motor Neurone Disease
Association
PO Box 246
Northampton NNl 2PR
tel. 01604 250505.
involvement in . A Different Strokes gr up
for younger stroke survivors is being estab
lished and one of the speech and langw.ge
therapists has been invo lved in tarring it.
Our Trust has a co mmunity uoke Rehab
Nursing Service \ hich ees both people
who have not been admined to hospital
and peopl e immediatel y after discharge.
They are an important link for us and we
recei e 3 number of referral s from them for
communi ty patients immediately post
stro ke.
The different organisati ons mean o ur
patients and carers can receive ongoing
suppo rt that co ntinues after they have
been discharged from speech and language
therapy. We also try to link up with oth er
o rgan isa ti ons s uch as the Alzhei mer's
Disease Society, the Parkinson's Disease
Sociery and the local specialist nurse, and
the l'vlotor Neurone Disease Assoc iat ion
and thei r Regio nal Ca re Advisor with
whom we have regular multidisciplinary
meetings,
4. Informati o n and support
We make wide use of information leaf1ets
from different organ isations to supple
ment the informati on we give patients per
sonally. We are develop ing an advice
leaf1et for relatives / friends of people who
have just had a st roke, We run a carers
group for people caring for / livi ng with
peopl e with dysphasia, memory problems
and Parkinson's disease. This is a forum
where we ca n share info rmati on and dis
cuss issues important to them and they can
gain suppo rt from one another, Those who
take part find the experi ence helpful, par
ticularly the opportunity of sharing practi
cal \ Jys of dealing wi th problems.
The future
Our service is uf (I urse li mited by the over
all number of speech and language therapy
sessions ava ilable and, whi le it would be
great to have more lime. the task i to make
the be t u e of our limited r ources. Areas
we wan! t look at are:
(i) carer / relati ve groups for support and
promoti ng communication ski ll s and
knowledge to enhance the communi cation
between the dysphasic / dysarthric person
and their relati ve
(ii) ways of addressing the demand for
early response to acute communi ty stroke
referrals
(iii) linked to this, we wal1lto look at the
provision of speech and language therapy
for acute stroke patients, how we can give
the best intervention to them and their
fami lies, particularly with il view to target
ing therapy resources at the time when
they are most likely to be effective,
The challenge for our service as for many
of us is to show that what we do is clini
call y effective. We need to keep on looking
at o ur caseload management to ensu re it is
helping facilitate effecti ve practice,
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Developments in assessment and technology are reported by an independent hearing
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' A technique known as the Client Oriented Scale of Improvement (COSI) helps Cubex
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A range of products is also available to make home life eaSier, including a Silent Alert
Radio Paging System, the Infraport television listening device and the Echo Induction
Loop. The Uniphone 1150 is a telephone compatible with 97 per cent of the world' s text
telephones which can be used by the deaf, hard of hearing and speech impaired.
For Cubex details or to arrange a demonstration / trial: Adam Shulberg, tel. 0171 9355511.
About Face
A new book explores why human
beings have evolved to have such
mobile and expressive faces.
SdentIJk evidence Is combined with
insightsfrom subjective experience,
Indu4Ing autistic author Donna
WIliams. The perspectives Of people
with vlsuallmpalnnent andfacial
tllsjfgurement are also considered,
About Face by Jonathan Cole is
published by The MIT Press.
B ~ 2 465 at 14.95,
26 SPEECH & u\NGUAGE THERAPY IN PRACTICE SPRING t998
ISSN (online) 2045-6174 www.speechmag.com
HOW L .
Commune Paediatric
A magi fonnula?
::t: It -< Ann Adams, with some
T SI R he/pfromherCDmmunity
paediafrictenm, describes
NH TRUST how theyare responding
tD changing c:irnJmstonCe5.
Ou r caseload management
scenario con tinues to evolve in
response to increased referral s,
changing education policy and
staffing challenges. From dis
cussion with colleagues, there
does not seem to be a precise,
tried and tested method that works fo r
everyone
Balance of staff (Figure 1)
Over the last seven years the balance of
staff has cha nged. Many clinics were run
by experienced part-time staff, now retired.
Recruiting has changed and new staff are
more likely to be full-time new gradu ates
who require conscientious support. The
district operates a Buddy system whereby a
more experienced therapist meets with the
new therapist on a regular basis.
Our central clinic covers the Redhill a nd
Reigate popul ation . Chil dre n are see n for
assessment a nd a package of care pre
scribed: review, group therapy or a block of
individual therapy whi ch might require a
wait. There is a priority system; MO star rating
is high priority and one is priority (fig. 2).
Motivation factors
Assessment of motivation of child and par
ent come in to play. If va luable resources are
given to those who do not put into practice
advice or therapy, there see ms little point in
providing more. Failure to attend continues
to be a problem, a lthough the procedure
has been tight ened up considerably. Clients
are sent a lett er asking if they wish to con
tinue having fail ed an appointment and are
asked to return the slip within a month,
otherwise they will be discharged. There
wi ll always be children who are re-referred
because of concern of other agencies.
Growth in referrals
As referral numbers have grown, different
methods of managing have been tried
including a move towards centralised
groups (figure 3). This helps the therapist by
removing the child from her caseload for
the time being or by working with another
therapist. The child ren improve in social
ski lls and learn from others. Parents meet
others in a similar situation and learn what
helps their child within the group. In gener
al, there are not enough children with simi
lar difficulties to warrant running groups at
outlying clinics. The running of groups
needs continual updating and improving,
according to the needs of the ch ildren con
cerned; thi s is done by the whole team.
Earlier referral
Whereas children were referred at about
three years, now they may be t\,o or be
transferred from Special Needs earlier than
that. This is panly a knock on effea of
Surrey Education Authority's change of age
of transfer four years ago. Junior school
transfer is now at seven rather than eight,
infa nt entry under fi ve yea rs and pre-school
pl aygroups have lowered the age to two and
a half wi th toilet training not esse ntial. This
has created extra pressure on our service in
that parents are hoping for a "cure" earlier.
To cope, the Parent and Toddler Group was
set up. One or MO therapists and an assis
tant use adjacent rooms, the parents and a
therapist in one and the chi ldren and other
staff next door. The door remains open so
chi ldren are free to move between rooms.
While the parents are sharing experi ences,
the therapist gauges the ir chil dre n's needs
and gives advice. The children are engaged
in play and their stage of play, type of inter
action and level of comprehension and
expression noted. Fo.llowing tl1e group, the
chil.d returns to the referr ing therapist.
Meanwhile, interest has been turning to
even younger children. Therapists are
bei ng timetabled in to the Health Visitors'
post-natal groups to give encouragement
o n the benefits of early language stimul a
tion . WILSTAAR is being considered to pre
vent a certai n amount of future referrals.
Figure I . scaff
Paediatric Head
Clinic Co-ordinator
Team of clinic therapists
Single-handed in own clinic plus
working with others at central cli nic
Specialist staff
expert advice from Infant and
Junior Language Unit Therapists
based in a local primary school
Part-time assistant
receipt and acknowledgement of
referrals piUS entry on to the waiting list
the operating of the group folder,
receiving referrals from clinic therapists
taking part in running groups with
a variety of therapists
Secretary
word processing facilities also available
In central clinic to staff happy to make
use of them
Locums
used to keep service moving when a
vacancy occurs, although there is
still a knock-on effect for the new
L-_____thera ist
Rgure 2 Possible reasons fOr
priority rating
where optimum timing of
treatment is critical, ego post
surgery
condition will deteriorate if not
assessed and treated, ego
dysfluency and voice
other agencies waiting for a report
before further action
anxiety about social and emotional
problems of the patient
degree of anxiety of the parents
severity of problem described In
referral and in relation to age
a referral marked urgent
(If appropriate)
URCE UPDATE. . RESOURCE UPDATE.. RESOURCE UPDATE. _RESOURCE
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A new video Telesaje 2 aims to help people with learn
ing disabilities combat crime.
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social services, it focuses on how to deal with bogus
callers, distraction burglars and harrassment.
Pavilion Publishing has also produced The Virtual Tenancy
an interactive computer programme to help people with
learning difficulties understand their rights and responSi
bilities as tenants and three new titles focusing on the ben
efits of involving service user feedback in the planning and
implementation of community care services.
Pavilion Publishing, tel. 07273 623222, Telesaje 2 price 88.73 +
p&p,
O_vslexia
J-randbook
Speech and language therapist
Rosie Wood has contributed to the
Dyslexia Handbook 1998.
The handbook aims to provide 'a
helpline in a book' for dyslexic
people, their families, and education
and healthcare professionals,
Substantially updated and
revised each year, it has sections
on useful national and local
organisations, dyslexia and
management of dyslexia. From:
BOA, tel. 07789662677, 5.
SPEECH & LANGUAGIo 11-I ERAI'Y IN PRACTICE SPRING 1998 27
ISSN (online) 2045-6174 www.speechmag.com
H OWl...
Liaison with education
Unlike the junior age group, there is not a
school based seIVice for the infant age group,
so they are seen by dinic therapists who
keep in dose touch with schools. Liaison has
increased because of the demands of the
Nationa l Curriculum with more children
having their language difficulties recognised.
Since the OFSTED inspections, nurseries are
wishing to improve their awareness and
knowledge of how to help.
Other changes from outside are a) the Code
of Practice whereby reports are requested
wi thin legal time limits and b) Local
Management of schools resulting in schools
buying in extra speed) and language thera
py from different sources. This can create
confusion and needs sensitive handling.
Coping with paperwork
The amount of paper work has increased,
with copies to many other agencies also. If
the report wri ting pile is rising to unac
ceptable limits, time needs to be put aside
from usual patient co ntact time. To con
centrate, it is often necessalY to find a quiet
room away from the office.
Working as a team
Regular clinic therapist meetings occur fol
lowi ng the six weekl y staff meeti ngs. This is
an opportunity to discover how clinics are
running, in terms of wa iting list, reviews,
etc. and anything that might h ave occurred
recentl y, like an influx of referra ls from a
new source. It is also a time when thera
pists might contribute their most recent
information on a new area of therapy. A
medley of tips from the team are in figure 4.
[ was asked to write this arti cl e while dis
cussing how best to manage a caseload,
particul arl y in respect to employing a new
graduat e to a single handed clinic. My
interest is of course in how other people
manage their caseload so, if any of you
have fo und the magic fo rmula, J sha ll look
fO lward to reading about it
l
Reference
Wiig, Secord & Semel (adapted 1994)
Clinical Eva lu ati o n of Language
Fund amen tals - Revised Ed ition UK
Adaptation (CELF-R""). The Psycho logical
Corporation.
Details of WJLSTMR training from Dr
Sally Ward, tel. 0171 383 3834. Manuals
and forms are ava il able fo ll owing training
and accreditation with WJLSTAAR.
fi&ure 3 Groups
Pre-school (In general one hour weekly for six weeks)
o Parent and Toddler
o listening and Attention
olWo language groups - low and higher level
Oral skills
olWo phonology groups - velar and fricative
School age
These are organised according to need and run intensively in the summer
holidays, daily for 1 - 2 hours for a week, ego
o Infant age language skills
o Pragmatics
o Junior language (run by Junior School service)
o Oral skills
o'S'
o Velar
Therapists are both clinic and special school therapists, giving the chance of
skill sharing.
Oysfluency
One group is run for parents of newly referred children two or three evenings per
year. Groups of stammerers from roughly nine years are run periodically as the
need arises.
spedal Needs
The general paediatric service has the option of referring children to a Special
Needs pre-school language group or a Communication Disorder group should
this be appropriate.
FigW'e 4 A Medley ofTlps from Colleagues
o Work in blocks of half terms for therapy and use holidays for reViews
and new referrals if you normally spend some time in schools.
o Try not to 'overload' with regulars but keep a few spaces for new
referrals and reviews. It is a question of balance as by seeing too many
new clients a bottleneck is formed and their treatment needs cannot
be met. However, this is rather easier to say than do.
o Be flexible and improve juggling skills.
o Put the onus on parents, ego their responSibility to help the child to
practise.
The department has a drawer full of different advice sheets to hand to
parents/ teachers or to send out with reports.
o Giving an appointment written on a compliments Slip provides the
parent with the correct address and telephone number.
o When sending sheets for practice, address it to the child as this gives
more incentive to practise.
o When a child has been assessed on the (ELF or pre-school version, a
copy of the explanatory notes about the subtests enclosed with the
report reduces the need for greatly detailed reports.
o It is Important to remember that a clinic waiting list is not owned by
the therapist but by the service .I trust or employing authority.
o It Is always easier to have a department policy with which to back up
individual practice.
o Write notes up immediately as a blank sheet is usually echoed by a
blank memory!
Practical Points - Caseload Management
1. Caseload !11anagement is a team not an individual exercise and therapists must have the
opportumty to pool resources.
2. Contracts must be flexible enough to reflect changing work practices.
3. A departmental prioritisation system is necessary.
4. Staff need time together to plan and discuss case load management so problems can be
picked up early aneJ addressed as a team.
5. Voluntary agencies can a ~ d r e s s gaps in provision, especially if supported by speech and
language therapy expertise.
6. Adequate administrative and technological support is essential.
28 SPEECH & lANGUAGE THERAPY IN PRACTICE SPRING 1998
ISSN (online) 2045-6174 www.speechmag.com
18 - 19 June 1998
The Management of Dysphagia
in Tracheostomised and
Ventilator Dependent Patients
Tutors: Karen Dikeman & Marta
Kazandjian Cost: flSS
Host Scottish Speech a Language
Therapists' Specific Interest Group in
Dysphagia
WilLie Clyde Hall, University of
Strathclyde, Glasgow
Linda Greig, Dept of Speech
a Language Therapy, St John's
9.Pp.
for People
Who Stutter
T11t'nw Let's Keep Talking
Host Speakeasy Stuttering
Association of South Afr ica
Vellut . Johannesburg College of
Education, St Andrews Road,
Parktown, South Africa
DI:I.IIls PO Box 3390, Parklands,
2121 , South Africa . ' .. ...
26, 27 8- 28 August 1998
8th International Aphasia
Rehabilitation Conference
TOPIU" medical and neurological ;
aosscuitural and bilingualism; outcomes,
quality of life, functional communi
cation and the family; computers;
reading and neuropsychology;
traumati c brain injury; motor speech;
ageing, dementia and geriatrics.
Host The Department of Speech
Pathology and Audiology,
University of the Witwatersrand
Venue Mt Amanzi, Hartebeesport,
South Africa
Df'lilis PO Box 3390, Park lands,
2121 South Africa.
'i'S':" W'Octotier' i 998
Communicating the Evidence
Conference
Royal Coll ege of Speech a
Language Therapists
Vt-'II It> Adelphi Hotel, Liverpool
JGaA Conferences a Events.
tel. 01905 724734,
29 bdcifier- i November, 1998
The Third European Parkinson's
Disease Association Conference
Accommodation without surrender
Venue. The Barcelona Hilton,
Barcelona. Spain
I img1J3gc Joint English and
Spanish
Martlet, Conference
Secretarial, tel. 01723 686889.
Various dales ' 1998
AFASIC In-Service Training
Programme
Includes Social Communication
Skills, Functional Language in the
Oassroom, An Introduction to WILSTAAR,
Followup day for WILSrAAR therapists,
Severe Receptive Language
Difficulties in the Classroom,
Understanding the Emotional and
Behavioural Problems of Language
Impaired Children, Collaborative
Working Styles Between Teachers
and Therapists, Professional
Partnerships and The Identification
and Assessment of Children with
Speech and Language Impairment.
\ enut> London Voluntary Service
Resource Centre
OMilII5. Carol Lingwood, tel. 01273
381009
. 2f - 1999
Thjrd International Symposi!-,m:
Speech and ImpaIrments
Frorn Theory toPractice
H st. AFASIC
Venue York
"1' "(tr , .., . to consider the interface
between speech and language disorder,
dyslexia and autism, and to link
theory to practice
Speakers include: Dorothy Bishop, Gina
ConURamsden, Margaret Snowling, Joy
Stackhouse and Susan Ellis Weismer.
Details: AFASIC Symposium
Secretariat, 29 Hove Park Villas,
Hove, East Sussex BN3 6HH,
ISSN (online) 2045-6174 www.speechmag.com
9] D iscussion local
colleagues. an
SIG for for me. I
These are ot wn therefore I
work mainly on my made
like the and other meet
and fostered at ether with frequent
These, tog d y knowledge.
courses. expa.n 1 I:eres
t
Groups
(List of Spec;aCollege of Speech &
from the Roya . tel 0 171 613
Language TherapISts, .
38SS.)
2] My tape recorder
This is essential for obtaining an
objective record of a patient's voice
on the first assessment, and for later
comparison after therapy. Mi ne is
also in constant use, as every patient
takes home a tape of the exercises
we have done together for home
practice. This reduces pOSSible con
fusion when faced with a sheet of
exercises alone.
MyTOD
Resour(eS
Heather Taylor is an Independent
Speech & Language Therapist who
specialises in the treatment of
patients with voice disorder.
I work at various private hospitals in the
North West, treating patients with voice
problems referred by their ENT Consllitants.
Three qllarters of my caseload consists of
people with dysphonia. I am responsible fM
their assessment, treatment and discharge.
The ten top items I have selected will not be
new to an experienced voice therapist, but
perhaps those starting to work with this
client grollp may gain a few tips. heets " by
erc\se S '-J ice Thera!',
\let of e)( "oice and 0 book on th\s
-------and\ng ,,!a a ted Irom lhe ere is a good 19
95
, whic.h
11 t'\y e)(f ''(aWl'-sigh tad MethOd l herapy are
-n.ese i"du ee l97 I), ",cc
e
t MethOd a MoSt 01 my d "d nhOtO"'
,.. R SOon , ",eee
n
h . ques. ... ' re a... s
\<..otby, lhde"oieecrait te
C
n
l
run
ali as req':nd short
by M tape) an more are dialogue a fore'6" '
co",es with co",puter SO ha'le passa\es. hing EngliSh as So",et\'lin&
.01 practice,eg.
cop' \ practice. I I lor readl"g Id
tof '1o
ca
",aterial use u b Ed'l'iard ",rn
o
.
Language I<.! " WIlson, pu .
to Say by e
ISSN (online) 2045-6174 www.speechmag.com