COVER STORY / user involvement help ensure that skills learnt in the school setting can be transferred to a respite

e setting. use her increased contact with parents and families to ensure strategies are consistent across all environments, and offer invaluable support. Using the strategies in a care setting provides an important role model for parents. The study has shown the important role that residential units can play in furthering childrens communication skills when they provide a setting in which children can continue to develop and practise them. The partnership between the Communication Development Worker and the speech and language therapy service has been key to the success of developing a quality communication environment. Isabels energy to focus solely on communication proved a huge impetus to change and success. To embed inclusive communication practice into organisations is a challenge but this respite service has achieved it and is able to make sure staff have the skills to listen to what the children and young people are saying, no matter how they are able to say it. Are you Listening? won the Scottish Care Accolade Award 2007 for Innovative and/or imaginative training programme. We are delighted that this project has also received funding for a further three years from the Big Lottery. Part of this funding includes the extension of the skills developed within the respite setting to other places that the children and young people use in the community. This will continue to ensure that everyone is listening to them, no matter how complex their communication needs. Elaine Crighton and Lois Cameron are Speech and Language Therapists working for NHS Forth Valley, Speech & Language Therapy Department, Euro House, Wellgreen Place, Stirling Fk8 2DJ, e-mail lois.cameron@ fvpc.scot.nhs.uk, and Isabel Forsyth is the Communication Development Worker for NCH Tayavalla. SLTP

Looking in the mirror

User involvement whats your experience? Let us know at the Summer 08 forum, http://members.speechmag.com/fo

Editor Avril Nicoll introduces our new series on user involvement.

I originally planned to do a single feature on user involvement but was so overwhelmed by offers of help that I decided to run a series instead. While user involvement is enshrined in all NHS policy documents, I have a very personal reason for wanting to see this aspiration put into practice.

REFLECTIONS DO I NURTURE THE ABILITY OF SUPPORT STAFF TO GIVE TIME AND PRACTICAL SUPPORT TO INDIVIDUALS? DO I NOTICE SIGNS OF CHANGE IN PRACTICE SUCH AS A REGULARLY UNTIDY RESOURCE BOX? DO I MAKE INFORMATION ABOUT A CLIENTS COMMUNICATION ACCESSIBLE?
How has this article been helpful to you? Do you have other stories from inclusive communication environments? Let us know via the Summer 08 forum at http:// members.speechmag.com/forum/. References

Millar, S. (2003) Personal Communication Passports: Guidelines for Good Practice. Edinburgh: Call Centre. Murphy, J. and Cameron, L. (2002) Let your mats do the talking, Speech and Language Therapy in Practice Spring, pp.18-20. Valentine, C. & McConkey, R. (2003) The Communication Profile & its use with a learning disabilities population, Evidencebased practice: a challenge for speech and language therapists. CPLOL 5th European Congress. Edinburgh 57 September.Further information from cathvalentine@devon.gov.uk.

When I qualified 20 years ago it was normal practice for therapists to call clients patients. Both children and adults were seen on their own, or with parents and partners present merely as onlookers. The patient had an impairment that needed to be fixed, and the therapist was the expert who held the answers. Case notes, reports and discussions were reserved for professionals. Choice really came down to whether or not a client chose to turn up. For whatever reasons, this made me uneasy and I was keen to do things differently. From the start I tried to be responsive to individual need and to involve families. I was also very influenced by the pioneering work on empowerment by people like Carole Pound who went on to co-found Connect, the communication disability network. I enjoyed campaigning during Speak Week to get the needs of people with communication impairments in the public eye. But the real change in my attitude came about when I had my children. A deep rage at the way I had been treated led me to become involved in campaigning for improved, woman-centred services. I have now been a user representative at Montrose Maternity Unit for 8 years (www.birthinangus.org.uk). Although I was nervous at the start (who was I to be telling professionals how to do their job?) I now feel incredibly privileged to have been part of the driving force behind major changes that have benefited so many women and babies. The midwifery team leader says, The changes at Montrose have been more than cosmetic there has been a fundamental shift in our attitude, philosophy and our very language. This evolution may have taken place without the input of our users, but it is unlikely. They held a mirror to our service, and we did not like the reflection (Winters, 2006). But the midwives hold a mirror up to me too, and I learn such a lot. I now understand far more about the benefits of helping people locate and draw on their own internal resources, to find their own way and solutions and about using language with other people that constantly reinforces a belief in their strength and ability. I also have a deeper appreciation of the importance of the relationship between client and therapist and what it means for the personal development of both. As Santorelli (1999) says, For too long care has been conceived of as either practitioner-centred or patient-centred. In actuality, the healing relationship has always been a crucible for mutual transformation. I hope this series will inspire you to have the confidence to make genuine user involvement a reality. Please use the forum to share your own experiences - http://members.speechmag.com/forum/.
References Santorelli, S. (1999) Heal Thyself Lessons on Mindfulness in Medicine. New York: Bell Tower. Winters, P. (2006) Holding up a mirror: the impact of user involvement, AIMS Journal 18(3), pp.12-13. Available online at http://www.aims.org.uk/Journal/Vol18No3/holdingUpAMirror. htm (Accessed: 8 May 2008).

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User involvement

Listening and learning

Mariela Angulo and Amy Wolfenden on how the process of gathering views from children, childrens centre staff, parents and speech and language therapists has shifted the focus of the service and resulted in a closer, more reflective team.

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ur project aimed to evaluate the services provided by speech and language therapists working across children centres in the Bradford district by seeking feedback from service users. The need for the project was highlighted in a childrens fund evaluation (2006) which recommended we ensure children using the service are involved in service delivery. The audit suggested a creative, participatory approach that reflected the needs of children experiencing language difficulties. We wanted to improve our service by listening to people but had a number of anxieties. How would we get the childrens views? How would we feel about peer evaluation by other speech and language therapists? Would parents feel they had to say positive things? Would we manage not to guide people in their answers? We divided the users of our service into four main subgroups and obtained information from each in different ways: 1. Children To gather the childrens views we used Talking Mats (Murphy, 1998). We did this in a group setting with six groups of 4-6 children aged from 2-4 years. We showed them photographs and pictures from their sessions so they could indicate the activities they liked and disliked, although we tend to think the photographs give a good indication of their level of enjoyment anyway. Most of the children understood the task and enjoyed using the Mats to tell us their views. However, some children struggled to understand the idea and others purposefully chose the opposite for amusement! It was interesting to see how dominant leaders emerged, and how many were influenced in their opinions by others. We found this a really useful activity for communication, and we now incorporate it into our daily practice. 2. Childrens centre staff and teachers We used a comments books and matrix questions to gather views of this group. Staff gave open and honest feedback about speech and language therapists and their value. Most comments were positive and some also identified areas for service improvement and collaborative working. We sought feedback from centre managers regarding the overall speech and language therapy service provision. Most comments were positive and emphasised the importance of this input for childrens confidence, well-being and overall development and to the childrens centre ethos. Many managers were pleased with our input and some even said we had exceeded expectations while others highlighted areas for improvement. 3. Parents / Carers The parents expressed their views through comments books and Parent Child Interaction Group evaluation forms. They commented on

individual therapists, therapy blocks received, service provision and advice given for home. Overall, comments were extremely positive and highlighted how both parents and children enjoyed attending the sessions. They also noted the longterm benefits through changes seen in their children at home following early interaction advice. Parents appreciated the convenience and flexibility of attending local childrens centres and the informal, child-focused approach of the therapists. 4. Speech and language therapists We used two methods of data collection with therapists: a) giving children choices in daily practice questionnaire b) peer evaluation. Offering choices is an important way of listening to children. We therefore asked each childrens centre therapist to complete a reflective questionnaire detailing how choices are offered to children in everyday provision. The responses showed that choices are offered in different ways including activity, equipment, location (home visit option where appropriate, indoor / outdoor play in childrens centre settings, or areas such as home corner / sand) and by going with the childs interest following the Hanen techniques of observing, waiting and listening (Manolson, 1992) and responding to the childs attempts to communicate. We also designed a peer evaluation questionnaire based on the SSCAN technique as discussed in Weitzman & Greenberg (2002). The focus was on the interaction between the speech and language therapist and the children in groups. We were looking for recognition that small groups are best, the setting up of an appropriate activity, careful observation of each childs level of participation or interaction, adaptation of response to each childs needs and an ability to keep this going. All the therapists were aware of the childs attention, participation and interaction and adapted their interaction accordingly. Signs and symbols were not always used. All therapists changed physical position and repeatedly used the childs name. Therapists responded by imitation, using gesture and extending play sequences. However, depending on the nature of the group, some therapists followed a more structured approach. All therapists used sincere questions and comments. Some groups used more focused questions while in others the emphasis was on commenting and modelling. While turn-taking and parent participation was encouraged, there was less opportunity in more structured groups for the children to interact with each other.

l-r, Amy and Mariela

We now offer choices for everything. We think more about the location of therapy, such as whether a home visit or different setting would be more appropriate. Our manager has been supportive throughout and the service as a whole has shifted towards having more user involvement. We want to provide evidence based practice but we need feedback that we are getting it right. While many things are easily changed on a daily basis, some issues are more structural and strategic. However, we have been able to draw them to the attention of managers so user views are being heard. The project relates well to clinical governance, in particular patient, public and carer involvement, clinical effectiveness, communication and team working. It also highlighted the importance of listening to children, and reinforced for us the messages that are in the literature. Listening to children: plays an important role in early interaction and how it impacts on developing communication, language and literacy (Rich, 2002) can help ensure that they are valued and feel valued (Rich, 2004) ensures that their physical, emotional and cognitive needs are met (Rich, 2004) results in increased opportunities for practitioners to reflect on practice (Clark et al., 2003) is vital in establishing respectful relationships with the children we work with (Dickins, 2004). Mariela Angulo and Amy Wolfenden are therapists with Bradford and Airedale Teaching PCT. Please forward any comments to our team leader Margaret Greer, e-mail margaret.greer@bradford.nhs.uk. Acknowledgement We would like to thank past and present children centre team members for their hard work and SLTP support during this project.
References
Clark, A., McQuail, S. & Moss, P . (2003) Exploring the Field of Listening to and Consulting with Young Children. London: Thomas Coram Research Unit. Dickins, M. (2004) Listening to young disabled children. Listening as a way of life. London: National Childrens Bureau. Manolson, A. (1992) It Takes Two To Talk. Toronto: The Hanen Centre. Murphy, J. (1998) Talking Mats: Speech and language research in practice, Speech & Language Therapy in Practice Autumn, pp.11-14. Available online at www.speechmag.com/Reprints (Accessed 8 May 2008). Rich, D. (2002) More Than Words: Children developing communication, language and literacy. London: The British Association for Early Childhood Education. Rich, D. (2004) Listening to babies. Listening as a way of life. London: National Childrens Bureau. Weitzman, E. & Greenberg, J. (2002) Learning Language and Loving It. Toronto: The Hanen Centre.

Choices

As a team, this has brought us even closer than before. We are more aware of the issue and constantly use what we have learnt to reflect on our practice.

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