HOW I

A safe context
Mel Adams, Celia Harding and Andrea Lillystone support students of speech and language therapy, social work, nursing and medicine to explore issues of client assessment with the assistance of carers of people who have complex communication needs.
L to R: Mel Adams, Celia Harding, Andrea Lillystone

HOW I (2):

They had two days in January to meet each other, set ground rules and make arrangements for meeting, using the Bulletin Board on a specific web site to share information and plan their presentation for March (see example in figure 1). We invited the carers to attend the presentations and give feedback.

Reduce barriers

nterprofessional education is a relatively new initiative within health and social care undergraduate courses across the UK. It occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care (CAIPE, 2002, cited in CAIPE, 2006). Evidence is beginning to show that students benefit from interprofessional learning opportunities as an additional way to consolidate knowledge gained in clinical practice and make the link between theory and practice. This education opportunity is now being included in speech and language therapy undergraduate training to support both clinical and academic learning. Our project (January - March 2007) involved fourth year speech and language therapy undergraduates in a three day interprofessional module set up by the department of Social Work at the University of East London, the Medical School at St. Bartholomews Hospital and the departments of Nursing and Language and Communication Science at City University. This enabled students from all four disciplines to work in multi-professional groups to explore: issues of client assessment working with carers of people who have complex communication needs the clinical reasoning to support strategies for intervention within an interprofessional context. During the course the students spent time listening to carers of clients with complex communication needs as they described the person they care for and their experiences of input from services. Participants were carers of children and adults with a range of learning disabilities including difficulties on the autistic spectrum. Carers and service users are being used increasingly to support student education within a structured learning context, and this can only strengthen the formal teaching carried out in the lecture theatre and the practitioner skills learnt on placement. We acknowledged that carers require appropriate financial recognition for their services. Preproject training and organised training and access to trained counsellors were provided should there be any issues arising. (These social work, therapy and nursing professionals met the carers at an introductory session and offered de-briefing after sessions with the students.)

Education facilitators - such as university lecturers and clinical tutors - provided feedback and support to the students. In their assignment, we wanted students to assess and evaluate how the challenges of providing a client-centred service to these individuals with a communication disability could be supported by the use of innovative multimedia communication methods, as well as more focused joint professional working. The students worked collaboratively within their interprofessional groups and created a presentation.
Figure 1 Group example - Luke Our group identified what multimedia communication methods could be used to help health and social care professionals assess and develop a person centred care plan for our client Luke. In determining what methods of multi-media communication would suit Luke and help us to make an assessment of his needs we agreed we would: theme this around what Luke likes adopt a specific interactive, structured approach with some flexibility use digital images, video, sounds, communication tools that Luke uses already use as many types of media as Luke is responsive to, not just one (visual effects, sounds, PECS, Widgit Symbols, video) use pictures of people and places Luke knows use Lukes communication with mum as a model keep Luke relaxed with soothing background music / visual effects remember positive reinforcement is important remember LESS and STRESS; go SLOW and SHOW; break down into chunks. In discussing how we would develop and communicate the person centred care plan to Luke, we decided: the plan needs to consider Lukes day to day needs and the health and social factors impacting on well-being, as well as addressing his meaningful involvement in planning meetings to remember that process takes precedence over product to liaise closely with people Luke knows well. We considered the likely challenges and how we would address them: if we misunderstand Lukes communication needs we have a useless result so we need to be sure we understand Luke before we start by getting to know him and his family and friends we need to be clear about each others priorities and standards and use assessment timescales, have resources to hand and avoid duplication.

From the teaching perspective we feel the opportunity for students from different disciplines to meet together to discuss common themes and carry out joint activities may reduce cultural barriers between professions and help individuals to understand one anothers conceptual frameworks and professional vocabulary use. It also gives students the opportunity to learn about one anothers roles before miraculously being expected to know this as soon as they start working. This is an unthreatening forum in which students explain their roles and where there is time to ask one another questions for clarification, as well as reflect on experiences that they have had in placements. This hopefully encourages a more holistic view of client care, a mutual respect for one anothers professions, and raises awareness of vital issues such as multidisciplinary goal setting with clients and carers in the process. A unique aspect of this learning experience was the opportunity to hear the perspective of the caregiver away from the busy clinical context. Students felt that they had time to probe and explore more challenging aspects of care for clients who require the support of more than one service. The assignment helped students focus and refine their skills in reflective practice, communication skills with other student-professionals, team-working, consideration of the fundamental importance of communication - especially augmentative and alternative communication strategies that all involved need to be aware of - and in giving a professional oral presentation. Caregivers felt strongly that they were making a significant contribution to the student learning opportunities. In particular, they wanted the students to learn from the challenging situations both they and the person they cared for had experienced, which were usually to do with limited liaison between professional groups. They all felt it was a very important opportunity to influence health and social care students before they start working. As final years, the speech and language therapy students had already accumulated a substantial number of different clinical experiences during their training and reported gaining great benefit from the project. They particularly valued hearing the carers accounts and having the time to ask questions about how service delivery could have been improved. Although a high number of students commented that they had had some experience of multi-professional and joint working in placements, as well as some opportunities to speak to parents and explore issues, the important aspect of this learning meant they appreciated the time to explore some of these clinical issues in more detail within a safe clinical context with support staff available.

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The speech and language therapy students also felt they were able to share considerable knowledge and expertise about communication disabilities with other students relevant to their cases. They valued highly the opportunity to explore other disciplines within this learning format, as meeting other healthcare and social work students allowed them to feel more confident about understanding roles within the workplace. They felt this was a learning bonus that gave them additional knowledge just before becoming practitioners.

Mel Adams is a clinical tutor at City University and a lecturer at the UCL Institute of Child Health. Celia Harding is a lecturer at City University and a speech and language therapist at the Royal Free Hospital. Andrea Lillystone is a clinical tutor at City university and a speech and language therapists / therapy placement facilitator with Waltham Forest.

References

UK Centre for the Advancement of Interprofessional Education (2006) Interprofessional Education. CAIPE Bulletin 26, p.3. Also available at: http://www.caipe.org.uk/index. php?&page=define&nav=1 (accessed 2 November 2007).

Resources

Acknowledgement

Many thanks to the parents and carers who gave up their time to make this project a reality, and to SLTP share their very personal stories.

PECS (Picture Exchange Communication System) see www.pecs.org.uk Widgit Symbols see www.widgit.com

Everyone can communicate something

Laura Brierley and colleagues introduce first year students to life story work with people with dementia and their carers in a good practice project that provides a reason to communicate as well as an understanding of the person behind the dementia.

HOW I (3):

ur experiences of life story work within the therapy department at The Meadows, Stockport are very positive. We find it is extremely important and rewarding and the difference it can make to communication and self-esteem for people with dementia is invaluable. A number of authors have also highlighted the value of life story work (Baker, 2001a; 2001b; Bryan and Maxim, 1998; Kindell and Griffiths, 2005; Murphy, 1994) for encouraging communication in a variety of ways. Kindell and Griffiths (2005) illustrate a case where life story work is included in speech and language therapy intervention. This demonstrates how the work can provide opportunities to share important life events, focus conversation and re-kindle communication and relationships between spouses. Bryan and Maxim (1998) evaluate a life story initiative providing training in communication skills for care staff, which in turn is useful in the future planning of activities and more person centred care.

Philosophy

The central philosophy to life story work is that everybody, no matter how impaired, can communicate something. It allows the opportunity to focus on all means of communication - speech, tone of voice, facial expression, body language and personal ways that often only close carers may be able to detect. Importantly, life story work helps others to recognise that, no matter how impaired someone is, they are still a person with rights and needs who at all

times should be treated with respect and dignity. By learning to understand the person behind the dementia we can develop a greater understanding of their behaviour and needs and foster a more positive attitude. It is particularly helpful for new staff to understand who they are caring for. At The Meadows the therapy team provides input to the continuing care ward, assessment ward and day hospital as well as to people in the community. In addition to life story work within therapy interventions, staff and relatives have access to advice and training opportunities. However, we felt additional hands on work would have a fantastic impact on our resources and service. As the University of Manchester is supportive of peer placements, this combination of incentives led to a student life story project proposal. Wilcox and Simms (2007, p.8) describe the benefits of peer placements as moving away from one student with the speech and language therapist at all times during the placement as if they are attached at the hip and moving towards a more liberal paradigm of distant supervision without feeling continually watched and judged. In this situation students have the opportunity to develop their own style and problem solving ability.

Inspiration

A further inspiration for creating this type of placement was to offer a large number of first year students exposure to dementia as, due to the lack of service provision available in some areas (RCSLT,

2005), this could be their only clinical experience of dementia in their student lives. Once students qualify, skills and awareness of service needs gained on placement can be applied during their career. Consequently, a vital factor in the future development of speech and language therapy provision for people with dementia is to provide student experience. The central part of the project was to produce information about the person with dementias life story, their likes and dislikes, what they enjoy and ways they communicate their views and feelings. This information was compiled into life story books. The books include personal photographs, historical photographs, pictures and information sourced from the library or internet. At the same time first year undergraduate students had the opportunity to learn about dementia firsthand from people with dementia and their carers. They also had the chance to develop skills in sensitively collecting information from interviews, medical notes and observations. This provided some crucial first year student experience in building rapport, gaining confidence and working in a multidisciplinary framework. Eight students took part in the autumn term placement and ten in the spring term placement. All students came for a one day placement, every week, for five to six weeks. Before the placement we delivered an introductory lecture to the students on dementia and life story work at the university. At this time, as part of their university course, students were learning about Personal Communication Passports (Millar, 2003). Passports are a way of documenting and presenting information about children and adults with disabilities who are unable to speak for themselves. The students made their own Personal Communication Passports and brought them to The Meadows to share with the group. This provided a constructive, person centred activity to begin the placement. As a contrast to the communication passports, we talked about life story books and looked through books our department had made earlier. The students worked in pairs to produce two life story books. Relatives and people on the wards and in the community were invited to participate. We aimed to provide an opportunity to make a life story book for people at different stages of their dementia, as this would help the students gain a broader experience.
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