Talking heads: Speech and Language Therapy in the Current Context – Challenges and Opportunities

1. Talking heads: Speech and Language Therapy in the Current Context – Challenges and Opportunities Victoria Joffe Division of Language and Communication Science City University London IASLT CONFERENCE Ireland, April 2013

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8. OPPORTUNITIES CHALLENGES

10. What is our starting point?

11. Committed workforce • Professional • Expert knowledge • Highly Skilled • Advanced communication skills • Critical and evaluative thinkers... BUT

12. In the face of this though we… • Work in isolation • Value anecdote more than robust evaluation and evidence • Are often frustrated at not being able to meet the needs of our clients • Feel disempowered when asked to show our value and contribution • Worry about our services being under threat • See research as separate from clinical activity • Are risk averse • Stagnate with for example, use of assessment materials, service delivery models, CPD, collaborative and integrated partnerships etc

14. Times of Austerity – economic recession caused a permanent loss of economic output, bringing challenges - home and away

15. Employment and expenditure are characterised by reductions - increasing numbers of the population in Ireland eligible for a medical card and decreasing numbers opting for private health insurance • Greater need by more people • Scarcer resources - carefully targeted to deliver more efficient and effective ways of providing services • Doing MOREfor LESS

16. Changing Population Demographics: Each year the total number of people over the age of 65 grows by around 20,000 persons. Ageing population will mean doubling the number of people over 65 years over the next 30 years - implications for health service planning and delivery (Irish census, 2011). • Increasing technological advances arerapidly changing the service delivery model • Rising consumer expectations in the context of suspicion and concern (mid Staffordshire reports)

17. Changing Market Place: More competitive, greater choice and user involvement • Payment by results – greater accountability and awareness of health economics, how much your service/intervention costs, cost-benefit ratio • Demand for clearly specified outcomes • Need for better data – systems that are Information rich, data poor

18. Inequalities of health care – Healthy Ireland 2012 • Impact of social deprivation on Speech, language and Communication Needs (SLCN) and other disorders • Gaps and limited services in certain areas of need – client group (for example, older children with SLCN, adults with developmental language disorders, people with behaviour, emotional and social difficulties, mental health needs etc.) and context (schools, care homes, homes)

19. Need to show why SLT is worth the investment • Not just an ‘add on’, a ‘nice to have’ but a necessity, an essential element ensuring the health and well being of our community • And how do we do that…

20. Collectively stepping up to the mark and seeing how these challenges are unique opportunities to do what we all want to do… Make a Difference

21. "If you always DO what you've always done, you'll always get what you've always got."

22. Levels of Evidence for EBP(http://cebm.jr2.ox.ac.uk)

23. Summary of levels of evidence for selected disorders(from RCSLT guidelines)

24. Evidence-based Practitioners • Barriers to undertaking Evidence based Practice – Clinician, manager, institution, time, skills and knowledge • Opportunities are all around us • Piece/s of the EBP puzzle • Build relationships between academic and clinical departments • Join regional research groups and start journal and research clubs • Become consumers of research • Critically appraise the literature and USE the research to shape and inform your intervention

25. Virtuous Circle(Snowling & Hulme, 2011) • Clinical practice should always be based on a sound knowledgeof theory and relevant research • Theoretically-motivated interventions should be evaluated to establish whether they are effective, efficient and for whom • Theory informs practice, and the evaluation • of practice informs and refines theories • We need to build our evidence base – • if we don’t someone else will.

26. Outcome Measures • Outcome measures are required by all – client and family, health care professional and the commissioner/purchaser • We need to be more strategic and get better at evaluating our interventions through the use of outcome measures • Differentiate between assessments for diagnostic purposes and for outcomes • Consider more carefully the relationship between our interventions and the outcomes we assess

27. Outcome Measures • What outcome measures are we using and for whom? • Roulstone and colleagues interviewed young people and their parents about the outcomes that mattered to them. • What do you think they were?

28. Outcome Measures • Johnson et al (2010) reported a 20-year follow up of a group of children with language impairments (LI) • At age 25, young adults with a history of LI showed poorer outcomes in multiple domains (communication, cognitive/academic, educational attainment, and occupational status) than their peers without early LI • However, there were no differences in subjective perceptions of their quality of life • Subjective well-being - primarily associated with strong social networks of family, friends, and others.

29. Outcome Measures • Use a variety of outcomes: formal and informal assessments – validity, reliability, sensitivity and specificity, easy to use • International Classification of Functioning, Disability and Health (ICF)—WHO – impairment, activity and participation • Levels of Outcomes – general, specific, management systems, qualifications • And from whose perspective – service user-based outcomes

30. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ Profiling Outcomes Across Time Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Excellent Average Very poor LANGUAGE & COMMUNICATION (including speech, fluency & voice) 0 1 2 3 4 5 6 7 8 9 10 SOCIAL SKILLS 0 1 2 3 4 5 6 7 8 9 10 EMOTIONAL WELLBEING 0 1 2 3 4 5 6 7 8 9 10 BEHAVIOUR 0 1 2 3 4 5 6 7 8 9 10 EATING & DRINKING 0 1 2 3 4 5 6 7 8 9 10

31. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ PRE-VERBAL COMMUNICATION Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Never Always Sometimes Initiates interaction with others 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Uses eye contact 0 1 2 3 4 5 6 7 8 9 10 Takes turns 0 1 2 3 4 5 6 7 8 9 10 Plays appropriately 0 1 2 3 4 5 6 7 8 9 10 Reaches 0 1 2 3 4 5 6 7 8 9 10 Points 0 1 2 3 4 5 6 7 8 9 10 Copies actions 0 1 2 3 4 5 6 7 8 9 10 Responds to voices 0 1 2 3 4 5 6 7 8 9 10 Responds to name Vocalises 0 1 2 3 4 5 6 7 8 9 10 Uses sounds meaningfully 0 1 2 3 4 5 6 7 8 9 10

32. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ TALKING AND LISTENING Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Always Never Sometimes Listens & pays attention 0 1 2 3 4 5 6 7 8 9 10 Talks using one or two words or with short sentences 0 1 2 3 4 5 6 7 8 9 10 Talks using long sentences 0 1 2 3 4 5 6 7 8 9 10 Understands one or two words or short sentences 0 1 2 3 4 5 6 7 8 9 10 Understands long sentences 0 1 2 3 4 5 6 7 8 9 10 Understands & uses lots of different words 0 1 2 3 4 5 6 7 8 9 10 Understands words with different or hidden meanings, for e.g. figurative language 0 1 2 3 4 5 6 7 8 9 10 Talks easily & appropriately with other people 0 1 2 3 4 5 6 7 8 9 10 Sometimes Always Never Shows frustration when not understood 0 1 2 3 4 5 6 7 8 9 10

33. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ SPEECH Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Sometimes Always Never Is easily understood 0 1 2 3 4 5 6 7 8 9 10 Is able to move tongue, cheeks, mouth, lips & face easily 0 1 2 3 4 5 6 7 8 9 10 Produces consonant sounds correctly 0 1 2 3 4 5 6 7 8 9 10 Produces vowel sounds correctly 0 1 2 3 4 5 6 7 8 9 10 Can identify the number of syllables in words 0 1 2 3 4 5 6 7 8 9 10 Can rhyme words & play with sounds 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Self monitors Self corrects 0 1 2 3 4 5 6 7 8 9 10 Sometimes Never Always Shows frustration when not understood 0 1 2 3 4 5 6 7 8 9 10

34. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ FLUENCY Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Never Sometimes Always 0 1 2 3 4 5 6 7 8 9 10 Is non-fluent Has sound repetitions 0 1 2 3 4 5 6 7 8 9 10 Has word repetitions 0 1 2 3 4 5 6 7 8 9 10 Prolongs or stretches certain sounds 0 1 2 3 4 5 6 7 8 9 10 Has blocks/gets stuck on specific sounds 0 1 2 3 4 5 6 7 8 9 10 Shows unusual facial movements when talking 0 1 2 3 4 5 6 7 8 9 10 Shows unusual body movements when talking 0 1 2 3 4 5 6 7 8 9 10 Is frustrated by non-fluency 0 1 2 3 4 5 6 7 8 9 10 Loses eye contact during non-fluency 0 1 2 3 4 5 6 7 8 9 10 Actively avoids speaking situations 0 1 2 3 4 5 6 7 8 9 10 Never Sometimes Always Shows awareness of non-fluency 0 1 2 3 4 5 6 7 8 9 10

35. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ VOICE Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Always Sometimes Never 0 1 2 3 4 5 6 7 8 9 10 Is easily understood Uses appropriate quality of voice & is easy to listen to 0 1 2 3 4 5 6 7 8 9 10 Speaks with appropriate speed 0 1 2 3 4 5 6 7 8 9 10 Speaks with appropriate volume 0 1 2 3 4 5 6 7 8 9 10 Uses appropriate pitch (not too high or low) 0 1 2 3 4 5 6 7 8 9 10 Is able to project voice without effort 0 1 2 3 4 5 6 7 8 9 10 Uses appropriate breathing to support speech 0 1 2 3 4 5 6 7 8 9 10

36. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ SOCIAL SKILLS Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Sometimes Never Always Takes turns appropriately 0 1 2 3 4 5 6 7 8 9 10 Uses eye contact 0 1 2 3 4 5 6 7 8 9 10 Uses appropriate facial expressions when talking 0 1 2 3 4 5 6 7 8 9 10 Uses appropriate body language when talking 0 1 2 3 4 5 6 7 8 9 10 Makesfriends 0 1 2 3 4 5 6 7 8 9 10 Interacts with other children 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Interacts with adults Interacts with unfamiliar people 0 1 2 3 4 5 6 7 8 9 10

37. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ EMOTIONAL WELL-BEING Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Sometimes Never Always 0 1 2 3 4 5 6 7 8 9 10 Shows feelings appropriately Shows good self esteem 0 1 2 3 4 5 6 7 8 9 10 Shows appropriate levels of confidence 0 1 2 3 4 5 6 7 8 9 10 Participates/engages in class 0 1 2 3 4 5 6 7 8 9 10 Actively joins in & participates in the playground 0 1 2 3 4 5 6 7 8 9 10 Participates in extra-curricular activities 0 1 2 3 4 5 6 7 8 9 10 Shows an interest in a variety of hobbies 0 1 2 3 4 5 6 7 8 9 10 Shows an awareness of events around them 0 1 2 3 4 5 6 7 8 9 10 Is able to make friends 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Appears happy Is aware & responsive to people’s feelings 0 1 2 3 4 5 6 7 8 9 10 Sometimes Always Never 0 1 2 3 4 5 6 7 8 9 10 Bullies others 0 1 2 3 4 5 6 7 8 9 10 Is being bullied

38. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ BEHAVIOUR Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Always Sometimes Never 0 1 2 3 4 5 6 7 8 9 10 Understands boundaries set 0 1 2 3 4 5 6 7 8 9 10 Follows rules Controls anger appropriately 0 1 2 3 4 5 6 7 8 9 10 Deals with conflict appropriately 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Is kind & considerate to others Deals appropriately with consequences of actions 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Is able to monitor behaviour Sometimes Always Never Shows inappropriate levels of aggression 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Is disruptive Gets into trouble frequently 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Appears Isolated 0 1 2 3 4 5 6 7 8 9 10 Is distractible

39. Name: DOB: Setting: Intervention: Completed by: Date: Autumn □ Spring □ Summer □ EATING & DRINKING Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number that best describes the child’s performance. Sometimes Never Always 0 1 2 3 4 5 6 7 8 9 10 Eats independently Enjoys meal times 0 1 2 3 4 5 6 7 8 9 10 Participates in mealtimes to the best of their ability 0 1 2 3 4 5 6 7 8 9 10 Uses appropriate equipment/utensils 0 1 2 3 4 5 6 7 8 9 10 Eats food with a range of flavours 0 1 2 3 4 5 6 7 8 9 10 Eats food with a range of textures 0 1 2 3 4 5 6 7 8 9 10 Eats without gagging 0 1 2 3 4 5 6 7 8 9 10 Eats/drinks without coughing 0 1 2 3 4 5 6 7 8 9 10 Accepts touch to and around the face 0 1 2 3 4 5 6 7 8 9 10

40. Working in Partnerships and Making Connections • Necessity and no longer an option. Drivers include: • Nature and complexity of disorders (for e.g., dementia) • Pervasive and long term nature of disorders (e.g. developmental SLCN) • Comorbidity of many of the disorders (e.g., LI and BESD) • Impact of SLC difficulties on all areas across the lifespan • Serving more for less • Moving into unknown territories (e.g., respiratory medicine) • Centrality of service users Integrated and sustained collaborative service delivery

41. Leading Transformation and Innovations • Technological advances – tele-medicine and tele-health (video-conferencing and Skype in aphasia intervention) • Filling the GAPs: research and practice in areas of need: older children and young people with SLCN, enabling workforce , re-enablement and community rehabilitation

44. “All that is necessary to break the spell of inertia and frustration is this: Act as if it were impossible to fail. That is the talisman, the formula…which turns us from failure to success.” DortheaBrande

45. Leaders…wake people out of inertia. They…get people excited about something they’ve never seen before, something that does not yet exist Rosa Beth Moss Kanter Thank You