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Listen
A Scottish Executive Review of Speech and Language Therapy, Physiotherapy and Occupational Therapy for Children and Speech and Language Therapy for Adults with Learning Disabilities and Autistic Spectrum Disorder
Appendix T CASE STUDIES
Jeannie's story
Jeannie (not her real name) is a family carer who lives in a remote part of Scotland. She has direct experience of speech and language therapy as her daughters have communication disorders. She also knows about other people's experiences of services through her role in local groups and she has recently been diagnosed herself with a communication disorder.
Jeannie said that from her own experience and talking to others, access to the service was easier for children than for older people. Children tended to get referred by health visitors and GPs. Adults did not realise that they could self refer. SLTs were a scarce resource in this remote area.
Experiences of services could be patchy, depending on the individual therapist. What parents were looking for, she said, was regular assessment and then follow through. She would like to see continuity between work with the child at home and at school. 'The child does not exist solely at home or at school.' SLT approaches should take account of the child's stage of development and what is important and interesting to that child. She would like to see individualised programmes available for young people at transition which stretched them educationally and socially.
Accessing expertise could be an issue, particularly in a remote area. This applied to both assessments and intervention programmes. Expertise might be held in specialist schools. The availability of skilled assistants was important because the learning could be cascaded.
Jeannie felt that Speech and Language Therapy Services could be important for different reasons to people with communication disorders, depending on their level of need. Those with severe communication needs could become extremely frustrated if they were not able to get their message across. Whereas people who had, for example, a speech disorder that was less obvious, might need support to develop strategies for particular situations. Their needs might not be identified in mainstream services and they might end up being labelled because of behaviour that was the result of a communication problem.
Jeannie thinks that the contribution of Speech and Language Therapy is essential to a full assessment of Autistic Spectrum Disorder, especially for children. Such assessment, in her experience, is hard to get as an adult unless there is a really noticeable difficulty. However, she thinks that the contribution of SLTs for adults with autistic spectrum disorder would be particularly important in social skills groups. For example, someone going to a job interview might need support and preparation to interpret body language, judge the right tone to speak in and know how much it was appropriate to say, for example if a question is asked about hobbies or special interests. Another example she gave was of a young person with Asperger's who had lost several jobs because he did not know how to explain that he was off sick. In the end he did not return to work.
What makes a good SLT? Willingness to learn from the client and their parents or carers. They are the experts. 'They've learned the hard way.'
Michael's story
Michael (not his real name), with a supporter (his community nurse), was interviewed about his experiences of speech and language therapy within the context of his life as a whole.
Michael attends college. He has just met the Speech and Language Therapist whom he is going to be seeing for about eight weeks. Michael explained that the Speech and Language Therapist, who he called by her first name, had come out to see him at home. She had sat for while and watched him with his family and pet. She is going to record his voice and let him hear his speech. His supporter explained that he had asked to see a SLT because he wanted to slow his speech down and not speak too loudly.
Michael had been referred to the SLT by the community learning disability team. When he had been attending a school leavers' group organised by an OT he had experienced difficulties picking up social cues, taking his turn and with the volume of his speech. These seemed to be related to issues of both hearing and speech.
Michael had a health problem that could affect the success of this work. He said that he had pain in his good ear that made him dizzy. He does not like having to take painkillers because they make his head feel 'numb'. According to the nurse, the GP had been trying to get him a hospital appointment quickly. He had had an operation on his other ear in the past and the community nurse thought that it would be important for the SLT to know about these problems. Getting his ear problems sorted was a priority for Michael.
At school Michael had also had a Speech and Language Therapist. He had not been able to hear the television in class. He thought the Speech and Language Therapist was good. They had played games like 'Snap!' She also had been helping him to speak more slowly and she has been in contact with the Speech and Language Therapist he is seeing now.
Michael gave some instances of how his hearing problems adversely affect his life. He has had to leave his college class and indeed is talking about leaving college altogether. He has trouble speaking to his girlfriend on his mobile phone. It costs a fortune and they fall out quite a lot because he is always saying "what?" On the other hand he can easily sing along to videos because he uses headphones. Speaking too loudly also gives Michael problems socially. Michael likes being in company but has stopped attending the club he used to go to because it is 'too much'.
He has got several certificates from college and now has an appointment with the Careers office, though not for the area of employment he would really like to go for. He has been having travel training on the bus which he does not like but in fact he has been making a weekly train journey on his own to visit a member of his family.
Michael was very clear about how working with the Speech and Language Therapist could help. He said that it helped you get experience (in talking appropriately). It helped you to be calm and relaxed and to 'chill out when talking to people' instead of getting 'nervous and excited'. He thought the job of a speech therapist was useful. He said 'yes'. He could think of other people who had been seen by them and 'helped to speak right'.
As to the qualities they should have, they should 'want to help folk'. Michael's main argument for the value of Speech and Language Therapy was based on his own experience of the social consequences of speech and hearing problems. He said that people tell you to slow down and call you names and that winds him up and he gets angry and into trouble. The benefits of effective intervention for him would be better social relationships and more respect from others, enabling him to make the contribution that he can and wishes to make.
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