How i

How I take speech and langua

In its response to the recent Bercow Review consultation, childrens communication charity I CAN stressed that Due to the fundamental importance of communication, it is essential that all children and young people develop speech and language skills. We know that in some deprived parts of the country, 50% or more of children are arriving at primary school without the communication skills they need to learn (p.2). It added that it would like to see SLTs working in a range of ways, as part of the team around the child [their italics] working jointly with other professionals (p.6). Communicating Quality 3 confirms we should enable education staff to incorporate the aims of speech and language therapy in the planning of an individual education programme within the context of the broad curriculum. It adds that education staff can most effectively be supported to make environmental changes to support inclusion through collaborative working strategies, including joint assessment, planning and working, as well as through training workshops (p.225). Our two contributions come from speech and language therapists who are achieving just that.
References
I CAN (undated) I CAN response to the Bercow Review of speech, language and communication needs. Available at: http://www.ican.org.uk/home/Media.aspx (Accessed: 4 July 2008). RCSLT (2006) Communicating Quality 3. London: Royal College of Speech & Language Therapists.

Resource

Bercow Review see http://www.dfes.gov.uk/bercowreview/

PRACTICAL POINTS
1. To be more of a therapist, try becoming more of a teacher 2. Offer whole class work as well as group and individual 3. Build on communication opportunities already in the classroom 4. Use the education context for more holistic assessment 5. Be explicit about the value of adults sharing skills 6. Help staff to wait, cue, use visuals and gesture, recast and reflect 7. Confidence measures can help evaluate change 8. Allow for different skill and experience levels of education staff 9. Jointly develop specific outcome measures 10. Story telling and acting are potent tools for learning.

HOW I GO INTO THE CLASSROOM (1)

Promoting pizzazz - and all that jazz

Keen to have more impact on the progress of children with specific language impairment, Kathleen Cavin recognised it was time to play a leading role in the classroom. So, instead of prompting from the wings, slick your hair, wear your buckle shoes - and prepare for showtime...

Kathleen Cavin and Katie Byrne (class teacher)

Imagine you are the director of a moderately successful West End show. However, a couple of cast members are letting the side down. Your sponsor employs a consultant from America to 22
SPEECH & LANGUAGE THERAPY IN PRACTICE autumn 2008

help you bring more pizzazz to their performance. The consultant watches the show, talks you through some ideas, hands you the Pizzazz Manual and then leaves. She may help the two cast members with their high kicks, but never directs the cast through a whole routine. Could this be how it feels when we give advice to class teachers and then continue to see children in small groups outside the classroom? Working in a language resource base in a large mainstream school has given me the opportunity to work alongside teachers in the classroom. The why to work in the classroom seems relatively straightforward: 1. Benefits for the child Although studies into classroom interventions are sparse there is a growing body of evidence indicating that, particularly for vocabulary and narrative based work, classroom intervention can be more effective than withdrawing the child (McGinty & Justice, 2006). Input into the classroom promotes communication skills in a more naturalistic setting and includes opportunities for children with specific language impairment to interact with their peers. Enhancing the wider communication environment of the children with specific language impairment has a positive effect on learning and behaviour. There are not only opportunities to reinforce individual speaking and listening targets of the children with specific language impairment and monitor progress, but also to observe how their language difficulties impact on them in the classroom environment. A positive effect on the speaking and listening skills of a range of children in the classroom, not just those with identified needs. 2. Benefits for the class teacher Demonstration of strategies and techniques by the speech and language therapist with the whole class group and individuals will hopefully have a longer lasting effect than discussion only. Learning new skills in this way complements a range of adult learning styles and implies a more active learning experience than passively reading notes. Problem solving with teaching colleagues using real examples from the previous lesson is a great way to learn from each other and build on previous successes. Resources can be provided which are appropriate for a number of children in the class and can be re-used throughout the term. 3. Benefits for the speech and language therapist The chance to monitor and improve your own advice and resources. Sometimes resources and strategies which work well in small groups or look good on paper arent always appropriate for whole class work. The therapist can gain valuable insights into classroom management, for example how to deal with the range of needs in the classroom

How i

age therapy into the classroom

Figure 1 Class teacher questionnaire

and maintain pace. As speech and language therapists, our training focuses on therapeutic skills developed during individual or small group training. I felt I needed to work at how these skills transferred to the classroom. Gain Brownie points! A common complaint amongst class teachers is that speech and language therapists swan in, give their advice and leave and dont appreciate the demands of the classroom. Being in class and practising what you preach at least removes this criticism and can help to build respect and understanding of your role. So that bit was easy, but how best to deliver classroom support was the source of many a debate and quite a lot of banging my head against my ergonomically designed desk. During the four years since our language resource base was first established, classroom support packages of care have evolved. This is a result of both school and language resource staff having worked to understand and make best use of different professional skills. Ive attempted a variety of models during the time Ive worked in school and have often felt dissatisfied with the impact of these sessions. The teaching staff had perceived in-class support as purely child-focused and not as an opportunity for skill sharing between the adults involved. As the resource is based on an inclusive model, where supported children are members of their mainstream class and are not taught in a separate classroom, it seemed imperative that this aspect of the language resource base input was further developed.

Name: _________________________

Date:_______________

Figure 2 News question balls

Please circle the number which best indicates your level of confidence in using the strategies listed below to promote the communication skills of the children in your class. 1= not confident 5=very confident 1. Reducing your language levels to aid understanding 1 2 3 4 5 2. Using visuals to promote understanding 1 2 3 4 5 3. Using graded prompts to elicit a response from a child 1 2 3 4 5 4. Using basic Makaton signs to promote understanding 1 2 3 4 5 5. Scaffolding and expanding a response 1 2 3 4 5 6. Promoting word learning strategies 1 2 3 4 5 7. Including speaking and listening targets in lessons 1 2 3 4 5 Figure 3 Session planning Speech and Language Therapy Classroom Support Language Resource Class Speaking Activities Base Pupil Aim and Listening Aims To attend to adult news To relate simple news to peer including who/where/ what To be able to identify who/what/ where in adult news To be able to use first/ then in own news Identify key news questions by choosing a symbol and identifying it. Place on news board. Children look at photographs from adult news and guess topic/setting for news Adult relates news and children answer key questions Children relate own news to talk partner Key children relate own news and all use news board to check they have included who/ where/what Lesson: Literacy (News) Strategies and Resources New vocabulary: blew- place on word wall Sign key questions Give forced alternatives for blue group Use lead in phrases for P and O Model correct sentence structure

On the periphery

On reflection, I felt this was because I had not been explicit enough regarding my role and therefore had tended to stay on the periphery of whole class teaching and concentrate on small group work in the classroom. I decided to trial a different model of classroom support where I was more explicit that part of the care plan centred on developing the communication environment. This would include direct work with class teachers to promote strategies and approaches to aid children with communication difficulties. Before introducing this I presented a document outlining the purpose and aims of classroom support and the expectations of both services. I then presented the teaching staff with a questionnaire regarding their confidence in using a variety of strategies (figure 1). To provide some outcome measures and prove the value of classroom support for teachers and children, a year one class teacher and I decided to run a small project over two terms. The main focus of the support was for narrative and vocabulary work, specifically verbs. Using the questionnaire we set targets focusing on her use of strategies. These included recasting responses and developing the range of Makaton signs used to cue children. This ensured that the teacher played an active part in her learning and I had

care aims which reflected my work in developing the classroom communication environment. 1. Phase one (September to December; direct input once per week for 45 minutes plus initial joint planning session and short weekly joint planning session) The aims for this term were: To promote and extend the use of class teacher strategies and resources to support speaking, listening and understanding. To support and monitor the progress of two language resource base children towards their individual education plan communication targets. To establish whole class understanding of who / where / when / what questions and simple time connectives such as first, then and last. To extend whole class ability to relate a short personal narrative. The measures used for this term included the short teacher questionnaire. I asked the class teacher to complete the questionnaire in September and then again in December. As a

highly skilled teacher with previous experience of working with children with a range of special educational needs, pre-input she rated the majority of her skills as threes or fours. Each session was based on the format of the North Lanarkshire Writing Scheme (Wilson, 1997) where a lead adult related a simple personal narrative and then asked the class wh questions around this narrative. Children then discussed their own news in talk partners and related this news to the class group. Each session maximised the use of Makaton cueing for questions and was based around colour-coded news question balls (figure 2). Sessions started with two or three photographs of the adults news projected onto the interactive whiteboard. The adult asked the children to look at the photos in preparation for listening to the story. Strategies to promote communication skills were made explicit in the planning, and we separated aims into those for children attending the language resource base and the rest of the class (figure 3). 23

SPEECH & LANGUAGE THERAPY IN PRACTICE autumn 2008

How i 2. Phase two (January-March) The aims for this phase were: To support and monitor the progress of two language resource base children towards their individual education plan communication targets. To extend class teacher knowledge and use of different approaches to developing narratives, including the use of symbol supported story mountains (based on work by Corbett, 2003). To extend the use of specific verbs in short narratives. The measures in this section included pre and post input stories from children chosen by the teacher as high ability and low ability. I took story samples from the two children in the class with specific language impairment. Subjective analysis using a skill rating form based on the Squirrel Assessment of Narrative (Carey et al., 2006) gave each child a rating out of 100. For this phase we chose two target verbs per week and incorporated them in games and in the adult story. Verbs were selected to link with class topics and texts. Two verbs per week seemed like a realistic target based on previous care aims and knowledge of the vocabulary learning potential of the class. These were then displayed on the class word wall in symbols. To aid links across the curriculum and help broaden definitions and use, the class teacher referred to the verbs during the course of the week. The stories were chosen around particular themes and settings to extend the children beyond news events and link with current curriculum topics, for example, Lost in a Dark Cave. The key points in the story were displayed in pictures on the story mountain. 3. Phase three (February-March) At this point the children were ready to extend their story telling ability and move towards imaginative narratives. The class teacher was keen to include a range of approaches to developing narratives rather than concentrate on the strategies only. The aims for this phase were therefore: To be able to identify and use a problem in a story. To promote the use of the helicopter technique in class (Gussin Paley, 1991). To promote the use of play scripts (based on work by Caterall, 1998). During this phase the children made use of role play which proved particularly beneficial

100 80 60 40 20 0

Figure 4 Pre and post input results for narrative skills scale HA = high ability (as assessed by teacher) LA = low ability (as assessed by teacher) SLI = has specific language impairment

Child 1 HA

Child 2 HA Child 3 SLI

Child 4 SLI

Child 5 LA Child 6 LA

for one of the children with specific language impairment. She was unable to make predictions when presented with sequencing cards, but during short playscripts demonstrated an ability to act out the next event and provide limited dialogue.

Improvement

space to generate their own ideas. I also realised the importance of teaching the children to talk in small groups to allow them all a chance to make an oral contribution. I had to learn to accept that feedback from their peer could be valuable and that, no, I didnt need to hear everyones story every week!

So, did it work? Post-input samples and analysis indicated that all children assessed made some improvement (see figure 4). The areas indicating most improvement were vocabulary and story structure; the two areas most targeted by the input. Perhaps most interestingly, children of a range of ability improved, indicating the importance of oral work in the classroom. The class teachers post- input questionnaire also indicated an increase in confidence of least one point in using all strategies. Through informal observation I would agree with her perceptions in that I noted an increase in visuals / cueing and Makaton and increased use of recasts. From a personal point of view I gained a lot from being directly in the firing line in the classroom. Although Id given it some thought before, it really gave me a sense of the difficulties of attempting to include and extend all pupils and the challenges of pacing lessons to maintain the attention of all children. I now try to move around more, and encourage copying of gestures and sign to support stories. I also use Writing with Symbols on the interactive whiteboard instead of presenting cut-out symbols. I learned to reduce the cueing I provided for more able children and to give them more

Skilled and innovative

References

Carey, J., Leitao S., & Allan, L. (2006) Squirrel Story Narrative Assessment. Keighley: Black Sheep Press. Catterall, P. (1998) Facilitating Narrative Competence: Helping Children to Describe Events and Tell Stories. NAPLIC Conference Papers. (Available to order via http://www.naplic.org.uk/archive.html#1998.) Corbertt, P. (2003) How to Teach Story Writing at Key Stage One. London: David Fulton. Gussin Paley, V. (1991) The Boy Who Would Be a Helicopter. Cambridge, MA: Harvard University Press. McGinty, A. & Justice, L. (2006) Classroom-Based versus Pull-Out Language Intervention: An Examination of Experimental Evidence, Evidence Based Practice Briefs 1(1). Wilson, T. (1997) The North Lanarkshire Writing Scheme. Motherwell: North Lanarkshire Council.

Resources

I was very lucky to work with an extremely skilled and innovative class teacher who quickly took on board ideas and incorporated and extended new techniques demonstrated in lessons across the curriculum. Although the samples were only of six children in the class, subjective comments from the class teacher indicated that many children in the class had improved their oral narrative abilities and this had a positive effect on their written stories. When repeating this kind of model, levels of teacher expertise and awareness need to be taken into consideration. Using the confidence questionnaire to complement class observations can help establish whether a whole class approach might be effective and help to inform decisions regarding the length of time for a package of care. I think I once heard it said that, to be more of a therapist, sometimes you need to become more of a teacher. I think thats true. For me the most effective way of sharing skills is demonstration and having the confidence to take on the role of one of the lead adults in the classroom. Within the resource base I dont see classroom packages as replacing the highly individualised small group or one-toone packages of care but rather existing alongside them as one of a range of ways of supporting children with specific language impairment. So, if given the opportunity to appear on stage, dont just stay in the wings whispering prompts - have a go at directing instead. Kathleen Cavin is a Speech and Language Therapist, Co-ordinator for Language Resources, Islington PCT, London, e-mail kathleen.cavin@islingtonpct.nhs.uk.

Makaton see www.makaton.org Smart interactive whiteboards http://smarttech.com Writing with Symbols see www.widgit.com 24
SPEECH & LANGUAGE THERAPY IN PRACTICE autumn 2008

Acknowledgements

With thanks to Katie Bryne, Laura Coakes and Jane Ladd for their ideas and comments.