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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.

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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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Organisation the key

Meetings with relatives, carers and people with dementia if appropriate took place at The Meadows and the students worked in their pairs to interview and collect photos. This was the part that required good planning from all involved ensuring co-ordination of times and rooms ran smoothly. Organisation was key for two therapists with limited room space and up to ten students! If the person had no relatives, or relatives who were unable to participate, therapy and nursing staff helped students collect information. The students compiled the information to create a first draft book. Subsequent meetings were arranged to go through the completed book. This allowed opportunities to amend and edit the books. All the students made the books using a scanner and PowerPoint / Word software, so original photos could be returned and pages could be added or changed easily. In addition to making the books the students had the chance to go to informal talks. We arranged talks with relatives, a lady recently diagnosed with Alzheimers Disease and her husband, a Community Psychiatric Nurse and an Occupational Therapist. The students also got involved with ward activities running at the time such as communication groups and craft groups. At the end of the project we had group discussion to reflect on what we had learnt. Each student received written feedback collected from staff, people with dementia and relatives. Individual comments included: Lisa and Jo worked with TK and his wife. TK has had a difficult childhood and the process of putting the book together has helped staff reflect on this and how it may relate to his current behaviour. TKs wife enjoyed the process of putting the book together and both she and the staff have looked through the book with TK. He responded very positively. Carol and Katy worked with DT and her husband. She was residing on the assessment ward with a view to moving to a residential home. DTs book has been very important for two reasons. It gave her husband something positive to do whilst his wife was in hospital - this was a very difficult time for him as he has never been apart from her. He was very pleased with the final book, if not a little emotional when he saw it all together. The book has also been helpful to inform the assessment process. It has gone with DT to her new home and will be an excellent way for them to learn all about her. Well done and thank you for all your hard work!

Rod Simmonds enjoys his life story book with wife Fay

The interest and enthusiasm from the students really shone. Both staff and relatives have commented positively on the work the students have carried out. Staff - new staff especially - were able to find out extra information about the people they care for and this has helped promote a better understanding of communication and behaviour. The books provide an insight into people beyond the medical information often available. Relatives told senior hospital managers that they were very pleased with the project and how the students delivered this.

I had never met anybody with dementia. I was concerned about appearing patronising and how communication levels would be affected. I learnt how important life story books are for people with dementia to enable them to communicate with others and be treated like a human being. I also learnt to act as a professional with clients and carers. I valued the experience of mixing with other professionals and seeing how they interact. The placement also made me think about time management and planning. This shows that students, at a very early stage in their degree course, felt they gained in several ways from the placement. The project has relied on team work and all involved have been very supportive. As a result our profile within the service is increased and staff approach us to ask about the project. We have shared our experiences with colleagues at our local Special Interest Group to encourage similar placements. The university is also involved in projects developing communication passports (Millar, 2003) with different client groups. We feel the project was incredibly worthwhile and we thoroughly enjoyed it. We are looking forward to meeting the new students participating in the project with us this academic year! The life story work project described was run by Jackie Kindell and Laura Brierley, speech and language therapists in older peoples mental health in Stockport for Pennine Care NHS Trust, and Linda Collier, clinical tutor in the speech and language therapy department at the University of Manchester. It has been chosen as an example of good practice for a department of health publication New Ways of Working for Allied Health Professionals in Mental Health. You can contact Laura SLTP via the e-mail laura.brierley@nhs.net.

Meaningful activities

On the placement the students also learned the importance of engaging people with dementia in meaningful activities such as music, exercise, quizzes and craft work. Students were able to see that people often have untapped skills that were not always apparent in the daily routine. They learned that these skills could be used to good effect in such groups and one-to-one activities. An important part of this was recognising that people require a focus or reason to communicate and that the speech and language therapist was able to give advice on this to encourage communication. Students also gained insight into the practical aspects of hospital work including looking through medical and nursing notes, understanding ward routine and making appointments with carers. A very important part of this placement was for students to develop understanding of the impact of dementia on relatives and carers. Students displayed a respectful and empathetic approach to carers they met and were interested in both relatives and the person with dementia. Students were required to do a reflective piece of writing for their portfolios. One student wrote:

References

Baker, J. (2001a) Life Story books for the elderly mentally ill, International Journal of Language and Communication Disorders 36, pp. 185-187. Baker, J. (2001b) How I manage dementia: Living in the real world, Speech and Language Therapy in Practice Autumn, pp. 24-26. Bryan, K. & Maxim, J. (1998) Enabling care staff to relate to older communication disabled people, International Journal of Language and Communication Disorders 33, pp. 121-126. Kindell, J. & Griffiths, H. (2005) Speech and Language Therapy Intervention for People with Alzheimers Disease in Bryan, K. & Maxim, J. (eds.) Communication Disability in the Dementias. London: John Wiley & Sons, pp. 216-218. Millar, S. (2003) Personal Communication Passports: Guidelines for Good Practice. Edinburgh: CALL Centre.

Murphy, C. (1994) It started with a Seashell. Life story work and People with Dementia. Stirling: Dementia Services Development Centre. RCSLT (2005) Speech and Language Therapy Provision for People with Dementia. Position Paper. London: Royal College of Speech and Language Therapists. Wilcox, F. and Simms, S. (2007) Getting the best out of students on placement, Bulletin of the Royal College of Speech & Language Therapists August 664, pp. 8.

Resource

New Ways of Working for Allied Health Professionals in Mental Health www.newwaysofworking.org.uk/allied_health_professions/speech__language_therapy.aspx

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