SERVICE DEVELOPMENT

READ THIS IF YOU DONT APPLY FOR BURSARIES / AWARDS ARE LOOKING TO STEP BACK AND THINK WANT TO LEARN FROM OTHER SERVIICES
hen a glossy circular lands in my tray my heart sinks a little. I worry about the number of trees its taken to produce and then I worry about my to do list and when Im going to have time to read it. So, when a mustardcoloured folder titled Getting better and better with a photo of smiling health professionals appeared in January 2006, I was less than inspired. I have a lead role for the community adult service in Aberdeen. We are a small but dedicated team (5 staff, 3.6 whole time equivalents). Back then we had just started a 6-month pilot of a screening system to prioritise new referrals. We were also planning a new group for people with aphasia in conjunction with the acute service. And I was going on holiday in five days, with my diary squeezed with clients, meetings and reports to complete. Im not sure what made me look at the folder more closely. Perhaps it was that the day before Id seen the programme for the Royal College of Speech & Language Therapists conference in Belfast and it had crossed my mind that there were some interesting sessions on aphasia and user involvement. Or maybe it was the tagline How the Scottish Executive AHP Travel Scholarship can benefit everyone. I spent a few minutes looking through and found this was a new scheme providing a scholarship of up to 5000. The award would cover travel and expenses including visas, insurance support, materials and backfill costs for up to 4 weeks. It was possible to use the funding for a number of options including undertaking preliminary research activity, work shadowing in another country and conference attendance. Applicants had to demonstrate the benefits for personal career development and in terms of remodelling aspects of NHS Scotland. To meet the deadline I had to complete the form before my holiday and several times thought about binning the idea. However, the process of applying affirmed the potential usefulness of the conference sessions in developing the community adult service in Aberdeen for clients with aphasia. Across NHS Grampian we have a good track record for innovative ideas and projects involving people with aphasia. A few years ago the Grampian Aphasia Action Project (GAAP) was started following an inspiring course from the Connect centre in London. The group was made up of speech and language therapists, people with aphasia and representatives from Chest, Heart and Stroke Scotland. Amongst other things, the Project led to the creation of a self-help group and an open day for members of the public to find out more about aphasia. More recently our team has introduced a number of initiatives to increase the involvement of all clients in decision making and planning around intervention. A feedback questionnaire (designed to be used during or after treatment) was symbolised to aid those with aphasia in completing it. Reports that used to be sent to the person

Work pressures meant Karen Yuill nearly missed the chance of a travel scholarship. Luckily she realised it was an ideal opportunity to gather fresh inspiration for developing her community service for people with aphasia.

Broadening
who had referred the client (GP, district nurse) are now sent to the client, written in a style which is easier to follow and documents our agreed goals. This report is also symbolised where appropriate, and a copy sent to the referrer.

Successful
The application was duly submitted and I received a letter confirming I had been successful. The awards panel suggested I include a visit to a specialist stroke centre as part of my trip. However, since my work is in the community, I felt a community service would be more relevant. I was lucky enough to be given contact details for Catherine Donnelly, speech and language therapy manager for North and West Belfast. She was instrumental in setting up two visits. Linzi Hatch, speech and language therapist with the Community Stroke Team, gave a morning of her time to discuss the service in North and West Belfast and her particular role. We shared resources and found that in some ways our services are quite similar. She works as part of a multidisciplinary team but often finds her input with clients is longer-term than most other disciplines. They are using symbolised questionnaires to aid goal setting and trying to provide accessible information wherever possible. Group work is being undertaken with some clients with severe expressive difficulties in much the same way as the planned group in our service. The North & West Belfast service has close links with Speechmatters, part of the Stroke Association. Speechmatters is a charity dedicated to supporting people living with aphasia, their families and carers. They are contracted by four Health Boards and Health & Social Services Trusts to provide a range of long-term services. Damien Coyle, Director of Operations at Speechmatters, kindly set up a meeting with himself and three members of the team: speech and language therapist Michelle Ross, aphasia social worker Marion McKeown, and speech and language therapy assistant / conversation partner Janet Thompson. Amongst many services, they run Aphasia Conversation Groups with referrals coming from speech and language therapists in the community. The groups are run

These examples of different types of support for carers got me thinking about how we could offer more.
We also have a well-established carers training day run every six months and were about to run a new group for clients with severe expressive aphasia, both projects in collaboration with staff in the acute service. My long-term goals for the community service were to: 1. provide a range of evidence based treatments for clients with aphasia 2. include clients expectations of the service in developing treatment options and a joint goal setting approach 3. take a longer-term view of the services offered to people with aphasia and their carers, including training for public service providers. I hoped to gain more information from the Royal College conference about: y the efficacy of particular treatment approaches y references for further reading y methods of involving clients successfully in service planning and development y providing training and information to wider society about the communication barriers faced by clients with aphasia.

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ting. She concluded that, whilst therapists are keen to share power, they shouldnt underestimate their expert role in helping people move on in the process of adjusting after stroke. y A study looking at the analysis of conversational data without transcription gave hope to the busy clinician with little time to spend in detailed examination of video-recorded interactions. Marian Brady, from Glasgow Caledonian University, concluded that further work is needed but initial results using a tallying process for different conversational behaviours are definitely encouraging. y On a rather different theme, radical possibilities for the future treatment of communication impairment using Brain Computer Interfaces was introduced by Morwena Collins from the Institute of Sound and Vibration research. This was fascinating and will make me think twice about my It would be great if we could just hook you up to a computer and read your thoughts but its not possible speech. Its not possible now but who knows what the future holds? Although not all the user involvement sessions focused on adults with aphasia, the presentations were all of interest: y Focus groups for clients or carers produced some insights into attitudes and expectations that can influence how therapy programmes are targeted. Rosalind Owen, University of West England, had used two groups of children one mixed group with children with diagnosed communication difficulties and their peers and a second separate group for the children with communication difficulties. Understanding what the children defined as talking versus telling made it clear that vocabulary isnt always shared. Perceived meanings need to be explicit especially if joint goal setting and choices for clients are to be meaningful. y James Law from Queen Margaret University College presented on a project using a communication booklet provided to GPs and other health centre staff to support clients with communication impairment when attending an appointment. This project highlighted the difficulties in establishing a new way of working from the grass roots level up. Interested parties took the ideas on board whilst others did not. Having new initiatives pitched at the right level to ensure adoption seemed to be the next challenge. y Another project, described by Ruth Nieuwenhuis of University of Wales Institute, had enrolled a service user with aphasia to help run a conversation group for newer service users. Whilst this had some positive outcomes for the individual including improved confidence and independence, there were some negative outcomes including fatigue. Posters were also on display ranging from the use of quality of life measures to look at the social impact of stroke to what one department had done to implement
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2007

Speechmatters staff l to r: Janet Thompson, Damien Coyle, Marion McKeown, Michelle Ross

the mind
by a therapist employed by Speechmatters. Carer support groups and a Living with Aphasia course for clients and their carers are well established. These examples of different types of support for carers were really interesting and got me thinking about how we could offer more for carers in Aberdeen. Our team has good links with Chest, Heart and Stroke Scotland, whose staff and volunteers provide group support for people with aphasia, and perhaps we could use these links to take the issue of support for carers forward. Speechmatters also involve people with aphasia in any training they provide to external organisations, with appropriate remuneration for their time. I was particularly interested in the training provided to staff in health board premises. These sessions are preceded by Secret Shopper visits by people with aphasia to look at signage and communication support on offer in different sites. The outcomes of these visits are used within the training to give staff clear examples of how things could be improved. This is a fantastic idea that could be used in a range of settings highlighting problems with communicative access alongside issues of physical access. tance of user involvement. One keynote speaker, Clem Stewart, had a stroke 22 years ago, and his insights into the journey hed taken and the support he received along the way were extremely moving and inspiring. There are so many ways we could be involving clients in driving service planning and delivery - and perhaps one of the simplest is by allowing service users to tell us where we are getting things right and where its not working. The needs of his family were also clear and for me the gaps in our service were highlighted once again.

There are so many ways we could be involving clients in driving service planning and delivery
A running theme of the aphasia sessions was the use of Quality of Life measures to look at outcomes in therapy as a useful way of including clients with aphasia who are often omitted from research because of the very nature of their communication difficulties: y Julie Hickin from De Montfort University presented a study that had used a very structured impairment based treatment but quality of life measures to look at outcomes. The study suggested that impairment based therapy can also impact positively on quality of life, when we can sometimes consider these two approaches as being at opposite ends of the spectrum. y Sarah Griffiths from the University of Plymouth looked at possible barriers to relationship building and empowering clients with aphasia in goal-set-

Relevance
At the conference (Realising the Vision, 10-12 May 2006) a number of presentations had direct relevance to the themes of my proposal. Some were posters with just a flavour of research or projects being undertaken. Some were 15 minute talks within organised sessions. The presentations were diverse; some very academic and research based with limited immediate clinical relevance but others surprisingly simple and very practical clinically. Themes for me were very much about the long-term impact of communication impairment and the impor-

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an Aphasia Strategy. Snapshots of the research and projects from different parts of the country gave me immediate references to follow up and a list of people to contact. Following my return from Belfast I felt the need to digest the information and reflect on the experience as a whole. As is often the case, busy schedules and other pressures mean that new ideas can be lost through lack of time to implement them. I tackled this through developing some short and long-term goals in conjunction with the other members of the adult team: 1. Short-term goals To introduce accessible information about the service and what we provide as well as pictorial appointment cards. To work with acute service colleagues to set up a carers support group. To follow up references on quality of life measures as a way of evaluating outcomes of therapy / intervention. To approach the local aphasia self-help group and clients for help in evaluating current and future attempts to provide accessible information, and to take part in future training. 2. Long-term goals To provide a joint Speech and Language Therapy / Counselling / Social Work model of support to clients and carers with aphasia. Consider training need within our service for formalised counselling skills.

To introduce quality of life measures into every episode of care for clients with aphasia. To approach local aphasia selfhelp group and clients to take part in focus groups to establish how they would like to see the service change / develop.

Unfortunately by the time this is printed the other deadlines for this particular award will have passed but I would urge everyone to think about the opportunities available that might be relevant to projects in your department. Who knows? There might be something sitting in your in tray right now! Karen Yuill is a speech and language therapist with the Community Adult Team, Speech & Language Therapy Department, Aberdeen City Community Health Partnership, NHS Grampian, e-mail karen.yuill@nhs.net.

Valuable experience
Attending the conference was a really valuable experience, giving me time to step back from a busy caseload and other pressures and reflect on my everyday practice. Having specific aims in mind when I was listening to the different presentations gave me a focus that helped me to gauge what might be possible for our service. The visits to services in Belfast were a great opportunity to share resources and to hear about practice and initiatives that include and consult service users in a meaningful way and offer short and long-term support to carers. Our team has already started on all the short-term goals we set and Im confident our service will continue to evolve to meet the needs of our clients and their carers. The Scottish Executive made 13 awards in February 2006 to speech and language therapists, physiotherapists, occupational therapists and podiatrists. More than half were for overseas destinations (Canada, Australia, USA). Successful applicants were expected to write a summary report for the Scottish Executive and pursue publication to ensure dissemination. I look forward to reading what the other successful speech and language therapists in Scotland did with their awards.

Acknowledgements
Thanks to Catherine Donnelly and Linzi Hatch (Belfast); Damien Coyle, Michelle Ross, Janet Thompson and Marion McKeown (Speechmatters); Jacqui Lunday (AHP Professions Officer) and Uriel Jamieson (Nursing, Midwifery and AHP Directorate, Scottish Executive); Pamela Cornwallis (Principal Speech and Language Therapist) and the Aberdeen Community Adult Speech and Language Therapy Team; and Aileen Robinson (Chest, Heart and Stroke Scotland). SLTP

REFLECTIONS DO I FORM SPECIFIC AIMS TO GIVE CONFERENCE ATTENDANCE A FOCUS? DO I RECOGNISE AN APPLICATION PROCESS CAN, IN ITSELF, CLARIFY GOALS? DO I MAKE TIME TO DIGEST AND REFLECT ON TRAINING?

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SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2007