groups

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 +8

t has been well documented that group
therapy for children is an effective way of
working (Brigman et al, 1992). It allows par-
ents to see their child in relation to other
children and gain a different perspective so
that, instead of solely focusing on their
childs difficulties, they can begin to appreciate
their strengths. However, when working in a busy
community clinic, it is very easy to select children
for group therapy on the basis of high caseload
numbers, rather then looking carefully at individ-
ual needs. This is particularly problematic for
bilingual children and their families as, when
selecting them for group therapy, their overall
language competencies may not be taken into
account. When a childs full abilities are not
acknowledged, parents are automatically margin-
alised and unable to participate fully in the group
therapy experience.
l
The advantages of
bilingualism are such that
a speakers overall
language competency
may be more than a sum
of parts. Panna Chavda
and Laura Helsby find that
recognising and facilitating
this in group therapy not
only has benefits for the
children concerned, but
brings parents and other
staff on board too. Here,
they tell us what they did
and why they did it.
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therapy groups
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want to measure
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The vibrant, multicultural City of Leicester has
many minority ethnic groups represented, and a very
high bilingual speaking community. We find bilin-
gual children can be included in general groups with
monolingual children where the aim is to improve
areas such as social skills, attention and listening.
However, we wanted to offer more targeted groups
with a focus on the specific needs of bilingual chil-
dren with language development difficulties.
When planning our groups for a busy inner city
clinic, we used the Malcomess (1999) decision-
making loop (figure 1) to identify the clinical
need, in other words the why of therapy. When
we ask why we do things with clients - as well as
what we do and how we do it - it enables us to focus
on a more functional model of service delivery
rather than just a diagnostic, medical model. It
allows us to tailor care to individuals and to begin to
look at the outcome of intervention. We then arrive
at a care aim which leads to goal setting, interven-
tion and review with a measure of effectiveness.
We grouped individuals according to their care
aims then identified care aims for the overall
group. Our level of input included the planning
phase (two weeks), running the groups (six
weeks), and the post-group report writing, review
and contact with schools (two weeks).
We ran two language groups for children chosen
on criteria of age, language difficulties, parental
commitment and support. All came from a bilingual
background with English and Gujarati spoken at
home. The first group had seven boys aged 5-8 years,
presenting with mainly moderate language difficulties
across both languages. The second group also had
seven boys, this time aged 7-10 years, with higher level
language difficulties across both languages.
Insight
At the start of the groups the parents completed a
questionnaire (adapted with permission from
Hulme et al, 2001). We wanted to look at parents
expectations of the language group and to gain
insight into their understanding of language issues.
The questionnaires were discussed with parents
in Gujarati and, if needed, in English. Several
themes emerged:
1. Many children with language 100% disagreed
problems are simply lazy.
All of the parents felt the difficulties their children
experienced with language were genuine.
Working with
bilingualism:
Panna Chavda Laura Helsby
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 +,
groups

2. Playing with your child is 100% agreed

important in learning language.
3. Parents play a vital role in the 100% agreed
treatment of language disorder.
While all agreed that parents as well as other mem-
bers of the family play an important part in the
treatment of language difficulties, some found it
difficult to fully support therapy due to time
restraints, lack of ideas and language barriers.
4. Language disorder is a 40% agreed,
new type of a problem; it 40% disagreed,
was not around years ago. 20% did not know
Although some parents knew about language dis-
order, over half did not know it existed.
5. Gujarati children have 70% disagreed,
language problems because 30% agreed
they have to learn to use or were unsure
more than one language.
Most parents related this question to their child.
A small number felt that learning Gujarati and
another language can initially cause confusion,
and that a child may find it difficult. The majori-
ty saw that the difficulties their child experienced
were not due to learning Gujarati and another
language. Comments included, It is the parents
attitude that causes the problem not the lan-
guage. Some parents reported that they had
been advised to speak in English to their child,
which gave them the impression that this would
resolve the language difficulties.
6. Learning to speak more 70% disagreed,
than one language causes 10% agreed and
language problems. 20% were unsure
Similarly, the majority felt that learning to speak
more than one language generally causes no
problem, and cited their own successful experi-
ences. They acknowledged that it may initially
take some children longer to learn two languages
but in the long-term there are more advantages
associated with it. They also noted the importance
of learning the home language for bonding with
the family members and for cultural identity.
7. Children with language 50% agreed,
difficulties often have 40% disagreed and
problems with their behaviour. 10% were unsure
The majority who agreed with this related it to
the children being unable to express themselves,
leading to frustration.
8. Children with language 95% disagreed and
disorder are stupid and will 5% agreed about
have problems getting a the difficulty in
good job when they grow up. getting a job
The majority disagreed. They felt that, with enough
help, their childrens language difficulties should
not hinder them in the future, and they were opti-
mistic about the children doing well. They felt the
attitude of other people such as teachers, parents
and employers would be important.
9. Attending the group 50% agreed and 50%
will cure my childs felt it would help the
language problem. language difficulty but
not cure it.
Half of the parents were hoping that attending
the group would cure the language problem.
Half did not feel the group would provide a cure
but that it would help the child to learn and give
ideas to parents on how to deal with the lan-
guage problem and think differently.
10. Speech and language 100% disagreed and
therapy does not work. felt it helped their child
The majority were very confident that speech and
language therapy
to date had made
a big difference
in the childrens
learning. A
number felt that
school had a vital
role to play and
that getting the
right help at
school was
i m p o r t a n t .
Parents said that
they had more
ideas on how to
work with their
childs language. They felt early detection of the
problem was important.
The questionnaire gave qualitative information
about the parents perception of their childs lan-
guage difficulty. Discussion with them during the
completion of the questionnaire gave insight into
the understanding of our role as speech and lan-
guage therapists, and meant we could reinforce cer-
tain perceptions and change others through the
group.
Closer bond
The groups ran in a local clinic for 45 minutes once
a week over a six week block with two bilingual
English / Gujarati speech and language therapists.
The group children who are statemented have
school-based language support assistants.
Holding the group over the school term from
January to March enabled these assistants to
attend without the burden of a larger time com-
mitment. They observed the group dynamics and
activities and got involved where appropriate.
They were an extremely useful resource and
helped to develop a very important closer bond
between schools and the speech and language
therapy service. In turn, the assistants reported
how beneficial it was to have time to reflect and
to practise the activities during the week.
After the six weeks the remainder of the term
time was given over to re-running the group tasks
in school at the discretion of the language support
assistants.
The groups had a structure each week:
A gelling game to encourage group cohesion
(for example, (a) fruit salad - objects or pictures
were given to each child, two items were called
out, and the children with those items swapped
places; (b) passing a ball with a verbal activity).
Activities to develop attention and listening
skills in a group setting via Sounds of the World
listening tape (UNICEF, no longer available).
The core of the sessions consisted of tasks based
on themes. Examples of themes were advertising
(for older children), countries and languages spo-
ken, food and drink, animals, transport, shapes,
Figure 1 Clinical Decision-Making Loop (Episode of care)
Identify Clinical Needs
Intervene
Review
goals and
measure
effectiveness
Set goals for
intervention
Kate Malcomess, 1999
the aim of our care
and training given so we take advantage of the
rich possibilities offered by bilingualism and
ensure that the children receive therapy appropri-
ate to their clinical needs.
Panna Chavda is Clinical Lead Speech and Language
Therapist (Bilingualism) and Laura Helsby Chief
Speech and Language Therapist with Leicester City
West NHS Primary Care Trust. Address for correspon-
dence: Childrens Speech and Language Therapy
Service, Prince Philip House, St Matthews Health and
Community Centre, Leicester LE1 2NZ.
References
Asian Book of Nursery Rhymes. Mantra
Publishing. (ISBN 1852697016).
Brigman, G., Lane, D. & Switzer, D. (1992)
Teaching Children Success Skills.
Journal of Educational Research 92
(6) 232- 329.
Cummins, J. (1984) Bilingualism and
Special Education: Issues in
Assessment and Pedagogy.
Multilingual Matters, Clevedon.
Hulme, S., Rahman Jennings, Z. &
Thomas, D. (2001) Alternative
Methods. Bulletin of the Royal
College of Speech & Language
Therapists August, 10-12.
Malcomess, K. (1999) Measuring
Effectiveness. Workshop. (See
Malcomess, K. (2001) The reason for
care. Bulletin of the Royal College of
Speech & Language Therapists
November, 12-14.)
Masidlover, M. & Knowles, W. (1979)
Derbyshire Language Scheme.
Derbyshire County Council.
Sage, R. (2000) Class Talk. Stafford Network
Education Press.
Useful Resources
* The Bilingual Family Newsletter is written by and
for parents. See www.multilingual-matters.com,
e-mail marjukka@multilingual-matters.com or
write to Multilingual Matters, Frankfurt Lodge,
Clevedon Hall, Victoria Road, Clevedon, England
BS21 7HH.
Online catalogue: www.bilingual-supplies.co.uk.
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 o
groups
words from one language are used in a sentence in
another language. So we said, I like baath for din-
ner for I like rice for dinner.
Positive and valuable
The children needed to feel they could use their
home language outside the home setting to help
with their communication. This approach increased
their confidence and self-esteem and enabled
them to use both their languages in a positive and
valuable manner. In addition, the language support
assistants and parents saw first-hand, or through
feedback in the homework discussion, how suc-
cessfully both languages could be used to help
bilingual children with language difficulties.
Having parents taking part in the groups with
feedback given in their home
language ensured the positive
aspects of bilingualism were
conveyed, and allowed code
switching and other normal fea-
tures of bilingual communication
to be reinforced.The language
support assistants were able to
understand the importance of
using the childs overall commu-
nicative abilities and to value the
learning of the home.
During each session, we kept a
record our observations of the
childrens language and interac-
tion while completing the tasks.
This information was used when
we completed a communication
skills rating questionnaire
adapted from The
Communication Opportunity Group Scheme
(COGS) (Sage, 2000), which is used in
Leicester to promote effective communica-
tion in schools. We found it a very useful
tool to measure baseline performance for
bilingual children, and will be using it as an
ongoing measure of change and as a basis
for discussion with parents and teachers.
The rating scale has four main areas: general
skills, formal conversation, formal presentation
(speech/writing) and non-verbal communi-
cation. It is rated from high competency to
no evidence of the skill on a scale of 1-5.
The communication skills rating alongside
conventional assessment provides a much
more holistic picture of the childrens lan-
guage strengths, weaknesses and progress,
allowing the mapping of skills over time
across both languages and along different
parameters.
Where there are fewer bilingual children
it can be problematic to have bilingual groups for
their specific languages but, for effective therapy,
it is better to include children who have the same
home language and English, rather than children
of many different languages. In areas where there
are no bilingual speech and language therapists,
co-workers and interpreters should be accessed
Do we seect cents or groups on
the bass o ther need - or our
need to get through our caseoad'
Do we oer a servce whch
takes account o the strengths
o a cents background'
Do we promote code swtchng,
exca borrowng and namng
n two anguages wth our
bngua cents'
Reectons

colours. We also had activities to develop giving

and receiving requests based on the Derbyshire
Language Scheme (Masidlover & Knowles, 1979)
and time sequences related to simple stories.
Maps of the world, cross cultural food items (pic-
tures and false foods) and advertisements from
local community and high street shops were useful
resources.
Gujarati nursery rhymes (adapted from Mantras
book of Asian Nursery Rhymes).
Although we had the structure and themes to
follow, there was flexibility for the pupils to intro-
duce and lead a topic of their choice.
Homework was given at the end of each session.
This was translated in Gujarati and discussed with
parents. This formed one of the most valuable
aspects of the intervention as it allowed the par-
ents to understand the what and why of the
groups. Parents who were present during the
group sessions benefited most from watching the
strategies the speech and language therapist
employed during the group, as they were able to
try these out at home. The aims of the group and
the homework set were, as a result, more thor-
oughly understood, and compliance on complet-
ing the homework was high.
Cummins (1984) discusses the idea of a common
underlying proficiency model in bilingualism. We
know there is more than enough room inside our
thinking quarters for two or more languages, and
research also suggests there is transfer between
languages. For example, a child taught multiplication
and subtraction in one language does not need to
have those concepts re-taught in the second lan-
guage, only the vocabulary to reproduce it. We
aimed not to do the tasks in one language then
another, but to use the
natural discourse of a
bilingual speaker accord-
ing to the situation to
facilitate vocabulary
and word finding. The
session reflected the
childrens natural bilin-
gual use of language
where code switching
and lexical borrowing is
a normal feature. All
the tasks were therefore
done in English and
Gujarati, led by the
bilingual Gujarati speak-
ing therapists.
In vocabulary work,
for example with our
food theme, we encour-
aged the children to
access and name items in both languages to build
up semantic links and facilitate word recall. Code
switching (for example, I have been to India, hu
rikshawma beto meaning I have been to India,
I sat in a Rikshaw) was used naturally through-
out. Names of food items were used in conversa-
tion as an example of lexical borrowing, where
We aimed not to do
the tasks in one
language then
another, but to use
the natural
discourse of a
bilingual speaker
according to the
situation to facilitate
vocabulary and
word finding.
Homework was
translated in Gujarati
and discussed with
parents. This formed
one of the most
valuable aspects of
the intervention as it
allowed the parents
to understand the
what and why of
the groups.