Private SLT

[slt101]

Hello everyone, every now and again I come across communities such as this forum that just sucks me in and hours later I can finally pull myself from the computer. I have been looking through many topics and it is very clear that many of you are passionate about ensuring your children receive the support they require in school.

 

I am extremely interested in the many discussions on families that have engaged the employment of private professionals. I am a NHS speech and language therapist. I have been recently involved with a SEN Tribunal concerning a teenager with AS. The parents had great difficulty in agreeing with the recommendations I had made and so they decided to employ a private therapist. On the information and advice given to them by this therapist the family disagreed with the provision set down in the Statement and took the LEA to tribunal.

 

The outcome of the tribunal fell in favour of the LEA, the panel made specific comments on the validity of information given to the family by the private professionals involved. I had known this teenager for the past 3 years and the private SLT had known him/her for 3 hours. I could give evidence of strength and difficulties observed in the classroom providing a picture of their overall language functioning, the private SLT could only give the result from standardised tests (tests that haven?t been standardised on an ASD population).

 

So why would a parent throwaway a professional relationship for the advice given by private SLT? Was it because the private therapist was keen to set down a very prescriptive programme? �X must receive 10 minutes of this� & �X must receive 20 minutes of that� After reading a number of posts on this forum that seems to be exactly the reason why my non-specific advice was deemed to be no longer appropriate. BUT where is the research to back up this very prescriptive approach? It is a common discussion point with parents on a presumption that �more has to be better�.

 

I am sure you are aware that there is a national shortage of SLT, more than ever are training but even more are leaving after a few years of doing the job. Some of you may have heard of the new NHS pay and conditions �Agenda for Change�. For a senior SLT this will result in an increase of the working week and a pay cut of approx 10-20% If you thought it was difficult to get to see a specialist therapist now wait until the mass exodus of SLT to non-NHS jobs. There will never be enough SLT to be in every school to follow a prescriptive programme; if it is written into the statement then the only way to staff this is by not seeing the other children on your caseload.

 

The family told me that they thought I was in collusion with the LEA and not thinking about what was best for their child. (Extremely hurtful to hear!) I have never lied to parent about what would be best for their child; if we don?t have resources for a specific activity then I will say so and let that be a case for further service development. So, the private therapist has now returned back to her cave (sorry, couldn?t resist) and I am now left to pick up the pieces and attempt to rebuild the relationship we had before the tribunal.

 

I never intended this to be such a rant, thank you all for reading. It is very clear that there simply isn?t enough resources for children experiencing any kind of SEN.

[helenl53]

Hello SLT

 

I don't think that anyone minds a rant so long as it does not become a personal or offensive attack against persons.

 

I can understand from both sides. I think that I understand that you are trying to do the best you can in a restrictive environment.

 

I have a very similar situation to the one you describe and my gripe is not against the professionals who deal with my child on a day to day basis but when a statement is written,attempts are made to exclude or minimise interventions suggested by the professionals. Parents then have to prove that their child needs specific intervention and the only way is to obtain independent confirmation of this. I have probably not won friends and influenced people by the track that I have had to follow, but at the end of the day, the needs of my child are paramount. I contacted the professionals involved with my son and explained that I would be obtaining independent reports and the reasons why and I hope that no one has taken offence. At the end of the day, I understand that the hands of professionals dealing with my child are tied to a certain extent.

 

Perhaps you need to talk to the parents and also try and understand why parents have to do what they have to do. I would say that it would be very rare that it would be done to attack a professional and it is merely to defend the rights of their child to decent provision.

 

I hope that you understand this point of view.

 

HelenL

[slt101]

Thank you for such a quick response HelenL.

 

I did leave out huge chunks of events from my original post, including the instance when the mother stood up during the Tribunal, shouting and pointing at me exclaiming that because of my dereliction of duty her son/daughter is now at risk of not leading a normal life. I think in this example the parent had approached a number of professionals until she found one that was willing to recommend the provision she wanted for her child.

 

I just find it difficult to have my professional integrity under question every single day. I am true believer in getting a second opinion especially when working with children with more complex needs but why does the findings from an independent therapist seem to be perceived as being more valid?

 

Is it any wonder more therapists are leaving the profession than joining?

 

I have to say, in my caseload of children with SEN in mainstream I have so many wonderful parents. When we work together you can see the difference in the confidence of the parent/teacher working with their child. However, I also have a minority of parents that want to point a finger and blame everything and everyone, including resources, money, school, LEAs and in those cases nothing provided is good enough and the collaborative working collapses.

 

I always try to work as closely as possible with parents to help build a professional relationship but when your integrity is pulled into question on a regular basis it is difficult to maintain such a relationship.

[call me jaded]

Is your integrity questioned every single day? I used to work in a service industry and one thing's certain: you can't keep all of the people happy all of the time. A serious suggestion, based on my numerous interactions with the NHS, is that health staff could really do with some Customer Service training. And whilst I'm on my soapbox, what is it with appointments, why are they always running behind?

 

Anyway, to put a parental perspective, LEAs habitually put something like 'regular access to a SLT' on a child's statement. [This is actually illegal: have a look at the IPSEA website.] In my son's case this meant an hour's assessment once a year (maybe, I found out it was much worse than that). It took me a long time to wake up and smell the coffee on this one, because both times that I visited the school before he started I saw therapy taking place and assumed that because some therapy was happening that all therapy was happening.

 

To cut a very long story short my son is will be starting a NAS school in September where he will actually receive his first speech therapy (as opposed to assessment) in his eleven non-verbal years.

 

And getting back to the point of the shortage of speech therapists, I could find a therapist tomorrow, I just can't afford to pay �75 an hour for anything more than a short burst of sessions. Surely the reason for therapists leaving the NHS is primarily financial, just as my PCT fails to appoint to vacancies because of its �12 million deficit.

 

The system is broke for sure, but it isn't a parent that broke it.

 

Sorry for my long rant in return: I'm sure you've heard it all before.

[LKS]

SLT I'm sorry to hear about the treatment you received from these parents. However I have to agree with other posters about specifying the amount of support. My daughter who is 8 has a condition which resulted in her at the age of 4 losing a great deal of her speech. Despite getting a statement after 10 months we were still waiting for her to be assesed. Finally the neurologist from Great Ormond Street wrote several letters of complaint and she was finally seen. On her original statement it said L would benefit from regular access to a Specch and Language therapist. Well so would many other children and unless there is a countrywide agreement of what is regular parents will always go for more clarification. L is now seen every 2 weeks by the S&LT and in between these visits both of her L.S.As have received training which enables them to carry out the programme daily. I can also contact my daughters therapist anytime to ask for help and suggestions. This seems to suit eveyone at the moment,

[helenl53]

Hi All,

 

I think LKS has put it into a nutshell.

 

Words like 'regular' and 'could benefit from' are not definitive or quantitative enough for statementing purposes and this is where frustration can set in. How on earth do you take an lea to task when they are providing 'regular' provision which has a different meaning to how parents have interpreted it.

 

Until the system changes and persons who write statements only have the motive of writing a clear blueprint of the childs difficulties and how these difficulties will be provided for, then the system is open to 'legal' abuse.

 

Professionals can usually shut the office door at the end of the day, parents have to live with the fallout from inadequate provision for 24/7, never mind the suffering of the children.

 

HelenL

[lsw146]

seems that a hornets nests has been bashed

 

Please remember that not all profesionals go home to easy lives. I work for a PCT in speecha and language and am one fo quite a high proportion who has a child (on the way to diagnosis) on the spectrum or with other problems.

 

You are right to say that wording can be very woolly but with huge caseloads to get through even the best of intentions can go astray in the write up.

 

I have been fighting for help for 10 years and asking for assessment for 5 but it has only been since moving to the PCT that I have realised how perseciptive as parents we must be to get any sort of provision.

 

I think the system is a on the spectrum unless we tellit exactly what we want time and time again it gets forgotten or changed!

[helenl53]

Hi LSW

 

I was actually talking about the LEA writing of statements when I talked about the woolly words - sorry, I didn't make myself clear.

 

I think that parent or professional - we are all under strain which does not help.

 

Best wishes

 

HelenL

[slt101]

I would like to comment on some of the comments raised from original post.

�what is it with appointments, why are they always running behind?�- I am well known for always running late but that is because I am forced to cram my diary with as many appointments as possible. I have a quota of children to see in a week and so I will squeeze in children in every available gap in my diary. With a system like this it is inevitable that it will run late.

 

�And getting back to the point of the shortage of speech therapists, I could find a therapist tomorrow, I just can't afford to pay �75 an hour for anything more than a short burst of sessions. Surely the reason for therapists leaving the NHS is primarily financial� ? you are right that one of the main reasons therapist leave is because of the pay but a MAJOR factor is working conditions. In my dept we have 8 people in one office and only 2 computers to share. The equipment budget is so small that it is not uncommon for a therapist to spend over �500 a year buying our own books/tests/toys/courses. Many people in the job enter the profession not for the money but they want to bring something positive to the community. After a couple of years of working as a SLT you quickly begin to realise that no-matter how hard you work you will still be shouted at and called names that I couldn?t post on a respectable forum such as this.

 

�The system is broke for sure, but it isn't a parent that broke it.�- I would have to argue that one slightly. When I first qualified I received a dressing down by a parent because I wouldn?t see their 5 year old child intensively to work on the sound �th�. This parent called my manager, the Chairman and Chief Executive of the Health Trust to complain. I just couldn?t justify spending time on a sound that is absent from the community I work in and keep children with more significant difficulties waiting longer on the waiting list. Well, after all the parents shouting I was ordered to see the child twice a week for the next 3 weeks! This parent was not concerned about the wider implications of her demand- I don?t know where you all live but it could have been one of your children who had to wait longer for an assessment because I was made to work on a sound the child. Like I said in my earlier post, it is a case that the loudest voice is heard but they may not be the neediest.

 

As a NHS SLT a big part of our job is balancing the children who would benefit the most from the input we give with the children who may have significant difficulties but who will not greatly benefit from SLT. In our hearts we want to help all but the reality of it is that we have to make very difficult decisions on who we see. That is why we work with something called Evidence Based Practice- working with what we know works well and expand on it. I have not come across recent research that indicates having a SLT visiting a child with ASD 30 minutes weekly brings about change. Therefore, I find it difficult to set down on paper such prescriptive comments because where is the research and proof that reports this is going to be the best thing for your child? I prefer to take a Care Package approach, test an approach, if it works then full steam ahead but if it doesn?t rethink and try something else. IT IS IMPOSSIBLE DO THAT WHEN THE STATEMENT STATES THE CHILD MUST HAVE X & Y. I have tried discussing it with parents but some wave the statement in my face (quite literally) and say that you must see their child for x minutes because it says so no matter if it is not suitable for the child or not. I sincerely believe that following such a prescriptive approach can sometimes hinder development and not help.

 

�Professionals can usually shut the office door at the end of the day�- NOT FAIR, NOT FAIR AT ALL! I have never been able to �shut the office door� at the end of each day. Events, discussions and formulating new ways of supporting children with ASD do not stop at 5.00pm. That statement makes us sound like we don?t care.

 

I do have to say that this forum is a wonderful way for any professional to gain a greater insight into the wider picture of living in a family with a child with ASD. I will pass on the web address to my colleagues.

[call me jaded]

When I first qualified I received a dressing down by a parent because I wouldn?t see their 5 year old child intensively to work on the sound �th�. This parent called my manager, the Chairman and Chief Executive of the Health Trust to complain. I just couldn?t justify spending time on a sound that is absent from the community I work in and keep children with more significant difficulties waiting longer on the waiting list. Well, after all the parents shouting I was ordered to see the child twice a week for the next 3 weeks!

 

This illustrates my point about customer service training: it gives you and your managers ways of saying no.

 

Did the child get the 'th' sound?

[mossgrove]

To bactrack to where we came in to this, which is what would a parent risk a professional relationship in favour of advice given by a SLT?

 

Perhaps the most common reason is that they do not think they are getting/being offered the support that their child needs, and getting a private second opinion can be a way of progressing this. To be cynical, it can be a case of he who shouts loudest gets most help, and a professional opinion can be a way of making a bigger impression.

 

It is also the case that many SLT's do not understand Autism, so there can be a genuine difference of opinion about what a child needs. As parents we do not have professional qualifications, but we know our chuildren better than anyone.

 

This issue is not confined to SLT's. So many parents have had to fight tooth an nail to get acknowledgement of their childs issues. We are not talking about conditions that only exisit in the minds of overanxious middle-class parents here, we are talking about real problems that have not been acknowledged by a series of professionals, so it is not surprising if a culture develops of not taking no for an answer.

 

In terms of where this gets us I can see both sides. We have not yet needed to get a second opinion, but I would not hesitate to ask for one if it was by genuine belief that by getting one I could secure a better outcome for our autistic children.

 

The obsession with getting things itemised in statement is down to the fact that if it's not itemised, in practice you don't get it. As an example, xxx will have SALT for 30 mins a week is legally enforceable. xxx will have a programme of SALT organised by a SLT may never happen.

 

Ultimately all roads lead back to lack of resources. I do lnow how hard it can be. (My sister in law is a SLT who has recently returned to the NHS after working in a special schopol for children with Autism, and I am the father of 4 children, two of whom are autistic).

 

I take your point about the loudest voice may not be the neediest, but in the experience of many parents on this forum sitting back and trusting that the professionals will do the right thing can often be a disaster. Ultimately our responsibility as parents is to be the advocate for our childrens needs, it is probably unrealistic to expect that parents will moderate their expectations to take into account local resourcing difficulties or the needs of other children.

 

 

Simon

 

PS Watch this space on agenda for change, SLT's may well fare differently in different areas which will cause problems of it's own!

[smallworld]

No need where we live !! (re. saying the 'th')

Sorry that's too flippant, but I have to agree with slt101 that I think many pushy parents can waste a SALT's time with things they could just work on at home.

We saw a SALT for our second child, and after watching him play sent us home with games to play and songs to sing (things we were doing already) she didn't feel the need to see us again ( i hadn't wanted this assessment)

But, and it's a big BUT,I wish now that she'd picked up on his behaviour.

But then again, she was there to assess his language.

With third child I knew better and refused referral to SALT asking to see ASD specialist at our CDC instead.

I think health visitors have something to answer for here, ours seem to use SALT as their first call of port if 'something's not quite right' I would have thought hearing and vision checks should be first ?

Our HV instead of referring us to CDC, referred us instead to a clinic for new ,young parents (don't fit either criteria by any means ! )

I know of numerous children who have been referred to SALT with no further action (all boys !!!) perhaps the referral process needs to change ? maybe a better checklist along the lines of CHAT to avoid unnecessary referrals, which would free up more time for SALTs to actually see the children who do need help.

Edited August 2, 2005 by waccoe

[oracle]

I have to begin by saying that generally I personally have a soft spot for SALT's. But I also know I have been very lucky.It was a SALT that helped me to fit the pieces of the jigsaw together for both Matthew and David, whom she was not even seeing. She and a little help from a couple of friends. I will be forever grateful to her as she clearly knew her subject which was ASD - specialist Speech Therapist.

 

May I ask stl 101 if you have specalised in ASD - because if not then maybe that's why the parent in your original post went for a private assessment for the tribunal?

 

Just like ASD comes in very many different shapes and sizes so do SALT's.

 

Our SALT at the moment is also wonderful. Matthew loves her and she is the one professional he actually loves to come visit us. (We home Ed)

 

Carole

[Helen]

So why would a parent throwaway a professional relationship for the advice given by private SLT?

Each parent would have his/her own reasons for challenging a professional's opinion.

 

I opted for a second opinion after a NHS SALT assessed my son. The NHS assessment had taken place without my knowledge in the school setting over a four-week period, it was around the time that I was disputing the content of my son?s Statement. The NHS report was not specific enough in its content.

I am sure you are aware that there is a national shortage of SLT, more than ever are training but even more are leaving after a few years of doing the job. Some of you may have heard of the new NHS pay and conditions �Agenda for Change�. For a senior SLT this will result in an increase of the working week and a pay cut of approx 10-20%

I?ve had a quick browse around on the net. I noticed that The Agenda for Change pay system relates to all staff in the NHS, but that it excludes dentists, doctors and very senior managers, so it?s not only your profession that'll be affected by these new conditions. Thank you for bringing this to our attention as this will be of interest to the parents on this forum who are also trying to get OT for their children.

If you thought it was difficult to get to see a specialist therapist now wait until the mass exodus of SLT to non-NHS jobs.  There will never be enough SLT to be in every school to follow a prescriptive programme; if it is written into the statement then the only way to staff this is by not seeing the other children on your caseload

.

Yes you are correct in what you say, in that particular circumstance there will inevitably be children on your caseload who?ll have to go without regular therapy and those children and their parents have my sympathy.

[lsw146]

to right that SLT's come in all shapes and sizes. I have only been working with them for a year but in that time I have seen many children referred on for other assessments with at least 2 for ASD. They had only been referred for language but all aspects of behaviour and communication were taken into consideration during intial assessment, including a good History from the accompanying adult ( and this is not always forthcoming and needs a lot of diplomacy)

It did help that the SLT I was working with was lucky enough to have someone else in clinic (just happened to be me) that day to discuss their thoughts. Cliinc can be very isolating and as we know unless ASD behaviours are observed first hand and often over a lengthy period they can be hard to explain to others.

 

To SLT101 where was your manager in all this? You sound very isolated and frustrated. Try not to question your own ability too much. Perhaps think through to the trigger for this whole case and see if anything could have been done differently. Having not met the parents or child involved it is difficult to know whether they were abusers of the system or just wanting the very best for there child.

 

Glad you find the forum helpful.

[Helen]

As a NHS SLT a big part of our job is balancing the children who would benefit the most from the input we give with the children who may have significant difficulties but who will not greatly benefit from SLT. In our hearts we want to help all but the reality of it is that we have to make very difficult decisions on who we see.

Well I know what that feels like, my son was practically non-verbal for the first five years of his life, if I remember correctly he received 11 x ? hour SALT sessions between the age of 2? and 11.

I have not come across recent research that indicates having a SLT visiting a child with ASD 30 minutes weekly brings about change.

My AS son receives SALT for ? hour each school week. The SALT has written up a SALT IEP for the school to incorporate in their daily routine and for me to follow at home. Progress is being made. I see a positive difference in my son because of this method of support. He doesn?t ask me to explain his homework questions to him as much as he used to and he tries his best to complete his homework independently. His grades in practically all of the curriculum subjects have improved and his exam results have improved. He is becomming more confident, he is prepared to ask for clarification if he doesn?t understand something that has been said to him and he is able to ask for repetition. He is able to recall a full message (with a little prompting) and he is beginning to not take himself so seriously.

 

My son also receives a regular social skills programme with the therapist. Until a few weeks ago I hadn?t seen any progress in this area. I had fought so hard to get this level of support, I had begun to feel disheartened because I thought it wasn't working for him as I personally hadn?t seen any attempt from him to socialise. Then a friend of his phoned up unexpectedly on one weekend and asked if he wanted to meet up with some of his mates. My son agreed to go out with his three mates and he had a really good time. I had waited so long for this to happen, for my son to actually want to spend some time in somebody else's company. I?m extremely proud of him.

 

My son is learning to show empathy towards people, he is also learning how to interpret literal language, it?s a slow process but there is progress. Our conversations are getting slightly longer and a little more detailed.

I find it difficult to set down on paper such prescriptive comments because where is the research and proof that reports this is going to be the best thing for your child? IT IS IMPOSSIBLE DO THAT WHEN THE STATEMENT STATES THE CHILD MUST HAVE X & Y.

Prescriptive comments ? I'm not sure how to interpret this, but I?ll give it a go? I can understand why a therapist may not want to include actual therapy techniques/strategies when writing up their assessment report as I think that any possible techniques/strategies could later be used for the child as a matter of trial and error. My son?s previous NHS reports confirmed his results, his strengths and his weaknesses and they included one or two vague recommendations ? they did not mention any particular therapy techniques/strategies.

 

The NHS SALT provided one vague -the only- recommendation in her last report. The LEA decided to take on board the recommendations of the independent therapist and has since specified and quantified the SALT provision in Part 3 of my son?s final amended Statement.

 

The NHS SALT has total control over the delivery of the programme, she decides which exercises to include/ not to include in the SALT sessions and her practice methods seem to be working.

[Helen]

slt101,

 

I was wondering if you could help me out? Where would I be able to find the SALT's Code of Practice - in particular some information relating to ethical practice?

 

I've searched on the Internet but I haven't had any joy in locating that specific information. TIA.

[call me jaded]

Helen

 

I have had long involvement in campaigning for therapy services for statemented children. In an old file I have some photocopies sent to me from the RCSLT of their therapists handbook which was most informative. I also have OFSTED/RCSLT Guidelines to Inspection for Therapists which was most useful in getting an increase in therapy services to the school at which I'm now Chair of Governors - I worked out that it would take nearly three years on the current level of service to meet the minimum standards. BTW the head of therapy services at our PCT has said to me off record how glad she is that this campaign is happening as it is only outside factors that can get the mammouthian NHS to change direction, even if ever-so slightly.

 

If you PM an email address I will send them to you. This offer is open to anyone else who's interested.

 

There will be a slight delay as I have to locate the documents (but I will need them shortly anyway) and, more troublesome, fiddle around with my new scanner (the old one having died). It could be a case of plug-and-go with the scanner, but who knows?

 

Anyhooo I could say loads and loads of things about speech therapy, but don't want to dishearten slt101 who I'm sure is doing a good job.

[slt101]

slt101,

 

I was wondering if you could help me out?  Where would I be able to find the SALT's Code of Practice - in particular some information relating to ethical practice?

 

I've searched on the Internet but I haven't had any joy in locating that specific information. TIA.

National Guidelines for SLT are published in a publication called Communicating Quality. I am not sure if it is available on general release but if I am asked by a parent to see it I would happily show them my copy.

[slt101]

Anyhooo I could say loads and loads of things about speech therapy, but don't want to dishearten slt101 who I'm sure is doing a good job.

[call me jaded]

I can't be liked by all of the people all of the time.

[Helen]

Call me jaded:I'd like to take you up on your offer, thank you. I've sent you a PM.

 

Slt101:Thank you for the info, I'll try to search online for it.

[call me jaded]

Scanner now working, Helen has mail.

[Helen]

Jaded: thanks for the info

 

Slt101:just to let you know that I phoned RCSLT this afternoon and was told that the publication Communicating Quality is available on general release at �18.30 including pp - it is being updated at the moment.

Edited August 5, 2005 by Helen

[bid]

Hi Slt101,

 

I'm a bit late to this thread...

 

As a parent, I have experienced fantastic professionals, and dreadful ones.

 

Professionally, I have experienced fantastic parents of children with special needs, and dreadful ones.

 

Which sums it up really...there are good and bad among professionals and parents alike.

 

And, without wanting to come across as rude, I don't think you can really compare working in the special needs field with living it as a parent. As I do both, I feel I have good experience of the difference...and it's huge

 

Bid

[Flora]

I haven't read all these posts; but as I was reading some of them they stirred a particularly frustrating and heart rending memory.

 

My youngest child was diagnosed 3 years ago with pragmatic language delay/disorder.

 

Shortly after the dx we relocated and the first thing I did was ask for a SALT referral for my son.

 

14 months later (14 months of NO therapy what so ever) the SALT saw my son at his school and delivered the gut wrenching verdict 'Not in need of therapy'.

 

I had prior to our relocation spent three and a half years getting my son diagnosed only to be told by a stranger who spent half an hour with him that he was not in need of SALT. How can that be with a dx of pragamatic language disorder??

 

18 months later after having spent a couple of thousand pounds on vision and sound therapy my son's language problems have all but gone.

 

However, I feel very angry and let down by the NHS system that I had to spend this money at all, to sort out a serious problem which had been diagnosed by several child psychiatrists and a battery of very expensive neurological tests, only to be told by a different health authority that he didn't need any help?

 

Senseless to say the least, and hardly surprising the NHS is in chaos.

 

I think as parents and advocates to our special children we have every right and justification to criticise professionals who are letting our children down by just a slip of semantics.

 

Rant over!

Lauren

[slt101]

Lauren,

I understand your rant, believe it or not, it is like my original rant that started this thread. One of my rants was about why the views of a private therapist who had only seen a boy for a couple of hours one afternoon seemed to be perceived as far more valid than my advice, gained from working with him/her for a few years. At least the Tribunal cleared up that little mess up.