Academic excellence for business and the professions
Talking heads:
Speech and Language Therapy in
the Current Context – Challenges
and Opportunities
Victoria Joffe
Division of Language and Communication Science
City University London
IASLT CONFERENCE
Ireland, April 2013
=
OPPORTUNITIES
CHALLENGES
What is our starting point?
 Committed workforce
 Professional
 Expert knowledge
 Highly Skilled
 Advanced communication skills
 Critical and evaluative thinkers...
In the face of this though we…
 Work in isolation
 Value anecdote more than robust evaluation and evidence
 Are often frustrated at not being able to meet the needs of
our clients
 Feel disempowered when asked to show our value and
contribution
 Worry about our services being under threat
 See research as separate from clinical activity
 Are risk averse
 Times of Austerity – economic recession caused a
permanent loss of economic output, bringing challenges home and away
 Employment and expenditure are characterised by
reductions - increasing numbers of the population in
Ireland eligible for a medical card and decreasing
numbers opting for private health insurance
 Greater need by more people
 Scarcer resources - carefully targeted to deliver more
efficient and effective ways of providing services
 Doing MORE for LESS
 Changing Population Demographics: Each year the
total number of people over the age of 65 grows by around
20,000 persons. Ageing population will mean doubling the
number of people over 65 years over the next 30 years implications for health service planning and delivery (Irish
census, 2011).
 Increasing technological advances are rapidly changing
the service delivery model
 Rising consumer expectations in the context of suspicion
and concern (mid Staffordshire reports)
 Changing Market Place: More competitive, greater choice
and user involvement
 Payment by results – greater accountability and
awareness of health economics, how much your
service/intervention costs, cost-benefit ratio
 Demand for clearly specified outcomes
 Need for better data – systems that are Information rich,
data poor
 Inequalities of health care – Healthy Ireland 2012
 Impact of social deprivation on Speech, language and
Communication Needs (SLCN) and other disorders
 Gaps and limited services in certain areas of need –
client group (for example, older children with SLCN, adults
with developmental language disorders, people with
behaviour, emotional and social difficulties, mental health
needs etc.) and context (schools, care homes, homes)
 Need to show why SLT is worth the investment
 Not just an ‘add on’, a ‘nice to have’ but a necessity, an
essential element ensuring the health and well being of
our community
 And how do we do that…
Collectively stepping up to the mark and seeing how these
challenges are unique opportunities to do what we all want to
do…
Make a Difference
"If you always DO what you've always
done, you'll always get what you've
always got."
Levels of Evidence for EBP
(http://cebm.jr2.ox.ac.uk)
Level I
Systematic review and meta- analysis of all relevant
randomised controlled trials (RCTs)
Level II
At least one high quality RCT
Level III
1. Prospective controlled trials
2. Prospective cohort studies or case series
3. Prospective single case studies
Level IV
Expert opinions, expert guidelines, descriptive
studies
Summary of levels of evidence for
selected disorders
0
(from RCSLT guidelines)
Diagnostic
Outcomes
Efficacy
level of evidence
1
2
3
4
Dysarth
Dysphagia
Aphasia
Voice
Stammer
Evidence-based Practitioners
 Barriers to undertaking Evidence based Practice –
Clinician, manager, institution, time, skills and knowledge
 Opportunities are all around us
 Piece/s of the EBP puzzle
 Build relationships between academic
and clinical departments
 Join regional research groups and
start journal and research clubs
 Become consumers of research
 Critically appraise the literature and
USE the research to shape and inform
your intervention
Virtuous Circle
(Snowling & Hulme, 2011)
 Clinical practice should always be based on a sound
knowledge of theory and relevant research
 Theoretically-motivated interventions should be evaluated to
establish whether they are effective, efficient and for whom
 Theory informs practice, and the evaluation
of practice informs and refines theories
 We need to build our evidence base –
if we don’t someone else will.
Outcome Measures
 Outcome measures are required by all – client and family,
health care professional and the commissioner/purchaser
 We need to be more strategic and get better at evaluating
our interventions through the use of outcome measures
 Differentiate between assessments for diagnostic purposes
and for outcomes
 Consider more carefully the relationship between our
interventions and the outcomes we assess
Outcome Measures
 What outcome measures are we using and for whom?
 Roulstone and colleagues interviewed young people and
their parents about the outcomes that mattered to them.
What do you think they were?
Outcome Measures
 Johnson et al (2010) reported a 20-year follow up of a group
of children with language impairments (LI)
 At age 25, young adults with a history of LI showed poorer
outcomes in multiple domains (communication,
cognitive/academic, educational attainment, and occupational
status) than their peers without early LI
 However, there were no differences in subjective perceptions
of their quality of life
 Subjective well-being - primarily associated with strong
social networks of family, friends, and others.
Outcome Measures
 Use a variety of outcomes: formal and informal
assessments – validity, reliability, sensitivity and specificity,
easy to use
 International Classification of Functioning, Disability and
Health (ICF)—WHO – impairment, activity and participation
 Levels of Outcomes – general, specific, management
systems, qualifications
 And from whose perspective – service user-based
outcomes
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
Profiling Outcomes Across Time
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
LANGUAGE &
COMMUNICATION
Excellent
Average
Very poor
0
1
2
3
4
5
6
7
8
9
10
0
1
2
3
4
5
6
7
8
9
10
WELLBEING
0
1
2
3
4
5
6
7
8
9
10
BEHAVIOUR
0
1
2
3
4
5
6
7
8
9
10
0
1
2
3
4
5
6
7
8
9
10
(including speech,
fluency & voice)
SOCIAL SKILLS
EMOTIONAL
EATING
& DRINKING
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
PRE-VERBAL COMMUNICATION
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Never
Always
Sometimes
Initiates interaction with
others
0
1
2
3
4
5
6
7
8
9
10
Uses eye contact
0
1
2
3
4
5
6
7
8
9
10
Takes turns
0
1
2
3
4
5
6
7
8
9
10
Plays appropriately
0
1
2
3
4
5
6
7
8
9
10
Reaches
0
1
2
3
4
5
6
7
8
9
10
Points
0
1
2
3
4
5
6
7
8
9
10
Copies actions
0
1
2
3
4
5
6
7
8
9
10
Responds to voices
0
1
2
3
4
5
6
7
8
9
10
Responds to name
0
1
2
3
4
5
6
7
8
9
10
Vocalises
0
1
2
3
4
5
6
7
8
9
10
Uses sounds
meaningfully
0
1
2
3
4
5
6
7
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
TALKING AND LISTENING
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Never
Listens & pays attention
Always
Sometimes
0
1
2
3
4
5
6
7
8
9
10
Talks using one or two
words or with short
sentences
0
1
2
3
4
5
6
7
8
9
10
Talks using long
sentences
0
1
2
3
4
5
6
7
8
9
10
Understands one or two
words or short
sentences
0
1
2
3
4
5
6
7
8
9
10
Understands long
sentences
0
1
2
3
4
5
6
7
8
9
10
Understands & uses lots
of different words
0
1
2
3
4
5
6
7
8
9
10
Understands words with
different or hidden
meanings, for e.g.
figurative language
0
1
2
3
4
5
6
7
8
9
10
Talks easily &
appropriately with other
people
0
1
2
3
4
5
6
7
8
9
10
Shows frustration when
not understood
0
Sometimes
Always
1
2
3
4
5
6
7
Never
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
SPEECH
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Sometimes
Never
Always
Is easily understood
0
1
2
3
4
5
6
7
8
9
10
Is able to move
tongue, cheeks,
mouth, lips & face
easily
0
1
2
3
4
5
6
7
8
9
10
Produces consonant
sounds correctly
0
1
2
3
4
5
6
7
8
9
10
Produces vowel sounds
correctly
0
1
2
3
4
5
6
7
8
9
10
Can identify the
number of syllables in
words
0
1
2
3
4
5
6
7
8
9
10
Can rhyme words &
play with sounds
0
1
2
3
4
5
6
7
8
9
10
Self monitors
0
1
2
3
4
5
6
7
8
9
10
Self corrects
0
1
2
3
4
5
6
7
8
9
10
Shows frustration when
not understood
0
Never
Sometimes
Always
1
2
3
4
5
6
7
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
FLUENCY
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Always
Never
Sometimes
Is non-fluent
0
1
2
3
4
5
6
7
8
9
10
Has sound repetitions
0
1
2
3
4
5
6
7
8
9
10
Has word repetitions
0
1
2
3
4
5
6
7
8
9
10
Prolongs or stretches
certain sounds
0
1
2
3
4
5
6
7
8
9
10
Has blocks/gets stuck on
specific sounds
0
1
2
3
4
5
6
7
8
9
10
Shows unusual facial
movements when
talking
0
1
2
3
4
5
6
7
8
9
10
Shows unusual body
movements when
talking
0
1
2
3
4
5
6
7
8
9
10
Is frustrated by nonfluency
0
1
2
3
4
5
6
7
8
9
10
Loses eye contact during
non-fluency
0
1
2
3
4
5
6
7
8
9
10
0
1
Never
2
3
4
5
6
7
8
9
10
0
2
Actively avoids speaking
situations
Shows awareness of
non-fluency
1
Sometimes
3
4
5
6
7
Always
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
VOICE
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Always
Sometimes
Never
Is easily understood
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate
quality of voice & is
easy to listen to
0
1
2
3
4
5
6
7
8
9
10
Speaks with
appropriate speed
0
1
2
3
4
5
6
7
8
9
10
Speaks with
appropriate volume
0
1
2
3
4
5
6
7
8
9
10
0
1
2
3
4
5
6
7
8
9
10
Is able to project voice
without effort
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate
breathing to support
speech
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate pitch
(not too high or low)
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
SOCIAL SKILLS
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Sometimes
Never
Always
Takes turns
appropriately
0
1
2
3
4
5
6
7
8
9
10
Uses eye contact
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate facial
expressions when talking
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate body
language when talking
0
1
2
3
4
5
6
7
8
9
10
Makes friends
0
1
2
3
4
5
6
7
8
9
10
Interacts with other
children
0
1
2
3
4
5
6
7
8
9
10
Interacts with adults
0
1
2
3
4
5
6
7
8
9
10
Interacts with unfamiliar
people
0
1
2
3
4
5
6
7
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
EMOTIONAL WELL-BEING
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Sometimes
Never
Always
Shows feelings appropriately
0
1
2
3
4
5
6
7
8
9
10
Shows good self esteem
0
1
2
3
4
5
6
7
8
9
10
Shows appropriate levels of
confidence
0
1
2
3
4
5
6
7
8
9
10
Participates/engages in class
0
1
2
3
4
5
6
7
8
9
10
Actively joins in & participates
in the playground
0
1
2
3
4
5
6
7
8
9
10
Participates in extra-curricular
activities
0
1
2
3
4
5
6
7
8
9
10
Shows an interest in a variety of
hobbies
0
1
2
3
4
5
6
7
8
9
10
Shows an awareness of events
around them
0
1
2
3
4
5
6
7
8
9
10
Is able to make friends
0
1
2
3
4
5
6
7
8
9
10
Appears happy
0
1
2
3
4
5
6
7
8
9
10
Is aware & responsive to
people’s feelings
0
1
2
3
4
5
6
7
8
9
10
Sometimes
Always
Never
Bullies others
0
1
2
3
4
5
6
7
8
9
10
Is being bullied
0
1
2
3
4
5
6
7
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
BEHAVIOUR
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Never
Always
Sometimes
Understands boundaries set
0
1
2
3
4
5
6
7
8
9
10
Follows rules
0
1
2
3
4
5
6
7
8
9
10
Controls anger appropriately
0
1
2
3
4
5
6
7
8
9
10
Deals with conflict
appropriately
0
1
2
3
4
5
6
7
8
9
10
Is kind & considerate to others
0
1
2
3
4
5
6
7
8
9
10
Deals appropriately with
consequences of actions
0
1
2
3
4
5
6
7
8
9
10
Is able to monitor behaviour
0
1
2
3
4
5
6
7
8
9
10
Always
Never
Sometimes
Shows inappropriate levels of
aggression
0
1
2
3
4
5
6
7
8
9
10
Is disruptive
0
1
2
3
4
5
6
7
8
9
10
Gets into trouble frequently
0
1
2
3
4
5
6
7
8
9
10
Appears Isolated
0
1
2
3
4
5
6
7
8
9
10
Is distractible
0
1
2
3
4
5
6
7
8
9
10
Name:
DOB:
Autumn
□
Spring
□
Summer
□
Setting:
Intervention:
Complete d by:
Date:
EATING & DRINKING
Please rate the child’s performance on each of the categories below by placing a cross along the line corresponding to the number
that best describes the child’s performance.
Never
Always
Sometimes
Eats independently
0
1
2
3
4
5
6
7
8
9
10
Enjoys meal times
0
1
2
3
4
5
6
7
8
9
10
Participates in
mealtimes to the best
of their ability
0
1
2
3
4
5
6
7
8
9
10
Uses appropriate
equipment/utensils
0
1
2
3
4
5
6
7
8
9
10
Eats food with a range
of flavours
0
1
2
3
4
5
6
7
8
9
10
Eats food with a range
of textures
0
1
2
3
4
5
6
7
8
9
10
Eats without gagging
0
1
2
3
4
5
6
7
8
9
10
Eats/drinks without
coughing
0
1
2
3
4
5
6
7
8
9
10
Accepts touch to and
around the face
0
1
2
3
4
5
6
7
8
9
10
Working in Partnerships and
Making Connections
 Necessity and no longer an option. Drivers include:
 Nature and complexity of disorders (for e.g., dementia)
 Pervasive and long term nature of disorders (e.g.
developmental SLCN)
 Comorbidity of many of the disorders (e.g., LI and BESD)
 Impact of SLC difficulties on all areas across the lifespan
 Serving more for less
 Moving into unknown territories (e.g., respiratory medicine)
 Centrality of service users
Integrated and sustained collaborative
service delivery
Leading Transformation and Innovations
 Technological advances – telemedicine and tele-health (videoconferencing and Skype in aphasia
intervention)
 Filling the GAPs: research
and practice in areas of need:
older children and young
people with SLCN, enabling
workforce , re-enablement and
community rehabilitation
“All that is necessary to break the spell of
inertia and frustration is this:
Act as if it were impossible to fail. That
is the talisman, the formula…which turns
us from failure to success.”
Dorthea Brande
Leaders…wake people out of
inertia. They…get people excited
about something they’ve never
seen before, something that does
not yet exist
Rosa Beth Moss Kanter
Thank You