Developing Supported Conversation across the Trust

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PAT MACKAY SLT
ROYAL WOLVERHAMPTON NHS TRUST
OXFORD AAC SIG – 16/5/2013
Supported Conversation training in
Wolverhampton
• Connect Website
• 2004 – needed change/alternative to
impairment based therapies
• Already involving training for families/
carers/staff – information giving
• New stroke guidelines (2004)
• Alex Stirling – Changing Attitudes to
Conversation in an Acute Setting
• Aura Kagan (1989) describes supported
conversation as a method where “The
partner acts as a resource for the person
with Aphasia and actively shares the
communication load. Supported
Conversation provides conversation
partners with methods and materials for
achieving this goal”
Key ideas
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Acknowledge and reveal Competence
Social, not medical model
Equal responsibility in a conversation
Conversation Props and Ramps message in and message out
• Total communication environment
Conversation Props and Ramps
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Writing
Gesture
Drawing
Pictures – magazines, newspapers, photos,
Books, diaries, calendars, life books, SCA resource
manual, relevant ‘remnant’ objects, initiators
• Communication books/ Communication passports
• NB other issues - taking turns, quiet surroundings,
taking your time
• Attended various Connect courses
• Flesh on the bones of what we were trying to
do
FIRST STEPS!
• Feedback and planning day ’05
• Brainstorming session – pros and challenges
• Long and short term goals – actions
PLAN OF ACTION
• Training in Social Model approach
SLTs, HCPs, expert patients
• Training ourselves as trainers
• User-friendly resources
• Creating opportunities for carers to see props and
ramps being used
• Creating own life books
• Enabling others to make life books
• Politics
• Groups – total communication (in and out
patients)
• SLT rooms more aphasia friendly
WHAT WE DID!
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Devised training package
Selected pilot base (neuro-rehab)
Offered monthly
Advertised with flyers and direct contact with
relevant managers
• Fitted in with mandatory nurse training
• Opened it up to all hospital staff
• Extended to acute hospital and the
community
• Adapted leaflets/hand-outs to be more
aphasia friendly
• Requested feedback from Functional Group
(clients with aphasia)
• Put up aphasia friendly signage around
hospital
• Wards provided with communication resource
box (props and ramps)
• Communication tips sheets at beds
• Symbol based drinks/snack choices for drinks
trolleys
• Weekly In/out patient communication group
(supported conversation focussed)
Supported Conversation
Speech & Language Therapy
Wolverhampton City PCT
2012
Acknowledgements:
Alex Stirling
Carole Pound
Aura Kagan
Connect
‘Supported Conversation’
• Communication – what is it and why is it so
important ?
• What happens when it goes wrong ?
• Supporting and helping communication
• Practical session and feedback
• Evaluation forms
Communication…….
• …….what does it involve ?
Why do we communicate ?
Think about different kinds
of communication difficulties
How would it feel if you couldn’t communicate
?
How would it affect your life ?
WHAT IS A CONVERSATION?
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Two way
Listening and talking
Spontaneous, not planned
Information exchange
Opinions and ideas
Fun, enjoyment, social connection
Who you are
Conversations and aphasia
Just the same but …..
• Both people need to work harder
• Both people need to be flexible and
resourceful
• Use strategies as well as speech
• Allow time for the conversation
• Give the person plenty of time
Examples of good and bad
conversations
Watch the DVD
Supporting and helping
communication
Message In - Message Out
• Message In
How we help someone understand our
message
• Message Out
How we help someone get their message
across
Support Modes
Drawing
Writing things down
Gesture/Pointing
Pictures
• helps get the message IN
• helps hold the message
• helps get the message OUT
Feedback
“I don’t feel so useless” (Rehab counsellor)
“It made me really think about how I communicate with
people who have aphasia .. Certainly take on board all
the ideas.. Have learned a lot “ (OT)
“I know what I should be doing now..” (counsellor)
“I have found this very useful and will continue to practise
and use these skills in my job” (enrolled nurse)
“I feel more confident to converse with people who have
communication difficulties” (HCA)
“It made me think more about how I can communicate
with people and how I need to give more time and
patience” (Housekeeping assistant)
What worked and what started well but faded…
• Training ourselves as trainers
• User-friendly resources - Adapted
leaflets/handouts to be more aphasia
friendly and put up aphasia friendly signage
around hospital
• Communication tips sheets at beds
• Symbol based drinks/snack choices for
drinks trolleys
• Enabling others to make life books
• Politics
• Groups – supported conversation/total
communication (in and out patients)
• SLT rooms more aphasia friendly
• Creating opportunities for carers to see
props and ramps being used
• Creating own life books
• Opened it up to all hospital staff
• Extended to acute hospital and the
community
• Wards provided with communication
resource box (props and ramps)
• Fitted in with mandatory nurse training
• Previously using role modelling as practise
• Now wanted to make it more realistic
HOW?
• 2 SLTs attended further Connect led training –
Training the Trainers
• Involved volunteers from around the region who
have aphasia being trained to be involved in
training Health Care Professionals
• learn how to give useful feedback about how
someone’s communication partner skills
• invited to participate in SC training in the region
• While first part of SC training is going on, SLT goes
through Training the Trainers presentation to
remind them/support them in what they
previously learned
Things to think about
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Travel arrangements
Travel costs
Payment?
Physical access to training area/toilets etc
Need more than 1 SLT for the SC training
Inevitably a longer training session overall and
so not suitable to fit into nurse mandatory
training times
• However, MUCH more effective!!
Who to target?
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New SLTs
AHPs in neuro rehab setting
Nurses on stroke unit
Early Supported Discharge team (AHPs plus
rehab technicians)
• Other staff in neuro rehab setting – dietician,
clinical psychologist
• Social workers linked with neuro team
Changes to training
• Longer than that offered during mandatory nurse
training (3 hours)
• Includes some practical time with trainers
• “Try it for real!”
– 15 minute conversation with someone who has a
communication difficulty (plus an observer)
– 5 minutes feedback on your conversational skills
– Return to main group for summary and group discussion
BUDDY PROJECT
Supported Conversation
Training for Buddy Volunteers
Buddy Project
• Supported Conversation Training for Buddy Volunteers
• The stroke buddy scheme came about from an idea
spoken about at the Stroke Conference
• It is a way to try and help people who have had a
stroke who are finding it difficult to take part in
rehabilitation
• These people were helped more by those who had had
a similar experience than by professional staff
• Draws on key concepts of Supported Conversation for
Adults with Aphasia (Kagan, 1995)
• New project in Wolverhampton – 2011
Stroke survivors volunteer to befriend & support
other people who have had a stroke & who are
having difficulty coming to terms with their
difficulties & life changes
• Team:
– Speech & Language Therapist
– Occupational Therapist
– Clinical Psychologist
– Volunteer + Buddy
Our Role
• Ensure involvement of People with
communication difficulty as buddies.
• Devise training packages for volunteers.
• Help to develop aphasia friendly information
to enable data collection pre/post project.
• General planning and devising paperwork for
the project.
• Once the volunteers had received training
about different communication
difficulties, they were then trained in how
to support communication, and this
training is based on Kagan’s SCA approach
– Supported conversation for adults with
aphasia.
The Role of the Volunteer
• The contact might include:
• Going round to their house, having a cup of tea and a chat
• Helping them to get involved in things that interest them
The overall aim is to gently encourage the buddy to
do more for themselves, make the most of services
and get more out of life
Supervision
• Volunteers will have monthly supervision with
an allocated therapist
• This is a chance for them to discuss issues that
may have arisen and ideas to help the buddies
further
• If an emergency situation occurs volunteers
will have the number of the therapist and an
emergency contact number
Further adapting!!
• Funding for 12 months
• 2 sets of training volunteers so far
• Funding continues into second year as some
left over from initial funding
• (difficult to get buddies to ‘buy into’ the
scheme)
• So, broadened the scheme so that volunteers
act more like conversation partners rather
than encouraging buddies to engage.
ANY QUESTIONS
THANK YOU FOR LISTENING!
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