The Symbol and DSA co-worker networkincreasing the availability of speech and language therapy for people who have Down’s Syndrome What is the co-worker network? Symbol UK and the Down’s Syndrome Association developed the co-worker network to train staff and support local networks to run speech and language groups that assist people who have Down syndrome to develop their communication skills. Local networks bring together co-workers, families, and speech and language therapists from NHS services or independent practice. Co-workers run the speech and language groups, supervised by speech and language therapists who have specialist skills in addressing the needs of people who have Down Syndrome. Local networks arrange funding, administration and publicity for the service, and identify the age groups that their groups serve. Co-workers are people with experience of providing support for people with Down’s Syndrome and their families, who undertake training in carrying out speech and language therapy activities that address the profile of communication difficulties associated with Down’s Syndrome. Speech and language therapists can develop specialist skills in addressing the needs of people who have Down syndrome through a range of means, including the Specialist Development Programme provided by Symbol. An accreditation scheme is available to offer quality assurance to those who use the services. This requires local services demonstrate that they work to the network’s standards. The co-worker network links local networks who provide accredited services with Symbol UK Ltd for quality assurance and continuing support and training. page 1 Progress: 2005-2012 Our initial training course provided in Summer 2005 lead to the formation of 10 co-worker lead services in England and Northern Ireland. The training was repeated in London in Spring 2008, Spring 2009 and in Autumn 2010 and Spring 2012 in initiatives with Early Support Wales, with a further course in Summer 2012 hosted by a local network in Hertfordshire. Supervising speech and language therapists have been recruited from supportive NHS services, and local independent practitioners. The initially a high level of demand for Symbol UK Ltd to provide supervising speech and language therapists has been superseded by the majority of groups being supervised by local speech and language therapists in independent practice or from the NHS. Network standards have been developed so that families and services can have confidence that services are approved as providing well structured and high quality speech and language therapy activities. Some groups have used the network’s registration and audit mechanisms for quality assurance. Training opportunities Training for co-workers takes place over 3 days, 4-6 weeks apart. This has been hosted by the Down's Syndrome Association at their head office in Teddington, as well as in conjunction with local networks who have 'bought in' training for their own co-workers and sold places to other networks. Please contact barbara.flook@symboluk.co.uk with enquiries and to go on our mailing list for training dates. We suggest that you start completing the application form and send it to us, with missing information to be completed when available, to inform us of your plans so that we can assess numbers of trainees ready to undertake the course. Closing dates for applications are usually 1 month before the training starts. New supervising speech and language therapists are requested to attend for the morning of day 1 for briefing about the network and how it operates, and on supervising co-workers within this network. Local network organisers may also attend if they wish to do so. Supervising speech and language therapists can develop specialist skills and knowledge in working with people with Down syndrome through a range of means. Symbol's specialist development programme for speech and language therapists model is advertised in Symbol's Life and Learning brochure available on our website: www.symboluk.co.uk. This provides in depth information supporting the approaches presented to co-workers. page 2 Background to the co-worker network Researchers and experts in the field recommend that people who have Down’s Syndrome have access to speech and language therapy that comprehensively addresses the challenges of speech production, expressive language and communication associated with the syndrome1. Clinical experience indicates that group sessions are a very effective way of promoting skill development, and supporting individuals and families. The co-worker network has been established in response to difficulties that families, schools and others experience when trying to secure speech and language therapy input for people with Down’s Syndrome. Statutory funding does not enable NHS services to provide comprehensive speech and language therapy input for all people who have Down’s syndrome. Many people who have Down’s Syndrome do not have access to therapists with specialist knowledge about the communication impairments associated with the syndrome and effective ways of addressing these. Symbol UK Ltd and the Down’s Syndrome Association have provided a specialist training course for speech and language therapists at least annually since 2005: ‘Effective Speech and Language Therapy for people with Down’s Syndrome’. Many of therapists with this training are not in a position to provide intensive, weekly speech and language therapy sessions, and many people who have Down’s Syndrome receive speech and language therapy from therapists who do not have specialist knowledge about Down’s Syndrome. Rationale behind the co-worker network We are confident that co-workers supervised by specialist speech and language therapists provide effective, and otherwise unavailable input to address speech, language and communication therapy input. Co-worker led groups are supervised by speech and language therapists with specialist skills in working with people who have Down’s Syndrome: the speech and language therapists set individualised targets for each person who attends the groups, to ensure that their speech and language therapy needs are addressed in an appropriate manner, as determined by a qualified and specialist speech and language therapist. The co-worker network was initially conceived as part of the National Strategy for Speech, Language and Communication (2005-2010), that set out initiatives to improve support to overcome communication challenges for people who have Down Syndrome. The strategy set out a joint plan of action by the Down’s Syndrome Association and Symbol UK Ltd, and was devised by Tessa Duffy, Fellow of the Royal College of Speech and 1 See leaflet on DSA website www.downs-syndrome.org.uk: HOW MUCH IS ENOUGH? Speech and language therapy provision for school aged children who have Down's syndrome, and booklets from the Down Syndrome Issues and Information Series (DownsEd): Speech and language development for individual with Down SyndromeAn overview, for infants (0-5); for children (5-11); for teenagers (11-16) available from: www.downsed.org/Publishing/. page 3 Language Therapists, Director of Symbol UK Ltd, and Speech and Language Advisor to the Down’s Syndrome Association. The National Strategy identified a number of ways to increase the provision of speech and language therapy, including the development of training and support for a network of speech and language co-workers, for children and adults with Down Syndrome. The rationale behind the co-worker network was described in a detailed proposal (2004). Key points are presented below. Key points from the proposal to form a co-worker network (2004) 1. People who have Down’s Syndrome need speech and language therapy. 1.1 Current research and empirical evidence from practitioners, indicates that people with Down syndrome have a predictable profile of speech, language and communication difficulties. This profile includes the existence of sensory disturbance and eating and drinking difficulties. 1.2 Research conducted in Belgium, indicates that there are some individuals with Down syndrome who have a typical profile of communicative competence. 1.3 The experience in this country is that all children present with a disordered profile of communication skills albeit individuals may be differently affected. 1.4 Despite a dearth of evaluative studies, it is clear to clinicians practising with people with Down syndrome that the identified profile of speech, language and communication may be assisted and to some considerable extent remediated, through the provision of targeted intervention of a specialist nature. 1.5 Parents and carers of people with Down syndrome are not concerned with the achievement of perfect speech, but they are concerned to ensure that their relative with Down syndrome is given every opportunity to develop their own personal potential. 2. Current speech and language therapy provision is limited and insufficient 2.1 People with Down syndrome are entitled to support to develop their speech, language and communication through the provision of speech and language therapy services. 2.2 The provision of such services at the pre school stage is the responsibility of the NHS. The service is part of primary care services and as such, children have no statutory right to this service. The provision of speech and language therapy services varies widely across the country. Provision depends upon local identification of need, community priorities and resourcing levels. 2.3 At school age, the provision of speech and language therapy services more commonly and properly, rests with the Local Education Authority. Parents who have fought, often through to tribunal, to ensure that provision is available, are too often disappointed to then receive services that are delivered by inexperienced therapists with little knowledge of the needs of children with Down syndrome. 2.4 The lack of speech and language therapists is a serious factor. There are approximately 8,000 practising Speech and Language Therapists in this country to meet the needs of hundreds of thousands of people with communication difficulties. page 4 2.5.1 Speech and language therapists treat clients with all forms of disabilities, including people with head injuries, stroke, physical disabilities, learning disabilities and children with developmental disorders, fluency and speech disorders. People with Down syndrome are but one group of individuals requiring speech and language therapy. 2.5.2 There are approximately 20,000 children with Down syndrome under the age of 16 years in this country. When we consider the numbers of adults that number more than doubles. Each speech and language therapist would need to hold a caseload of 5 clients with Down syndrome, in addition to all other communication impaired clients. 2.6.1 In addition to recognising the particular communication difficulties experienced by people with Down syndrome, we are also aware of the particular models of service that most effectively meet their needs. Children and adults with Down syndrome learn at an accelerated rate and sustain that learning most effectively, when they receive specialist intervention in a group setting coupled with opportunities to engage in a language rich environment. Children and adults do well in an atmosphere of high expectations and realistic goals. 2.7 Across the UK there are few services that offer intervention in the way described above. Increasingly, NHS services are beginning to emulate these models of good practice, but currently these remain few and far between. 3. The co-worker network is proposed as a mechanism for increasing provision for people with Down Syndrome 3.1 Quite clearly the current situation requires a radical and innovative solution. We cannot expect the answer to lay in the future provision of speech and language therapy services. The limited specialist resources need to be employed in the most efficacious manner to meet the needs of the maximum number of people with Down syndrome. 3.2 The development of an extensive education and development programme for professionals in health and education services is an important component to any plan to meet needs but will not in itself, be sufficient. It will not meet the needs of children awaiting services today. 3.3 We would like to set up a network of services for people with Down syndrome delivered by trained co-workers recruited from a range of backgrounds across the country. 3.4 This network would be established through: • The recruitment of personnel with an interest in enabling the development and life opportunities of people with Down syndrome, working under the direction of specialist speech and language therapists’, providing targeted, evidence based intervention to our population; • The development of a modular training programme aimed at the remediation of the speech, language and communication needs of this population; • The development of a supervision network staffed by speech and language therapists; • The development of a practice manual. What does setting up a local network entail? The co-worker network is designed to be flexible and existing co-worker led groups use a number of different models working with schools, local parent led groups, NHS speech and language therapy departments, Portage services and other partners. Rather than prescribing how services should be set up, the application process offer page 5 the opportunity to outline plans and get feedback on putting the necessary arrangements in place. The three part application forms are at the back of this pack, with completed examples to provide guidance if needed. Requirements include: Commitment to the principles of the network. Co-workers should have some relevant experience and attend full training course. Identified speech and language therapist who will supervise the co-worker(s). A local network that will act as a point of contact for individuals/families who wish to join groups. The requirements of local networks, co-workers and supervising speech and language therapists are set out in a checklist on page 9. Most co-workers work with specific age ranges, for example babies and preschool children, or young adults. Coworkers usually work one or more days per week during term time, with groups 2-6 individuals organised by age and communication skills. As well as running group activities, co-workers also keep records and share information with parents and carers. Co-workers work closely with speech and language therapists, seeking support and taking direction provided through supervision at minimum once a term after initial set up. Co-workers are expected to carry out activities as taught on the co-worker course and directed by speech and language therapists, and to adhere to standards of good practice. Next steps for local networks We suggest that local networks aim to have at least two trained co-workers so that services can continue in the event of a co-worker becoming unavailable. NHS speech and language therapy departments may wish to put forward pairs of therapists and assistants to augment existing provision. Local networks of families, Portage services, education support services, groups for young people with Down’s Syndrome, schools or school clusters, FE colleges and other provision for adults could approach local NHS speech and language therapy services and/or local independent speech and language therapists to provide supervision. The project aims to ensure that co-worker groups are supervised by local speech and language therapists so that the project supports development of local experience and expertise, and to ensure time-effective use of speech and language therapists and cost-effective use of funds. Local networks can approach Symbol UK Ltd to discuss ‘buying in’ supervision, subject to availability of staff, to assist in the development of local provision. Groups will be asked to explore local options for supervision, page 6 including local NHS speech and language therapy services, and speech and language therapists in independent practice. The training courses Details of the training for speech and language therapists and co-workers and are outlined on page 10 and 11. Training is provided by speech and language therapists from Symbol UK, an independent organisation provides a range of specialist service for people with learning disabilities. Symbol UK are leading specialists in the field of speech and language therapy for people with Down’s Syndrome, and act as speech and language therapy advisors to the Down’s Syndrome Association. Ongoing support after initial training Network standards provide a framework to guide the development and running of services. Requirements include providing information about the service, an outline of a complaints procedure, and regular supervision for coworkers including support and guidance with continuing professional development (CPD). Full details and the rationale for these are given on Day 1 of the course. Co-worker network study days provide opportunities for coworkers, supervising therapists and local network organisers to get together to share successes, challenges and solutions, and extend their knowledge around specific topics. Experienced co-workers are invited to consider attending modules 3.1 and 3.2 of Symbol's Specialist Development Programme (see details in our Life and Learning Brochure) to further their knowledge of interventions for this client group. . Registering as part of the Symbol and DSA co-worker network Local networks are invited to undertake annual audit to demonstrate that they comply to the network’s standards through completing and submitting a self-audit with copies of evidence (e.g. copy of service leaflet). Additional aspects of the service will be randomly audited: groups will be asked to provide further evidence for specific aspects of the service (e.g. copy of individual co-worker’s CPD plan), and in future, visits will be made to services. Networks that choose to participate in these processes and demonstrate that they comply with the coworker network standards can state that they are part of the Symbol and DSA co-worker network. page 7 The steps to gain and maintain membership of the network include: • • • • • Complete satisfactory initial application Submit service information for registration on setting up local network and service. Complete annual self audit (‘paper audit’) Submit further info as required by random checks (‘spot audit’) Participate in more detailed audit through visit from Symbol staff member (‘audit visit’), for services selected from time to time. Submitting an application Networks wishing to train co-workers should complete the three part application form (attached), with sections to be completed by a representative from the local host network, by each person who wishes to train as a coworker, and by the supervising speech and language therapist. Please use this article, and the example completed forms, to inform your application. Please return all three parts of the application together. Co-workers will be accepted onto the training course from groups/services that are in a position to set up and run a local network (or working towards this!). Please send enquiries or applications to barbara.flook@symboluk.co.uk in the first instance. page 8 Checklist for setting up co-worker led groups Local networks will need to: □ □ □ □ □ □ □ Ascertain that there is local need and demand for the project, and liaise with local speech and language therapy services. Identify the age range of people with Down’s syndrome who would like to take part. Set up a group or identify an organisation to run the project (make decisions, deal with problems, hold bank accounts, act as a contact point for local families and services, and employ the co-worker if not hosted by another organisation). Identify local staff: co-worker(s) and supervising speech and language therapist. Secure an appropriate venue for groups. Plan how to fund the service, including payment of staff, buying equipment, and paying for a venue. Groups have secured support through approaching local services who may loan a venue at low or no cost; fundraising and applying for grants; and charging individual families. Administer the group: send out information and publicise the group, act as a contact point for people who want to join, administer money and payments. Co-workers need to: □ □ □ □ □ □ □ □ Have experience of training/working with the proposed age group that the service will cater for. Have, or gain experience of working with/supporting people who have Down’s Syndrome. Make a commitment to the local project. Be available to work a minimum of one day per week during term times. Attend 3 days training (one day per month over 3-4 months). Complete tasks between training days which may include contacting local services, observing speech and language therapy sessions or other activities, carrying out tasks with clients, reading, developing skills (e.g. signing) through self directed learning or attending courses. Attend further training/study days after completing initial training. Work with local speech and language therapist(s). Speech and language therapists need to: □ Have or develop specialist skills in providing speech and language therapy intervention for people with Down’s Syndrome, including a comprehensive knowledge of interventions recommended for this client group. □ Attend specialist training for speech and language therapists working with people who have Down Syndrome, or demonstrate that they have gained specialist knowledge through equivalent Continuing Professional Development activities. □ Make an undertaking to support the local project, with commitment from service managers where applicable. □ Provide termly supervision for the co-worker, with more intensive support during the start-up phase if needed. A minimum of once a term, the speech therapist will accompany the co-worker in their usual working pattern, observing sessions, modelling activities, and setting targets with the co-worker. □ Carry out more detailed assessment where required, and identifying appropriate strategies when other input is required (e.g. management of hearing difficulties, assessment and advice for complex eating and drinking difficulties). □ Be available to provide support to the co-worker as needed (for example, providing advice by phone, and responding to unanticipated events). □ Be available as a resource for parents and carers, providing additional advice and information when needed. page 9 Specialist development programme for speech and language therapists working with people who have Down syndrome: Module 1: An in depth introduction to Down syndrome and the Down syndrome community for speech and language therapists, teachers, psychologists, and other practitioners and researchers Comprehensive information about Down syndrome including genetic basis, historical perspectives, and support networks. A specific profile of health and sensory issues across the lifespan Psychosocial issues at ages and stages, mapping lives and life issues. A specific profile of speech, language and communication: features and implications What does research tell us? Total communication and supporting comprehension: how do we make verbal language accessible? A specific learning style Designing and delivering intervention; gaining participation and dealing with behaviour issues. Module 2: The research base and Evidence Based Practice- Principles for assessment, goal planning and intervention for speech and language therapists Module 3.1:Intervention targeting language and social communication for speech and language therapists and highly experiences/specialist speech and language therapy support practitioners Module 3.2: Intervention targeting speech and feeding for speech and language therapists and highly experiences/specialist speech and language therapy support practitioners See our Life and Learning Brochure for upcoming training dates, or contact barbara.flook@symboluk.co.uk for information. page 10 The co-worker training course The training focuses on addressing the learning style and communication impairments associated with Down’s Syndrome, and does not prepare co-workers to provide this kind of service to people with other diagnoses. For co-workers who work with a wider range of special needs, many of the techniques and strategies may be effective with other people who have learning difficulties and/or communication difficulties. DAY 1 The co-worker project; About Down’s Syndrome; About communication impairments and developing communication skills Introduction to the co-worker network for co-workers and new supervising speech and language therapists. Introduction to content of groups and overview of approaches to building communication, to language development, and to developing speech skills. About Down Syndrome: continuities and differences between individuals; history of opportunities and provision; philosophy of ordinary living and inclusion; importance of expectations and opportunities; profile of needs: physical, medical, learning style; profile of speech and language impairment. Working with different age groups DAY 2 Addressing the specific needs of people who have Down Syndrome: Techniques to use Curriculum of areas to address and activities to address these including: Listening, attention and turn taking skills; Play skills; Oral motor skills; Speech production skills and phonological awareness; Vocabulary skills; Expressive language skills; Narrative skills; Auditory memory skills; Whole word recognition skills; Social communication skills; topics for preschool children and older groups. Promoting development of eating and drinking skills; Signing; Reading; Working in partnership with families and carers. DAY 3 Planning sessions and presenting activities Tailoring activities to learning style associated with Down’s Syndrome; presentation skills; choosing and making equipment Planning and running sessions: Understanding baseline skills; Accommodating needs of individuals within a group; Structuring a group session: termly plans and session plans; Sequence of activities, beginnings and endings; Goal setting, SMART targets, and recording outcomes; Maintaining motivation and managing avoidance behaviours; Managing equipment and the environment. Setting up groups: Establishing networks of local users and providers; Liaising with local SLT services; Gathering information about participants and planning groupings; Setting up and planning the first session; Running the block of group sessions; After the first block of sessions. page 11 The co-worker network Application Form Part I: to be completed by host organisation Proposed name of local network: Completed by: Role: Email address: Postal address: Phone: Location (town or place where you anticipate groups will be provided): Covering area (where people will attend from): Partner organisations: Proposed age range to be served by the group and rationale for this: Please give brief information about existing provision for people with Down’s Syndrome and their families from each of these partner organisations: What aspects of the project will each partner organisation fulfil? How will these be funded? Have you contacted local NHS speech and language therapy service manager(s) about the proposed co-worker provision? If yes, please give name and position of contact and brief notes on their response Proposed co-worker(s) and current position(s): Availability to work on the project: Projected employment arrangements for the project: Signed: Date: The co-worker network Application Form Part II: to be completed by prospective co-workers (please complete one form for each applicant) Proposed name of local network: Prospective co-worker’s name: Current position: Email address: Postal address: Phone: Location: (place where you anticipate groups will be provided) Availability to work on the project: Please describe previous experience of supporting people who have Down’s syndrome and their families: Please describe previous experience of speech and language therapy: What skills, knowledge and experience do you have already that you will bring to the role? What skills and knowledge do you need to develop before taking on the role? Any other information, including any queries or concerns: Signed: Date: The co-worker network The co-worker network The co-worker network Application Form Part III: to be prospective supervising therapist Name: Job title: Current role: Email address: Postal address: Phone: Location (place where you anticipate groups will be provided): Proposed employment arrangements for the project: Previous experience of working with people who have Down’s Syndrome and their families: Previous experience of supervising speech and language therapy support workers: Do you consider that you already have specialist skills in working with people who have Down’s syndrome? If yes, please describe how you developed these. If no or incomplete, please indicate whether you plan to attend specialist development training with the DSA or other CPD activities to develop skills. Any other information: Signed: Date: The co-worker network: Example of completed form Application Form Part I: to be completed by host organisation Proposed name of local network: Horley Completed by: Amy Cole Role: Chair of Parent Support Group Email address: acole@gmail.com Postal address: 3 The Avenue, Horley Phone: 01273 333777 Location (town or place where you anticipate groups will be provided): Horley Covering area (where people will attend from): Horley, Grinstead and surrounding area. Partner organisations: “ups and downs” local parent support group; Coastal Sussex NHS Trust speech and language therapy service Proposed age range to be served by the group and rationale for this: school aged children, mainly primary. The NHS speech and language therapy service already provides preschool groups, all families linked to our support group who are looking for additional SLT have school aged children, mostly aged 5-9 and two 12 year olds. Please give brief information about existing provision for people with Down’s Syndrome and their families from each of these partner organisations: Our parent support group meets termly and occasionally organises social events; speech and language therapy service offers around 2 blocks of 8 weekly speech and language therapy groups for preschool children with DS, 6 monthly review and advice for pupils in mainstream schools, and one or two blocks of weekly group therapy per year for pupils in Special schools. What aspects of the project will each partner organisation fulfil? How will these be funded? Parent support group will employ and fund the co-worker post and training, and therapist’s attendance at specialist development training course. Parent group is fundraising and applying for grants . Speech and language therapy service will provide venue and supervision for co-worker from existing budget. Have you contacted local NHS speech and language therapy service manager(s) about the proposed co-worker provision? If yes, please give name and position of contact and brief notes on their response Yes, Jane Smith the service manager has agreed to provide the venue and therapist initially for two years. After that, they will review arrangements. Proposed co-worker(s) (name, current position): Cara Long, currently stay at home mum. Availability to work on the project: 9.30-3pm, up to two days per week term times from Jan 08 Projected employment arrangements for the project: The Parent Support Group will employ Cara Signed: Date: The co-worker network: Example of completed form Application Form Part II: to be completed by prospective co-workers (please complete one form for each applicant) Proposed name of local network: Horley Prospective co-worker’s name: Cara Long Current position: Stay at home mum Email address: long@gmail.com Postal address: 27 Ifield Road, Horley Phone: 01273 123456 Location (town place where you anticipate groups will be provided): Horley Availability to work on the project: 9.30-3pm, up to two days per week termtimes from Jan 08 Please describe previous experience of supporting people who have Down’s syndrome and their families: I have acted as a parent contact for new families for our local support group for 3 years, and have spoken to people on the phone and some have come to visit our family. My middle son who is now 7 has Down’s Syndrome. Please describe previous experience of speech and language therapy: When my son was little I took him to preschool language groups run by our local speech therapy service. I speak to his speech and language therapist from time to time and have talked to his TA at school about carrying out the speech and language therapy programme that the therapist provided. What skills, knowledge and experience do you have already that you will bring to the role? Before having children I used to work as a children’s librarian and ran story sessions for preschool children and key stage 1 children. Since my son was born I have been to a couple of conferences about Down’s Syndrome and read up a lot about speech and reading. We used to sign when my son was small but haven’t used signing for a while. What skills and knowledge do you need to develop before taking on the role? I need to refresh my knowledge of the activities we did in groups when my son was small and revive and improve my signing skills. I feel I know less about working with school aged children and need to learn about speech and language therapy for this age group. Any other information, including any queries or concerns: I’m least confident about working with the two 12 year old who are part of our group because I haven’t spent much time with that age group. I’m not sure whether it will work for me to work with my own son in groups but I don’t want him to miss out. Signed: Date: The co-worker network: Example of completed form Application Form Part III: to be completed by prospective supervising therapist Name: Jessica Marsh Job title: Specialist speech and language therapist Current role: I work two days a week in our Child Development Centre, and two days in a special school catering for all needs, ages 4-16. Email address: jmarsh@coastalnhs.net Postal address: Speech and language therapy department, Central Clinic, Horley Phone: 01234 123456 Location (town or place where you anticipate groups will be provided): Horley Proposed employment arrangements for the project: I will be released from sessions at the Child Development Centre to attend training and thereafter 2 days per term to work on the project, working as part of my employment with the NHS Trust. Previous experience of working with people who have Down’s Syndrome and their families: I have worked with children who have Down’s Syndrome aged 2-16 for five and a half years as part of my special needs caseload. I work closely with families in the preschool service. Previous experience of supervising speech and language therapy support workers: I supervise an assistant who works 1 day per week in the special school. Do you consider that you already have specialist skills in working with people who have Down’s syndrome? If yes, please describe how you developed these. If no or incomplete, please indicate whether you plan to attend specialist development training with the DSA or other CPD activities to develop skills. I think my skills are probably ‘incomplete’. Provided that the parent group has been successful in fundraising to pay course fees, my manager has agreed I can attend the training in Autumn 07or Spring 08. Any other information: Our service is also considering whether we could train an assistant to work with preschool children in our groups, but it’s unlikely we can make arrangements in time to get someone trained this year. Signed: Date: