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CONFERENCE CALLS

Conference calls:
The I CAN contingent from left: Mary Hartshorne, Rachel Brown, Kate Freeman, Jenny McConnell. (Missing from the picture is Lesley Culling.)

THE 5TH ROYAL COLLEGE OF SPEECH & LANGUAGE THERAPISTS CONFERENCE REALISING THE VISION RAN FROM 10-12 MAY 2006 AT THE UNIVERSITY OF ULSTER, JORDANSTOWN, NORTHERN IRELAND. THERE WERE 5 KEYNOTE ADDRESSES, 16 PARALLEL SESSIONS AND 66 POSTER PRESENTATIONS. RCSLT PLANS TO MAKE SOME OF THE CONFERENCE MATERIAL AVAILABLE ON ITS WEBSITE WWW.RCSLT.ORG AND THERE WILL BE A SPECIAL EDITION OF THE INTERNATIONAL JOURNAL OF LANGUAGE AND COMMUNICATION DISORDERS. THE CONFERENCE ALSO SAW THE LAUNCH OF COMMUNICATING QUALITY 3, RCSLTS UPDATED GUIDANCE ON BEST PRACTICE IN SERVICE ORGANISATION AND PROVISION.

Integrity is the key


Editor Avril Nicoll reflects on some key themes from the Royal College of Speech & Language Therapists conference Realising the Vision.
A. THE CONTEXT Professor Pam Enderby is living proof of her own pronouncement that you can never get bored with speech and language therapy. One of the foremost ambassadors for the profession, she argues that, rather than being put off by the push for an evidence informed approach, we should be excited by the opportunity for clients to benefit more from our service. Specifically, Pam says it is essential that we increase our knowledge about the size and needs of the populations we work with and that we select the right type of therapy and are clear about its aims. We also have to make sure that the available evidence actually impacts on our practice. In spite of a significant increase in the number of speech and language therapists there are - and will always be pressures. We need to look at where therapy is offered, to whom it is offered, when and how much. (While the 6 week block and the 6 month review are commonplace, these choices have no evidence behind them.) In the future, Pam anticipates we will be looking at more opportunities for independent practice and more funding through insurance, a greater skill mix, more patient choice and expectation and greater regulation and bureaucracy. She says integrity is the key to moving forward as a caring profession with a scientific base, without letting one polarise the other. Recommended action: 1. Where there is evidence, use it. 2. Where there is evidence of no benefit, dont do it. 3. Where there is no evidence, be creative and gather evidence and research. 4. Be less precious and more confident about what you promise - and about what you dont need to provide. 5. Where appropriate, be more open to enabling other professionals to take responsibility (eg. screening). 6. Go at least once a year to a multidisciplinary conference, and seek opportunities for cross-fertilisation of ideas and evidence from other disciplines. 7. Share single case studies with colleagues. Another champion of the profession, Professor Sue Roulstone, says this combination of different angles and knowledge bases is one of the things that drew her into the profession in the first place. Agreeing that our decisions should be increasingly open to being challenged, she chose to focus on the ongoing and inevitable need for prioritisation. Interestingly, she argued that our fears about service users behaving like consumers are not borne out by the reality and that problems arise when they perceive we are covert and inexplicit about our prioritisation. Exploring the factors that influence our professional judgement and decisions, she suggests we aim for the middle ground between intuition and analysis where possible. B. BEING HEARD Sue Roulstone noted that the presentation by Clem Stewart with speech and language therapist Rosalind Gray Rogers made a significant contribution to our listening and the mood of the conference. Clement Stewart had a stroke when he was 37 years old. Twenty two years later, he agreed to talk to the conference about his experience of aphasia and speech and language therapy. To my knowledge this is the first time a service user has been asked to participate in a Royal College conference, and the response from delegates suggests it is worth exploring different ways of doing this again in the future so that it impacts positively on practice and on the service user(s) concerned. Clem emphasised the importance of speech and language therapists to him, of their ability to listen and thereby reduce his explosive feeling, and of their role in stimulating laughter. He says speech and language therapists cannot have a frosted face. He saw impairment based therapy as necessary but humdrum, and liked the way that group therapy made him feel his ideas

At the conference gala dinner from left: Evelyn New, Noreen Murphy, Oriana Morrison-Clarke, Sarah Nash, Sally Murray and Jenny Moultrie.

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CONFERENCE CALLS

were not wasted. He feels very strongly that as a profession it is essential we have face-to-face and telephone contact with spouses and families, who know pre-stroke strengths and interests that can be built on - and that we remember to enquire how they are. Asked Where are you now?, Clem replied It is 22 years to stand up and talk to you with my wordsPast and future tense is there, but living the present tense is vital for meIf I can prepare this talk to you, I am mentally strong. I asked several delegates what impact this session had on them and what it will mean for their practice: I am a researcher at the moment, but starting a postgraduate speech and language therapy course this year, so this was my first contact with a person with aphasia. It was good inspirational really to hear about the qualities needed in students, and what students need to think about. I definitely feel I am suited. Ive been involved in so many conversations about the academic side of the work and evidence based practice that it has really made a difference to me to get a personal point of view this is the reason were doing it. Amy Riddett, prospective student Since Clems talk Ive discussed with colleagues and friends the way he focused on being able to laugh, and we all agree that it really helps to be cheery. Its nice to know that that first impression of a smile really does make a difference. Its also good to know that people do continue to go to different kinds of therapy even years after their stroke, and that 6 week blocks over the first year are not the end. Its lovely to hear good things about speech and language therapists and to know youre doing a good job. Victoria Young, speech and language therapist Its good to know that we are appreciated if we put the personality in and give people the motivation they need. We really noticed when he said you should ask family members - How are YOU? - and it was clear to us how important it is to involve the family. The whole relationship is so important, and we really agree that you get the work done when you have the greatest fun with a client. Sinead Fox and Katherine McBride, students We need to see people as individuals. And just because we might not think we should provide any more therapy doesnt mean we shouldnt if a person is so motivated. Sarah Heneker, speech and language therapist He expressed enormous frustration and sense of loss the battle of every day - really articulately. You do see it in kids too, but they dont know its loss. We dont talk enough as therapists with people about the emotional stuff , perhaps assuming someone else is doing it. On a practical level it maybe comes down to the time issue as were always constrained. Maggie Vance, speech and language therapist It really made us wonder how universities can accept speech and language therapy students without doing face-to-face interviews. How can you sense that warmth through an application form? We were interested to hear about the range of therapy Clem had had over the 22 years, and it reminded us that as therapists we sometimes lose sight of the functional things among all the nouns and verbs.

We have never been as affected by a presentation from a service user. He had clearly put in a lot of preparation, and we really heard his need for professionals to ask his wife How are YOU? because she misses his verbal attentions. We enjoyed the humour about him sharing homework with his grandson. Its really powerful when someone tells their story with all its deep-seated emotion and says they are glad to be alive. Libby Downie and Katy Creaney, speech and language therapists C. LEARNING Universities have seen an increase in speech and language therapy students in recent years, with a resulting pressure on placements. Parallel session 2 included an opportunity to hear how educators are rising to the challenge and, in the process, benefiting service users. Linda Collier and Karen Sage at the University of Manchester advocate a conversational partner role for 1st year students. The students have had taster sessions with three local aphasia support groups, and people with aphasia have welcomed the opportunity to evaluate their conversations and suggest ways they could improve. Volunteers are given gift tokens and some people with aphasia have gone on to become involved in research. The project has highlighted at an early stage people who are not suited to the speech and language therapy course. The success of

disorders. The videos, medical history and assessment data were used with groups of students to see how they reached a diagnosis, and the issues arising are forming the basis of learning resources for the next phase of the project. For example, students find it difficult to reach a diagnostic conclusion, so videos will be made of people doing this. What surprised me was the difficulty that the researchers had in recruiting students to take part in the project, as it sounds like an opportunity many therapists would jump at! Similarly, final year students involved in Claire Parker and Karen Sages problem-based learning project to prepare them for working with people with aphasia viewed it as an added extra at a time when they were preoccupied with final exams. Third years were more positive about the workshops which used videos as triggers to work through the problem of identification, assessment and management of the clients communication impairment, identifying group learning objectives and researching these through student-directed independent learning followed by feedback. D. ONES TO WATCH (i) User involvement The profession appears to have mixed views on the value, priority and extent to which we should be embracing the user involvement agenda. Sharon Symon cautioned that, while many allied health professionals think they do involve users in decision-making about their care, it is still very therapist-led and the majority of users are not aware they have any other options. Some researchers are focusing on ways of gathering users views about their communication difficulties and their therapy, others on methods of helping service users get their voices heard. Others have gone further and are involving users in the planning and delivery of services. Sharon Symons enthusiasm is clear: I just really look forward to going on being involved in it. (ii) Ethos Mary Wickenden is an anthropologist as well as a speech and language therapist. In talking about the views of parents of disabled children in Mumbai, she raised interesting points for reflection on the whole focus of speech and language therapy and research. Do we follow the expert style (do this); the transplant style (do this because) or the empowerment style (this or that what do you think?) Do we make enough use of narrative interviews where the storyteller decides what to tell and chooses the emphasis? Do we understand that, while impairments are universal, disability varies because it is a construct? Do we draw sufficiently on anthropological research methods such as ethnography? (iii) Economic evaluation Anna van der Gaag says as a profession we are uncomfortable with economic evaluation discussions because our education didnt cover it and it doesnt fit with our values. But the reality is that there are costs in delivering a service, costs to society and costs to individuals, and all these need to be taken into account. By engaging with health economists we will be more able to influence the debate in the direction of cost utility analysis, which adds a quality of life dimension and includes outcome data. SLTP

Go at least once a year to a multidisciplinary conference, and seek opportunities for crossfertilisation of ideas and evidence from other disciplines.
the venture means it has been extended to Sure Start and involvement with making communication passports with adults with learning disabilities. Students at the University of East Anglia are now trained as conversation partners to do outreach visits for 1 hour a week over 6 months as a clinical placement. Simon Horton and Sally McVicker explained how the partnership with Connect developed, and how the impact on clients of Connects Conversation Partners Outreach Project is subject to ongoing evaluation. They said it is particularly strongly felt by service users as an opportunity to talk and to become more confident. Students are offered tutorials, video feedback and informal phone and e-mail support, and people with aphasia are also involved in their training. Issues that have arisen include communication strategies; topic management; using and accessing resources; coping with emotions; roles and boundaries; and ending the placement - all relevant to life as a therapist. Students also need to develop clinical reasoning skills. Kirsten Hoben described how the University of Sheffield is using PATSy (the Patient Assessment and Training System) which offers access to real data on 20 adults with acquired disorders and 3 children with developmental

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