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Changes in practice

Wolverhampton City PCT Speech and Language Therapy team

Pat Mackay and her team wanted to improve their service options to clients. Not only did they want to offer something different to traditional impairment therapy, they wanted to offer practical solutions to clients, rather than just 'information giving'. They turned to Connect training to help them draw all their ideas and experiences together.

The Wolverhampton City PCT speech and language therapy team. Left to right Faye Lewis, Sally Onions, Pat Mackay, Catherine Cresswell and Heather Pascoe.

Why Connect training?

We were already aware of the importance of involving communication partners and were providing training to family, carers and staff. Also, we were looking at how we approached goal setting for our clients. The New Stroke Guidelines (2004) recommended re-informing and training staff and relatives about communication techniques and we explored Alex Stirling's project 'Changing Attitudes to Conversation in an Acute setting'. We wanted to pull some of these ideas together to help us to move forward with the service we offered to our clients.

Connect training addressed the issues we were concerned with (practical, functional therapy ideas, based on the person and their families immediate and long term needs and desires to communicate) so between us we attended:

  • Meeting the Challenges of Severe Aphasia
  • Develop your Communication Skills and Make a Difference
  • New Ways of Managing Disability
  • Training the Trainers

How did it help?

These courses pulled what we were doing together and helped us to move forward.  It showed us that we had more of a practical role in disseminating information and skills to all involved with someone with difficulty communicating, rather than a select few.  It also helped us to think of difficulties in terms of 'barriers' to be removed by both parties, rather than the client owning the difficulty.  It helped us to re think our current training to the Multi Disciplinary Team, which was at the time, more theoretical.

What were the hopes for our service?

  • A greater range of therapy options
  • we want a positive impact on all (SLTs, colleagues, clients, carers, families…)
  • we want to enable the clients more effectively
  • we want to work on what the clients can do, leading to
  • positive psychological well being/perception of competence
  • we want to gain a more positive profile for speech and language therapy
  • we would like positive job satisfaction (offering something that works)
  • we want to meet political agendas (e.g. Stroke Guidelines, modernisation agenda, RCP guidelines, disability discrimination act)
  • we want a positive impact on families and carers

How we got started

We held a feedback and planning day where we each fed back from the various Connect courses we had attended. This was followed by a brainstorming session looking at the positive aspects and the challenges, what it would involve and where to start.  We set long and short term goals and gave ourselves some actions.

We scheduled a regular slot in the monthly team meetings to discuss this new approach, and a working party was set up to move things forward. We set some targets:

1. Training in the Social Model Approach/Supported Conversation 

  • for SLTs in department
  • health care professionals in and out of Hospital setting     
  • expert patients  

2.  Training ourselves as trainers
3.  Making our service documents more accessible  – questionnaires, leaflets, signage around hospital, props for all, communication packs on the ward
4.  Creating opportunities for carers to see props and ramps being used
5.  Creating our own life books
6.  Being able to help others create life books
7.  Approaching those 'with power', pressing the right buttons, decisions regarding what to offer, when?
8.  Run groups – total communication (involving nurses, AHP's..) in and out patient
9.  Reviewing access/travel
10. Examining our SLT rooms/environment to see how we can make them more 'aphasia friendly'

What we did

We put together a training package (and evaluation forms) and piloted the training in the neuro-rehab setting.  An initial introductory session was offered to Rehab staff during an ongoing SLT slot in the monthly educational meeting and this was a chance to gain feedback from all involved.

We aimed to fit in with current mandatory training offered to nurses by liaising with nursing managers.  This was important for two reasons: we felt that we needed the nursing manager's full support in order to free up nurses time to attend and that by using the training day already in existence, we would not be creating an extra training session for them and putting more demands on their time.

The training was then opened up to all other hospital staff (kitchen staff, cleaners, porters, AHPs, medics) by the use of advertising flyers and phone contact with managers This training is now offered on a monthly, ongoing basis.

Sally Onions (right) using a communication resource pack on the ward

We asked for feedback from the current 'Functional Group' (clients with aphasia) to help with adapting our current leaflets/handouts etc to be more 'aphasia-friendly and all relevant literature has since been adapted.  Also, aphasia-friendly signage has been put up around the hospital.  Wards have been provided with a communication resource box, full of props and ramps.

  • Communication tips sheets are placed at the bed of each appropriate client, to help family and staff know how to provide better communication  opportunities.
  • Symbol based drinks/snack choices were provided for the use of hospital staff taking round the drinks trolleys.
  • We set up an in/out patient communication group (supported-conversation focussed) to be run weekly within the hospital site involving clients from different units within the hospital
  • A longer term goal was to identify and train expert patients from the communication group.

Hopes for the future

  • Improved menus (aphasia friendly)
  • Extend training and aphasia friendly signage to acute setting stroke unit
  • Increase carer/staff involvement
  • Increase confidence of staff/carers in use of supported conversation/AAC
  • Offer more practical training and support
  • Increase staff awareness of communication difficulties/barriers and link with Mental Capacity Act requirements
  • Introduce people with aphasia to training sessions to make practise more realistic
  • Produce video of therapists using supported conversation with clients and also of therapist doing patient centred goal setting with clients
  • Extend training to community settings

Back

'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', Occupational Therapist

'I have found this very useful and will continue to practise and use these skills in my job' Enrolled nurse

'It made me think more about how I can communicate with people and how I need to give..more time and patience', Housekeeping Assistant

Using supported conversation