We spoke with Eva Thompson, a Speech and Language Therapist working for Suffolk County Council, in the Speech, Language and Communication Needs Education Outreach Service.
Tell me about your work as a Speech and Language Therapist (SaLT) with Suffolk County Council and the Suffolk Youth Justice Service (SYJS)?
In comparison to most SaLTs who work for the NHS, I work as part of a relatively small team of therapists for our local authority, Suffolk County Council. Three years ago, we were asked to be part of a pilot delivering SaLT services to young people alongside the SYJS. During this time, we got to know this client group and developed a good working relationship with the practitioners who work with them, including youth justice service staff, educational psychologists, police, primary mental health workers, social workers, and education staff. We work with a range of young people; some are attending an educational placement, and some are not in employment, education, or training. Many young people we work with are permanently excluded from school or vulnerable to exclusion, some are in pupil referral units and some are just at home and not engaging in anything. We also write SaLT reports for courts, to explain the communication strengths and weaknesses of young people. Often the young people we work with do not quite meet the threshold for one of the more well-known diagnoses such as ASD, ADHD or dyslexia. Therefore, they may not have received the extra help in school that would come with an Education, Health and Care Plan (EHCP) or mental health support, which can lead to their difficulties being overlooked and a history of behavioural issues. Unfortunately, this can sometimes lead to a pathway into criminality for these vulnerable young people.
How do you assess a child/young person that is referred to you?
Assessments vary depending on the age and communication skills of the child but usually we will try to take a full case history from the parent/carer which may reveal some overlooked early developmental issues, for example a hearing impairment or a bereavement. Early trauma is a common theme. We also discuss the case with the Youth Justice Practitioner who has completed the referral, and any other relevant agencies such as school staff to get their view as this all contributes to the assessment. In the past we would assess children face to face in their homes, school, or the youth justice offices but currently this is mainly done online due to the COVID-19 pandemic and national lockdown. We assess a young person’s receptive language (understanding) as well as their expressive language (talking) and have found that there is often a significant discrepancy between these two aspects of communication. An impairment in understanding is a hidden disability and adults often assume that a young person’s level of receptive language is far higher than it actually is. Through our assessments we can demonstrate the true level of a young person’s understanding. We look at all aspects of a young person’s receptive language, including vocabulary, grammar, abstract verbal reasoning, memory, time and sequencing. We also consider their understanding of higher-level language such as sarcasm, irony and ambiguous language. Specialist assessments can reveal gaps in a young person’s knowledge and understanding of language.
How have you adapted during the pandemic?
Our service is traditionally delivered face to face without masks; ideally, we need to see all the non-verbal communication such as facial expression, gestures, posture and body movements. However, we have adapted our assessments to online methods; like many professions we have had no choice. Moving to online sessions was initially difficult but this has become easier and more successful over the past year. Suffolk County Council uses Microsoft Teams for online meetings, and this has some benefits for example ease of access to our service. Some children are more comfortable meeting online or by telephone, particularly initially when they can be quite anxious about meeting a new person. Many of the teenagers we see have no knowledge or experience of a SaLT so building an effective therapeutic relationship is important at the beginning and does not have to be done via a face-to-face interaction. Young people who struggle with eye contact may find telephone calls easier and some young people prefer to be off camera during a session, with a supporting adult on camera. In this way they can see me, but I cannot see them which can help to build trust and a rapport with the young person in the initial sessions.
What is a common issue you find with the young people you work with?
The language used in the youth justice system is complex and the way young people are asked questions is often inappropriate, which means they may not understand what is being asked of them. Frequently, an adult will give a young person a long complex piece of information and then say, ‘Do you understand?’ The automatic reaction to this may be ‘yes’, a shrug of the shoulders or a response of disengagement which may be taken for a lack of interest or remorse. Many young people will not ask for clarification in this situation; they just want to get away as quickly as possible.
There is a model of questioning and abstract verbal reasoning that teachers and SaLTs often use called the Blank Levels of Questioning. Using this framework, we can work out where a young person is developmentally in their understanding of and ability to answer questions. Broadly speaking, in terms of the hierarchy of questioning, the easiest questions to understand are the ‘Who?’, ‘What?’ and ‘Where?’ questions. The ‘Why?’ and ‘How?’ questions are harder, and we often test young people and find they are not at the level where they can fully understand and answer these types of questions. In this situation questions should be reframed to support the young person to give a reliable account or response; ideally by someone who has received training in this approach such as Elklan training.
Another common problem we find is that young people often have difficulties with memory, affecting their learning and their recall of events. We can identify this and raise awareness of their difficulties, which can help adults to understand why a young person is unable to recall an event that happened a month prior or struggles to retain information at school. Sometimes the identification of a young person’s difficulties and explaining to them that this is a common problem for others too can improve their confidence and self-esteem. This can result in them beginning to engage with interventions at school or in the SYJS, where they may previously have been resisting the support offered.