My current working day varies. I brave the commute to London two days a week, to work at a private clinic, where we offer educational psychology assessment, occupational therapy and SLT. As a team we provide clinic-based therapy both in the form of groups and one-to-one, we work within schools, we deliver training and we see lots of overseas families who come to the clinic. My days here are full and challenging in a positive way and very rewarding. Being able to introduce a communication method, such as PECS (Picture Exchange Communication System), to a child with autism, who is perhaps non-verbal, and see them communicate with their parents for the first time is a special moment, which we should never take for granted. I also enjoy the team environment on my clinic days and, funnily enough, as a SLT I do like to chat!
Qualifying and working as a speech and language therapist has been an amazing journey. While working in the NHS I was able to develop my areas of specialist interest, and the path I’ve followed into independent work has allowed me to explore the varied roles of an SLT.
As an SLT I assess the following skills:
- attention and listening, concentration, processing of language and memory
- understanding of language and (more frequently in schools) how this is impacting on reading comprehension, as well as accessing spoken word curricular tasks
- expressive language, vocabulary, syntax, grammar and pragmatic use of language
- social communication skills, impacting on how children form and maintain relationships with others and understanding the world around them
- communication difficulties related to medical conditions such as cerebral palsy, autism, Down’s syndrome and other syndromes and developmental disorders where there is delayed and disordered areas of communication.
Within my week I may also assess a child for appeals, if parents are initiating an appeal for their child’s statement of special educational needs, which may lead to a tribunal. These formal assessments are to gain age equivalent scores and include writing a report to quantify the support the child requires.
Other assessments include reviewing a child’s progress or making an initial assessment when meeting a family for the first time. This is an opportunity for parents to discuss their concerns and any diagnosis the child has. As I work independently I am able to give parents the appropriate time; I aim for them to go away with questions answered, concerns discussed and a plan for their next steps.
On Tuesdays I am mobile – travelling to and arriving at children’s houses or schools feeling and looking like Mary Poppins, with bags of toys and, with the recent rain, an umbrella. I choose to see children at their homes, as most are pre-school age. Seeing the children at home eases any anxiety for many children as well as their parents. With primary aged children I mainly carry out therapy sessions at school. I like to liaise with teachers and I provide resources and agree IEP targets.
The support of teachers and teaching assistants (TAs) is vital for children to make progress, and some of the most positive outcomes and quickest progress has been where therapy activities have been carried out between my visits. Many difficulties can be targeted by implementing classroom strategies and adapting the curriculum to make tasks more accessible for the child.
Last Tuesday I visited a nursery school and spent a couple of hours with staff about the benefits of using signing (such as Makaton) to enhance communication skills and how to introduce signs to their setting. These sessions are always fun. I like to shape them so that staff come up with ideas, appropriate to their setting and the children they care for, which I can then help them put into practice.
Next Tuesday I have two school visits, approximately an hour each, to deliver therapy sessions and then a meeting with a preschool to discuss working there a day a week. Variety is the spice of life.
On Wednesdays and Thursdays I work at two set schools. I tend to plan and prepare resources at home, sometimes writing reports and targets. This week has been very varied at the schools. At one school I attended a multi-disciplinary meeting for a child, along with all the professionals involved with the family. After this I started assessing those children about whom teachers have raised concerns. I meet with parents following this, if appropriate. At the other school I met with some parents first thing, then assessed their child. Depending on the severity of the concerns I may meet with parents before assessing the child.
As a therapist the type of assessment used depends on the age and developmental stage of each child. Formal assessment is standardised and uses age-equivalent scores. Informal assessment consists of observation, play-based tasks and use of therapy-based resources such as pictures and toys.
As well as assessments I spend the day seeing children for their weekly one-to-one or paired therapy sessions. Playtimes give me time to discuss with the child’s teacher/TAs. I work very closely with the SENCos and support staff.
After a school day I may visit a child at home for therapy. Being able to offer after-school sessions works well for many families, as I know from my niece’s busy social life at primary school that there are endless events and after-school clubs they miss if they have to come out of school. (I seem to remember just netball and chess club when I was at primary school: how times have changed!)
I may also have supervision with a colleague, to share concerns, successes and resources. I have a close network of friends who have also made the step to work independently. Often we meet for these supervision sessions over a coffee.
Then comes Friday and I’m back on the train to London, cramped and having spent a fortune on my ticket. Today turned out to be a ‘snow day’ so I did not commute, but what a great opportunity to enrich language this snow is, so I will take some snowy photos to use next week. Now for a hot cup of tea ...
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About the author
Debbie Smart is registered with the Association of Speech and Language Therapists in Independent Practice (ASLTIP), the Health Professions Council (HPC) and the Royal College of Speech and Language Therapists (RCSLT). She has specialist interests in autism, associated social communication difficulties and pre-school/primary-aged speech and language difficulties.
This article was first published in the April 2013 issue of SEN Leader magazine.