Speech and language therapy provides treatment, support and care for children and young adults who have difficulties with communication, or with eating, drinking and swallowing. The Speech and language therapists (SaLTs) are NHS health professionals. They work with parents/carers and staff as well as other professionals, such as the school nurse, school doctors, occupational therapist, and educational psychologist.

• Support with implementing whole class interventions such as: PECS, interactive storytelling, lego therapy, attention autism, social communication groups and communication at snack times
• advice on communication strategies and style e.g. use of visuals, opportunity/motivation and functional communication
• developing resources e.g. PECS, communication books, social stories, work stations
• liaison with the communication team regarding whole school communication approaches
• advice and training sessions for staff e.g. PECS surgery, intensive interaction, Q&A sessions, using visuals, introduction to communication books and social stories, TEACCH approach
• general liaison and advice with parents including parent coffee mornings on topics such as: lego therapy and behavioural feeding
• liaison, advice and planning provision with staff around developing systems of communication e.g. PECS, objects of reference, photographs, symbols, communication books
.

• Delivering or training staff to run targeted groups, e.g. PECS, interactive storytelling, lego therapy, attention autism, social communication, attention and listening, Makaton and supported communication group
• coaching staff to develop PECS and communication book use for children not on the caseload (targeted)
• attendance at MDT meetings, e.g. TAS meetings and the primary and secondary weekly meetings.

• Onward referrals/liaison with outside agencies support for staff with implementing low and high-tech Augmentative and Alternative Communication systems
• e.g. Grid 3, Lightwriter and Partner 2
• 1:1 sessions for therapy and assessment, including implementing PECS
• liaison with and advise staff to support individuals on the specialist caseload
• dysphagia assessments/reviews for high risk pupils, provision of mealtime guidelines and delivery of specific staff training
• participation in MDT meetings e.g. TAS, secondary meetings
• liaison and advice for parents via appointment
• eating and drinking training for mealtime partners supporting specific children in behavioural feeding groups
• updating, implementing and monitoring communication systems e.g. PECS, communication books and/or high tech Augmentative and Alternative Communication
• liaison with parents/carers to share information and jointly set targets and make resource e.g. social stories
• liaison with external agencies e.g. Occupational Therapists, Educational Psychologists, social services, Tobi Churchill (assistive technology centre), Visual Impairment team, Hearing Impairment team
• multidisciplinary advice provided for priority/complex cases and attending meetings for these cases
• writing EHCP conversions, attending EHCP and Annual Review meetings
• writing targets for children on the caseload
• transition reports for school lea
vers
• liaison with current NHS therapists for new school attendees.

Occupational Therapy (OT) provides support to children who have difficulties with the practical and social skills necessary for their everyday life. An Occupational Therapist will aim to enable a child to be as physically, psychologically and socially independent as possible.

Occupational Therapists are NHS professionals who work staff as well as other professionals, such as the school nurse, school doctors, speech and language therapists, and educational psychologist.

An Occupation Therapist assesses children who are experiencing difficulties with everyday activities; i.e. dressing, handwriting, using cutlery, play development and hand skills.

The Role of an Occupational Therapist:

• Facilitate independence with functional tasks.
• Support development of underlying component skills e.g. gross motor, fine motor, visual perceptual skills.
• Manage the effects of disability – e.g. hand and arm muscle tone, range of movement, sensory difficulties.
• Adapt the environment/provide equipment in order to optimise functional ability.

 

Functional Tasks include:

• Self care (Personal care): Washing, Dressing, Toileting, Feeding, food repertoire and using cutlery and Personal Grooming.
• Productivity (Learning/ School work): Attention, Following routine, Problem solving, Handwriting, Tool use and Organising themselves.
• Leisure (Play): Cause and effect, Construction, Puzzles, Posting, Messy play, Mark making, Imaginary and Social interaction.

 

At Turney School, Occupational Therapy is provided as a universal approach. The therapist provides advice and training to school staff to support the sensory, motor and functional development of all children which includes classroom observations, small group work and joint work with other professionals.

At Turney School Occupational Therapy Service consists of:

• Training and advice for staff
• Providing recommendations and strategies to support child and young people in the school environment
• Provide modelling and training to staff on implementing recommendations and strategies
• Recommendation of specialist equipment to support functional skills and learning
• Direct work with children and young people in a group to model strategies for staff to implement within the school setting.

The Educational psychologist works with staff and other professionals to help children and young people achieve their full potential and experiences of learning. The Educational Psychologist uses psychology and knowledge of child development to assess difficulties students may be having with their learning and advice and training on how staff can help children to learn and develop.

Strategies may include

• teaching approaches
• improvements to learning environments
• advice on curriculum materials and
• behaviour support.

At Turney School we provide flexible, responsive and highly individualised learning opportunities utilising a wide range of interventions which have been proven to be effective in the research literature. Interventions are selected to suit the needs of each child and will be incorporated with a differentiated National Curriculum.

We operate within the framework of the SCERTS Model (see Prizant et al, 2003), which derives from a theoretical as well as a research-based foundation and addresses the core challenges of children with Autistic Spectrum Conditions, namely Social Communication, Emotional Regulation and Transactional Support.

The main approaches we use are briefly outlined below; SCERTS, TEACCH, Intensive Interaction and the Attention Autism approach.

TEACCH is an ASC-specific approach which provides visual information, structure and predictability and capitalises on many children’s strengths in visual skills and adherence to routine in order to develop skills and minimise difficulties (Schopler and Mesibov, 1995). 

TEACCH is an evidence-based service, training, and research programme for individuals of all ages and skill levels with autism spectrum conditions.  Established in the early 1970s by Eric Schopler and colleagues, the TEACCH program has worked with thousands of individuals with autism spectrum disorders and their families.

Key Principles:

• Autism is presented as a culture: focus on understanding the world from the autistic point of view and building on strengths
• Use of visual supports– pictorial or written

All materials available

What does end product look like

Use of colours, highlights to clarify order sequence

• Reduced language – visual is your voice
• Tasks given in manageable chunks
• Consistent and clear organisation

 

At Turney School we use these guidelines throughout all of our lessons to ensure clear communication and provide consistent structures and routines.

Described as one of the ‘new generation’ of interventions and approaches for children with ASC, the SCERTS model was devised in response to the call from the National Academy of Sciences for the development of innovative educational models as existing models for addressing the needs of children with ASC were found to have limited impact, with no one approach being significantly better than another in terms of outcome (National Research Council, 2001).

The model was developed by a highly skilled group of clinicians and practitioners and reflects clinical experience and research spanning over thirty years. It particularly addresses some of the main areas for development for a young child with ASC by focusing on:

• Social Communication (SC)
• Emotional Regulation (ER)
• Transactional Support (TS)

 

The Social Communication component of SCERTS focuses on the development of communication and positive participation in social activities. With an emphasis on functional communication, the model supports the development of joint attention (helping your child to become more able to participate in reciprocal interactions with others).

Increased competency in joint attention can result in an increased ability to share attention and emotions as well as to express intentions with a social partner.

Another prioritised communication skill is symbol use (a means to communicate which may include signs, picture symbols systems to support speech).  For some children, using picture or symbol systems in order to communicate can lead to increasingly more sophisticated and abstract means to play and communicate with others.

Emotional Regulation supports your child’s ability to regulate their levels of emotional arousal and, in doing so, supports their ‘availability’ for learning (because children need to be emotionally calm in order to enhance their ability to learn). In the SCERTS model this is undertaken at three different levels:

• Self-regulation: the capacity to remain organised and focused despite potentially stressful events (which may be positive or negative).
• Mutual regulation: the capacity to seek assistance and/or accept support from others to restore emotional regulation in situations of emotional ‘dysregulation’.
• Recovery from dysregulation: the capacity to use self and or mutual regulation strategies to support a return to an appropriate level of emotional regulation.

 

Transactional Support focuses on the environmental factors (both physical and human) that can best support your child. It may include any of the following:

• Interpersonal supports consider the necessary and effective adjustments made by any of the people who successfully communicate with your child, to support positive, well regulated interaction and learning.
• Learning and education supports take into account the necessary and effective modifications to the environment to support access to activities and learning.  An example would be the use of visually based systems.
• Family support involves you, the immediate carers, in collaboration and information sharing as well as participation in the development of appropriate strategies to support the social communication, emotional regulation and daily living skills for your child.

 

The SCERTS model is systematic but individualised for each child. It is flexible with a hierarchy of goals addressed through activities which are consistent, structured and predictable. The SCERTS Assessment Process is used to inform IEP target setting. The framework provided by SCERTS is based on a set of core values and guiding principles which also reflect Turney School philosophy:

SCERTS Model statement of core values and guiding principles:

1. The development of spontaneous, functional communication abilities and emotional regulatory capacities are of the highest priority in educational and treatment efforts.

2. Principles and research on child development frame assessment and educational efforts. Goals and activities are developmentally appropriate and functional, relative to child’s adaptive abilities and the necessary skills for maximising enjoyment, success, and independence in daily experiences.

3. All domains of a child’s development (e.g. communicative, socio-emotional, cognitive, motor) are interrelated and interdependent. Assessment and educational efforts must address these relationships.

4. All behaviour is viewed as purposeful. Functions of behaviour may include communication, emotional regulation and engagement in adaptive skills. For children who display unconventional or problem behaviours, there is an emphasis on determining the function of the behaviour and supporting the development of more appropriate ways to accomplish those functions.

5. A child’s unique learning profile of strengths and weaknesses plays a critical role in determining appropriate accommodations for facilitating competence in the domains of social-communication and emotional regulation.

6. Natural routines across home, school, and community environments provide the educational and treatment contexts for learning, and for the development of positive relationships. Progress is measured in reference to increasing competence and active participation in daily experiences and routines.

7. It is the primary responsibility of professionals to establish positive relationships with children and with family members. All family members are treated with dignity and respect.

8. Family members are considered experts about their child. Assessment and educational efforts are viewed as collaborative processes with family members, and principles of family-centred practice are advocated to build consensus with the family and enhance the collaborative process.

The SCERTS Model: Enhancing Communication and Socioemotional Abilities of Children with Autism Spectrum Disorder, Barry Prizant with Amy Wetherby, Emily Rubin, Amy Laurent, Patrick Rydell. Published: 2005, National Professionals Resources, Inc.

Attention and Listening: Developing attention and listening skills is crucial for children with ASC.  We use Intensive Interaction and the Attention Autism approaches to develop these skills in a fun and exciting way.

Intensive Interaction: Intensive Interaction tries to create a communication environment that is enjoyable and non-threatening to the individual on the autism spectrum, or with severe learning difficulties. In some respects the model of the approach is taken from the way we first start to communicate with naturally developing infants, where interactions are short, and involve noises, touch and eye contact. Interactions are brief but can grow over time.

Ultimately we are looking for the individual to:

• Accept our presence
• Allow some presence in personal space
• Attend to another person (even fleetingly at first)
• Allow and use some touch
• Engage in eye contact
• Use facial expression
• Focus on body language and facial expression
• Take turns in communicative behaviour
• Take turns using vocalization which may start to have meaning
• Experiment with communication
• Learn cause and effect

 
At Turney School we want individuals to be an active participant who is motivated to communicate and who will take the lead and feel a sense of control over the communicative situation. Through Intensive interaction, staff can make a connection with an individual, create an enjoyable exchange, reduce challenging behaviour, and develop communication skills. To begin with, sessions may be very short, but expanded over time and be varied in activity. Sessions take place several times a day on a one-to-one basis.

The following principles are used throughout our lessons, but especially in our attention and listening activity sessions devoted specifically to this area.

• Always create an irresistible desire to communicate.
• Low risk speaking situations.
• Capitalise on the visual learning style of children with ASC.
• Staff model appropriate attention skills.

 

At Turney School we encourage a carefully structured environment with planned activities to reduce obsessive play and distraction. Activities begin with an exciting visual and practical demonstration, capturing the children’s interest and briefing them on the task ahead.

Children learn to take turns in activities and to transfer their experiences from a group context into their play/learning.  The activities are planned to provide for each child to take their learning further. There is always scope for staff to ‘go with the child’; that is, to follow the children’s interests or unplanned experiences in the development of the approach.

These are the approaches currently used at Turney School. All are evidence based and do not need to be used exclusively.  They can be used in conjunction with each other and have been proven to be highly effective in a variety of contexts.

The Speech and Language Therapists, Occupational Therapist and the Educational Phycologist support the use and development of these strategies and interventions through training, observation and feedback to continually develop and personalise the use of the approaches.