Articles

Nice Work in Sheffield - Issue 11, Spring 1999
by Isabel O'Leary, Kate Williams, Ann Birks and Sally Spearing
1993 saw the establishment of a new full time specialist dysfluency post in Sheffield, a city with a population of approximately 530,000.
  The post was offered as a job share, comprising five sessions for adult work and five for working within paediatrics. Part of the early remit of the post was to determine how many dysfluency referrals were being made to the service, who the main referral agents were, to what extent the referrals being made were appropriate, as well as to offer timely therapy intervention.
  Sheffield Community Paediatrics Services comprises two locality based teams working broadly in the North and South of the city. Each team has a team leader, whilst an overview of the whole of the Community Service is provided by a Paediatric Co-ordinator.
  Historically there had been some differences between how the two locality teams managed their dysfluency case load, based largely on levels of therapists confidence working with this client group, and this quickly became apparent to the therapists newly in post who were responsible for co-ordinating the dysfluency service across both teams.
  Obtaining the appropriate balance between the component parts of the post - managing our own clinical case load, supporting colleagues and the need for research - was becoming increasingly difficult in the time available.
  We were enthusiastic about experimenting with different ways of working and planned training opportunities with other professions, worked with the BSA on their information pack for teachers, and began to run intensive courses for different ages of client.
  1996 saw the launch of the BSA Primary Health Care Workers Project, a chance for us to sharpen the focus of our referral data collection and push it into a wider national arena. At the same time we had presented a model of working for generalist/specialists, based on our own experience, to the whole of Sheffield Speech and Language Therapy Agency. This had been enthusiastically received but meant we had to find increasingly more imaginative ways of being flexible in meeting the requests of colleagues for different levels of support, whilst at the same time maintaining our own high clinical commitment.
  By the beginning of 1997 our energy levels were beginning to wane and we were running out of ways to be creative within the time we had available to the post. The statistics we had been collecting showed that whilst 7.5% of the total paediatric referrals were dysfluent, the post only represented 4.7% of the total therapy time available to the Community Paediatric Service, a clear shortfall.
A meeting between ourselves, the two Team Leaders and the Paediatric Co-ordinator was arranged to discuss our concerns and service difficulties, and to our delight we were offered an additional four sessions a week. The seeds of the establishment of a dysfluency team were also sown. It was proposed that a generalist from each of the locality teams could be seconded to the dysfluency post for a period of six months. This was really exciting and signalled a change in vision for the dysfluency service from being a somewhat segregated specialist service, to one that could be more fully integrated into paediatrics as a whole through the appraisal process.
  By the end of 1997, a colleague, Ann Birks, had expressed a desire to work more with dysfluent clients and the 'team' was finally born in February 1998. By this time our referrals had increased from 88 in the period January - December 1996 to 132 from January - December 1997.
  Ann was allocated four sessions a week for a period of six months to work with the two specialist therapists. It was agreed that one session a month should be for self directed study with an opportunity for reading, looking at videos etc, and that the remainder should have a clinical focus.
  As Ann had expressed a particular interest in parent interaction it was agreed that she should attend the Michael Palin Interaction Therapy Training for Generalist Therapists, at the earliest opportunity. This provided a useful framework for planning therapy with her clients during the secondment.
  Regular formal/informal clinical supervision times were arranged with the specialist therapists. So that by the end of her secondment Ann was confident about offering therapy to young dysfluent children and their families where it was felt an interaction therapy approach would be beneficial.
  Ann continues to work with this client group as a result of the service's recognition that the knowledge and skills she has gained are of immense value and given the large number of referrals the service receives.
  On her return from maternity leave in September 1998 Sally Spearing also joined the dysfluency team as the secondment was extended to a second six-month period.
  Sally already had some experience of working with younger children and specifically wanted a chance to develop her confidence in working with borderline/confirmed stammerers.
  Observation opportunities were provided in the early stages of the secondment and Sally was also involved in the planning and running of a group for 8-10 year olds.
  From feedback Ann had given from her secondment a regular monthly meeting of one hour was arranged where all four therapists could consider such things as:
-    referral numbers and overview of caseload
-    individual training needs, (e.g. attending local SIGs)
-    planning training for other professionals
-    ways to give each other support (Sally and Ann have set aside one session a week for co-working)
-    reading interesting articles and discussing them
-    giving single case study presentations.
  These meetings have been very valuable in terms of team cohesion and in providing an overview of the dysfluency caseload which enables us to be more informed when advising managers about the needs of our dysfluent clients.
  Issues that have arisen during the secondments have included:
-    ensuring dedicated time for reading
-    the importance of meeting/working as a team
-    timetabling overlap of sessions for supporting seconded therapists
-    seconded therapists can support each other.
  Reflections on the secondments from Sally and Ann are that both therapists have gained skills in working with the stammering caseload. There is a hope that as more therapists come through the secondment, stammering work will begin to be seen in a more positive light. As more therapists become skilled in this area it should free up the specialist therapists to provide more support (e.g. within the Special Schools Team), and perhaps give them an opportunity to take on a more balanced and mixed case load themselves.
  Isabel and Kate have reflected on the experience of the secondments in the following ways:
-  there is a need to get a balance between encouraging therapists to 'have a go' but being available in a supervisory capacity
-    there is relief and optimism that this is a sustainable service development that is no longer solely dependent on the specialist post
-    there is a general recognition within the paediatric service of the need for additional dysfluency sessions and that the establishment of a secondment opportunity with a dysfluency team is a positive way forward
-    the more informal support offered ensures that skills developed working with dysfluent children are transferable to working with other client groups
-    there has been an increased opportunity to provide therapy groups including a regular monthly group for adolescents and recently a group for 8 - 10 year olds and their parents.
  Our final thoughts are that this secondment model could be successfully applied to other specialist areas within the agency. A meeting to discuss this has been arranged for April 1999.