Cuts hit Speech Therapy in the NHS

sidebyside : 30th June 2014 22:53 : blog, news

Health Commissioners don’t really understand Speech and Language Therapy. Now Podiatry. That’s a community-based health service they can really get behind. The care pathway only has a few branches, and people progress through it quickly. Feet don’t have complex, multi-layered problems that require multiple assessment sessions. Feet’s parents don’t ignore appointment letters. Feet don’t spend the first three or four sessions being shy and refusing to engage. Feet need scraping, nails need cutting, advice regarding after care needs giving. In and out.

For a service to be easily commissionable, it needs to have measurable, positive outcomes. The gravity of communication impairment – the impact it can have on people’s lives, is enormous. We didn’t actually need the Bercow Report to tell us that. But scientifically linking that back to the block of sessions working on early attention skills in a nursery, or to the clinic-based sessions spent talking to parents about interaction styles, is something that Speech and Language Therapists are very bad at indeed.

The Royal College of Speech and Language Therapists is always on our back about proving our effectiveness, and rightly so. Their recent information-gathering exercise – a survey of SLTs in the NHS, has indicated (reported here in the Independent, yesterday) that:

some children were waiting up to a year to see a speech and language therapist (SLT), up from about 18 weeks three years ago. […] 52 per cent of SLTs reported budget cuts over the past year.

I’m surprised that there have been enough commissioners actively noticing SLT and bothering to make cuts. Their policy has generally been, in my experience, to ignore it and hope it goes away on its own. Services are being funded at the same levels as in the eighties, despite a massive growth in need, arising from what can only be described as a spiral of deprivation.

SLT just doesn’t sit right in the NHS. Of course, there are medical aspects to it – some children are so unwell, or their general level of functioning so low and flat, that they will never attend a mainstream school, and these children will always have a strong input from health services into all aspects of their lives. Other children known to SLT have medically-mediated problems, such as palatal insufficiency; or psychologically-mediated problems, such as the more obvious presentations of autism and Specific Language Impairment.

Outside of this though, schools are faced with intakes of children that have massive levels of delay in all areas, from self-care skills to communication. How helpful is it to medicalise just one aspect of that? It frustrates schools that parents do not take them to appointments, and actually, come September, when the new ‘Code of Practice’ for schools comes into place, that will no longer be a viable excuse when they explain why they have low speaking and listening levels in their school.

This is why schools are starting to fund their own therapist time. Once again, like everything, we have a hodgepodge of inequality, and early intervention is being forgotten. Hopefully Public Health Commissioners in Local Authorities will see more value in the work we do than the Community Health Services Commissioners did.

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Child development in the Mail

sidebyside : 10th June 2014 00:07 : blog, news

Like many rational human beings, I visit the Daily Mail website from time to time, not for the toxic celebrity sideshow, but for the “human interest” stories – the people who eat gravel when they’re stressed, the people who spend their benefits on gucci handbags, you know the kind of thing.

Beyond this rather tragic form of diversion, I enjoy trying to squeeze some intellectual value out of their stories which touch on language development:

This was a small scale (just 65 families), unpublished American study which seems to have relied on parent interview rather than direct observation. This study reports a statistically significant link between increased touchscreen use and decreased language development, a link that is backed up by my experience and by conversations I’ve had with my colleagues. The study also fails to identify any positive effects from so-called “educational games”. This topic is crying out for a bigger study, and a better reporting system. Perhaps an app could be developed which could monitor a child’s touchscreen use in a more reliable manner.

Faced with a stream of essentially meaningless syllables, how exactly do babies learn where words start, where words end, and what words mean? Researchers from Purdue University postulated that a simple touch on the knee might guide a child towards making these kind of judgements. They put together a rather cunning experimental design to prove that this was indeed the case. The study is due to be published in Developmental Science. Quite what any of this has to do with ‘tickling’ I have no idea (although tickling is indeed a noble thing to do to a baby).

“Top Lib Dem” Ed Davey scored some political capital with this rather obvious little sound bite. People seem to agree with Ed in the comments (although, unsurprisingly, one commenter takes the opportunity to blame the terrible over-population in the UK). Many commenters make the link with the rising incidence of asthma. It’s not just about what children are breathing in though. Shuttled around at knee height they get very little taste of what it means to interact meaningfully with the world. They are strapped in for the ride, unwilling subjects of the wild experiment on child development we seem to be running here in this autistogenic Western society.

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Top ten lift-the-flap books

sidebyside : 9th October 2012 00:21 : blog, books, therapy materials

I love lift-the-flap books. I use them in small groups to develop the children’s turn-taking, attention and interaction skills. That flap also gives the children a nice, concrete bit of bang, there it is, naming to do or to listen to. In one-to-one, on an adult’s lap, the flaps can help to sustain a wriggly child’s flagging attention. Pop-ups do the same kind of thing, as do noisy books, and books with textures, like the ones that can be found in the the mindless ‘That’s not my…’ series, published by Ladybird. Personally, though, I am a flap man.

I have trawled through high-street upon high-street of desolate, murky second-hand shops so that you don’t have to. Most of the books in this top-ten can still be bought new. For those that are no longer in print, I recommend (and link to) Abebooks – they have better book descriptions than Amazon Marketplace, and the books are usually cheaper. The links to buy the books are coloured red.

10 – The Three Little Pigs (Nick Sharratt)

Nick Sharratt and Stephen Tucker’s version of the Three Little Pigs is about as funny as a lift-the-flap book is ever going to get. It’s a tale of rural poverty – the desperate little pigs are edged out of the family home by new siblings on page one, with just a piece of fruit and a toothbrush in each of their bags to sustain them. Off they go to make their houses, in the time-honoured manner.

Meanwhile, the wolf paces around his kitchen. We are able to look into his tragically empty fridge and cupboards. You will actually feel sorry for him as he goes about his campaign of terror. This book is probably more of a four-year old’s book than a three-year old’s book, especially if you’re going to get all of the rhyming couplets understood, but most children would be able to get something out of it, as long as you can let them take the lead.

9 – Where’s Rusty? (Stephen Cartwright)

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Stephen Cartwright died tragically young in 2004, leaving behind at least a couple of generations of unknowing acolytes, who never really got to thank him for all the work he did for Usborne books, like the perfectly sedate Farmyard Tales books with Heather Amery, and the magnificent First Thousand Words, with that little yellow duck hiding somewhere in among the chaos.  

This book has Rusty the dog as the star. It’s a bit of a run of the mill ‘where’s x’ affair, but you really can’t go wrong with Cartwright’s drawings.

8 – Zoom and Fly Mr Croc (Jo Lodge) 

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I don’t actually own this book. And it’s more of a pop-up book than a lift-the-flap book. Other than that, it’s a shoe-in!

The Mr Croc series had to be included somewhere – they’re high quality and very popular. The simple scenes depict Mr Croc doing something related to that book’s theme (e.g. getting dressed, impersonating other animals, doing some sport). Either the page pops out as you open it or there is a tab that you or your child can pull to animate the scene in a novel manner. The book I’ve included here has a aeronautical theme – they all looked good to me in Waterstones though. These books are heavy on the verbs – great for children who are starting to combine their words together into short phrases.

7 – Dear Zoo (Rod Campbell)

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The daddy of the genre. Some of these animals are a bit on the niche side for very little ones (camel and tortoise spring to mind) but they all have great characters which you can act out together after you have discovered them under their flaps. I find the idea of the story inherently rather complex (the boy wants a present, the zoo send a series of animals which make for inappropriate pets for one reason or another) but children can enjoy the story at all sorts of levels. And the doggy at the end is particularly cute. This book comes in mini board book form, as well as a larger paper version.

6 – The Big Book of Crazy Mix-ups (Nick Sharratt)

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I know I’m getting a bit flexible here with the definition of a lift-the-flap book, but in my defence, this book is quite flappy. Just as with its sister tome, Ketchup on Your Cornflakes, Sharratt has cut the page in two in order to bring about a vast potential for incongruity. This one is the better of the two, for me, by virtue of the jellycopter alone. You do not have to be a particularly silly person, to have some fantastically silly thoughts to share with your little person, using this highly facilitating book. It is a bit like a distillation of the atmosphere of a childhood spent with Spike Milligan as your father (just the nice bits though).

5 – Maisy Goes to the Playground (Lucy Cousins)

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I wasn’t sure about Maisy at first, all those shaky lines just looked a little condescending to me. However, the content of this series of pop-up and pull the tab books is very well-thought out indeed. This one in particular has loads of ingenious tabs, more than one per page at times, that animate the pictures in such a way as to capture that all-too-elusive verb vocabulary. The only problem with these books is that when they break, you have to take the pages apart to get to the workings to sellotape them back together.

4 – Ping and Polo Playtime (Jo Lodge)

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Smaller again than the Maisy books, and much, much hardier, these are specifically designed for very little hands to hold. According to the reviews on amazon, the best of the series is the Peekaboo title, which I haven’t actually seen. I can see why, because the peekaboo page is the best in this title. The four other pages show the penguin and the polar bear doing nursery-related things together, their endeavours animated by means of tabs embedded in the cardboard. This book is just too sweet for words.

3 – Buster’s Birthday (Rod Campbell)

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Unlike Dear Zoo and Oh Dear, which are well-distributed, you might be excused for not knowing about this book – it’s not very prominent in the bookshops I look in. There is no confusing narrative underlying this one, the child just gets to reveal some presents on behalf of Buster. There is a superb clarity to Rod Campbell’s illustrations through all of his work, and this book is no exception. The final present is an actual thing – open up the flap top and bottom to reveal a living, breathing book within a book. This basically makes Buster’s Birthday Rod Campbell’s Hamlet.

2 – Where’s Spot (Eric Hill)

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It’s a tale that resonates through the ages – little dog goes missing, little dog’s dinner time is due, big dogs search for little dog, big dogs find little dog, little dog eats his dinner, the natural order is restored. But what of this Spot character? Is he hiding, or has he somehow managed to get himself trapped in that basket? What is his motivation? We await the memoir. Until then, all we have is this document.

Not all Spot flap books are as good as this. In the Farmyard one, for example, we have Spot rather confusingly searching for some baby animals to play with, some of the flaps just cover up text, which is no fun at all, and he actually finds two sets of baby animals in the end, to no great effect. It’s deeply unsatisfying. This one on the other hand is pretty much perfect, just as long as your little one can stomach another dose of animal vocab. Just like ‘Dear Zoo’ you have to choose between a poky 15 cm board book version, or a 20 cm paperback. If you’re feeling adventurous, the edition published in 2000, which can only be purchased secondhand, is a 20 cm hardback.

1 – Where are Teddy’s Shoes (Belinda Gallagher)

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Why aren’t there more books like this? Look at teddy on the cover! He’s got no clothes on! Just a bow tie! It is an absolute scandal. We must get some clothes on him. So we follow him around the house as he puts on his trousers, shirt, socks, jumper, jacket, hat, scarf and gloves. All of these have been placed in slightly awkward places around the house. One cannot decide whether teddy is either engaging in acts of self-sabotage, or if he just has to do this to properly wake himself up in the morning.

I jest, and I shouldn’t because this is the most beautiful book I have ever used with children and it demands respect. It is part of a small series, but it seems to me as though the other books are more to do with letters and numbers than everyday life like this one. Get this book (secondhand) – I promise you won’t regret it.

One for luck – Maisy’s Show (Lucy Cousins)

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More tab-pulling nonsense from Lucy Cousins – this one didn’t make it into the list because I only wanted to put one book in from each character, and this Maisy book seems to me to stimulate vocab that is less useful than the vocab in the playtime book (spinning, dancing, disappearing, bouncing ball, etc). This book is pure, demented theatre though, and comes highly recommended.

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Five toys that I think have merit

sidebyside : 23rd September 2012 01:26 : blog, toys

If you read my post a while back, you may have detected a touch of negativity in the way I view the toys that we are expected to buy for our children. Amazon is full of horrible, pink, plastic rubbish that children will probably pick up only once. If you dig a little deeper though, you will find plenty that will give your children cause to think, learn and laugh. Remember though, the thing that gives most toys their staying power is the child’s playmate (i.e., you).

Tumbling clown

You can buy click-clack tracks everywhere (the wooden toy where cars zoom down four little ramps in sequence) but this particular cause-and-effect toy you have to know to look out for. I use it all the time, because it’s compact, it attracts children’s attention, and it’s easy for children to get involved.

Set the little man up at the top (he can jump up the ladder, or even fly up there), give him a gentle push, and by the magic of gravity and a hidden weight, he will cartwheel his way slowly to the bottom. It doesn’t sound much, but it is what you make it. £6.78 at Amazon, plus £5.99 delivery – still a bargain if you ask me.

Bubble trumpet
Bubbles are the king of toys. They’re exciting enough to make almost any child find a way to ask for more (if you manage to hold off blowing more, that is). They give you and your child a real sense of shared purpose, of shared attention, and shared attention is the basic stuff of communication.

There’s no better way to sharpen that focus than to use a bubble trumpet to make one big bubble. It slows the process right down. It’s highly amusing when it pops, or is popped, in your face. Furthermore, it’s much easier for young children to blow their own bubbles using one of these. Only available on import at the moment from Amazon, with punitive postage. I bought mine for a rather dear £10.99 plus a couple of quid postage. I’m sure it’ll be back soon.

Latches board
I don’t own this – it’s a bit dear for me, and I’d get minimal use out of it. You might wonder whether this is the right kind of thing to be giving your child. It really depends on whether or not there are latches in the house that your child can reach that you don’t want them opening. If that is not a concern for you, and you want your child to develop their motor skills and their attention skills, then why ever not?

Many children are enormously preoccupied with doors, switches, locks and latches. They don’t do it to annoy us – they recognise that the adult world is full of these things, and the adult world is out there for children to master. Giving them toys that accept that fact seems sensible to me, and the queen herself, Maria Montessori thought so too. If you’re handy, you can construct your own. Otherwise, it’s a hefty £17.20 over at Amazon.

Doll’s house (on a budget)

In my pretend play posts in this blog, I talk about large-world imaginary play. If your child has done a lot of that kind of thing – putting teddy to bed, giving him tea, wiping his nose and so on, then maybe they’re ready for small world play.

This is made of tough cardboard, tough enough to last long enough for a child to work out whether or not this is the kind of thing they’re into. A gamble worth taking – £12.99, over at Amazon, plus £3.95 delivery .


Is it just me that calls this stuff ‘floam’?

People have some weird things they don’t like touching. I personally can’t abide the idea of soap under my nails. Makes me shiver, ugh. Some people have a real issue with polystyrene. I’m not sure what they would make of floam. It is made of tiny polystyrene balls, held loosely together with an inherent gooeyness that seems to last forever if you store it correctly. It’s dry to the touch and weird on the eye. It’s not as good as plasticine for model-making, but then that’s not what floam is about. You can mix the colours together if you want to, but you’ll spend the rest of the night separating them back out. Floam is £12.20 from Amazon.

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Three things we buy for children that sound like a good idea, but aren’t

sidebyside : 22nd July 2012 23:58 : blog, rant, toys

Just because I live in the present, it doesn’t mean I have to like it. When I look at the TV that is created for our children, the amount of time the average child spends with a working parent, the level of distraction these parents submit themselves to, and the products we surround our children with, I truly wonder at the motives of the architects of this situation.

Q: When is a bed not a bed?
 A: When it is a toy. A toy that completely undermines the first rule of infant sleep hygiene – bed is a place for falling asleep, sleeping and waking up in.

This product is designed to milk parents who are struggling to get their children to sleep in their own bed. ‘He doesn’t like going to bed – he just wants to play’. ‘He falls asleep on the couch and I lift him into his bed’. ‘When he wakes up in the night either I let him into bed with me or he’s up the whole night’. These are the kinds of things I hear all the time in my job.

Some children find it hard to wind down at the end of  the day. Some children lack the emotional tools to understand that it is ok to be alone for a little while in your room. These children are not going to be helped in any measure by a bed such as this.

“Black sky” double-decker pram of doom
Which baby would you rather be? Front or back? I’d go for back every time. True, you might come to the conclusion in the end that the sky is black (unbelievably this product’s name is ‘black sky)’, but at least you might be able to get some proper sleep in there.

Quite simply, our prams face the wrong way. Can you imagine what it is like down there? Feet clattering. Cars, buses, fire engines, all careering along, just feet away. No control over the direction of travel. Exposed to the elements, until someone decides to wrap damp, smelly plastic around you. And that someone – how to get her attention? What is she thinking at the moment? What is she looking at? Is she looking at the same thing as me? This is a recipe for increased levels of anxiety and delayed development of language and joint attention. And studies do seem to be pointing strongly in that direction.

Baby ipod ‘aptivity’ case
Young children want to play with electronic toys. And no wonder – they are transfixing enough for us. These children are living miracles! Steve Jobs is ‘changing their OSes‘! Unfortunately, the online generation of the future also see us as a cause and effect toy.

Baby apps and so on are great if they are used for very short periods of time and if the experience can be explained and shared with another. However, we all know that this is not how these things are used. They are a babysitter that robs our children of the ability to find wonder in the normal, the prosaic. Maria Edgeworth, in Practical Education (1798) got it spot on:

When a nurse wants to please or to pacify a child, she stuns its ear with a variety of noises, or dazzles its eye with glaring colours or stimulating light. The eye and the ear are thus fatigued without advantage, and the temper is hushed to a transient calm by expedients, which in time must lose their effect, and which can have no power over confirmed fretfulness. The pleasure of exercising their senses, is in itself sufficient to children without any factitious stimulus, which only exhausts their excitability, and renders them incapable of being amused by a variety of common objects, which would naturally be their entertainment.

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The rationale for interaction groups

sidebyside : 20th July 2012 00:10 : ASD, blog, groups

Some children are hard to engage with. They want their episodes of play and interaction to give rise to warm, familiar feelings. They want their cognitive landscape to be of their own design. In terms of the ideas they are prepared to have, they are in a warm, fuzzy feedback loop. We might see the domain of their experience as being worryingly limited, but if that experience is everything to a child, then that child is all-powerful and all-knowing. Intrusions and impositions are generally unwelcome. He just can’t accept that a decent idea can come out of something as intrinsically random as a person. If we don’t find the right way to make him feel comfortable, the ideas and the experiences we seek to offer him run the risk of becoming a source of irritation. He could already be fading us out, back into the background.

So when we are working in one-to-one with a child, and when we are helping that child as part of a very small group, he will explore new mental territories with more vigour if we can dress the experience in familiar clothes. In one-to-one, this means echoing what he does does, enjoying it, and trying to make him understand that we are enjoying it. The closer we can get to his way of thinking, the easier it will be for him to incorporate and attribute any variations, extensions and explanations we might occasionally proffer. He will find it easier still if he sees us as being interesting and emotionally available.

In a social interaction group, the above still stands, but the rules and structure, repeated within and over the short sessions, themselves feed into the child’s wish to have some degree of ownership over an essentially familiar experience. In one way then, the aim of a block of social interaction groups is for the patterns and rhythms that underlie them to be as apparent to the children as they can be. To this end, we:

  • Use visual timetables. These give the children a readout of what the current activity is, and how far through the activities they have come.
  • Repeat roughly the same activities, in the same order, from session to session.
  • Have a definitive sense of completion and finality after each activity.
  • Promote repetition within activities by offering opportunities for each child to have a turn, and then to experience the activity again as an observer.

The lower the level of a child’s attention and social interaction skills, the more play all of the above will have. It never stops being true though – everyone knows that children generally do better when their environment is thoughtfully structured. Adults who work with children would do well to remember this as they go about deciding just how much novelty they can get a certain child or group of children to take on board in a given session.

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Childcare is in a total mess in the UK and we're going to make it worse

sidebyside : 19th June 2012 18:14 : blog, news, rant

BBC News – Childcare: One in four providers ‘make loss’
BBC News – Childcare review launched as nursery reforms urged

I think it’s fair to say that childcare is in a bit of a crisis here in the UK (although I’m sure that Scotland and Wales are somehow absolutely perfect like usual). Parents pay huge sums for childcare (and four or five times as much in London as elsewhere, I read today) and places for some 2- and all 3- year olds are centrally funded at one of the highest cost-levels in Europe. Yet nursery managers are apparently taking home an average of £13,500 a year and the workforce, despite all the training they have to trundle through, and despite the sheer complexity of trying to squeeze a child into the EYFS, they get the minimum wage in almost every case. It’s not much compensation for the sheer weight of responsibility heaped on these people from both directions – upwards from busy parents and downwards from nervous law-makers.

The same thing can be seen in social care for the elderly. Councils pay quite large sums, private tenants’ cross-subsidy to the council-funded tenants is frankly eye-watering (my grandmother pays £900 a week for what seems to me to be rather hands-off care), and once again it doesn’t seem as though the people who own care homes are bothering the rich list particularly.

Another thing these two sectors have in common is the fact that hardly anyone ever has anything positive to say about the people on the ground providing the care. Today the problem is the fact that nursery workers and childcarers in general lack an A-level equivalent qualification, and that their literacy and numeracy skills are inadequate.

Admittedly there must be something very wrong with the numeracy skills in a sector where some settings have taken it upon themselves to pay 92p a pint for milk… but I digress…

Was it the the Swedish model or the Finnish model we were meant to be following? I forget. We failed either way.

The first component of these models must have gone unnoticed by the legislators when they were on their jollies in Scandinavia. They were presumably overawed by the settings they saw, and the top-class early educators they met, without considering the fact that the countries who get childcare right can afford to do so because they make full use of the adults (neighbours, family) in the community to deliver informal child care the rest of the time. Of course in this country, even two female police officers can be prevented from looking after each other’s children because they are not registered as childminders. We need to do something to develop ours into a compassionate society where people do things for one another simply because they can and because they want to. Certainly we could start by getting rid of any legislation that prevents us doing so. We overpay for care in this country because we don’t, or can’t, care enough for one another without being given some sort of financial jolt to do so, or without having a badge that says we’re allowed to.

The second component of these models was the one they focused on, but again they didn’t look deeply enough. These settings understand that young children learn from play, from direct experience and from each other. In many countries in Europe, sit-down learning starts well after a child reaches 7 years of age. In the former Czechoslovakia, it used to be, if your child couldn’t draw a circle clockwise and anticlockwise, and if he couldn’t touch his left ear with his right hand, and his right foot with his left hand, he wasn’t made to sit in a classroom to learn. Here we have taken on the bits of the system we like, without actually considering the experience of the child. Some reception teachers understand that it is too much to expect children to adopt a rigid learning plan just because they happen to be turning five years of age before some random day or other. Likewise, some nursery staff understand that a total absence of structure is confusing for young children. But the bulk of children in this country experience the shock of transition from Child-Led (read “child-left”) Play to ‘sit-down and listen’ without any consideration for where they are in their development. In this country we have the option of holding a child back a year. But one day that child has a serious dose of reality coming their way when they have to get back into their correct year group before a change of school.

So to get back to the original point – the supposed need for early years’ staff to be educated to A-level level. I couldn’t care less if they can’t read a story to the child. What I want to know is, can they make a story up off the top of their heads and tell it in an exciting manner? Can they leap into the child’s world and instinctively offer intellectual morsels that draw the child’s thinking onwards through the proximal zone of their development? Can they spot something the child is doing today that they weren’t able to do last week? Do they know what the child likes to do? Do they enjoy doing what the child enjoys doing? Are they able to make the child understand that they enjoy getting involved in what they are doing? Do they even like children?

None of these things (apart from the last one) are easy. It is precisely because delivering child-led learning, to a skeleton curriculum, on the hoof, pitched perfectly to arouse a group of disparate souls is so difficult that we have lost our way in childcare in the UK. It takes a special person to be able to nurture children in all domains, to understand them and to love them, and with every policy review we get further and further away from getting early “education” right.

When we find our workforce, they may or they may not have additional skills in administration and accounting. It could not be any less relevant for the children.

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The boot of my car

sidebyside : 24th May 2012 21:17 : blog, therapy materials

So, as I approach the end of an insanely busy and varied week, I come to think about the boot of my car. When things are getting particularly desperate back there, it’s just about all I can do to find one more empty canvas bag from Tesco or ASDA, and sort through the toys for what I will need in the next session.


Speech sound resources are mixed up with bubbles, stacking toys, balloons and spinning light-up fans. Assessments lurk in the bottoms of bags of toy foods. Teddies and their nemeses -crocodile puppets and toy snakes, brawl in dark corners. Glittery balls would be rolling around in a distracting manner, if only there were space for them to do so. Tumbling men, ladder clowns, and tree dwelling monkeys will be lodging for another night, in, or possibly out of, one bag or other. It’s all back there somewhere!

Somehow, tomorrow I need to make sense of this, as I will empty out my boot to make way for my stuff (mostly washing) to transport halfway across the country, to my other half of my life. If this all sounds rather depressing and toilsome, then you’re right. Four years of this has quite frankly turned me into a distracted soul. I’m still waiting for that formal job offer!


Still full time NHS

sidebyside : 23rd May 2012 21:09 : blog, my day

It’s a bad place to start, with an admission, but I may as well go ahead and admit that, I don’t have a business plan, but I have sent off for 250 business cards. I know this isn’t all that wise, but what can I say? They were cheap!

I’ve had a busy day in my NHS job today, discharged three children (two of whom had speech difficulties which have resolved, and one who spoke very freely with me and who just needs the right kind of encouragement to interact more in his nursery).

I’ve gone round an autistic child’s house, taking photos of objects that his family will use with him in picture exchange, and done the same at his nursery, and carried out two separate sessions with him in both of these settings.

I’ve also seen a seven year old girl who amused me with some rather scatological play ideas. She has a rather unusual interaction style and a real difficulty paying attention in the classroom and forming friendships. I will talk to her mother tomorrow to see what her experience is of the girl at home. It might be appropriate for us to follow up a diagnosis of ASD.

Finally, well after the day should have ended, I went to see a parent of a child on my caseload who is going through an extremely difficult time. She doesn’t have much of what we rather euphemistically call a ‘support network’ around her, so I tried to point her towards some services which I thought could help. I spoke to our vulnerable adult safeguarding manager before doing this.

Then, rather tragically, I came home and tried to do some work on an assessment and therapy tool I’m trying to develop. I won’t go into it now, but it involves the book ‘Papertoy Monsters’, folding, glueing, and lots of talk of ‘ad-hoc category formation’.

So there’s my ‘day in the life of an SLT’.

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