What does a Speech and Language Therapist actually do?
By: Beth Morrant (The Speech and Language Garden)
Lots of people won’t have encountered a Speech and Language Therapist unless they or someone they know has needed one. This might be for their children to help with talking and speech sounds or for an older relative who has had a stroke or has Parkinson’s, for example.
We are helpers.
We’re health care professionals who provide assessment, treatment and support for people who have difficulties with communication, eating, drinking or swallowing. Speech and Language Therapists (SLTs) can work with people of all ages and with a wide range of conditions and needs. Lots of SLTs specialise in Paediatrics or Adults. I work with children (Paediatrics), more so with children in mainstream education who do not have complex needs and additional medical conditions.
Our governance and professional status
We are regulated by the Health and Care Professions Council and have a strict set of standards of proficiency to which we must adhere in order to provide the best care for our patients and service users.
In the UK we also have membership to the Royal College of Speech and Language Therapists which provides a range of resources and support to its members to ensure that we are able to practise safely, with the most up-to-date information from the evidence base.
In addition, as I am an Independent (i.e. Non-NHS) Speech Therapist, I am also a member of the Association of Speech and Language Therapists in Independent Practice which supports Speech Therapists in the independent sector.
What do I do?
I see individual children in my clinic for assessment and intervention for a range of difficulties including:
✔ Saying words clearly
✔ Talking in full sentences
✔ Concentrating and listening to instructions
✔ Processing language and following instructions
✔ Making themselves understood
✔ Speaking fluently (stammering)
✔ Finding the right words
✔ Having more than one language (bilingualism)
✔ Coping in social environments
On top of this, as a mainstream schools SLT, I help children who find things tricky in school. I visit a few schools in my local area and provide assessments, intervention (therapy sessions or demonstrations and staff training) and advice for a range of difficulties which might be causing barriers to learning for children. These include:
Attention and Listening
This is a foundation area to language skills and some children find it very hard to pay attention and this causes knock-on difficulties with memory, processing and comprehension.
I work with teachers to identify suitable classroom-based strategies to help the child in the classroom and I also suggest activities for home. Occasionally a referral needs to be made to a Paediatrician to investigate underlying medical issues (such as ADHD).
Play and Social Communication
Children with speech, language and communication needs can find social skills and having friendships very difficult.
I work with school SENCOs to implement different levels of intervention and strategies to help the children. Often social skills groups are set up or reinforced with positive talking strategies. Sometimes 1:1 sessions with a Teaching Assistant are prescribed to follow a set workbook or series of activities.
Comprehension and Understanding Skills
This is a huge area where children can have difficulties. They can struggle with comprehending longer instructions, which can impact on their ability to follow direct teaching in class and specific concepts which impacts on their maths skills i.e. prepositions, comparatives, ordinal, positional concepts.
Memory, retention and processing
This is such a huge area for children with SLCN and one of my biggest referral reasons in year 2 upwards: “processing problems”. Children struggle to remember all of the spoken information they have been given and then cannot process the words in order to act upon them.
It’s surprising how many teenagers I work with who can’t recite the months of the year. It’s no wonder that they struggle with their times tables…
Use of Spoken Language
From sequencing their ideas to formulating sentences, using grammar appropriately, to vocabulary deficit and word retrieval difficulties. This is another huge area for which we SLTs have a range of tests and resources to help children.
The largest area of need for many Speech Therapy services for the 2-5 year age group. Fundamental to literacy skills, as well as communication, children with speech sound difficulties can find their reading and writing skills impacted upon by their difficulties in sounding out words clearly.
Social skills can also be affected as children can find it hard to make themselves understood by their peers.
This is a very specialist area and one I wrote a blog post on recently, you can find it here. The golden rule is to contact a Speech and Language therapist for advice if you have a child who stammers.
There is a wide range of assessments and resources which SLTs can use to help children with either one or a combination of the above areas of difficulty. We have plenty of formal assessments which provide us with standard and percentile scores from which we can gain age equivalences that can help us in our clinical decision making skills, as well as add weight to our reports.
We also use lots of informal assessments to test children’s language functioning. Formal assessments are not always required or they don’t always show us the whole picture. An example for this is children with high-functioning Autism who may achieve very high scores on formal assessments but really struggle with social skills and processing information in particular scenarios.
Assessments help us to highlight areas of need but the challenging part can often be working out what to work on first with some children once we’ve identified those needs.
Once the child’s speech, language and communication needs have been identified, I then need to work out the best way to help them overcome this. Often children will need a programme of targets and suggested activities which they can do at home and school.
Some children require therapy sessions with the Speech Therapist before they can do work with their TA or Teacher in school. The Speech and Language Therapist will be able to use their knowledge of the evidence base to decide which is the most appropriate course of action and at which point the child’s progress should be reviewed.
Sometimes a target area is identified and there are few activities or some not very appropriate games suggested for the children i.e. the resource is aimed at a different age group. Some resources have been used for years and staff are bored of them. New members of staff might feel a little out of their depth and lack confidence in working with the children on their directed interventions. This is where I got the idea to create my e-books and online courses.
I genuinely love therapy sessions. We get to choose some fun games to help the child to work on their target and there are almost always pictures resources in my therapy sessions. We don’t always work at a table as some children need to generalise their skills by working in a different setting and some children struggle to focus their attention when sat at the table.
I record responses and often take a tally of the number of times the child met the target for the session (which can be a step towards their main target for the therapy block). At the end of the session, the child is given a sticker if they want one. Then they head back to class wearing their sticker with pride.
I put this in as a joke and then realised that I actually spend A LOT of time cleaning the toys and resources I use in my clinical practise. Infection control and preventing the spread of germs is very important, especially when some of my patients have weakened immune systems.
Clinical note keeping and report writing
Admin is a big part of my job. For every contact with a child, a clinical note is required. I’ll regularly need around 45 minutes to write up the clinical notes from an assessment session and around 15 minutes for a therapy session. Reports can take anywhere from 20 minutes to 6 hours. I tend to do all of my face-to-face working in the morning in a school and then head to my office in the afternoon to write it all up and record everything, but it is different for each Speech Therapist.
In addition to the client-based administration, we also have to keep up to date with our clinical professional development and have training sessions, meetings, research and reading to do to ensure we are maintaining our professional standards. Working across multiple age groups and specialist areas, I read quite a few journal articles, bogs, webinars and books on different topics, keeping myself topped up with tea and biscuits while I read.
I have weekly meetings with the SENCos in my schools and also attend annual review and EHCP meetings too. Occasionally I meet with parents to update them on the child’s progress and to include their wishes for their child when creating new targets. I’ll demonstrate fun homework ideas and reinforce how the games will help their child in school.
I also have meetings with other Speech and Language Therapists where we share best practise, discuss current events in our profession and give each other moral support.
Any Other Business
There’s lots of other things a Speech and Language Therapist does in their daily job, include stashing hoards of games in the boot of their car or attending webinars and conferences.
So there you go. Being a Speech and Language Therapist requires multitasking skills and involves quite a bit more than pop-up-pirate and stickers. If you see a Speech Therapist having fun with their working they are doing their job well! There’s a lot of science, assessment, analysis, planning, paperwork and passion that goes into our working with our patients but I love it!