How effective is the Mainstream Intensive Support Speech and

Language Therapy Team (MIST) in providing for children with complex needs (including Down Syndrome) attending mainstream schools in

Brighton and Hove

Dr Lisa Butterworth – Salmon Specialist Speech and Language Therapist Sussex Community NHS Foundation Trust

Lisa.Butterworth-Salmon@NHS.net

Children’s Speech and Language Therapy in Brighton and Hove

Aim: to provide equitable support and intervention for all children with speech, language, communication and swallowing difficulties from 0-16 years based on their needs rather than a diagnosis.

The Balanced System - ‘Communication is every ones business’

The Balanced System (Cascoigne, 2013)

Mainstream Schools Service

�  SLT allocated to each mainstream school across Brighton and Hove. Termly meetings with SENCO to plan SLT support for the term. Universal – Targeted – Specialist.

�  Clinical decision made about SLT provision based on child’s need.

�  5-6 hours (annual assessment and advice)

�  3-6 hours (across a term)

�  9-12 hours (across a term)

�  SLT provision provided in school.

Mainstream Intensive Support Team �  MIST SLT part of schools service. Children referred to the

service with an identified complex needs. �  Significant SLC difficulties and additional need �  Significant multiple need and multi-agency involvement �  Implementation of AAC

�  Children on the MIST caseload tend to receive provision 9-12 hours.

�  Training and demonstration �  Liaison e.g. SENCO, outreach teachers, private SLT �  Multidisciplinary meeting / Annual Review etc. �  Direct therapy �  Observation and advice �  Regular meetings with parents and opportunities for home visits �  Changes made to provision depending on need of child / competency

of staff / setting

Down Syndrome �  Attend both mainstream and special school

provision.

�  68 mainstream schools in Brighton and Hove.

�  27 children with Down Syndrome currently on the SLT caseload (attending primary and secondary mainstream schools).

�  12 children with Down Syndrome on MIST caseload

Case Studies 1

FD (7 years old)

�  Reception year: challenging behaviour, attention and engagement skills poor, now aided hearing, speech unintelligible. SLT working through short highly motivating activities to encourage communication and encouraging Makaton signing within the classroom. Trying to establish sight vocabulary (See and Learn) and vocabulary learning work. Skilled support staff, teaching staff found working with him more challenging.

�  Year one: behaviour management strategy in place. New teaching staff with experience. FD engaging more with adult tasks. Structured therapy sessions more successful. Incorporating speech and communication targets. Beginning to develop a communication book to aid intelligibility. Reading and Language Intervention now more successful.

Case study 2 �  FJH (8 years old)

�  Primary school

Initiating communication, practising speech sounds, developing vocabulary, working on See and Learn early reading.

�  Junior school

Staff feeling challenged by FJH needs. Class teacher struggling with differentiation. Support staff attended training on Reading and Language Intervention. Needing lots of support. Targets kept simple: creating more opportunities to communicate, Reading and Language Intervention. Continue to be challenges.

�  Transition to year 4

Parents haven't been happy with current mainstream school. Asked LEA for dual placement: 2 days special school – 3 days mainstream school from Sept 2016.

Case study 3 TSM (5 years old)

Arrived in UK March 2015. Trilingual family: Italian, Bengali, English.

Delayed attention and listening, developing early play skills, understanding some familiar routines and associated vocabulary, small expressive vocabulary, developing social communication skills with peers, some mild eating difficulties with mixed textures.

Very busy reception class, very free flow. Large space to explore. Support focused on direct therapy to support and demonstrate building communication through interaction, liaison with specialist outreach teachers.

Targets: to create more opportunities to communicate, developing simple language around routines through e.g. modelling/repetition.

Emergency Annual Review meeting July 2016 – parents want to move TSM to special school.

Some final thoughts. Research and next steps?

�  Is there anything special about MIST?

�  Quantity and / or quality?

�  Importance of ability to react to need quickly / build relationship with parents / support and advise parents, as well as school staff and other professionals.

�  Other SLT services across the UK supporting children with complex needs in mainstream school.

�  Patient and Public involvement

�  Qualitative methodology: consider how best to engage with parents to collect reliable and valid information

�  Audit service through evaluation of parent experience of MIST at a key transition point; starting school

Any questions?

Dr Lisa Butterworth – Salmon Specialist Speech and Language Therapist Sussex Community NHS Foundation Trust Lisa.Butterworth-Salmon@NHS.net