professional development

Targeting training
The tenth anniversary of Elklan inspired founders Liz Elks and Henrietta McLachlan to reflect on the evolution of the training brand, consider the reasons for its success, and pass on top tips for learners and trainers.
n the current climate speech and language therapy departments are increasingly being asked to meet many varied targets. Indeed, sometimes it seems that there are so many targets to shoot at we dont know where to start. There is frequently a tension between providing the best care for a child - which could involve a variety of aspects such as training, home visits, collaboration with others - and the constant demands to meet waiting list targets and maintain a high number of face-to-face contacts. We are also facing the pressure of auditing the work we do to ensure it is cost effective and fit for purpose. We should however be heartened by the Bercow Review of Services for Children and Young People with Speech, Language and Communication Needs in England (Bercow, 2008), and the Speech and Language Therapy Task Force report for Northern Ireland (DHSSPS, 2008). Both identify the broader role we have to play in equipping the wider workforce in health and education, as well as parents and carers, to enable them to support children with speech, language and communication needs more effectively. Both highlight areas of good practice and, as a profession, we need to extend this current work rather than re-inventing the wheel. Ten years ago, we were both, and still are, community speech and language therapists with an interest in spreading good practice through training others. We couldnt have envisaged at the time that this would lead us to oversee a business offering 10 different courses via a network of 798 Elklan tutors throughout the UK and Ireland as well as Australia, Pakistan, Germany and Singapore! This network has between them trained over 7000 learners, the majority in the UK. In reflecting on our experience we hope to achieve two things. Firstly, to keep training of others as a priority for speech and language therapists and, secondly, to provide an example of the unexpected but rewarding directions your career can go in when you have a good idea and opportunities to take it forward. As speech and language therapists we know it is a good thing to train others who are involved with the child. It makes sense that those who are with the children more than we are - teachers, assistants, support workers and parents - know what and why we are doing the things we do and how they can
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help. With budgets being stretched, training has to be effective and give staff the information they need. For children with identified speech, language and communication needs, who are supported by the speech and language therapist through collaboration with assistants and teachers, training education staff enables our service delivery to be more appropriate, costeffective and efficient. Other children with less significant speech, language and communication needs can have these met within their school or pre-school setting without specific speech and language therapy support as long as staff can identify the need in the first place and are aware of the practical strategies which can be used to enhance the childs learning within the educational context. Training does not replace 1:1 therapy, but it does mean that education and early years staff can give the appropriate, additional support that many of these children need to progress. The first step in the Elklan journey was in 1999 when we were commissioned by Cornwall Local Education Authority to write a course to support teaching assistants working with children with speech, language and communication needs in Cornish mainstream primary schools. Following the employment of speech and language therapists by Cornwall Local Education Authority in 2000 we were asked if we

could support them delivering our successful ten week course. Thus began the difficult task of taking material which we had taught and making it very clear to somebody else so they could pick up and teach it. We managed this, and decided to see if other speech and language therapists in the rest of the UK would be interested in using it.

Small beginnings

Our first Elklan Total Training Pack course was held at the Royal College of Speech & Language Therapists training rooms in November 2001. In great fear and trepidation we trained six people, one of whom is continuing to use the programme eight years on. From these small beginnings we have gone on to write training packages for parents, carers, education and health staff which cover the age ranges 223 years as well as courses supporting children with autism spectrum disorder, unclear speech, complex needs and hearing impairment. In September 2001 we submitted the primary course for accreditation through the Open College Network South West Region. By this time Liz had moved to Northern Ireland and so Henrietta worked extremely hard to complete the very demanding process. As a result, all our courses are now accredited, and this adds value for both staff and employers. As Elklan has grown we have shared our

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training packages with specialist language teachers so they co-teach with a speech and language therapist. This has helped to improve collaboration between health and education staff on the ground as well as enabling learners to benefit from the expertise of the two disciplines during the training sessions. Elklan trains the local speech and language therapists and specialist teachers to become Elklan tutors. Elklan tutors are given all the materials required to teach others in their area. After the initial training is complete we continue to have an ongoing relationship with tutors. Telephone and email support is available and message boards have been developed online to encourage tutors to help each other. There are also message boards for the learners to chat about the courses they are completing, and these make interesting reading. Sometimes learners want practical support around completing portfolio tasks and using the website. One post we received gave us the heartening news that, as a result of completing the training, she wanted to look further into a career in speech and language therapy. We endeavour to listen to the needs of both our tutors and learners, and take the feedback we receive very seriously. Our courses are not static but have evolved over time and continue to do so. We respond to the information received from others by changing and updating the courses and incorporating suggestions made by tutors and learners. This is challenging as there are frequently as many different ideas and opinions as there are people involved. We seek to resolve issues and listen to others views through a series of meetings that we hold annually in different parts of the country. Following these useful discussions we periodically make changes to the course material and are grateful to our more experienced tutors for acting as guinea pigs to ensure that what we have written is clear to others not always an easy task! We continue to learn through constructive criticism and the written feedback we receive from every learner who completes the accredited programme across the UK.
Figure 1 Top tips from learners to learners 1. During the sessions do what the tutor tells you to do, even if it seems crazy at the time. 2. Apply what you have learnt into your context this takes time, effort and discipline. 3. Contribute to discussions and workshops, as you learn more that way. 4. Be prepared take a pen and some note-paper with you. 5. Volunteer (its less embarrassing in the long run). 6. Be aware that, while everything you hear may not be directly relevant to you, it will be for someone in the room. 7. Respect confidentiality and the issues others may be concerned about. 8. Listen to all those contributing, especially when feedback is given from group work; its good to get ideas from colleagues as well as from the tutor. 9. Be willing to learn. 10. Go with a positive attitude and enjoy yourself.

Figure 2 Top tips from learners to trainers 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Use visual aids. Ensure plenty of time for discussion. Give us time to reflect and put what we have learnt into practice. Enable us to learn from each other through small groups and discussions. Use practical ideas that are fun. Keep your voice interesting. Keep the sessions short, focused and full of information. Make sure the room is well lit and well ventilated and that the chairs are comfortable. Consider the timing of the sessions try to find a time when it is easy to stay awake. Arrange lots of coffee breaks.

Figure 3 Top tips from trainers to trainers 1. 2. Know your material well prepare effectively. Give yourself time to set up and ensure all the technology works before you stand up to speak. 3. Practise what you preach use multi-sensory teaching and vary activities to suit different learning styles. 4. Dont use jargon (be aware that what we think isnt jargon probably is). 5. Ensure you have frequent learning and refreshment breaks and a comfortable learning environment. 6. Use labels so you can address contributors by name. 7. Always have an eye on the clock - stick to the timetable and finish on time. 8. Stick to the course content. Dont get side-tracked by learners with an agenda, but speak with them afterwards. 9. Know your audience. 10. Maintain a sense of humour at all times and expect the unexpected...

Need to know

One of our key principles is only to teach information that learners say they need to know to support children more effectively. Elklan explores what is required to implement speech and language therapy programmes, as well as offering many practical strategies to support childrens speech, language and communication across the curriculum. We strive to enable educational establishments to use their staff resources more effectively. We have found over the years that, to be most effective, training needs to be linked in with service delivery. This enables speech and language therapists to work in collaboration to provide the best possible support for children. Many of us have been involved in training

others at some point and have some tips to pass on, often learned through harsh experience. We asked trainers and learners from around the country to share their top tips to help us all to be more effective in the training we offer (figures 1-3). So, does Elklan work? In November 2007 Herefordshire Education Authority and Speech and Language Therapy Department undertook an independent audit to evaluate the impact of Elklan Speech and Language Support for Under 5s in the county. From 2004-2007, 371 early years practitioners attended courses from 46 early years settings, with a potential impact on over 1000 children. The audit showed that the Elklan Training Programme has had a significant impact on raising the quality of provision not only for young children with speech and language difficulties but for all children attending preschool settings in the county (Jackson, 2007, p.1). The author reports specifically that staff can identify and meet the needs of children with speech

and language difficulties, share information with parents and refer on appropriately. They also support the work of speech and language therapists with individual children. The training has helped to create a shared ethos and collaborative working approach amongst practitioners, agencies and childrens services in Herefordshire (Jackson, 2007, p.1), something which the Bercow and Task Force reports both mention as being crucial to the success of future interventions. A smaller audit has been completed by John Andrea, speech and language therapist in Oldham. His evaluation study measured the effectiveness of the Elklan Primary school course, Speech and Language Support in the Classroom. He measured how participants knowledge, skills and ability to liaise effectively with other professionals had been affected by the training. He carried out the Wilcoxon Matched-Pairs Signed Ranks Test on the data. He found significant improvement in all three areas - knowledge, skills and liaison - at significance level of p =/< 0.05 (Andreae, 2008).

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Editors choice

So many Journals, so little time! Editor Avril Nicoll gives a brief flavour of articles that have got her thinking.
In the short but beautiful My journey into relationship-based practice, Kristy Collins describes the familiar anxiety we feel when faced with strong parental emotions, and how our natural desire to solve problems quickly is counterproductive. She demonstrates the value of a dynamic therapy approach, creating a safe environment, holding the strong emotions, and the importance of relationships (parent / therapist, parent / child, therapist / child) to long-term success. Her comment about the mother in the clinical scenario is telling: As her confidence grows, so does mine. (p.168) (ACQ (2009) 11(3), pp.167-168) Advocating consistency of parental language with a child with communication difficulties and English as an additional language doesnt address the fascinating and natural phenomenon of code-switching. In Code switching in bilingual children with specific language impairment, GutierrezClellen, Simon-Cereijido and Leone find no significant differences compared with children with typically developing language. They conclude there is no support for the recommendation to avoid or prevent mixing the language in communication with these children at home, at school, or in a clinical setting (p.106) and that we should value the information code-switching provides about their bilingual development. (International Journal of Bilingualism (2009) 13(1), pp.91-109) In How do individuals cope with voice disorders? Introducing the Voice Disability Coping Questionnaire, Epstein, Hirani, Stygall and Newman emphasise that managing the stress of illness is a process not a goal. Seeking social support and information is more positive for outcomes, while avoidance and passive coping may be useful in the early stages but can have a long-term negative impact on quality of life. This clinical tool is for use before and after intervention as well as to guide it. I would be interested to compare it with a more dynamic, solution focused tool where the questioning aims to prompt and support adaptive coping. (Journal of Voice (2009) 23(2), pp.209-217)

In Great Yarmouth speech and language therapists Susan Lyon and Louise Hess have been responsible for changing their service to their school-aged population. From one which was delivered via the local clinic, it is now based in schools with therapy integral to the childrens school day. This change involved training education colleagues to enable them to work collaboratively and effectively. They trained classroom assistants with the Elklan 10 week course Speech & Language Support in the Classroom and the two day overview of the same information was given to class and advisory teachers, educational psychologists and Special Educational Needs Co-ordinators (SENCOs). As a result they have found that children with speech, language and communication needs do best when staff attend training and use a designated learning support assistant to support them. They also found that when staff are actively involved in target setting in collaboration with the therapist and follow these targets that children make significant progress. They say, As a team we can report feeling more positive about the service we provide to school age children, their families and their schools...We are also excited by the real progress children are making in a language friendly environment (Lyon & Hess, 2007, p.23). Other evaluation reports are available on the Elklan website. We think one of the reasons for Elklans success is our working partnership, as our styles complement each other well: Liz says, I really enjoy the privilege of meeting with and supporting speech and language therapists from across the UK. We have a wide network of therapists and teachers that we have trained to be Elklan tutors and, because we meet with many of them annually, they have become friends as well as colleagues. There really is an Elklan family. I find all the administration really hard work, and am pleased that I have Henrietta to cover up my mistakes and offer support. However, the feedback from Elklan learners is heart warming and allows me to feel I am doing a worthwhile job. Some have honestly said that Elklan has changed their working life and they now feel so much better equipped to work with the children they are responsible for. Henrietta adds, I enjoy the contact, discussions and feedback with tutors and learners but also revel in the constant and diverse challenges that Elklan demands. The challenges range from basic accounts to organising multi-cultural DVD clips; from matching diagrams in Welsh to Welsh text without understanding a word of it; from simple emails to one requesting information about weaver fish (used in a vocabulary map in our book Language Builders). I am less fond of the fear of not meeting other peoples expectations and e-mails from the printers announcing a delay in producing

the books because the machines have broken down - a factor which is definitely beyond our control! Whatever training you do we hope that you continue to find it worthwhile and enjoyable and that, above all, it helps those children who need our help the most. SLTP Liz Elks (e-mail [email protected], tel. 0289 042 2069) and Henrietta McLachlan (e-mail [email protected], tel. 01208 841450) are speech and language therapists. Together they are Elklan, Sunnyside, Wadebridge Road, St Mabyn, Cornwall PL30 3BQ, www.elklan.co.uk. References Andreae, J. (2008) Elklan course Primary Lyndhurst / South Failsworth Schools Feb-May 2008. Pre and Post Course Rating of Students Knowledge and Skills. Speech and Language Therapy Service, Oldham Primary Care Trust. Bercow, J. (2008) Bercow Review of Services for Children and Young People with Speech Language and Communication Needs. Available at: http:// www.dcsf.gov.uk/slcnaction/ (Accessed 14 October 2009). DHSSPS (2008) Report on Speech and Language Therapy Services for Children and Young People Improving outcomes for children and young people with speech language and communication needs Northern Ireland. Belfast: Speech and Language Therapy Taskforce Northern Ireland Executive. Available at: http://www.dhsspsni. gov.uk/regional_speech_and_language_ therapy_task_force_report.pdf (Accessed 14 October 2009). Jackson, L. (2007) Speech and Language Support for the Under 5s. Herefordshire Evaluation Report. Speech and Language Therapy Service, Herefordshire County Council. Available at: http://www.elklan.co.uk (Accessed 14 October 2009). Lyon, S. & Hess, L. (2007) All Change, Bulletin of the Royal College of Speech & Language Therapists 665 (September), pp.22-23.

REFLECTIONS DO I SUPPORT AND LEARN FROM COLLEAGUES WHO USE SIMILAR APPROACHES, EITHER VIRTUALLY OR IN PERSON? DO I FOCUS ON WHAT PEOPLE REALLY NEED TO KNOW WHEN I OFFER TRAINING? DO I UNDERSTAND THE RELEVANCE TO MY PRACTICE OF INFLUENCING AND TAKING ADVANTAGE OF POLICY DEVELOPMENTS? Do you wish to comment on the difference this article has made to you? Please see the information about Speech & Language Therapy in Practices Critical Friends at www. speechmag.com/About/Friends

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2009