Communication Conquests in the Community · SWOT analysis of this development Opportunities •...

Dr Rita Micallef, MSc (Dub) Cl. Sp.&Lang. Stds; MSc (Leic) Trg. & HRM; Ed D (Sheffield), Manager Speech Language Pathologist; lecturer UoM.

Gertrude A. Buttigieg Comm.Th. B. Sc.. (Hons.), P.Q. Dip. HSc Mang., MSc Principal SLP

5th PHCD ConferenceDolmen Hotel, Malta, 23rd October 2009

Communication Conquests Communication Conquests in the Communityin the Community

SPEECH LANGUAGE DEPARTMENT

DipartimentDipartimentDipartimentDipartiment taltaltaltal----KuraKuraKuraKura PrimarjaPrimarjaPrimarjaPrimarja SPEECHSPEECHSPEECHSPEECH----LANGUAGE DEPARTMENT LANGUAGE DEPARTMENT LANGUAGE DEPARTMENT LANGUAGE DEPARTMENT

Tel: 21230822 Tel: 21230822 Tel: 21230822 Tel: 21230822

Dr. Rita Micallef, Gertrude A. Buttigieg

How the Speech Language Services How the Speech Language Services have grown in the community over the have grown in the community over the past couple of decades.past couple of decades.

•• Speech Language Pathologists have seen the signs Speech Language Pathologists have seen the signs

of times and are the only Health professionals of times and are the only Health professionals

together with GP services and nurses to be widely together with GP services and nurses to be widely

distributed on a community leveldistributed on a community level

•• Today Speech Language Department has around 65 Today Speech Language Department has around 65

SLPs and 50 of which are deployed in the SLPs and 50 of which are deployed in the

community this is a considerable increase over the community this is a considerable increase over the

past 28 years and this has allowed services to past 28 years and this has allowed services to

develop in the way they havedevelop in the way they have


The The BiopsycosociolinguisticBiopsycosociolinguisticModelModelThe services have tried to respond to the needs of our The services have tried to respond to the needs of our

client group by:client group by:

•• Listening to and understanding the needs and rights of Listening to and understanding the needs and rights of each and every individual/each and every individual/carercarer exhibiting the disorder.exhibiting the disorder.

•• Assessment becoming a dynamic venture that takes into Assessment becoming a dynamic venture that takes into account the context of the client and the life style that account the context of the client and the life style that the client is used to.the client is used to.

•• Locating the learning potential of the client within the Locating the learning potential of the client within the clientclient’’s functional needs and abilities.s functional needs and abilities.

•• Empowering the Empowering the carerscarers. .

•• Applying findings reported in the literature and the Applying findings reported in the literature and the research that is going on in the area.research that is going on in the area.


Areas of service deliveryAreas of service delivery

Speech-Language Intervention

Services

Health Centres

8

Hospitals

9

ATCs

8

Special Schools

5

Mainstream schools

28

District Clinics

21


SPECIALIST CLINICSSPECIALIST CLINICS

•• Fluency Specialist ClinicFluency Specialist Clinic

•• Parent Training GroupsParent Training Groups

•• Cochlear Implant Cochlear Implant Specialist ClinicSpecialist Clinic

•• VoiceVoice

•• Communicating through Communicating through playplay


RESEARCH GROUPSRESEARCH GROUPS

•• LinguisticsLinguistics

•• AutismAutism

•• LiteracyLiteracy

•• AAC AAC

•• Early intervention play groupsEarly intervention play groups

•• DysphagiaDysphagia


Core Guidelines + Core Guidelines + Professional standardsProfessional standards•• Open referral systemOpen referral system

•• Admin and discharge at discretion of SLPAdmin and discharge at discretion of SLP

•• All referrals acknowledged (All referrals acknowledged (SUsSUs seen within 15 working seen within 15 working days)days)

•• InIn--patients seen within 1 working daypatients seen within 1 working day

•• No waiting listsNo waiting lists

•• Appointments offered at nearest clinicAppointments offered at nearest clinic

•• Involvement of families and/or Involvement of families and/or carerscarers..

•• Multidisciplinary approachMultidisciplinary approach

•• Adoption of collaborative practicesAdoption of collaborative practices

•• Home service when individual is immobileHome service when individual is immobile


OUTCOMEOUTCOME•• Maintenance of optimal communication and/or Maintenance of optimal communication and/or

swallowing abilitiesswallowing abilities

•• Improvement in communication, language and Improvement in communication, language and speech abilitiesspeech abilities

•• Reduction of communication anxiety and avoidanceReduction of communication anxiety and avoidance

•• Improvement of existing functionsImprovement of existing functions

•• Provision and use of AAC where communication is Provision and use of AAC where communication is limitedlimited

•• Improvement in interaction and effective social Improvement in interaction and effective social communicationcommunication

•• Differential diagnosisDifferential diagnosis


Outcome contOutcome cont……•• Increased awareness of others about Increased awareness of others about

communication and/or swallowing disorders and communication and/or swallowing disorders and management.management.

•• Improved communication environmentsImproved communication environments

•• Improvement in the individual Improvement in the individual ‘‘s understanding of s understanding of the disorder and the implications.the disorder and the implications.

•• Treatment deferred or transferred to other agencyTreatment deferred or transferred to other agency

•• Self dischargeSelf discharge

•• Failure to attend 3 consecutive appointmentsFailure to attend 3 consecutive appointments

•• Health deterioration/ death of SUHealth deterioration/ death of SU


Extension of role related skillsExtension of role related skills•• Contribute to CPD Contribute to CPD –– case presentations case presentations

•• Individual Care PlanIndividual Care Plan

•• SupervisionSupervision

•• Lecturing to students and other professionalsLecturing to students and other professionals

•• Organization of workshopsOrganization of workshops

•• Educating the general public through leaflets, Educating the general public through leaflets,

participation in TV and radio participation in TV and radio programmesprogrammes

•• CounselingCounseling


Client groupsClient groups

•• Learning disabilityLearning disability

•• Sensory impairmentSensory impairment

•• Motor disorderMotor disorder

•• ADD/ADHDADD/ADHD

•• AutismAutism

•• Cleft lip/palate/Cleft lip/palate/velopharyngealvelopharyngeal anomaliesanomalies

•• Acquired Acquired neuorologicalneuorological disorder.disorder.

•• Voice problemsVoice problems


Client groups Cont..Client groups Cont..

•• Mental healthMental health

•• ENTENT

•• Elderly populationElderly population

•• AACAAC

•• Developmental speech and language Developmental speech and language difficultiesdifficulties

•• DysphagiaDysphagia

•• Literacy difficultiesLiteracy difficulties


Total attended Total attended (as per 2008)(as per 2008)

27142714Special SchoolsSpecial Schools

582582ATCsATCs

542542Special Interest ClinicsSpecial Interest Clinics

1961319613Hospitals/SVPR/Elderly HomesHospitals/SVPR/Elderly Homes

50315031Mainstream SchoolsMainstream Schools

1986619866District ClinicsDistrict Clinics

1437814378Health CentresHealth Centres


Sessions in SLP clinics vs sessions outside clinics 2008(January-December)

52%

8%

1%

1%2% 2%5%

29%

Speech-Language Clinics

M ainstream Schools

Hospitals

Special Interest Clinics

ATCs

Special Schools

Home Visits

School Visits


Caseload Adult versus ChildrenCaseload Adult versus Children

19719700Special SchoolsSpecial Schools

00329329ATCsATCs

262600Special Interest ClinicsSpecial Interest Clinics

234234466466HospitalsHospitals

117011707171District ClinicsDistrict Clinics

118811888383Health CentresHealth Centres

ChildrenChildrenAdultsAdults


Liaisons/Integrated ServicesLiaisons/Integrated Services

The SLD works in partnership with people The SLD works in partnership with people

with disabilities to help them achieve full with disabilities to help them achieve full

inclusion to the best of their abilities by inclusion to the best of their abilities by

gaining access to mainstream activities, gaining access to mainstream activities,

leading to an independent lifeleading to an independent life


Sharing of InformationSharing of Information•• Client Detail Form for Filing PurposeClient Detail Form for Filing Purpose

–– Client DetailsClient Details

–– Summary of Intervention PlanSummary of Intervention Plan

–– Frequency of SessionsFrequency of Sessions

–– Periodic Review of ProgressPeriodic Review of Progress

•• Referral to other ProfessionalsReferral to other Professionals

–– Reason of dischargeReason of discharge

–– Date of dischargeDate of discharge

–– Details of transfer locationDetails of transfer location


Service Achievements Service Achievements –– A current overviewA current overview

•• Proliferated intensely the communityProliferated intensely the community

•• ATC ATC –– evidence of role transition to consultancy/training evidence of role transition to consultancy/training providerprovider

•• Hospitals Hospitals –– role expansion (AAC consultancy/role expansion (AAC consultancy/DysphagiaDysphagiaspecialityspeciality))

•• Rehabilitation Rehabilitation –– specialists, team work specialists, team work

•• Schools Schools –– direct participation in IEPs, consultation on direct participation in IEPs, consultation on curriculum planning, peer preparation, ACTU curriculum planning, peer preparation, ACTU involvementinvolvement

•• Training and consultancy role Training and consultancy role –– Education DivisionEducation Division

•• Diversity in skills applied Diversity in skills applied –– counseling, trainer etc.counseling, trainer etc.

•• Intervention through other mediums Intervention through other mediums –– play etc.play etc.


What service users have to say?What service users have to say?

•• More informationMore information

•• Participation at IEPsParticipation at IEPs

•• CounselingCounseling

•• Empowered and treated on equal termsEmpowered and treated on equal terms

•• Relationship Relationship centredcentred interventionintervention

•• Need to be listened toNeed to be listened to

•• Need Need SLPsSLPs to appreciated how problem effects their to appreciated how problem effects their lifelife

““it is not what they do but how they do it that it is not what they do but how they do it that countscounts……. The way they greet you and understand . The way they greet you and understand

your hurtyour hurt””


What What ‘‘alliedallied’’ professionals have to say?professionals have to say?

•• Need more information regard what to expect Need more information regard what to expect

from the SLPfrom the SLP

•• Need to familiarize more with what the SLP can Need to familiarize more with what the SLP can

offer. offer. ““I never knew that the SLP could help my I never knew that the SLP could help my son with his literacy problemson with his literacy problem””

•• ““I think as a culture we are not used to working I think as a culture we are not used to working together however, it has become common together however, it has become common occurrence that you see an SLP in case occurrence that you see an SLP in case conferencesconferences””


What What SLPsSLPs have to say?have to say?•• Reports not accepted/not given enough importanceReports not accepted/not given enough importance

•• Involvement in curricular planningInvolvement in curricular planning

•• Not seen as part of an educational serviceNot seen as part of an educational service

•• ““Has the education system prepared the SLP for the Has the education system prepared the SLP for the workplaceworkplace??””

““I have learnt the techniques necessary but dealing I have learnt the techniques necessary but dealing with the general public has been a struggle with the general public has been a struggle especially in the beginning, but then experience especially in the beginning, but then experience helpshelps””

•• ““I have had to change and develop other skills such I have had to change and develop other skills such as negotiation skillsas negotiation skills…”…”

•• CPD CPD -- ““best learning is onbest learning is on--thethe--job but use of job but use of foreign tutors helps to brush up/top up knowledgeforeign tutors helps to brush up/top up knowledge””


SWOT analysis of this SWOT analysis of this developmentdevelopment

StrengthsStrengths

•• Well trained staffWell trained staff

•• Highly accessibleHighly accessible

•• Infrastructure used Infrastructure used

wellwell

•• Staff personally feel Staff personally feel

responsible for their responsible for their

clients andclients and

WeaknessesWeaknesses

•• Staff may feel Staff may feel

isolated at timesisolated at times

•• Resources need to be Resources need to be

split between the split between the

various clinicsvarious clinics

•• Lack of commitment Lack of commitment

towards service by towards service by

other agencies other agencies


SWOT analysis of this SWOT analysis of this developmentdevelopment

OpportunitiesOpportunities

•• Growth of service Growth of service

and staff increase in and staff increase in

specialisation specialisation

•• Increase in Increase in

awareness amongst awareness amongst

public and other public and other

professionals professionals

facilitates timely and facilitates timely and

early interventionearly intervention

ThreatsThreats

•• Changes over time Changes over time

may jeopardise some may jeopardise some

of what has been of what has been

achieved so farachieved so far

•• Limited resources Limited resources

e.g. In IT limit how e.g. In IT limit how

much more the much more the

service can develop service can develop

to meet todayto meet today’’s s

needs and standardsneeds and standards


Client Satisfaction Interviews Client Satisfaction Interviews

•• SemiSemi--Structured interviews with 16 Structured interviews with 16

clients were carried out.clients were carried out.

•• These were randomly selected from 333 These were randomly selected from 333

clients which which had received clients which which had received

uninterrupted service over 2 years, only uninterrupted service over 2 years, only

from the community clinics. Initially 25 from the community clinics. Initially 25

clients were selected but eventually 16 clients were selected but eventually 16

participated in the data collection. participated in the data collection.


Themes DiscussedThemes Discussed

AccessibilityAccessibility

how easily it is to get how easily it is to get

to and use a service, to and use a service,

it includes physical it includes physical

availability and costavailability and cost

Technical Technical

managementmanagement

technical care and technical care and

technology used in technology used in

the management of the management of

the health problem, the health problem,

considers also the considers also the

interaction between interaction between

client and service client and service

providerprovider


Themes DiscussedThemes Discussed

Interpersonal Interpersonal

processprocess

expectations of service expectations of service

usersusers

Continuity Continuity

the client is followed the client is followed --

up by the same up by the same

health professional health professional

from assessment to from assessment to

case management case management

includes documentation includes documentation

and record keepingand record keeping


LimitationsLimitations

•• Interviewer role and ReflexivityInterviewer role and Reflexivity

•• Small Sample Small Sample -- poor generalisabilitypoor generalisability

•• Interviewee bias Interviewee bias -- nonnon--respondents biasrespondents bias

•• Interpretation biasInterpretation bias


RESULTSRESULTS

•• Clients considered themselves satisfied Clients considered themselves satisfied

since services were available by since services were available by

professional staff and their condition professional staff and their condition

improvedimproved

‘‘The service is offered close by, on a regular basis, The service is offered close by, on a regular basis, and I have no parking problems. Qualified staff and I have no parking problems. Qualified staff who know what they are doing and are happy who know what they are doing and are happy

doing their jobdoing their job’’ (service user)(service user)


RESULTS AccessibilityRESULTS Accessibility•• Geographic and physical accessibility are of Geographic and physical accessibility are of

utmost importance utmost importance -- near school and near school and

parking problems very important for clientsparking problems very important for clients

•• flexibility of appointments although flexibility of appointments although

considering longer hours of service such as considering longer hours of service such as

after school was suggested. The fact that after school was suggested. The fact that

SLP is just a phone call away was a positive SLP is just a phone call away was a positive

aspect aspect

•• Some clients wanted more frequent Some clients wanted more frequent

appointments appointments


RESULTS Accessibility RESULTS Accessibility

factors effecting acces s ibil ity

0

1

2

3

4

5

6

7

8

9

1 0

flexib

le ap

no st

airs

waiting

area

acce

ss on

foot

park

ing fa

cilite

s

near

scho

olop

en re

ferral lif

ts

1 bus

punc

utalit

yfre

e of c

harg

e

fact o rs

no. o

f re

spon

dent

s


RESULTS Technical ManagementRESULTS Technical Management

•• Small rooms and poor environmental conditions Small rooms and poor environmental conditions --

too hot and noisy in summer with windows kept too hot and noisy in summer with windows kept

open, in Winter too stuffy open, in Winter too stuffy

““The room could be better, more colourful, having The room could be better, more colourful, having pictures on the wall is not enough to make it pictures on the wall is not enough to make it

suitable.suitable.”” (a parent)(a parent)

““..would do with some more modern furniture instead ..would do with some more modern furniture instead of heavy metal cabinets. Furniture has to have of heavy metal cabinets. Furniture has to have rounded corners just in case of hyperactive rounded corners just in case of hyperactive

childrenchildren”” ( a participant)( a participant)


RESULTS Technical ManagementRESULTS Technical Management

•• Clients trusted staff as since they are employed Clients trusted staff as since they are employed

they are qualified enough although being nice and they are qualified enough although being nice and

gentle to children and approachable was considered gentle to children and approachable was considered

equally important equally important

•• Need to have more modern resources such as use Need to have more modern resources such as use

of ITof IT

““My child gets distracted easily and using My child gets distracted easily and using the computer can help him more during the computer can help him more during

a sessiona session’”’”(a parent)(a parent)


RESULTS The management of the RESULTS The management of the interpersonal processinterpersonal process

•• All participants perceived that staff members All participants perceived that staff members

treated then courteously during their encounters treated then courteously during their encounters

““This is the 3rd or 4th therapist and they This is the 3rd or 4th therapist and they ‘‘ve always ve always been goodbeen good”” (a parent)

•• Majority of interviewees were unaware of Quality Majority of interviewees were unaware of Quality

Service Charter Service Charter -- need to have a feedback system need to have a feedback system

in place in place

•• Satisfied and refrained from placing complaintsSatisfied and refrained from placing complaints

““I would only make a complaint if I know that the I would only make a complaint if I know that the therapist will not get into trouble.therapist will not get into trouble.”” (a parent)


RESULTS ContinuityRESULTS Continuity

•• Primary Service provider Primary Service provider -- rotationrotation

•• Aware that there is a record keeping Aware that there is a record keeping

system in place but none claimed that system in place but none claimed that

they considered the files as their propertythey considered the files as their property

•• Their role in their progress was Their role in their progress was

considered important:considered important:

““Very important since with 30Very important since with 30--45 minutes 45 minutes you wonyou won’’t get fart get far”” (parents & an adult client)(parents & an adult client)


ConclusionsConclusions

Current StatusCurrent Status

•• Geographic AccessGeographic Access

•• FacilitiesFacilities

•• Client involvementClient involvement

•• Satisfaction & Satisfaction &

DissatisfactionDissatisfaction

Important issues to Important issues to

be addressedbe addressed

•• Clinics design and Clinics design and

environmental environmental

facilitiesfacilities

•• Development of a Development of a

feedback procedurefeedback procedure

•• Better use of ICTBetter use of ICT


Concluding RemarksConcluding Remarks•• Irrespective of ones clinical competence, Irrespective of ones clinical competence,

the environment, policies and standards, the environment, policies and standards,

clinical outcome and client satisfaction clinical outcome and client satisfaction

are important to be taken into account in are important to be taken into account in

the delivery of Speech Language the delivery of Speech Language

Services. Services.

•• Ongoing techniques are changing, Ongoing techniques are changing,

culture is changing and people are all the culture is changing and people are all the

time changing, however if there is true time changing, however if there is true

belief that change can be achieved then belief that change can be achieved then

things can start and results will follow.things can start and results will follow.


Thank you for your attentionThank you for your attention

Communication Conquests in the Community · SWOT analysis of this development Opportunities •...

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