Updated January 2006

Demystifying the medico legal world
While we might see expert witnesses in TV dramas looking composed and professional, the reality can be very different. Even just the phrase ‘medico legal’ or ‘special educational needs tribunal’ has the potential to turn well-adjusted and logical SLTs into anxious self-doubting wrecks.

It is also an area where sides are drawn up in combat, not necessarily with conciliation of compromise in mind – at least that is how it might seem at first to the uninitiated and for most of jus this sort of work is not our everyday experience.

In a drive to unit and break down the concepts of ‘sides’ and ‘winners and losers’, the Association of SLTs in Independent Practice (ASLTIP) has set up a group to focus on deico legal aspects fo the profession.

Twenty SLTs – representing both acquired and developmental aspects of clinical work from the NHS and independent/voluntary sectors from across the UK – attended the first meeting on 12^th September 2003. Those present wrote a constitution and officers volunteered to run the group.

The group aims to demystify the world of medico legal work, address the need for support and reduce the anxiety from a potentially fraught situation. A number of exciting initiatives emerged from the meeting including the establishment of an email round robin – similar to the one ASLTIP members can join. Round robin members can refer concerns and enquiries and gather the collective advice and experience from the group almost immediately. Another initiative will identify and build up a body of research/papers pertinent to the medico legal cases.

Rebecca Matthews
Independent SLT who set up the RCSLT Medico Legal Special Interest Group

Article published in Professional Issues section of the Royal College of Speech & Language Therapist’s monthly journal ‘Bulletin’ in December 2003

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The implementation of total communication at a specialist college for the physically disabled
Treloar College is part of the Treloar Trust which has, for almost a century, provided education and care for children with physical disability. In that time it has expanded and changed its provision to suit the current needs of this population. Over the last ten years there has been a steady increase in the number of students within the College who have some degree of speech & /or language difficulty. For many of the 300 strong College staff whether in an educational, care, administrative or grounds maintenance role, the implications of communicating effectively with a speech & language impaired student is very much the student’s responsibility. Total Communication encourages and accepts the use of signing and symbol systems as well as speech and was identified as a philosophy that could support these students in their communicative effort.

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A survey to identify high tech AAC knowledge, application & training of therapists working in the United Kingdom
Recent research in Australia (Balandin & Iacono, 1998) has identified a lack of postgraduate training in high tech or electronic Alternative & Augmentative Communication (AAC) for Speech & Language Therapists (SLTs). At Treloar College (TC), the SLTs have acquired wide experience and knowledge that could be shared with others who have fewer clinical opportunities to acquire skill in this area of expertise. Questionnaires, a modified version of the one used by Balandin & Iacono, were sent to 500 SLTs selected at random. The purpose of the questionnaire was to identify how knowledgeable SLTs in various clinical settings across the UK considered themselves to be in the prescription, training, support and use of high tech AAC in an increasingly technological world.

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A preliminary research project to evaluate the continued use of Alternative/Augmentative Communication (AAC) equipment by past Treloar College students
Treloar College (TC) provides education for students 16 to 25 years of age with physical disability. The number of students using high tech alternative/augmentative communication (AAC) has increased over the last 15 years. Thirty seven AAC user past students, some of whom had left the College over 10 years ago were approached and asked to complete a questionnaire. The questionnaire aimed to identify changes in ex students’ communication equipment/systems, their current communication opportunities (Price 1995), any adjustment in their vocabulary (Carlson, 1981, Light, 1988, Beukelman & Murrow, 1992) and access to professional support (Murphy et al, 1996) to identify key parameters necessary to ensure long term use of high tech AAC kit.

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Making Technology Work
Even to the most casual observer, it is apparent that technology has developed our horizons further than could have been imagined a decade ago. This technological information revolution mirrors in many ways the transportation revolution of the 1820’s with the first steam engine, which heralded the industrial revolution. The modern day equivalent is the ‘information age’.

Any successful Speech & Language Therapist (SLT) will wish to embrace and develop with whatever the ‘information age’ has to offer. There is a whole spectrum of manufacturers producing hard and software – a mind-boggling array difficult for the busy SLT to keep abreast of.

We are fortunate at Treloar College that we have the opportunity to exploit this information age. Available to us is a wide range of alternative and augmentative communication (AAC) electronic aids ranging from Lightwriter to Dynavox and Pathfinder. As the manager of the SLT service at Treloar College I was interested to see if other SLTs were as fortunate.

In Australia back in the mid 1990’s, two researchers (Ballandin & Iacono) had set about finding out how much their Australian SLT colleagues knew about and used high tech AAC. So I was fortunate to be able to reduplicate their work, although adapted for a British based audience. At random, 500 British based SLTs were sent a questionnaire designed to take just 15 minutes of their time. The questionnaire firstly asked about their current caseload, types of communication problem and age of their clients, in what sort of setting they were based and their geographical location, time since qualifying, where they had trained, what sort of employer they had and whether they were part or full time. The second set of questions asked about experience, perceived knowledge of symbols, signing and high tech communication aids, access to information and support as well as training prior to and after qualifying.

To my surprise and mixed with some horror as I realised the enormity of the task I had taken on, 320 SLTs replied with completed questionnaires. After hours taping in the information into the computer at home, I was able to produce figures and finally answer the questions I had set out to ask. After evaluating the figures I was confident that I could make a few conclusions. In essence the overall picture was very similar to the Australian survey so nothing new or startling to explain.

In summary SLTs who worked with four or fewer communication problems were more likely to prescribe any form of high tech communication aid. Those who were working with adults and were also hospital based were much more likely to prescribe high tech AAC as opposed to their colleagues working with children. Interestingly those employed in the Voluntary Sector were more likely to prescribe high tech AAC unlike those working for an LEA or the NHS. Training opportunities appeared to be limited to what the suppliers of high tech AAC equipment provided and most of the SLTs in this survey felt that their undergraduate training had consisted of a few hours and for many was focused on symbol and signing systems with no experience working with or even chatting to an AAC user. There appeared from the SLT’s responses to be a trend away from including AAC in their undergraduate training – those that qualified 3 to 5 years ago seemed to access some sort of AAC awareness unlike those that qualified 1 to 2 years ago. It came as no surprise that SLTs rated themselves better able to use and more knowledgeable in using signing and symbol systems than high tech forms of AAC.

Having reflected on the answers and figures that quantified the responses, I felt that I was indeed lucky to work where I could easily access a range of equipment and get the best system sorted and supplied for the young adults that attend Treloar College. It is not surprising though that I am in that fortunate work setting - my survey showed that those who worked with adults, had four or fewer communication problems and were employed by a charity were the most likely to prescribe any form of AAC!

The patchy picture of knowledge and access to support and impartial, unbiased training that emerged from my survey needs to be changed if people with communication impairment whatever their age, particular problem or ability to access whatever sponsored service can be presented with every available option including high tech AAC. In the course of my career, technology has advanced enormously and radically altered the way in which I work. I have embraced these changes as have many others, in many instances without realising. Technology could provide solutions for a wider audience than just the physically disabled and as the technology is so increasingly used by industry, business and personal users, the associated high costs ought to reduce. Who can predict what the range of Wireless Application Protocol (WAP) technology will bring in the way of solutions for individual with communication impairment but I have some ideas and I hope that others will embrace & develop those ideas.

There is a vast range of communication aid systems that use modern information technology. Getting the right equipment for an individual with communication impairment is not straightforward. Training and expertise are needed to train the individual to sue the modern technology to gain maximum benefit and communicate effectively. From the survey carried out there would seem to be patchy knowledge and experience of communication aids. As the array of aids increases as well as what they can do, it is essential to train SLTs unfamiliar with this clinical technology so that neither they nor their clients are disadvantaged.
Reference
Ballandin, S., Iacono, T., (1998), AAC & Australian speech pathologists: report on a National Survey, AAC, 14, 239-249.

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