BAS Conference 2011, Day 3

Day 3 of the BAS conference showed no signs of letting up in terms of inspiring people and offering nuggets of wisdom and things to reflect on. I’m concerned that I won’t be able to do justice to all the talks that I found exciting on that day so I’m just going to focus on three in particular that I found useful in providing food for thought. I should probably therefore apologise to Anne Whitworth who gave a keynote speech on measuring change in connected speech and in the process made an auditorium of SLTs feel a little less guilty for never quite getting around to transcribing and analysing all those speech samples that have been collected throughout the years. I’m hoping that I’ll be forgiven for skirting over this as Anne is also currently one of my PhD supervisors and she would appreciate that I am looking to branch out and reflect on clinical areas which are perhaps not my speciality … cough cough

Archeology of SLTPam Enderby (Uni of Sheffield) and Susan Edwards (Uni of Reading) gave back-to-back presentations on the “archeology of aphasia therapy” which gave both sobering and inspiring perspectives on the future directions of aphasia research and its link to therapy. Admittedly these talks covered a lot of interesting ground and were so engaging that my attention was mostly focused on listening and my note taking suffered, and due to my poor memory I’ve forgotten a fair bit of the detail. However, one of the major themes was around developing the evidence base for SLT through research, particularly by increasing levels of clinician involvement in research. This was something that greatly intrigued me as this is something the North East is generally very strong at. Through my NHS position as a Research Facilitator for SLT within the North East SLT Research Collaboration, I’ve had a fair bit of involvement in increasing research capacity of clinical-based SLT teams and individuals. So while I think it’s great news that we [the North East] are doing a great job in this area it’s also concerning that other areas of the UK are perhaps not receiving the necessary support to develop clinician involvement in research.

Another key theme was around collaboration and the extent to which speech and language therapy has maybe tended to be inward-facing, i.e. SLTs tend to talk to other SLTs and there is little promotion, or at least not as much as there could be, in terms of getting the value of our work out to a wider audience. Greater promotion of SLT has obviously been a specific aim of the Royal College of Speech and Language Therapists Giving Voice campaign, however another example given was in the selection of journals that SLTs tend to publish their studies – these tend to be SLT focused journals rather than more general journals, e.g. those general to allied health and medical disciplines. These sentiments resonated with me as a similar message had come from Karen Middleton (Chief Health Professions Officer for the Dept of Health) when I met her at a showcase event for allied health professions in the North East back in July 2011. She stressed the importance of third party endorsements in service commissioning – commissioners are more likely to listen to other people championing your work that you championing your own work.

Maybe you should set specific goals ... I'm not sure it's realistic to want to get into everythingDespite the adoption of SMART (Specific, Measurable, Achievable, Realistic, Time-bound) goals within clinical aphasia intervention, Deborah Hersh (Edith Cowan Uni, AUS) highlighted that these tend to be dictated by the clinician rather than the PWA. Interview data regarding therapy goals were presented from PWA, their family members, and also speech therapists/pathologists. Goals from PWA included: a return to pre-stroke life, return of communication, information about aphasia, physical health, return to social and leisure activities, dignity/respect, and feeling they are making a contribution to society. Goals of family members were split between those for their own benefit and for the benefit f the PWA and included: information provision, support networks, information/training on ways to communication and maintain relationship, and so on. Goals for speech therapists/pathologists were tending to be impairment focused, functionally focused, and education on aphasia. The diversity in goals that were seen to be relevant to the different groups were found not to be easily accommodated within the exiting SMART framework and a new SMARTER framework was proposed in order to promote increased collaborative goal setting: Shared, Monitored, Accessible, Relevant, Transparent,Evolving, and Relationship-centred. From my perspective I can definitely see the tension with using SMART goals as perhaps only the trained clinician has the necessary skills to put goals into this format in a way that can attempt to satisfy all concerned (including service management  and those at the level of service commissioning who require concrete data on  outcomes). A move toward SMARTER goals would appear to make sense and I’ll be interested to see further publications reporting the actual use of these goals and how they can effectively capture outcome data and deliver on working towards goals of PWA.

See:

Worrall, L., Sherratt, S., Rogers, P., Howe, T., Hersh, D., Ferguson, A. (2011). What people with aphasia want: Their goals according to the ICF. Aphasiology,  25(3), 309-322.

Hersh, D., Worrall, L., Howe, T., Sherratt, S. & Davidson, B. (under review). SMARTER goal setting in aphasia rehabilitation. Aphasiology.

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About chrissp1980
Currently a lecturer in speech pathology in North Queensland, Australia. I'm lecturing in acquired disorders of speech and language and also attempting to enthuse students in conducting clinically-relevant projects using principles of Evidence-Based Practice. Wish me luck!

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