Janet O'Keefe, Speech and Language Therapist

Effective therapeutic interventions, in any discipline, have always depended on a careful identification of the factors comprising the presenting problem; the systemic processes shaping, and shaped by, the child; and the information and belief structures supporting the coping strategies developed as a result. For the Speech and Language Therapist, difficulties in the acquisition of social communication skills frequently signals the presence of a wider range of language, emotional and educational issues, all of which could be impacting on the child`s potential for independence, integration in society, educational attainment and long- term mental health. As a result, social communication work is often an integral part of programme delivery, and much time and energy has been devoted to the development of the many excellent resources available to address social communication needs in a range of settings and client- groups.
Shapwick School is a specialist day and boarding school for pupils (8yrs – 19yrs) with dyslexia, DCD, ADHD, developmental verbal dyspraxia, sensory processing difficulties and other related disorders. Approximately 70% of our pupils attend weekly individual and/or group Occupational and Speech and Language Therapy sessions and all new students are screened by both therapies on entry. The Therapies are seen as an integral part of the school`s multi-disciplinary approach to the educational process and are involved in all aspects of the school`s functioning. We take the view that, while language and sensory processing difficulties impact on every aspect of our students` lives, they can be remediated or compensated for most effectively when a unified approach is applied by the whole system- school/ college, parents, students and their peer group. Systemic thinking is by no means new in education or therapy, but its application often presents a thornier issue as daily life interferes with theory! I feel it is vital that we at least acknowledge that every decision or action we take, as teachers, clinicians or parents, will have a knock-on effect on every other aspect of our children’s provision, and ultimately the child’s decision- making. As social communication is about making decisions which affect oneself and others, the ability to recognise chains of reaction is a cornerstone of the SCAEP approach.
The Social Competence and Enhancement Programme (SCAEP) was formally introduced about 8 years ago as a weekly group session for students with identified social skills difficulties. It drew on a range of materials from published social skills, emotional literacy and pragmatics programmes and ran for two terms every year. Other forms of medium and short- term interventions (e.g. Circle of Friends; “Pitstop” ) were also regularly used in the rest of the school in response to perceived need, but varied from year to year and were often driven by the needs of specific pupils or contexts.
However, over the last 5 years I have become increasingly aware of three important factors which seem to be impacting on the long- term carryover that our students achieve in real- life situations, when trying to apply the principles they have worked on in SCAEP group viz. 1) In many cases the severity of their sensory processing problems, literacy, working memory and language needs interferes with their access to language- based social skills interventions. Co-working between Occupational Therapy and Speech and Language is becoming increasingly vital in laying the sensory processing groundwork to support our social communication work across the school. 2) Our students have marked difficulties in connecting the ideas and concepts contained in social skills programmes with their own understanding of how the world works. Many of them have difficulties with theory of mind, but also with basic semantic issues such as categorisation, so that identifying social similarities and differences becomes a language test rather than a coping strategy. These difficulties appear to have a particular impact in Yrs 8/9, when the opinions of the peer group assume primary importance, and has resulted in the complete reworking of SCAEP delivery at Shapwick School. 3) At the same time, there is an increasingly alarming body of research emerging from different clinical, psychiatric, educational and criminological fields indicating a significantly high incidence of literacy, social communication and language difficulties amongst young people with severe mental health problems and in the justice system. My concern is that if the sensory processing problems of our students have such a fundamental effect on the development of their cognitive constructs, and if many of our students cannot fully access remediation programmes on offer because of language difficulties, then they are also prevented from accessing the mainstream talking therapies on offer in the NHS. This raises the issue of where our students will go for support as adults.
In the current climate of continuous cost- led reform, there is a temptation to sit tight, rely on existing resources and protect our personal fields of influence. It is vital that we do not lose sight of the fact that our disciplines exist as a result of need, and that meeting those needs continues to rely on an expanding knowledge- base and willingness to share, adapt and apply principles from related fields in order to fine- tune our work and counteract some of the effects of continuous instability in the systems we live and work in.
My workshop will outline the key features of the SCAEP programme and describe an attempt (in progress!) to design a multidisciplinary intervention which serves three purposes: 1)Taking students back through the sensory building blocks of basic social communication concepts e.g. personal space, in order to construct more complete concepts /schemas based on sensory processing of, and shared attention to, key sensory characteristics; 2) The development of sensory and language correlates (shared code) needed to describe participants’ experiences of (mis)communication and to develop verbal problem- solving strategies and an understanding of chain reactions; 3) The core language and sensory building blocks to understand analogy and metaphor, allowing students to compare how a situation appears to them and someone else, and improving our students` potential use of talking therapies e.g. CBT, family therapy etc.