ACE Centre Rachel Moore Speech and Language Therapist Jackie Ayre Occupational Therapist

1. ACE Centre Rachel Moore Speech and Language Therapist Jackie Ayre Occupational Therapist

2. Communication “Communication is crucial.Communication is a fundamental human right.Communication is a key life skill. Communication is at the core of all social interaction.” • From "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).

3. The ACE Centre • Assessment of children with complex communication difficulties • Multi-disciplinary team • Training • Information • Research and Development

4. But we were not seeing children early enough… • “Communication starts with interaction and the earliest behaviours of children – there are no prerequisites.” Cress 2000 • “What are we waiting for” Kangas & Lloyd 1988

5. The political picture “Early identification and intervention are essential”. From: "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008). During this time we cannot afford to get things wrong. The early years are critical in children’s development. Children develop rapidly during this time – physically, intellectually, emotionally and socially. From "Curriculum Guidance for the Foundation Stage" (Foreword by Margaret Hodge, Parliamentary Under Secretary of State for Employment and Equal Opportunities, 2000)

6. So much happening… • It is well documented that from conception to first day of school development proceeds at a pace exceeding that of any other stage of life. • “Children are active participants in their own development, reflecting the intrinsic human drive to explore and master the environment” Shnokoff & Philips • “Human Development is shaped by a dynamic and continuous interaction between biology and experience” Shnokoff & Philips • Play is a motivational tool

7. Play! • “Through play children learn about the world around them. They learn to communicate, interact with others, develop their own identity and build on their social skills…” • From ‘Play Talks’, SCOPE “Children find out about the world around them through a process of observing, exploring, speculating and making discoveries.” Mary D Sheridan (1999). Play in Early Childhood. From birth to 6 years.

8. Play is !! • Having fun • Communicating • Developing skills • Taking control • Physical difficulties can reduce opportunities for exploration and play • A child with complex disabilities needs tools at every stage. • Tool needs to be pitched at the right level.

9. Toys2Talk Project • Early Intervention (The youngest child we saw was 11 months) • Children with a wide range of diagnosis and difficulties • Support for both families and professionals • Information, strategies, equipment.

10. Support for both families and professionals • Parents are experts on their children. • Experiences and expectations tend to be based on the “normal” developing child / no previous experience of a disabled child. • Parents are looking for information, advice and support

11. What did Toys2Talk involve? • Referral • Information collection • Contact visit • Loan of equipment and information provision

12. Information Collected about the child • Individual approach to all children referred • Collect information from Parents and professionals, • For example: • Communication • Physical abilities and difficulties • Level of play and interaction, sensory through to imaginative play. • Attention • Likes and dislikes

13. Contact with the Child • Sessions at ACE Centre • Visits to children at home • Visits to pre-school professionals

14. Following a visit with a child • Loan Boxes • adapted toys, access devices for early computer play and communication resources • whatever is necessary for the child to use the equipment, including advice and guidelines • CD of photos and video clips

15. Contents of a typical toy box

16. How did we go about it? Picture/video of child

17. Identify appropriate tools for the individual.Different types of play required different tools • Exploratory play • Constructive play • Pretend play • Social interaction (types of play Sheridan 1999) • Developing control skills • Motivation

18. Exploratory Play (Edward) • Constructive Play (Oscar) Picture/video of child Picture/video of child

19. Pretend Play (Tamsin) Picture/video of child Cooperative play (Poppy) Picture/video of child

20. Parents aware need for tools to enable children to play. • Were often unaware of what tools were available.

21. Tools Control devices • Switches • Touch screen • Joystick

22. Switch Control • Switches • Stick • Latching box • Activity- toy / Simple communication device/ environmental control

23. Why Switches Different reasons for introducing switches, strategies and techniques.

24. Touch Screen Different reasons for introducing touch screens, strategies and techniques.

25. Joystick • Different reasons for introducing joysticks, strategies and techniques.

26. “Communication starts with interaction and earliest behaviours of children – there are no pre-requisites” Cress 2000 • Communication is integral within a child’s development and learning from the earliest stage ….. • An integral part of play.

27. Communication Issues • Young age of children • Communication difficulties may not have been considered • Some normally developing children may not yet be speaking • Within Toys2Talk project, limited potential for long term support.

28. Communication issues • Sometimes there was no SLT involved • Always liaised with a SLT if one was involved • Sometimes keen for any suggestions • Sometimes they asked for specific input • E.g. Equipment, • Discussion / introduction of ideas

29. Parental approach • Parents recognition of communication issues varied widely • Required flexible approach • Some parents are keen to support communication as early as possible • Some parents concerned whether alternative communication methods will delay speech development?

30. Where an SLT was not yet involved, parents required advice and discussion • Saarah. On a 6 month waiting list. Discussed strategies for encouraging sound production, loaned a signing dictionary and a LITTLEmack Picture/video of child

31. Some parents required information and support with specific situations: • e.g. Morgan, had lost ability to communicate and his mother wanted to investigate a small, lightweight single message communication device

32. Some parents were actively seeking support for their child’s communication, open and interested in any ideas. Sienna Discussed signing, loan of a signing dictionary Discussed how to use core symbols, provided these Cameran Discussed eye pointing to symbols. Provided core symbols and an E Tran frame. Eye Gaze Folder discussed. Loan of Boardmaker software Picture/video of child Picture/video of child

33. Poppy Thomas Eye points to either side for Yes/No. Communication book is under development. Lent an E tran frame, core Symbols, Loaned Boardmaker. Already has a LITTLEmack Talked about eye pointing to symbols, lent E tran frame with core symbols to support activities provided. Already has a LITTLEmack Picture/video of child Picture/video of child

34. Case Study: Tiago • Age 16 months • Cognitively bright • Cerebral palsy • Physically complex • Attends the Bobath, moves through a variety of positions through the day Picture/video of child

35. Tiago was placed in a variety of positions during our initial visit: Picture/video of child

36. ..and more positions at home… Picture/video of child

37. Tiago was interested in everything! He particularly loved the computer Picture/video of child

38. Equipment loaned after initial visit • 2 Jelly Bean switches • Ruler with Velcro • Maxess Wedge • Mouser • Powerlink • Ablenet single switch latch and timer • Range of simple cause and effect software • Tape recorder • List of books with repeated lines • Guidelines on how to use equipment • E tran frame • Core Symbols • A CD of photos and video clips taken during the visit will be included

39. Communication Resources Provided • Tiago produces a range of sounds, 2 syllable babble including some consonants, no words. • Good eye pointing skills developing • LITTLEmack already in place • Toys2Talk provided E Tran frame, core symbols, yes/no symbols

40. Alison provided feedback soon after initial contact • Request for further visit • lots more symbols: for meal times, nursery rhymes etc • Mounting switch so that Tiago could play with the computer independently • Trial of a joystick • Further loan of toys

41. Developed a bank of symbols in a short time, used throughout the day

42. Toys Control Choice Picture/video of child Picture/video of child

43. Fun! Picture/video of child

44. Use of Computer Picture/video of child

45. Bercow considers that failure to intervene at an early age has far reaching effects “If a child does not benefit from early intervention, there are multiple risks, which may become apparent over a number of years – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects, challenges to mental health ….” From: "A Review of Services for Children and Young People (0–19) with Speech, Language and Communication Need" (Bercow July 2008).

46. Rachel Moore - Speech and Language Therapist moore@ace-centre.org.uk Jackie Ayre – Occupational Therapist ayre@ace-centre.org.uk