The Elephant In The Therapy Room
An opinion piece by Tara sheds some light on the challenges we face as therapists.
I’m going to have a controversial opinion here, it’s an important one… so please bare with me. The easiest part of our job is the therapy in the room with the client, and the hardest part? Not the paperwork, not the constant fight for funding, not the lack of time for CPD… but….
Upskilling and training the staff involved with the client.
There, I said it.
That’s not because the staff are useless, bad at their job or unskilled. Quite the opposite. I’ve worked with some incredibly talented staff who take their job seriously and do it so well.
The issue:
Treatment fidelity is extremely difficult. As therapists, it’s hard enough ensuring you are doing the right thing. Now imagine you have 70+ staff members who all interact with your client in one way or another. Who all have varying levels of experience and training, mixed with high levels of staff turnover and ever-narrowing time constraints. Failure is almost inevitable.
In addition to this (yes, there’s more) staff training is typically at the end of the day. Everyone is tired, they’ve worked hard and generally have a backlog of admin tasks and planning to do. So, if your training isn’t fun, engaging, interactive and creative, then you have lost the CPD battle before it’s even started. This bespoke training takes time, and that is something that is not freely available to most therapists working in education.
So there you have it, I’ve painted a picture of the harsh reality.
So up-skilling is difficult, I guess there’s just no point then…
Now that might seem like I’ve had a rant, spoken about how hard it is for both parties to find the time, energy and consistency to maintain high quality standards when it comes to staff implementing techniques from SaLT. However, the point of this is not to vent and moan, in fact it’s our mission statement to try and inspire positivity into the workforce. So here’s my attempt at that.
Training is hard. Treatment fidelity is hard. Forming good working relationships with all staff involved in the care of a client is hard. What do all of these elements of our role have in common? They are vital for the client to make progress.
The Dream
Imagine the benefits to the clients if the carryover from sessions was flawless. If staff were confident enough to carry out programmes, track data and report back to the SaLT on what has been achieved.
Imagine if the staff felt empowered enough to talk ‘speech’ with us. If they felt like they understood some of the common words we use like receptive, expressive, phonological awareness and working memory.
Imagine the reduction in referrals and clients needing such a level of specialist support from us, if all students were exposed to confident, competent, SEN and SLCN trained staff. Staff who could tell which students needed a priority referral, staff that could trial strategies in the interim of being seen, staff that had the time and energy to plan and prepare their lessons with language and communication at the forefront of their planning.
I don’t believe these things are unachievable. In fact I’ve seen and worked with staff within settings like this. It doesn’t come easy, and there are obvious financial and timely costs attached.
Investing in outcomes.
When you commit to this you are playing the long game.
You are commiting to cultivating strong working relationships with staff, you are commiting to providing training and an atmosphere that will invigorate people after a long day of work. You are commiting to pushing through the resistance you will get when you keep pushing for training or being in the classroom observing, providing feedback. But ultimately, you are commiting to a culture shift, to providing outstanding services at a universal level.
Imagine if instead of such an emphasis on 1:1 direct therapy for X hours a week, the emphasis was on whole service impact. If SaLTs were commissioned to provide coaching, quality training based on what the staff need and want. I’m not talking about the consultancy model and I’m absolutely not poo-pooing direct therapy. I’m talking about becoming leaders in creating strong, confident, empowered work forces. Leaving more time for direct specialist input for those that need it most.
There are many ways you can do this, but the ways I would recommend doing some further research on is:
- The three tiered model of service delivery (Universal, Targeted & Specialist)
- Coaching model of feedback and training
- Behavioural economics
- Organisation Behaviour Management
- Evidenced based teaching methods such as precision teaching (this is not just for the clients we work with, it’s for the staff and ourselves too).
- Treatment Fidelity
‘’I am no longer accepting the things I cannot change. I am changing the things I cannot accept.’’- Angela Davis.