1. Identifying the need

2. Care Aims model adopted by the Northern Health and Social Care Trust Care Aims model adopted by the Northern Health and Social Care Trust Fundamental principles of the Care Aims model: Fundamental principles of the Care Aims model:  Focus on IMPACT – client based  Focus on functional communication

3. Evaluation of current practice  As a clinician am I addressing the true impact for the older children on my caseload?  Do the older children I work with feel equipped as a result of my input and empowered with the tools to manage their communication difficulties?  Is my focus on over-assessing and providing additional work loads instead of getting to the root of the issues?  Is my intervention clinician led, resulting in limited discharge as I am not fully addressing the concerns of children and their parents?

4. Listening for the Impact  “I am really worried that my child is withdrawing and chooses to hold back in the classroom”  “I would like to know what to do to help my child when he is experiencing difficulties”  “I can see my child’s confidence decreasing and he gets so frustrated because he cannot seem to tell me what he wants to in the way that he wants to”

5. Listening for the Impact  “I know in my head what I want to say but I cant get the right words”  I find it really hard to remember everything my teacher says as she talks so fast and I get left behind”  “I hate it when my teacher asks me to speak out in the class. I get all muddled up”

6. Forming a Response  Functional impact  Client focused  Equipping and Empowering

7. Group Intervention  Children to attend 7 sessions with a focus on development of a range of higher level language skills  Introduction and practice of a range of strategies  2 training sessions provided for parents and teachers

8. Fundamental Aims  Develop higher level language skills  Equip children, parents and teachers with functional strategies  Increase confidence  Increase participation  Decrease frustration  Decrease isolation and withdrawal

9. Importance of team work  Speech and Language Therapy Assistant  Clerical Officer  Education staff  Parents  Colleagues: to ensure sustainability and transferability

10. Outcomes

11. Outcomes Percentage of discharges as an outcome of group intervention 73.68% 73.68% Percentage of children provided with a follow up school programme and pending discharge 15.79% Percentage of children requiring ongoing therapy 10.53%

12. Outcomes Percentage of discharges as an outcome of group intervention 62.5% Percentage of children provided with a follow up school programme and pending discharge 12.5% Percentage of children requiring ongoing therapy 25%

13. Evaluation

14. Evaluation  “All of the exercises were very beneficial and the strategies were really helpful”  “All of the information was beneficial for my child to progress and to cope in life”  “I am looking forward to using the “How I can help myself” cue cards”  “More of these courses please. Older children tend to be overlooked”

15. Further evaluation  “I liked hearing that other kids find it hard to remember things”  “I ask my teacher to repeat things and sometimes he writes them down for me so that I can remember”  I use my cue cards a lot so that I don’t feel stuck”  I showed all my teachers my cue cards so that they know I might need some help”  I am not afraid to put my hand up and ask for help. This helps me get my work done properly”  “When I cant think of a word my Mum helps me to use my Word Web”

16. Amendments and Future Plans  Action plan to accompany training sessions  Separate training sessions provided for parents and teachers  Evaluation of feedback from the children as well as the parents and teachers  Possible transfer of group intervention to the educational setting: increased working across the boundaries of health and education  Possible co-facilitation of groups with education staff so that strategies and supportive techniques can be demonstrated  Continued evaluation and amendments as appropriate

17. Maximising Resources  Skill mix: close working with SLTA  Focus on Impact and functional communication: increased parental and child satisfaction resulting in more timely discharge  Training provided for parents and teachers: on-going long term support  Empowerment: increased management of current and future communication difficulties  Fundamental focus on strategies vs years of direct clinician led therapy: shorter care pathway  Intervention model that is transferrable and sustainable: already replicated with similar positive outcomes