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Afasic Cymru Voice for Life and Youth Justice Board

Training Day Metropole Hotel Llandrindod Wells on

Thursday 18.06.15 Report by Gabriella Simak

Introduction – Conference Opening:

Dusty Kennedy – Director of YJB Cymru Wales

Jeanette Carr – Director of Afasic Cymru

Reviewing policy in relation to speech and communication skill assessment in YOTs

and YOI is part of the sector prioritisation model in which the SLCN training was

offered to staff last year (2014), which then was positively received by those who

received such training. Then in late last year communication skills and abilities of

young people in YOTs and YOI became part of effective practice once the need to

help young people to better communicate within the service was established.

Effective practice policy was translated into practice development that was based on

recent research highlighting the prevalence of young people with speech language

and communication needs (SLCN) both in YOI and YOTs (see for example:

Evaluation of the Leeds Speech and Language Therapy Service Provision within the

Intensive Supervision and Surveillance Programme provided by the Leeds Youth

Offending Team NHS Leeds by Gregory and Bryan, 2009; The Bercow Report: A

Review of Services for Children and Young People (0-19) with Speech, Language

and Communication Needs 2008).

In order to address their communication needs, young people must be screened,

which then requires a standardised screening tool to identify/assess and break down

young people’s communication skills/needs. Asset was recognised as a screening

tool which failed to include a section on SLCN in its Core Profile. The RCLST (Royal

College of Speech and Language Therapists) advocated for a standardised

screening tool specifically designed to be used by Youth Justice Professionals in

settings such as YOI and YOTs. As a result, AssetPlus was adapted to its now

current version and includes a section on SLCN screening – Speech, language,

communication and neuro-disability screening tool. Although different approved and

standardised screening tools are now in use by practitioners to screen young people,

the goal of meeting the communication needs of young people are the same in

England and Wales. Still other practitioners use the Speech, Language and

Communication Screen, a tool designed by the RCSLT1 or the Blank Levels of

1 This is a general screening tool for SLCN in both adults and children

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Questioning2 to help young people engage with services. Subsequently, SLTs

developed the Speech and Language – Further Screening Tool as a direct result of

the pilot study in 2009 in the Leeds YOT. However it is important to recognise that

the tools to meet young people’s needs are devolved to the Welsh Government at

the strategic policy level.

Claire Moser – Policy Officer RCSLT (see PowerPoint titled: Embedding speech,

language and communication [SLCN] in AssetPlus)

The transition from Asset to AssetPlus has been ongoing from mid-2014 as

AssetPlus was released as an EPC (Early Practice Change) last year to selected

YOTs. It is a screening tool for use specifically within CJ settings for young people

11-18 and up to 21. AsstePlus will assume that young people will have some form of

SLCN until proven otherwise – such as: not understanding terms or phrases

frequently used in CJ settings (e.g. breach, contract) or have everyday language

issues. Those young people with one or more forms of SLCN will often nod but may

not understand what is happening to them.

Once released and fully in use, AssetPlus will be referred to in the PSR and

magistrates will have access to its results within the PSR.3 However, once SLCN is

flagged in the PSR, it is too late: young people have already been to court, been

through a trial. Often the parents themselves have SLCNs that may be undiagnosed

and untreated. Therefore, it is important to work with families of young people and

help parents support their children through the process.

It has been a 7 year campaign run by RCLST to raise awareness of the importance

of addressing the SLCN of young people in CJS. The goal of the campaign is to

raise awareness, but also to achieve all YOTs/YOI to have regular access to an SLT

on staff. Changes in the staff working with young people in YOI and YOTs and the

lack of SLCN screening included in Asset has made the campaign a long one. Due

to the fact that Asset failed to include an SLCN screening tool and by selectively

implementing SLT service in to the core service of certain YOTs meant that young

people working with YOTs with an SLT practitioner were assessed at minimum and

in some cases may also have received individual or group interventions by the SLTs.

However, in those YOTs where there was no seconded SLT on staff the young

people would not even be screened for SLCN at all. The RCSLT commissioned a

piece of research eliciting the views and opinions of SLTs and YOT/ YOI

practitioners, which resulted in (2 years later) the conceptualisation of the SLCN

2 This tool is to help simulate children’s language development and engagement and is not meant as a screening tool: Blank, M., Rose, S.A., Berlin, L. J. The Language of Learning: The Preschool Years ISBN: 9780808910589 https://books.google.co.uk/books?id=fVmUQgAACAAJ 1978 Grune & Stratton

3 i.e. the same as for example the young person’s learning styles would be reported.

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screening tool – originally designed by SLTs working with children. There is no easy

answer, but working with parents, practitioners can support the whole family.

AssetPlus has been released (since 2014) as an EPC document and is in the

process of being formally rolled out to all YOI/YOTs by the end of 20164. It is

important to note that the SLCN screening tool in AssetPlus is just what it is meant to

be: a screening tool and if practitioners have doubts about a young person, they

should refer to an SLT who can then identify specific SLCN of the young person.

Practitioners in YOI/YOTs are encouraged to become familiar with AssetPlus and the

SLCN assessment tool; feel free to start using it and AssetPlus training will continue

for all staff as the rollout progresses. Unfortunately, some of the rollout plans for

AssetPlus were pushed back, but the updated AssetPlus rollout schedule is included

in the slides.

Also, The Box is a training programme provided by the RCSLT to help raising

awareness of SLCN and how to respond once SLCN is identified in a young person

or child. 5

To continue with the campaign of SLTs in every YOT/YOI, SLT managers are asked

to make a business case/argument to provide SLT service to all YOTs. They need to

make the business case to each authority individually and will need numbers from

each YOT to show business case to commissioners in individual local authority.

Dr Rachel Taylor, University of South Wales - SLC Research in Wales

As a result of 2 years of research a final report was published in February 2014 by

the Children’s Commission and the Communication Trust6 in which it was noted that

some practitioners are not aware of what is meant by SLCN. SLCN can be thought

of as an umbrella term which includes social communication and all communication

needs of the individual. For example, social communication is defined in relation to

nuances of language use in social interactions and falls within the umbrella term

SLCN7.

4 See PowerPoint Slide 15 for details of AssetPlus rollout. 5 See more here:

http://www.rcslt.org/speech_and_language_therapy/the_box_training_for_the_criminal_justice_sector/open

6 https://www.thecommunicationtrust.org.uk/policy-and-practice/send-reforms/support-around-joint-

commissioning-for-slcn/february-2014-conference/ See more at: Report from the Children’s Communication Coalition (2010) Engaging for their futures and our society Improving the life chances of children with speech, language and communication needs. Available at

http://www.rcslt.org/about/campaigns/ccc_report_2010

7 The Bercow Report: A review of Services for Children and Young People 90-19) with Speech, Language and Communication Needs (full report). Available at:

http://webarchive.nationalarchives.gov.uk/20130401151715/https://www.education.gov.uk/publications/standar

d/publicationdetail/page1/dcsf-00632-2008 Reference: DCSF-00632-2008

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Young people with some form of SLCN are overrepresented in the youth justice

system. Those with SLCN will have difficulty engaging with services and SLCN will

prevent these young people from fully participating in interventions. Young people

presenting with SLCN are also at risk of bullying8 and are likely to develop ineffective

communication. It will also affect individuals’ employment prospects (both ineffective

verbal and written communication). 9

In terms of Restorative Justice (RJ) constructive and articulate speech is essential to

repair the harm caused by an offence. SLCN in young people will increase their

stress levels in RJ meetings which may lead to an unsuccessful RJ meeting.

By introducing the work of Communication Champions to the YOS may ease the

identification of SLCN in young people. 10

For some young people, SLCN and other needs are ‘very hidden’, their needs are

very complex and may have underlying difficulties/needs, such as hearing

impairment or impaired sight. Sometimes, a simple hearing test or eye test can help

young people’s SLCN.

Early identification of SLCN in young people is highlighted throughout the

presentations. Emphasis is on early diagnosis and will lead to early intervention. It is

‘the failure of the system’ that some young people are diagnosed with SLCN once

they have committed offences already.

Some of SLTs working in YOTs in England have had the chance to work with the

local police and were able to train police officers. However, SLT services as part of

the core service of YOTs are still at the early stages and SLTs in Wales have not all

had a chance to work with the police yet. It is a work in progress. In terms of RJ

efforts, diversion systems have been introduced in England where the police work

with YOTs closely to divert young people from being formally charged or going to

court – see Bureau Panel (also introduced in Wales). Most but not all police stations

divert young people at the first instance. In England, the YJB also introduced the

triage system in some YOTs where the young people are seen by an SLT at the

court and a quick assessment is done on the spot. Based on this assessment, the

SLT will write a report and recommendation of interventions if needed.

8 Geoff Lindsay , Julie E. Dockrell & Clare Mackie (2008) Vulnerability to bullying in children with a history of specific speech and language difficulties, European Journal of Special Needs Education, 23:1, 1-16, DOI: 10.1080/08856250701791203 9 Vaswani, Nina (2014) Speech, Language and Communication Difficulties, Centre for Youth and Criminal

Justice www.cycj.org.uk

10 More at: https://www.thecommunicationtrust.org.uk/projects/local-champions/

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The SLCN and neuro-disability screening tool11 in AssetPlus assesses neuro-

developmental disorders, developmental coordination disorder that may manifest as

behavioural difficulties. Because young people may present with complex needs,

specialist referrals may need to go in several directions in order to address all of

young people’s needs. AssetPlus is designed to assess as many of the possible

needs young people may present with as possible; needs assessment is more in-

depth with AssetPlus. However, it is important to remember that YOTs and YOI work

with a diverse client base with diverse needs and there needs to be a flexibility to

meet these diverse needs and to remember to allocate services to those who need it

without compromising service to others.

It is crucial to raise awareness early on in the CJS of SLCN before sentencing

occurs in order to provide with different interventions to enable young people to

engage. To help young people to communicate more effectively should be an easy

referral to mainstream external services. The issue then arises that sometimes

referrals to mainstream SLT services will take some time and by the time the young

person can be assessed by an SLT in mainstream services, they may have

completed their orders and the YOT will not monitor their attendance with SLT.

There is a danger of some young people with SLCN to fall through the cracks and go

on without the SLT support they need. Time is essential and SLT services should be

accessible in a timely manner for all young people without delay. Continuity of

service provision is also important, even after young people have completed their

orders and no longer work with YOTs or are released from YOI.

There is a particular concern of those young people who turn 18 while in custody.

This means they have to transition into adult corrections, including other services

(e.g. mental health services) provided within corrections and mainstream services.

As is often the case in YOI, many services are provided within the YOI framework

and are easily accessible to young people in custody. Many of these services will

then be commissioned externally, mainstream, and may not be readily available or

accessible to young people transitioning into adult corrections. For those young

people turning 18 while in custody and entering adult services, continuity of service

provision is important, especially when transitioning into adult custody. Example was

given: Cardiff Prison: specialist mental health services are provided to young people

entering the adult prison services to ease their transition.

11 Screening tool and Supporting Guidance available at: https://www.gov.uk/government/publications/assetplus-speech-language-communication-and-neuro-disability-screening-tool

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The Workshops

Lowri Burgess – SLT covered Conwy-Denbighshire, and Gwynedd Mon YOTs

Amy Ballard – SLT covered Flintshire, Wrexham YOTs

Comment re- police training: by the time young people get to the YOT, police deal

with them, would have often interviewed them, may not recognise and flag

communication difficulties of some young people. In North Wales, both Lowri and

Amy have done some training with North Wales Police to raise awareness of SLCN

of young people, particularly new recruits and PCSOs. In some cases they have

trained magistrate and solicitors as well. More training is needed and it is a work in

progress to have all police officers and police staff trained. It is their priority to raise

awareness of SLCN and the training they provide focuses on awareness of different

types of SLCN and how to identify and recognise these communication difficulties in

young people.

Another comment from the audience: Communication difficulties of young people

can be conceptualised in two ways:

1. As a social developmental issue related to learning

2. As a pathological issue – medicalisation of SLCN

Attachment to family is important as described in social learning theories – therefore

it is important to approach SLCN of young people in a holistic way involving the

family and working with the wider environment and social circle of young people may

help with their communication difficulties.

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Activity: The Communication Chain (see attached) 12

12 Provided by Clare Booth – Administrator, Afasic Cymru www.afasiccymru.org.uk

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How to work with young people who have SLCN/D?

Vocabulary: Keep it Simple!

Anecdote: Young person had been working with an SLT as part of her work at the

YOT for some weeks. Young person with stammer was at supervision meeting with

YOT case officer. The officer voice recorded the session with this young person and

at the end played the recording back to her. When the young person heard herself

speak without stammer, she burst into tears. As the young person explained, she

had never heard herself speak without a stammer. Subsequently the parents heard

the recording as well and were surprised at their daughter’s progress. Before coming

to the YOT, the young person was thought to have been on the autistic spectrum,

which was not the case.

Some of the possible outcomes of living with undiagnosed SLCN:

Isolation

Poverty

Mental health difficulties – depression

Child sexual exploitation

High risk behaviour

Use of psychoactive substances (“legal highs”)

Being labelled as ‘difficult’, ‘different’

Closed worldview

Vulnerable to abuse

Specialised (i.e. language used in CJS, courts.

Conceptual - impossible to convey precise meaning non-

verbally)

Abstract (i.e. responsibility, whereabouts, supervision More complex language -

difficult to convey non-verbally)

Basic (i.e. what where when how. Can easily convey non-verbally: draw or mime basic

vocabulary)

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Time is of the essence: A Service Gap

There are certain difficulties that arise from current practice. It is difficult to refer

young people to mainstream SLT for a number of reasons. SLTs in the mainstream

service often work with young school aged children and by the time a young person’s

SLCN is diagnosed at the YOT, they are much older than those children SLTs mainly

work with. Mainstream SLTs may not have the time in their practice to accommodate

these more mature young people in their schedules. There may be further barriers

for young people to access mainstream SLT services, such as access to resources.

There may not be enough time for mainstream SLTs to work with young people 1-2-

1 with the provision of specialist interventions that are age appropriate. Also, some

SLTs with seconded roles at the YOTs provide assessment and screening of young

people while lacking the time and resources to provide interventions – group therapy

or 1-2-1 support. Referral to mainstream SLT services can be challenging as well

because of the time lapse between assessment by SLT at YOT and referral to

mainstream SLT interventions when the young person is most likely to fall through

the cracks and never being seen by an SLT. Often parents lack a support network

and contacts to follow-up with recommendations of the YOT officer. Reports

prepared by the YOT and assessment results may be lost or not read – information

is lost. How can YOTs advocate for young people if no one else listens? Therefore,

effective information sharing between different services is crucial.

Other barriers to accessing SLT services for young people who work with YOTs can

be due to the fact that language demands may be higher at secondary education.

Language used in secondary education is not as structured and more complex than

it is in primary school, thus young people with undiagnosed and untreated SLCN are

more likely to struggle with coping and may not reach their full academic potential. It

is also less likely that SLCN will be picked up and diagnosed in young people in

secondary education because the structure of the environment helps children to

understand (i.e. breaking down and explaining concepts to easily understandable

chunks) at primary educational level, but much less so in secondary education. As a

result, young people with undiagnosed SLCN will have difficulty understanding

instructions given, which may lead them disrupting the class and displaying

behavioural problems, which again may lead to young people being labelled as

‘difficult’ or ‘kids with problem behaviour’. There is a knock on effect of this chain of

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events that will eventually become a cycle:

SLCN may lead to a cycle of difficulties: SLCN will affect the young person’s

performance in class, which if negatively impacted will lead to mental health

difficulties such as depression and anxiety (isolation). In turn anxiety and depression

will reduce capacity and performance will decrease even more, which will lead to

possible explosion of bad behaviour and truancy. At the end of the cycle the literacy

and educational options of the young person will be negatively impacted by SLCN.

With lowered literacy skills and educational attainment of the young person the

employability and life style options will also be affected and greatly limited in the long

term. This, of course, will then affect the choices of the individual and may lead to

criminal and offending behaviour.

Difficulty performing

in class

Anxiety/depression

Bullying/exploding

behaviour

Truancy/bad behaviour

Disengage from

education

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To stop the cycle and to make a positive impact on the life of a young person with

SLCN there are some easy steps that practitioners can make a big difference with:

Slow down the rate of speaking and the young person’s rate of speaking will also

slow down, especially if they are anxious and are rambling. Ask simple questions –

refrain from asking complex questions, as well as asking WHY? questions may lead

to misunderstandings.

The last point is particularly important because if practitioners ask: “Do you

understand?” the young person will be inclined to say “yes” because they just want

to be done with the process and leave. Young people with SLCN will not understand

facial expression and will not be attuned to, responding to body language. The same

goes for tone of voice. It is extremely isolating for young people with SLCN not being

able to follow a conversation because they don’t understand non-verbal cues. By the

time a young person with SLCN picks up on a non-verbal cue, the conversation has

moved on many times over – with time lapsed, it is difficult for them to catch up with

conversation. Young people will feel left behind and left out – peer pressure to keep

up with their peers. Due to this pressure, young people with SLCN will not be able to

communicate their opinions effectively, which will lead to loss of confidence at

expressing their opinions and may feel under pressure to keep up with their peers.

Thus, young people’s behaviour will be greatly influenced by their peers. As well,

often young people would like to have help but don’t know what it is they need help

with.

SLCN means that young people have difficulty understanding information, which

may also lead to them avoiding certain situations if the information is not processed

correctly, therefore, young people with SLCN may follow instructions poorly. This

may lead to them breaching their orders and being sent back to court.

Explain concepts with context: use pictures, charts, models, narrative sequences

Break larger, more complex concepts down and use smaller chunks. Use simple language!

Pause often and ask them to repeat what you have told them at frequent intervals

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Young people with SLCN are unlikely to understand idioms, colloquialism and non-

literal meaning. They will take language very literally! When they are questioned by

police and understand lingo literally, they may come across to police officers as

‘cocky’, ‘arrogant’, ‘rude’. In an example it was explained that a particular young

person was thought to have Asperger’s, whereas he had severe communication

difficulties as it was revealed later on.

From the perspective of the parents and carers: it is a great relief for parents to know

exactly what the problem is – and SLCN diagnosis by an SLT will also include a

breakdown of the communication needs/difficulties, e.g. specific expressive difficulty.

How can young people deal with change in their lives? Take the time to understand

their questions. It is not only important that they understand what practitioners tell

them to do, but also important that practitioners take the time to explore young

people’s questions. This way, young people may be more likely to understand and

take advice from practitioners which will help them change their lives.

Overall: SLCN may lead to several other difficulties for the young person:

Offending behaviour

Limited life choices Labelled as 'offender'

School exclusion

Low literacy level Isolation

SLCN/SLCD

Low self-esteem Low confidence

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What we see in the young person is the behaviour problem, which is the symptom of

the underlying difficulties the young person faces – the tip of the iceberg. If the

underlying difficulties (e.g. SLCN) are addressed, the young person’s social life can

be completely changed. Children can become introverts and withdrawn from social

situations. But! It is often a range of different needs and difficulties that need help

and support – it is never only communication needs/difficulties alone. SLCN/D are

often coupled with other difficulties, such as mental health issues or chaotic family

backgrounds. All of these complex needs must be addressed and other external

services need to be involved to address and intervene in order to stop the knock of

effects of the underlying issues. SLCN can also affect the relationship that young

people form:

Practitioners in general can help support healthy relationships that young people

form, which will have a positive impact on their behaviour overall. For example,

Parent Support Officers have been appointed and schools can refer young people

who can then liaise with Afasic Cymru to support the young person with SLCN and

their whole family. Another example of the excellent holistic approach to support: a

Family Support worker has just been appointed in Gwynedd.

Other programmes that should consider training in SLCN awareness, such as the

consequential thinking, anger management programme, and substance misuse

programme.

SLCNSocial

situations/relationshipsUnhealthy coping/bad

behaviour