Developing Supported Conversation across the Trust

PAT MACKAY SLTROYAL WOLVERHAMPTON NHS TRUSTOXFORD AAC SIG – 16/5/2013

Supported Conversation training in Wolverhampton

• Connect Website• 2004 – needed change/alternative to

impairment based therapies• Already involving training for families/

carers/staff – information giving• New stroke guidelines (2004)• Alex Stirling – Changing Attitudes to

Conversation in an Acute Setting

• Aura Kagan (1989) describes supported conversation as a method where “The partner acts as a resource for the person with Aphasia and actively shares the communication load. Supported Conversation provides conversation partners with methods and materials for achieving this goal”

Key ideas

• Acknowledge and reveal Competence• Social, not medical model• Equal responsibility in a conversation• Conversation Props and Ramps -

message in and message out• Total communication environment

Conversation Props and Ramps

• Writing• Gesture• Drawing• Pictures – magazines, newspapers, photos, • Books, diaries, calendars, life books, SCA resource

manual, relevant ‘remnant’ objects, initiators• Communication books/ Communication

passports• NB other issues - taking turns, quiet

surroundings, taking your time

• Attended various Connect courses• Flesh on the bones of what we were trying to

do

FIRST STEPS!

• Feedback and planning day ’05• Brainstorming session – pros and challenges• Long and short term goals – actions

PLAN OF ACTION

• Training in Social Model approach SLTs, HCPs, expert patients • Training ourselves as trainers• User-friendly resources• Creating opportunities for carers to see props

and ramps being used• Creating own life books• Enabling others to make life books• Politics• Groups – total communication (in and out

patients)• SLT rooms more aphasia friendly

WHAT WE DID!

• Devised training package• Selected pilot base (neuro-rehab)• Offered monthly• Advertised with flyers and direct contact with

relevant managers• Fitted in with mandatory nurse training• Opened it up to all hospital staff• Extended to acute hospital and the

community

• Adapted leaflets/hand-outs to be more aphasia friendly

• Requested feedback from Functional Group (clients with aphasia)

• Put up aphasia friendly signage around hospital

• Wards provided with communication resource box (props and ramps)

• Communication tips sheets at beds• Symbol based drinks/snack choices for drinks

trolleys• Weekly In/out patient communication group

(supported conversation focussed)

Supported Conversation

Speech & Language Therapy

Wolverhampton City PCT

2012

Acknowledgements:

Alex Stirling

Carole Pound

Aura Kagan

Connect

‘Supported Conversation’

• Communication – what is it and why is it so important ?

• What happens when it goes wrong ?

• Supporting and helping communication

• Practical session and feedback

• Evaluation forms

Communication…….

• …….what does it involve ?

Why do we communicate ?

Think about different kinds of communication difficulties

How would it feel if you couldn’t communicate ?

How would it affect your life ?

WHAT IS A CONVERSATION?

• Two way• Listening and talking• Spontaneous, not planned• Information exchange• Opinions and ideas• Fun, enjoyment, social connection• Who you are

Conversations and aphasia

Just the same but …..• Both people need to work harder• Both people need to be flexible and

resourceful• Use strategies as well as speech• Allow time for the conversation• Give the person plenty of time

Examples of good and bad conversations

Watch the DVD

Supporting and helping communication

Message In - Message Out

• Message In How we help someone understand our

message

• Message Out How we help someone get their message

across

Support Modes

DrawingWriting things downGesture/PointingPictures

• helps get the message IN• helps hold the message• helps get the message OUT

Feedback “I don’t feel so useless” (Rehab counsellor)“It made me really think about how I communicate with

people who have aphasia .. Certainly take on board all the ideas.. Have learned a lot “ (OT)

“I know what I should be doing now..” (counsellor)“I have found this very useful and will continue to practise and

use these skills in my job” (enrolled nurse)“I feel more confident to converse with people who have

communication difficulties” (HCA)“It made me think more about how I can communicate with

people and how I need to give more time and patience” (Housekeeping assistant)

What worked and what started well but faded…

• Training ourselves as trainers• User-friendly resources - Adapted

leaflets/handouts to be more aphasia friendly and put up aphasia friendly signage around hospital

• Communication tips sheets at beds• Symbol based drinks/snack choices for drinks

trolleys• Enabling others to make life books• Politics• Groups – supported conversation/total

communication (in and out patients)

• SLT rooms more aphasia friendly• Creating opportunities for carers to see

props and ramps being used• Creating own life books• Opened it up to all hospital staff• Extended to acute hospital and the

community• Wards provided with communication

resource box (props and ramps)• Fitted in with mandatory nurse training

Growing/Adapting

• Previously using role modelling as practise• Now wanted to make it more realistic

HOW?

• 2 SLTs attended further Connect led training – Training the Trainers

• Involved volunteers from around the region who have aphasia being trained to be involved in training Health Care Professionals

• learn how to give useful feedback about how someone’s communication partner skills

• invited to participate in SC training in the region• While first part of SC training is going on, SLT goes

through Training the Trainers presentation to remind them/support them in what they previously learned

Things to think about

• Travel arrangements• Travel costs• Payment?• Physical access to training area/toilets etc• Need more than 1 SLT for the SC training• Inevitably a longer training session overall and

so not suitable to fit into nurse mandatory training times

• However, MUCH more effective!!

Who to target?• New SLTs• AHPs in neuro rehab setting• Nurses on stroke unit• Early Supported Discharge team (AHPs plus

rehab technicians)• Other staff in neuro rehab setting – dietician,

clinical psychologist• Social workers linked with neuro team

Changes to training• Longer than that offered during mandatory nurse

training (3 hours)• Includes some practical time with trainers• “Try it for real!”

– 15 minute conversation with someone who has a communication difficulty (plus an observer)

– 5 minutes feedback on your conversational skills

– Return to main group for summary and group discussion

BUDDY PROJECT Supported Conversation Training

for Buddy Volunteers

Growing/Adapting

Buddy Project

• Supported Conversation Training for Buddy Volunteers• The stroke buddy scheme came about from an idea

spoken about at the Stroke Conference• It is a way to try and help people who have had a

stroke who are finding it difficult to take part in rehabilitation

• These people were helped more by those who had had a similar experience than by professional staff

• Draws on key concepts of Supported Conversation for Adults with Aphasia (Kagan, 1995)

• New project in Wolverhampton – 2011

Stroke survivors volunteer to befriend & support other people who have had a stroke & who are having difficulty coming to terms with their difficulties & life changes • Team:

– Speech & Language Therapist– Occupational Therapist– Clinical Psychologist– Volunteer + Buddy

Our Role

• Ensure involvement of People with communication difficulty as buddies.

• Devise training packages for volunteers.• Help to develop aphasia friendly information

to enable data collection pre/post project. • General planning and devising paperwork for

the project.

• Once the volunteers had received training about different communication difficulties, they were then trained in how to support communication, and this training is based on Kagan’s SCA approach – Supported conversation for adults with aphasia.

The Role of the Volunteer• The contact might include:

• Going round to their house, having a cup of tea and a chat

• Helping them to get involved in things that interest them

The overall aim is to gently encourage the buddy to do more for themselves, make the most of services

and get more out of life

Supervision

• Volunteers will have monthly supervision with an allocated therapist

• This is a chance for them to discuss issues that may have arisen and ideas to help the buddies further

• If an emergency situation occurs volunteers will have the number of the therapist and an emergency contact number

Further adapting!!

• Funding for 12 months• 2 sets of training volunteers so far• Funding continues into second year as some left

over from initial funding• (difficult to get buddies to ‘buy into’ the

scheme)• So, broadened the scheme so that volunteers

act more like conversation partners rather than encouraging buddies to engage.

ANY QUESTIONS

THANK YOU FOR LISTENING!