Managing the communication needs of young offenders by developing a social self-sustaining pathway as an alternative to a clinical model

Transcription

1 One example of a business proposal to support the SLCN of youth offenders. Managing the communication needs of young offenders by developing a social self-sustaining pathway as an alternative to a clinical model Proposers: xxxxxxxxx Speech and Language Therapist/Clinical Co-ordinator xxxxxxxxx Service Manager, Specialist Services and Development, Targeted Youth Support and Youth Offending Services Current situation: The development of effective communication skills is critical to children and adolescents cognitive, social and emotional development and helps them to develop relationships, understand social contexts, and express their individuality. International and national research into the youth offending populations has identified that young people with poor language and communication skills are at significantly more risk of emotional and mental health difficulties and are more likely to become involved in criminal activity than young people from similar socialeconomic and academic backgrounds who do not have language or communication difficulties as evidenced from speech and language assessments (Bryan, 2008). The Bercow Review (2008) identified that the communications needs of young people was currently unsatisfactory and that commissioners needed to work together to ensure that access to specialist staff was available from 0-19 years. The Youth Crime Action Plan (2009) has also highlighted the need for: access to speech and language therapy services for young people. training and resources for all people involved in working with young people in custody around SLCN. The Communication Trust and Royal College of Speech and Language Therapists have recently begun to produce information and guidance for Youth Offending Teams. These include: Explanations of the value of SLT in crime prevention Explanations of the types of communication difficulties youth offenders may have and suggestions of how speech and language therapy can help Statistics about the prevalence of communication disability in youth offenders and the associations with mental health difficulties and literacy difficulties. Evidence about the research and impact of speech and language therapy with youth offenders undertaken in the UK Booklet entitled Sentence Trouble written for everyone working in YOT s to help improve their understanding and communication with the young people they support. What is happening locally? The local speech and language therapy service currently has resources located although there is currently no funded speech and language therapy service for young people with communication needs who access PRU s or YOS.

2 As we know the prevalence of communication disorders in the population, we can extrapolate the level of unmet and undiagnosed needs in the general population who may be attending mainstream provisions, as well as the percentage of young people who may need identification and support and are attending specialist provisions and youth offending services... are experienced providers of services.and have been involved in providing training, resource development, speech and language therapy assessments and advice to staff around the communication needs of the young people they work with. A local 3 month research project in.. screened young people attending an SEBD specialist school whose pupils were at risk or known to offend. 60% of those screened were identified as having significant communication needs that affected their ability to communicate effectively. This is in line with national and international research statistics. Proposed investment: Local PCTs are under intense scrutiny to obtain better value for money with regard to services, whilst at the same time retaining high standards of quality; this is mirrored in services funded by Education, Social Services and Youth Justice. There is a need to ensure that young people with SLCN are able to obtain specialist advice, and opportunities for support from trained professionals. However there is an absence of specialist speech and language therapists working with the SEBD population, and in the current economic climate it is unlikely that there will funds available for permanent posts to this population. One solution would be to deliver a time-limited discreet project with the view to screening the TYS -YOS cohort to identify SLCN, training staff to make the most of communication opportunities with young people, establishing communication supportive environments, adapting and developing paperwork, resources and interventions so that current practices are time effective and accessible to young people. It is advised that any Speech and Language Therapist working within TYS- YOS should be experienced and specialist.. A service level agreement would be drawn up outlining precise terms of reference and costs, following any declaration of interest/agreement. It is proposed that the practitioner would be located within the Integrated Health Team within TYS-YOS. Value of the project This proposal would move away from a medical model of identifying communication deficits in young people and driving a demand for specialist speech and language therapists to provide clinical interventions when there is currently no capacity to provide this.

3 Instead it focuses on both strengths and needs, and works with the assets of the YOS to empower them to meet the needs of the young people they work with. It is anticipated that the vast majority of young people with SEBD and SLCN can have their needs supported by workers who have had awareness training and support to understand and utilise new strategies. There may be a small minority of youth offenders who require more specialist speech and language therapy work such as swallowing difficulties/dysphagia, stammering or aphasia (linked to stroke/head injury). Risks of not carrying the project forward The cost to society of having young people with unmet communication needs in the youth justice system can be tracked in relation to the numbers of young people residing in youth offender institutions and prisons with SLCN. Approximately 65% of young people in these settings are identified as having significant communication difficulties which impacts on their daily interactions with peers and prison officers, as well as impacting on their ability to access learning and intervention activities e.g. substance misuse courses, literacy development and parenting skills. Case Study A (Names have been changed) Luke was a 16 year old young man who had already been excluded from school, and was currently seeking college placement. He was known to the YOT who reported that he attended appointments and was generally compliant during his meetings. Nevertheless, they felt that Luke would often not say what was on his mind, and had great difficulty explaining himself coherently; they were concerned that his college placement would be unsuccessful unless staff used a lot of support to help him settle in, and were available to help him with the academic work tasks. Luke did not have a Statement of Special Educational Need and when assessed by an Educational Psychologist via YOT he was found to have good cognitive abilities with particular weaknesses in relation to verbal reasoning and vocabulary. Luke had poor self-esteem, had already dropped out of school and felt that he was unable to learn. A speech and language therapy assessment indicated that Luke s language levels were significantly disordered and approximated to the functional levels of a 6 year old child. Luke had difficulties understanding spoken English e.g. instructions, information and conversation, he also had expressive language difficulties such as problems using accurate vocabulary, sentence structure and grammar. The speech and language therapist was able to deliver a morning session of training for all staff on the course that Luke had enrolled in to raise their awareness of his specific needs, and support them develop strategies that would ensure that Luke was accessing the work at an appropriate level. Luke s transition to college was supported by resources, training and advice delivered to key workers and there were no further demands for clinical support by his college.

4 Case Study B Shana was a 15 year old young woman who had reportedly suffered bullying at her mainstream school and was considered very vulnerable. She had been admitted to the local mental health hospital and was diagnosed as having acute psychosis. Shana was put on medication by the psychiatrist and was given access to CAMHS and education via the hospital network. Shana remained as an outpatient for 14 months, and whilst her mental health showed improvement she was reported to be virtually silent with staff and her peers throughout this period. The speech and language therapist offered a session of training for staff around supporting communication with young people in their care (not specifically targeting Shana) but looking more broadly at how communication opportunities were developed. The session incorporated ideas for making communication less threatening, reducing language demands, and encouraging participation. One month later an of thanks was received from Shana s key worker which indicated that the techniques she had used following this session had been invaluable and that Shana was now talking and engaging with herself and a peer, and had even given a mini-presentation. Shana was not referred to speech and language therapy but the techniques used provided a way into communicating with her that other professionals including CAMHS had not explored previously. Patient involvement Young people who have been excluded from school and who are attending specialist provisions have been interviewed about their own communication skills and the relative importance of communication skills to them. The majority have good awareness that they have difficulties with communication in terms of understanding others, and being able to express their thoughts and opinions. They are also aware that in order to make a good impression with others whether in court, or at job/college interviews good communication skills are seen as vital. Projected outcomes from investment Identify and improve the speech, language and communication skills of youth offenders and enhance their opportunities to make informed choices Develop wider outcomes in relation to access to interventions that are currently provided and mediated using written or spoken language e.g. drug counselling, sexual health advice, literacy and learning interventions. Develop the wider workforce s awareness, knowledge and skills in order to have the confidence to support the communication needs of the young people they work with. Develop tailored resources for use with youth offenders who have SLCN (speech, language and communication needs). Support staff to screen and identify young people and consider interventions that will provide opportunities to develop the language and communication skills of young people either directly e.g. accredited communication skills or indirectly e.g. social skills embedded into other learning opportunities e.g. photography course.

5 Evaluate and provide feedback and data on the impact of this work on a regular agreed basis Speech and Language Therapy will ensure that all targets are developed in full collaboration with the YOT, and will reflect on existing best practice to help promote and develop this. Interventions must be self-sustaining and embedded within the YOT. Evidence Based Practice in support of proposal There is a gathering evidence base for speech and language therapists working in YOT s, although this correlates with the number of therapists working in this field and the work they undertake. In the UK there YOT s have started to commission speech and language therapists directly into their service. Dr Karen Bryan has demonstrated that SLT can be effective via both direct and indirect interventions, and is the lead practitioner in the UK in this field. There is emerging data from some of this work e.g. Leeds and Bradford YOS have recently published the impact of having an SLT seconded to their service, which demonstrates the impact on both the staff and young people. In addition recent research in neurological development in the adolescent brain is showing that teenagers go through another phase of neurological growth and this lends weight to the need to use this opportunity for teenagers to learn and further develop their communication and thinking skills...