Connect inspires Essex team
03 May 2007
Two years ago the Mid-Essex Speech and Language Therapy team had long waiting lists for out-patient services and feedback from people with aphasia reflected a high level of frustration with the service offered. The service looked to Connect for inspiration and a way to rethink their service. Six members of the team attended “Groups Work” and now therapists feel more supported and satisfied, they are working together more and above all the feedback from service users is much improved.
Debbie Stanton (left) and Teresa Eade (third from left) and members of the Mid-Essex Speech and Language Therapy team.
What was the problem?
In January 2005 we had long waiting lists for outpatient services. People with aphasia and their families understandably felt high levels of frustration. Therapists felt anxious and unsupported in their work with these people. Our principle of providing long-term therapy and support for people with aphasia was impossible to manage and in our linear model of outpatient care it was difficult to see a way to change this.
How we found a solution
In February 2005 we held a 'Service Improvement' away day. Amongst the decisions taken was one to provide group therapy for people with aphasia. We were unsure as to how we were going to take this decision forwards. We were also uncertain of how those people we were already working with would regard the proposed changes.
In April 2005 six members of the team attended the Connect course Groups Work: How to design, implement and evaluate group therapy. The study day initiated a u-turn in our way of thinking. As we travelled home from the course, The 'Aphasia Explorer Groups' and the new structure of our service to people with aphasia began to take shape.
Back in the department, the idea developed and we met with people with aphasia to discuss our proposals. They contributed useful insights and suggestions and attended our first Explorer Group as our Critical Friends.
How a new service structure developed
Two years later our service now offers initial interviews within approximately two weeks of referral. A plan is agreed where people can choose from a variety of groups and/or individual therapy. The groups, suggested by families with aphasia, currently include everyday writing skills, total communication, numbers and money, improving conversations (based on SPPARC (Lock, Wilkinson & Bryan, 2001)) and the Aphasia Explorer Group which is the most popular; its format, suggested at Connect and in SPPARC, runs every 6-8 weeks. At the end of each intervention individuals revisit their therapy plan and agree their future goals.
The Aphasia Explorer Group is a six week course for people with aphasia and their principal communication partner. It enables participants to 'explore' aphasia, its causes, its impact, ways to help and information about national and local services and organisations. Many of these contacts have been recommended by participants.
Social model practise is difficult to evidence (Pound 2007; in The Aphasia therapy File Vol 2 Byng et al). However, our outcomes are very encouraging. In line with Pound we found growth in confidence of most people. We measure this using the disability questionnaire from the Comprehensive Aphasia Test (Swinburn, Porter and Howard, 2004) and, importantly, in patient comments;
'I feel bolder' (Harry, who has aphasia)
'I felt alone and isolated, and then came explorer groups. Fantastic! It would have been really nice to have done those things very early' (Mary Whittlesey).
Harry and his wife felt he no longer needed speech and language therapy after the course, having the confidence to return to their pre-stroke activities. Mary attends the final week of the Explorer groups as a guest speaker, talking about her experiences. She has also spoken as part of an expert panel at SIG Aphasia Therapy about her experience of aphasia.
People with aphasia have regular contact with therapists, there is still a wait for individual therapy but we hear less frustration regarding lack of support by our service. Therapists feel more supported and satisfied, working together, providing timely quality therapy.
We are a small team working in rural Essex providing services to people with acquired disorders of communication and swallowing. The allocated time for aphasia community therapy is approximately one WTE post, provided by five therapists. While some funds were found from within the service to provide administrative support, these changes were achieved within our existing provision.
We have developed packages of care, based on best practice. We are able to provide information to service providers regarding cost and allocation of resources.
We constantly seek to improve our aphasia service and feel we have now built strong foundations. We want to expand the variety and frequency of groups, provide peer led groups and work with people with aphasia as volunteers and assistants. We would also like to develop links into the community.
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