Activity

Monday 7th July 7.00 – 8.30pm.

AGENDA

1. Welcome to any new NQPS – please introduce yourself and a quick overview of where you’re working if you haven’t as yet joined an NQP mentoring session

2. Focus on individual case disucssion

3. Focuss on session management and client expectations

A.O.B – can you reply all with additional agenda items you would like to cover in the above agenda – I have purposefully left this one more open to cover more pressing points you have

We will all join together in this months session

NQP group 1: Karen, Katherine,
Caroline, Sabrina,
Shahzeb, Margaret,
Rebecca G, Neilam,
Amy H, Sai, Rebekah
J,Amy K, Laura O,
Sarah,

NQP group 2; everyone outside of
group 1 list above

Next NQP session:

Monday 4th August 6.00 – 7.30pm

Amy Kennedy joined the conversation
Alexandra Tolley joined the conversation
SaiPrasanna Bangera joined the conversation
Sarah Hodgson joined the conversation
Victoria Robinson joined the conversation
Aafke Dek joined the conversation
Sarah Davis
Evening folks – how are you all?
Amy Kennedy
Hi everyone
SaiPrasanna Bangera
Hello
Victoria Robinson
Hello everyone
Alexandra Tolley
hello
SaiPrasanna Bangera
All well, thank you. Hope the same with everybody 🙂
Sarah Hodgson
Evening all
Sarah Davis
Can anyone see Haru online to add her please
So far folks with those logged on I cant see that anyone is new to NQP mentoring – is that right? Anyone joining for the first time tonight?
Haru Shoji joined the conversation
Sabrina Anderson joined the conversation
Sarah Davis
So far folks with those logged on I cant see that anyone is new to NQP mentoring – is that right? Anyone joining for the first time tonight?
Sabrina Anderson
Hi all 🙂
Sarah Davis
Aha Haru – fire away and introduce yourself
I know you did a great job introducing yourself over email however last week 🙂
Sabrina Anderson
I’ll be joining for the team meeting in an hour. Just working on some training. Im no longer a NQP!
Nimisha Mistry joined the conversation
Sarah Davis
Hi Nimisha
Haru Shoji
Hello! I am Haru. I just joined a few days ago! I am based in NW London. Pleased to meet everyone.
Sarah Davis
Sorry Sabrina I cant get used to not inviting you 🙂
Sabrina Anderson
haha!
Sarah Davis
Thanks Haru and again a BIG warm welcome
Nimisha Mistry
Hi Sarah. I hope everyone is well
Sarah Davis
Nimisha have you joined NQP mentoring before?
Nimisha Mistry
Yes I have Sarah
Sarah Davis
Brill, Righto so we will get started
2. Focus on individual case disucssion
I thought we are usually short of time for case disucssion so I thought we would allow some greater time this month to talk about cases
Isobel Baird joined the conversation
Sarah Davis
I know a number of you have just started seeing new cases and some have an established caseload too
Any one want to fire away with some backgound info on a client they are seeing –
Haru Shoji
Well, I have a child, 5 years old with high functioning autism. Father wanted some help on how to encourage son to eat. I observed that it is not sensory, he will try anything regardless of the colour, texture, smell of food. He has no problem in chewing and swallowing (corn on cob and pasta went down well). It seems to be lack of motivation that is the major hurdle. Son can feed himself, but after a while, just prefers to have food placed in his mouth. A further complication is that father has son over infrequently, so putting in place and reinforcing strategies will be difficult.
have suggested:
-involving son in making food (pizza etc) – apparently this has not been a great motivator in the past.
-offering more finger food (small sandwiches, tacos, mini pizza) -father will try this
-involving son in choice of food (empowering son, perhaps motivating)
-praise for trying food and good sitting/ eating. Father did not wish for reward chart as son has other charts and visits are not frequent enough.
is this in line with what you may suggest? I also suggested OT involvement
Sarah Davis
HI Haur
Haru* I rea
Haru Shoji
In addition, son is afraid of the dark. I am not sure what to suggest…
Sarah Davis
read your email feedback about this client and I do supsect that there could be factors between the dynamics of the relationship between father and son that may need to some of these factors
You mention he dosent stay frequently and father not wanting lisaing with others right?
I guess it’s a bit of a super nanny approach, if we dosent want to use reward based systems that could be trickier
For the dark you could use the landing plug in night light, you could also try a social story about not needing to be scared of the dark?
Any ideas folks on both the eating and the scared of the dark factors?
Haru Shoji
Thank you Sarah. I had a look, and I do not have any email feedback yet….
Alexandra Tolley
I have just started seeing my first bristol client, nearly 3 developing typically except for expressive language, only about 10 words which are inconstant and shuts down with any type of activity that he feels may involve talking. Have discussed PCI and using my sessions to model the strategies with specific vocab but as I don’t usually work with EY wanted to check that others would do the same. Sarah- did you get my email, was the summary ok? would like to send it off to parents tonight if all ok
haru, did you say you have OT already or just suggested? If so they can hopefully help with the sting side of things
*eating
Haru Shoji
I have suggested OT involvement. OT is not seeing client yet
Sarah Davis
I think an OT to support the independent skills Haru might be useful aslo is there any co oridntation difs which is slowing down his independent skills?
Isobel you have been writing social stories recently, was the dark a factor for your client at all?
Isobel Baird
No it wasn’t unfortunately
Sabrina Anderson left the conversation
Haru Shoji
I observed good play skills and some writing. Child will raise fork to mouth and eats, but is quite happy to not eat for hours or days if not prompted.
it really seems like lack of motivation and insight into why he needs to eat (though insight has improved)
Sarah Davis
I think a social story could be a good starting point then Haru. Also do you know if he eats at his mothers and at school/nursery? A
SaiPrasanna Bangera
I think most children at this age have these fears
Of the dark, I mean
Aafke Dek
Hi Haru – does your client have any sensory difficulties?
Sarah Davis
All the strategies you gave about not overloading his plate etc, reward charts etc are spot on, also dont forget this is a ittle out of your remit too so dont take too much responsibilty for this area, you could suggest a referral to the health visitor or Dietician if father is really getting concerned
Im sure they will suggest reward charts, firm boundaries etc
Sai I agree about the fear of the dark
If he will go to bed with a little light on which you switch off when he is asleep – no harm there
Haru Shoji
father is best at ensuring child eats. mother was shocked at how much father was able to encourage son to eat. school was bad at supervising eating. This has improved, child is putting on weight.
Sarah Davis
Alex – did you not get my email back saying good to send?
It looked spot on!
In terms of him shutting down
Alexandra Tolley
no emails received today sorry sarah, please resend as I don’t get many emails atm not sure if there is a problem as know jess gets many more!
Sarah Davis
Did the mother feel confident with the PCI approach
Aafke Dek
Sorry Haru, I missed the first bit of your information – I see you observed it is not sensory :-)!
Sarah Davis
that’s strange I swear I pressed send, I drafted it early this morning I double check after this
I think if parents feel comfortable with the PCI (Parent Child Interaction approach this is def, a good way of encouraging more expressive language
Haru Shoji
hi Aafke. child does not seem to have sensory difficulties. father reports child will eat whatever given to him. there were some questions about sensitivity to sound….. but was happy to be in the room when he invited me to pull a party popper, he even did one himself, whilst covering his ears…..which i found a little baffling
Sarah Davis
Any other thoughts on encouraging early expressive language peeps?
Alexandra Tolley
I didn’t say we were doing PCI I more explained the strategies and they are going to pick 1 per week to focus on i.e actually making him make choices and the child focus will be a core vocab of 3 key words every two weeks drilled repetitively through activities and following his play so he hears it lots of times!!
any other suggestiosnwelcome
no worries sarah, thanks for taking the time to reply
Sarah Davis
Do you think his father is mildly aspergic Haru?? I often find some quite ‘quirky’ fathers with children with ASD
Kat Morrison joined the conversation
Haru Shoji
Thanks Sarah, I did mention to the father that from a SLT point of view, he is chewing and swallowing well and as it is not sensory, an OT would be better at investigating other possibilities.
Isobel Baird
I find that playing alongside clients and copying what they do really helps as it kind of shows them you are willing to do/say what they understand
Sarah Davis
Yes I agree Haru – so work on the other aspects he has concerns about but keep track of this
Aafke Dek
I would also go for child-centered approach and do things to ‘break routine’
Haru Shoji
You know what Sarah, when taking case history, father did not say he is on the spectrum….. but I had a strong inkling he may be!
Sarah Davis
Alex I wouldnt shy away from weekly direct sessions if the parents are up for this as it is amazing the skills we have which we can bring out in a child and often parents can struggle to do so, sometimes therapy sessions where you are using the PCI appraoches are really helpful to give the child a kick start
Ah for some reason Haru I thought you mentioned the child was on the AS
Aafke – do you want to talk through any of your cases you have at present?
SaiPrasanna Bangera
You might find some interesting tips on eating problems on the NAS website, Haru
*National Autistic Society
Haru Shoji
Thanks Sai, I will check it out
Sarah Davis
Good idea Sai!
Isobel any clients you would like to chat through
SaiPrasanna Bangera
http://www.autism.org.uk/living-with-autism/understanding-behaviour/dietary-management-for-children-and-adolescents/dietary-management-restricted-diet.aspx
Sarah Davis
Sai? Any school based clients you would like to share?
Aafke Dek
Hi Sarah, I have a 54 year old male client whom I saw last week for the first time. His carer expects ASD and his ability to make eye-contact, turn-taking and poor expressive language abilities make me think this is quite likely. The client’s carer (sister-in-law), is very keen to get him to speak in ‘full sentences’ although he currently mainly speaks in 3-5 words sentences, telegram style
SaiPrasanna Bangera
I’m seeing 18 at the moment
Isobel Baird
Nothing that really jumps out as a concern with my clients atm but happy to discuss them!
SaiPrasanna Bangera
Any suggestions/ strategies for children with ADHD?
Alexandra Tolley
thanks all he is a very quiet child not even many sounds except when cross and very reluctant to use words or even copy sounds he does have hence the PCI reasoning… pleased others would do the same and that I am not to rusty!! Sarah I did explain it would be me playing with child, following his lead and using the strategies which they seemed happy with ( I know some parents aren’t keen but fortunately they were), I would be happy to increase from fortnightly weekly but not sure budget allows. I am confident they will quickly pick up the strategies though and fingers crossed we can give his a boost!!
Sarah Davis
Great Isobel – only need ones you need help with 🙂 I know weve discussed them at NQP mentoring in the past
Alex maybe the videong aspect of PCI would be useful here too 🙂
Aafke Dek
Any suggestions for ASD with adults – I want to explore AAC options for executive functioning skills
Alexandra Tolley
please can you remind me about how that works do they record and I feedback each week?
Sarah Davis
Perhaps colourful semantics Aafke could be helpful for ypur client to increase sentence length?
Amy Kennedy
This isn’t a huge problem but I am having a bit of trouble with one of my adult dysfluency clients now that we have reached the desensitisation phase of his therapy. He is incredibly anxious about this and is avoiding doing any tasks that I set. We have been taking things very slow to build his confidence up and I don’t want to push him before he is ready but it’s starting to feel like we aren’t making much progress. Any tips to encourage him a bit??
Sarah Davis
http://www.specialdirect.com/shops/sd/Default.aspx
Aafke I love the low tech solutions on this website:
Aafke Dek
I thought about that. However, the client worked on syntax before but made little progress in spontaneous speech. Do you think it’s advisable with a 54 year old to focus on language content?
Haru Shoji
Aafke, when i worked with TBI clients, many found having google calendar and reminders useful for the planning side of exec func… i know this is not aac, but i thought i would let you know.
Aafke Dek
O I’m definitely taking a look at that thanks sarah
Sarah Davis
YEs that’s right Alex, you set them their task for hw then you record the session and spend time feeding back. I have tried this by doing the feedback over skype when the chold is in bed and they both have time to focus on it – works brilliantly!
I think keep it functional Aafke but colourful semantics really does add some structure for clients with ASD
so works better than other approaches
Aafke Dek
Thanks Haru, I think he will like using PC and getting more control over /insight into his only daily
Sarah Davis
BTW the low tech solutions I use things like the recordable cards – as memory recall Aafke and to help spontaneous requests etc
Aafke Dek
Ok that’s great – I will definitely introduce colourful semantics as I do think they want to work on syntax as well. I was thinking mainly functional too though.
Haru Shoji
Sai, can you elaborate on what kind of strategies you need for children with adhd?
Sarah Davis
I think functional AAC like google apps Haru is absolutely ideal as t normalises AAC which is much better!
Also inclussive Technology website may be good Aafke
Amy yours is tricky oe I think becaue of age
Aafke Dek
Thanks, I am going to have a good luck at that as well Sarah
Sarah Davis
It almosts puts us as a therapist in a tricky situation as we cant feel like we are treating him like a child yet he does need to practie
SaiPrasanna Bangera
The child is extremely distractible, screams and shouts most of the time. He has a limited receptive vocabulary and has difficulty accessing classroom curriculum and hence spends most of the time outside with his LSA
Sarah Davis
I think there is a discussion to be had however about how practice aids the generalisation stage
Amy Kennedy
yes it’s difficult! So far I have just been reminding him of the importance of learning to become his own therapist so that any progress we make doesn’t go as soon as therapy stops
Sarah Davis
Could he practice with a non SLT as a next step so he’s comitted to the timecale of practicing – perhaps effectively asking him to find a buddy as this will help him stick to practicing
SAi did I miss the beg. of yours:
The child is extremely distractible, screams and shouts most of the time. He has a limited receptive vocabulary and has difficulty accessing classroom curriculum and hence spends most of the time outside with his LSA
Amy Kennedy
yea that’s a good idea, main problem is that he hasn’t told anyone about therapy. He is VERY covert! I think that is a big part of the problem as he is going it alone and doesn’t have a lot of support
Rachel Harrison joined the conversation
Victoria Robinson
It sounds as if he has very low confidence
SaiPrasanna Bangera
Amy, I think that’s the most tricky bit. The client I was seeing had dependency issues as well. However, as he grew in confidence, he did tell me that he felt he could manage really well. We worked on specific tasks: conversations with his peers, presentations in class etc and as he faced these situations that he feared initially, he did overcome his fears and was so amazingly confident!
Sarah Davis
I guess if not Amy – increasing his sessions (perhaps via skype) to work on generalisation more frequenlty together?
SaiPrasanna Bangera
Increasing the gap between sessions helped as well. I saw him once a week initially and then once a fortnight and in a month….
Amy Kennedy
That’s great Sai! Yes I think if he could just complete one of the tasks and do it successfully it would give him so much more confidence to continue
Sarah Davis
Sai does your client relate to ADHD as well?
Amy Kennedy
I am going on holiday on wed so won’t be seeing him for another 3 weeks so have given him a lot of stuff to practice over this time so hopefully that will get things moving
Sarah Davis
Victoria / Rachel any clients you want to discuss?
SaiPrasanna Bangera
oh no. This was the client with stammering I saw last year
Haru Shoji
Sai it sounds like your client may be very stressed. would he benefit from a stress ball?
SaiPrasanna Bangera
Maybe he has anxiety issues, Amy and is not ready?
Sarah Davis
Oh I see!
Victoria Robinson
unfortunately I don’t have any clients at the moment, i was doing therapy packs for one boy with ASD. However now he has an official diagnosis and is receiving specialised input from the ASD team who have suggested he follows a behaviour programme so parents are choosing to focus on this now
Amy Kennedy
Possibly! He seems very keen and ready to make changes but it’s just finding the confidence to do it. I have even being doing some basic conversation, eye contact skills etc. work with him and that seems to be helping
Aafke Dek
Are there any support groups for stammerers your client join now he’s learned all the ‘core skills’?
Sarah Davis
Victoria = what a shame, i wouldnt be suprised however if actually once starting behaviour support they come back as they often realise that communication is the key to beh!
Amy Kennedy
I am actually in the process of taking over the running of the belfast support group so I have mentioned that to him but he feels he is not ready for that yet
Rachel Harrison
I’m due to see a 2yr old with sounds like possible autism – non verbal, limited eye contact. As well as the normal case history etc is there anything else I should do at the initial assessment?
SaiPrasanna Bangera
Maybe you could make a list of different situations from the least difficult to the most and work though this hierarchy, Amy? This would help him in building his confidence step by step?
Victoria Robinson
I think it is also because he has come on leaps and bounds with exp and receptive language in the past year, although he does not communicate intentionally with others at all, so they feel now is the time to focus on his behaviour
SaiPrasanna Bangera
I think the Hanen’s checklist is very useful, Rachel.
Sarah Davis
Well that’s encouraging Victoria
Rachel Harrison
Ok, thanks Sai
Sarah Davis
Rachel I think get a good idea of his motivators before you go even if it means a phonecall with the parents first.
SaiPrasanna Bangera
It’s available on downloads
Sarah Davis
Always good to go well armed with motivators
Rachel Harrison
Ok, will do, thanks
Sarah Davis
Ditto wht Sai has said
SaiPrasanna Bangera
Also look at joint attention and symbolic play, Rachel
Amy Kennedy
Yes doing this at the minute Sai and his first task was to tell his mum that he is seeing a slt because she is the only person he speaks to about his stammer. He though that would be easy for him but he still hasn’t done it. Think we need to go back to the drawing board and think of something even less threatening than that
Aafke Dek left the conversation
Victoria Robinson
Instead of telling his mum verbally would he be able to tell her in a different way e.g a letter?
Sarah Davis
Righto folks I am mindful we havent got onto part two of the agenda – caseload management but I wanted to allow us time for case discussion tonight, so we will touch on caseload management next at the team meeting.
Aafke Dek joined the conversation
Victoria Robinson
To try and increase his confidence a bit and reduce his isolation?
Sarah Davis
Ok folks Im going to start up the team meeting chat, feel free to keep chatting on here until I have us all logged in.
SaiPrasanna Bangera
The client I was seeing (with stammering) had no family involvement at all. He was very anxious initially but did amazingly well as he was soooo motivated!
Aafke Dek left the conversation
Amy Kennedy
That’s a good idea Victoria! I’ll suggest that to him
That’s good to hear Sai, I think my client will get there, it’s just going to take time and baby steps
SaiPrasanna Bangera
I’m sure he will, Amy!
good luck 🙂
Amy Kennedy
thanks for your help 🙂
Victoria Robinson
I’,m guessing he has lived with the stammer for quite a long time? So I guess it is bound to take time but he will get there 🙂
SaiPrasanna Bangera
I used this attitudes and something checklist from downloads which was really good, Amy
More like a CBT approach
Amy Kennedy
yea he is 28 and has had it since childhood but uses a lot of avoidance so there are a lot of feeling under the ‘iceberg’!
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Amy Kennedy
Thanks I’ll check that out! Hoping to do mindfulness training soon so looking forward to trying some of that with him too
SaiPrasanna Bangera
covert feelings are really tricky to address
Sarah Davis
Right o folks we are ready to swap over I shall send you the minutes of this chat afterwards 🙂
Isobel Baird left the conversation
Victoria Robinson left the conversation
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Nimisha Mistry left the conversation
Amy Kennedy
can someone add me to other chat please?
Kat Morrison left the conversation
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