Do children even need face to face therapy?

With the recent ASLTIP statement supporting Independent SLT’s contributions to an EHCP, I’ve been reflecting more and more on the ‘dosage’ of speech therapy that I recommend; not just in EHCPs but when working with families and making recommendations for how often they come and see me.

It can be very easy to subscribe to the ‘consultative’ model - that is that SLTs advise those that have regular, consistent contact with a child on how to interact and support that child, make recommendations about environmental modifications and review and monitor with little direct contact with the child. It’s a bit like establishing the ground rules for supporting communication.

And while I’m a big supporter of this model - I’ve spent years trying to make the strategies and advice that would make up a big chunk of this consultive way of working accessible to all - I was reminded yesterday how it’s only one piece of the puzzle and that direct, face to face, specialist (after all, all SLTs are specialists in communication development) therapy is valuable, necessary and a right for all children with SLCN (Speech, Language and Communication Needs).

Yesterday, I was delivering a therapy sessions for a child I’ve worked with for a while. They’ve historically had attention & listening needs and we’ve been trying to follow their lead and introduce really interesting and exciting activities to help develop and extend their attention.

I know their Mum well, and together we are a great team, both working hard to support her child and meet their needs within the session. We’re flexible, creative, responsive and gradually, little by little her wonderful little one has learnt the routine and are demonstrating increased engagement and attention & listening skills.

Then yesterday, it happened. The golden session. The session that meant it was all worth it. They came in and they joyfully shared with me all the activities I had planned. They laughed and shrieked with delight. They fizzed with excitement. They got up when they needed to, they tried to drink one of the resources I was using, and they gave the window a good lick.

But they also responded to the simple language I was using, looked at the visual support I offered and used their communication skills to share the fun with me, requesting more, commenting on what they could see and relating what we were doing to something exciting that had happened at the weekend.

A 13 year old girl I work with has weekly, face to face sessions from an SLT included in the provision of her EHCP. I took this work on when I was just starting in independent practise so she was only 10 then. I wasn’t sure that weekly sessions at 10 years old was really warranted, wasn’t sure why I wasn’t doing more consultative style work. But the progress she has made has blown me away. Of course, I can’t claim all the credit, but I don’t know how I would have trained someone else to respond, extend, model and shape her nuanced and subtle communication attempts like I have been doing every week. She deserved the chance to develop her communication skills and I’m so thrilled to have worked with her. Her family even decided to wait for me to come back from maternity leave rather than find someone new to work with her - something I have taken to be such a compliment!

So I won’t be given up on the consultative model, but I also won’t be stepping back from face to face support and I won’t hesitate to recommend it in my EHCPs.