Chapter 1:
Working together
As a speech and language therapist (SaLT), have you ever felt overwhelmed by your caseload?
In today’s climate where SaLTs are in short supply and funding is tight, supporting children’s communication in schools is a challenge. SaLTs often have an overwhelmingly large caseload, which can lead to low job satisfaction and, consequently, a high turnover of staff. This can mean continuity of care is poor, with schools and families losing confidence in the service.
Teachers: have you ever had parents desperate for help with their child’s communication and felt out of your depth in trying to answer their questions? Have you ever been tasked with carrying out speech and language therapy (SaLT) programmes with no idea where they fit in with the curriculum and classroom routines?
In school, children’s communication difficulties are a major barrier to learning. Although teachers do their best in trying to support children’s communication within lessons, they often feel helpless in the face of complex communication and interaction needs. Communication difficulties are fundamental to the child’s ability to learn, but offering SaLT support as an add-on is never going to reach the heart of the matter.
SaLTs do not need to be afraid of a big caseload if they can share the task with the other professionals who have the same goal – that of developing the child’s effective communication.
Communication at the Heart of the School (CATHS) means sharing a complete approach to supporting children’s communication in school. Having a shared vision and working together closely in the classroom mean both the teacher and the SaLT feel supported and are more effective. Working together equips everyone to tackle complex communication challenges. It allows us to share successes, meet failures and move forward as a team.
CATHS is underpinned by the Communication and Cognitive Framework that teachers, SaLTs and families use as a shared reference point. The framework is a description of communication and cognitive development from birth to around four years, focusing on practical communication in real-life situations. It helps SaLTs and teachers to identify the developmental level of the child, which is used to guide classroom practice and SaLT support.
CATHS provides a complete package of communication support to schools who are educating children communicating at early developmental levels. The target population is for children whose primary diagnosis is of Profound and Multiple Learning Disability (PMLD) or Severe Learning Disability (SLD). The framework leads to a communication assessment completed by all those with close knowledge of the child. The assessment directly links to a bespoke future planning page documenting how to best support the child’s communication in the classroom and at home. The CATHS Pathway helps guide SaLTs through to the appropriate course of intervention. A few children will receive one of eight Specialist Packages due to their complex communication difficulties. These Specialist Packages include all the information required to deliver the appropriate intervention. In addition, all children also receive the Classroom Environmental Package, which involves both the teacher and SaLT closely working together in the classroom to achieve the best communication environment.
CATHS follows a yearly cycle of assessment, plan and intervention. This is a whole-school approach which, once it is embedded in everyday practice, is not reliant on any one person to drive it forward. Where the teaching staff and the SaLT share the task of supporting communication, morale is raised and job satisfaction is increased.
CATHS is founded on two complementary theories of communication development. Firstly, the semantic-cognitive theory (Bloom & Lahey, 1978; Piaget & Inhelder, 1972) suggests that language development is intertwined with cognitive development. Children use language to express ideas that they already understand, so in simple terms, the child needs to experience and understand the concept of “big” before they can give the concept a word label. Cognitive development is considered alongside language development in the CATHS framework.
The second foundation stone of CATHS is the recognition of the social context of communication, which is described as the social-pragmatic theory. One of the elements of this theory is the ability to use language for different purposes or functions. Language functions which change as the child grows in their understanding of the world around them form the basis of the CATHS assessment. We strongly believe in facilitating the use of communication for a wide range of developmentally appropriate purposes.
CATHS also recognises the value of communication for the sake of social interaction where meaning is less important. Sometimes called small talk, phatic communication establishes a social bond and is, perhaps, the most important form of communication, especially for those with language difficulties.
CATHS has been built upon these solid foundations. It evolved slowly with each part being tried and tested before being further developed. As the approach was reviewed and adapted, we continued to refer back to the theoretical foundation, which we believed was the most effective way to develop communication skills.
The complete approach has been successfully implemented for several years in a school for pupils with PMLD and SLD and more recently with pupils with Autism Spectrum Conditions (ASC). The approach is transferable to all settings where SaLT and education are working together to develop children’s communication skills.
The principles of CATHS came into life in the 1990s as an attempt to develop a whole-school approach to the fragmented language development programmes then in place. Ann Miles, working as a class teacher and Clare Latham as a SaLT recognised the need for consistent communication development work across the school. This was published as Assessing Communication (Latham & Miles, 1997), which was an assessment leading to a future plan which could be easily followed both in the classroom and by the SaLT.
Rachel Sawford joined the team in 2000 and after enthusiastically implementing the programme contributed to its development from her own experiences. In recent years, Rachel worked with Amanda Bousaki on developing pathways and packages based on best practice and research. These guide clinical decision making and provide equity of access to SaLT intervention for all children. The CATHS Pathway and Specialist Packages evolved from this initial work on meeting the needs of children within the context of growing SaLT caseloads.
As a single part-time SaLT in a growing school, Rachel also developed a new service delivery model. This involved training and supporting learning support assistants to become communication assistants who were then able to deliver interventions, allowing Rachel to focus on assessment and whole-school support.
Over the years, this very successful approach has been refined and developed. The framework has maintained its principles and roots but has also been under constant review. It has evolved to meet changing needs and to incorporate new approaches and ideas which complemented the basic principles.
The book is intended to be a tool with each school or therapist using it in their own way. The most important aspect is to maintain the sound philosophy that CATHS is built on, rather than rigidly follow the detail. As new approaches in communication development become available, it is important to assess their effectiveness by keeping the key principles of CATHS at the forefront. By doing so, CATHS can grow and evolve by including the best of new initiatives.
References
- Bloom, L., & Lahey, M. (1978). Language Development and Language Disorders. Chichester: Wiley.
- Latham, C., & Miles, A. (1997). Assessing Communication. London: David Fulton.
- Piaget, J., & Inhelder, B. (1972). The Psychology of the Child. New York: Basic Books.
