SmiLE Therapy

Functional Communication and Social Skills for Deaf Students and Students with Special Needs

Karin Schamroth, Emma Lawlor

• Verlag: Routledge
• Jahr: 2017
• ISBN:
  9781351383721
• Auflage: 1
• Thema: Pedagogía
• Thema: Educación general

Students with communication difficulties need skills to communicate functionally in everyday situations, without the usual support and protection from home and school. These skills need to be explicitly taught, to enable them to become confident young adults. Smile Therapy is an innovative therapy designed to equip students with the skills necessary to become responsible individuals who operate at the highest level of independence that their circumstances and condition allow. Teachers and speech and language therapists have always included functional life skills practice in their work with students. Now, for the first time, they can do so using a therapy with a proven method that has demonstrable outcomes. This book is a practical step-by-step resource, designed to guide teachers and SLTs in the delivery of Smile Therapy with students who have communication difficulties due to deafness, specific language impairment, learning difficulties, autism or physical disability. Features: a clear step-by-step approach to preparing, running and evaluating Smile Therapy, with photocopiable resources. clear outcome measures from each module to share with parents, staff, education and health managers.

Part 1
Theory and key elements of smiLE Therapy

Introduction

There are approximately 900 children born each year in the UK with ‘significant permanent hearing impairment likely to affect their own and their family’s quality of life’ (NHSP, 2014) and, currently, the prospects for those children are not looking good. Over three-quarters of deaf children start school having failed to achieve a good level of development in the Early Years foundation stage (DfES, 2011). They are more likely to fall behind as they move through primary school and the gap between deaf children and hearing children is widening (NDCS, 2012).

Despite early identification through the NHSP, early intervention and incredible advances in technology, deaf children are still faring badly. As a result, deaf students are leaving school with an average reading comprehension age of approximately nine years (Holt, 1994; Traxler, 2000). It doesn’t get any easier once they are out of the education system; severely and profoundly deaf people are four times more likely to be unemployed than the general population, even when there are low levels of unemployment (Action on Hearing Loss, 2013).

Deaf children in the Early Years

More than 90 per cent of deaf children are born into hearing families who have little or no previous experience of deafness or sign language (Hindley & Kitson, 2000). For children who cannot access spoken language and therefore need to sign, the family is in the unusual position of having to learn a language at the same time as their child. This is different from hearing children of hearing parents or deaf children of deaf parents. Families who learn British Sign Language (BSL) to facilitate communication with their deaf child tend to use it in a functional way, with the emotional and conversational aspects of language being much more limited,

if not entirely absent (Schlesinger & Meadows, 1972). This results in the deaf child being exposed to only a very basic level of concrete vocabulary and communication skills. Even for those children who can access spoken language with technology (such as hearing aids or cochlear implants), it can still be difficult for them to access as much language as a hearing child. A child with a hearing loss, even a mild or unilateral loss, is often unable to overhear what people are saying or follow events that are occurring (Davis, 1990) because of mitigating factors such as background noise, distance from the speaker, unfavourable acoustics of the listening environment and faulty or inadequate technology.

Research in the field of developmental psychology indicates that about 90 per cent of what very young children know about spoken language and the world they learn incidentally (Flexer, 1999); in other words, by ‘overhearing’. Not only does the lack of opportunities for incidental learning mean that deaf children may not access key language concepts, it also means they miss out on the pragmatics of language; for example, knowing how to start a conversation, how to negotiate with peers, make requests, compromises and jokes, and use sarcasm (Flexer, 1999). In the hearing world, it is essential to be able to communicate effectively in order to establish and maintain relationships with other people, and to feel included in society.

Assimilating an identity as a deaf person in a hearing world can be challenging and requires access and exposure to not only good language models but also other deaf role models. Many deaf children grow up being the only deaf member of a family or even the only deaf person in a town. With the shift in education policies towards the inclusion of deaf children in mainstream schools (Kumsang & Moore, 1998), some may be the only deaf student in their class or even their school: of the 35,000 school-aged deaf children, 85 per cent attend mainstream school (NDCS, 2010). In addition, many social and support services such as youth clubs, extracurricular activities and drop-in centres are generally not accessible to deaf people because of the communication barrier.

Difficulties establishing a clear identity (‘Am I a deaf person or a hearing person?’) can generally lead to depression, anger and personality problems, with language deprivation and isolation having an increased impact on a deaf individual’s mental state (Austen, 2006). Demographic studies of deaf children have shown that they have two to five times more mental health problems than hearing children (Hindley & Kitson, 2000). The Department of Health figures indicate a prevalence of mental health problems in 40 per cent of deaf children compared with 25 per cent in their hearing peers (DH, 2005). These difficulties continue into adulthood: Cowen & Wolfe (1973) found that children who have difficulty with peer relationships are more likely to experience a variety of social problems in later life. This is further supported by an overrepresentation of deaf people in prisons and secure mental health settings (DH, 2005; Austen, 2006). Young et al (2000) report a 12 times higher prevalence of deaf people in the high-security hospital population than in the general population.

Communication skills that need to be taught

To be considered a competent communication partner, a person must be able to use a range of skills to maintain the conversational flow. Communication breaks down even for the most skilled communicators for a variety of reasons, including: insufficient information provided, unintelligibility of the speaker, unfamiliar vocabulary being used, wrongly assuming listener knowledge, and auditory difficulties or comprehension problems (Lloyd, 1999).

The ability to recognise times of ambiguity or misunderstanding and ‘to request clarification ... is an important feature of effective face-to-face interaction’ (Jeanes et al, 2000, p238). Opportunities to observe and practise a variety of social skills are essential to develop the ability to manage communication breakdowns (Crocker & Edwards, 2004) and typically developing children acquire these skills by the age of eight years through experience of and active involvement in conversational interactions (Owens, 1996). For deaf people, however, these skills can be harder to learn. They have fewer opportunities for naturalistic, meaningful interactions and are therefore less likely to acquire the full range of conversational pragmatic skills (Jeanes et al, 2000). Research has shown the majority of children with sensory–neural hearing losses, even to a mild degree, experience significant delays in social conversational skills (Carney & Moeller, 1998) with often significant consequences for successful communication. These delays have long-term consequences; more than half of employed deaf people (55 per cent) report feeling socially isolated at work (Action on Hearing Loss, 2013).

It is often assumed that deaf children will learn about social interactions naturally, however it appears that this is not the case (Brackett, 1983). Deaf children have a reduced knowledge of, or ability to use, repair strategies and limited skills in pragmatics to restore a broken conversation. This includes, for example, seeking clarification, responding to clarification, solving disagreements, leading conversations and repeating what is said for confirmation or by offering additional information. As Arnold et al (1999) found, deaf children tend to use significantly fewer requests for clarification than hearing peer controls. This makes it more difficult for them to be an effective communication partner and to take an active part in keeping a conversation going (Kretschmer & Kretschmer, 1980; Stinson et al, 1996; Stinson & Antia, 1999; Jeanes et al, 2000). It has also been found that deaf people tend to use non-specific requests for clarification, for example, ‘What?’, ‘Huh?’ or ‘Pardon?’ (Tye-Murray et al, 1995 in Ibertsson et al, 2007). This means that the conversation partner does not know which part of the message needs clarifying, and is therefore not as effective as a specific request (for example, ‘Where are we meeting at 7 p.m.?’).

Even children who have had access to spoken language through technology for over four years can continue to have difficulties in this area. Tye-Murray (2003) studied the conversational skills of 181 children aged eight to nine years for which he defined ‘conversational fluency’ as (1) minimal need for clarification, (2) ample opportunity between conversation partners to speak and (3) few prolonged periods of silence. He found that even those children who had had their cochlear implant for four to five years still had poor conversational fluency compared with hearing peers. A longitudinal study of children who had been implanted for five to seven years showed that they still had difficulty understanding what their teachers were saying and had problems taking part in conversations in the classroom setting (Preisler et al, 2005).

In specialist provisions for deaf children (for example, hearing impaired units, resource bases or specialist schools), where staff are trained to be deaf-aware and to facilitate communication from that child or student to the best of their ability, studies show that adults tend to do a lot of the talking for deaf children, with high levels of adult control in conversations, and reduced time to respond (Wood et al, 1986). As a result, opportunities for students to learn to take responsibility for their own communication are severely limited.

A teacher working with a group of 17-year-old students at a Special Educational Needs department of a sixth form college summed it up perfectly: ‘we support, prompt, guide without even realising that we have never taught them what they need to know’ (Kate Annett, Special Needs Teacher, talking to colleagues at a smiLE Therapy Staff Workshop).

One of the consequences of not having the skills to manage a misunderstanding or breakdown in a conversation is seen in the study by Reeves & Kokoruwe (2005), who assessed deaf people’s access to health care and communication with health professionals. They found ‘one in three left their last consultation uncertain if the doctor had managed their case correctly, gained no better understanding of their illness, and did not fully understand the doctor’s advice on what to do next. One in four had at some time been prescribed medication without adequate information, or that they believed to be incorrect’ (p95).

What smiLE Therapy offers

The need for creating opportunities to expose deaf children to a variety of real-life situations and encouraging them to take an active part in these is compelling. SmiLE Therapy provides an intervention for deaf students that takes the focus away from their speech difficulties and language delay and empowers them to make significant improvements in their communication, using a variety of strategies. Cowen & Wolfe (1973) and Beazley (1992) believed a social skills programme could help improve and develop a range of life skills which would affect deaf people’s future happiness, social adjustment, emotional stability and self-esteem. It has been recognised that social skills training is an effective medium for enhancing a child’s self-esteem and motivation. Moseley (1993, p4) states that ‘The task of enhancing self-esteem is the most important facing any school’.

Traditionally, the approaches used by SLTs for deaf children have focused on auditory perception and training, speech reading, speech production or intelligibility, and vocabulary and syntax without an equal and necessary emphasis on the use of language for interaction in communication (Bench, 1992). While the former therapy areas are all relevant, it appears that the consideration of real-life everyday communication skills that deaf children face is insufficient. Carney & Moeller (1998) found no mention of studies regarding social interaction or real-life communication skills in their review of treatment efficacy in deaf children.

The essence of smiLE Therapy is for students to learn how to be actively responsible for their own communication and social participation without the constant need for adult back-up or support. The term ‘Live English’ was coined by Pickersgill & Gregory (1998) in a document describing a model of bilingual sign education, differentiating written English from English used in face-to-face communication. It refers to ‘all the strategies which deaf children need in order to communicate with non-deaf peers and adults … in social and communicative contexts’ (p4). The term has since been used by many SLTs working with deaf client groups, to be synonymous with functional therapy, focusing on ‘live’ communication between the deaf person and a non-signing hearing person.

Delivering smiLE Therapy

Evidence-based techniques found to be useful specifically for deaf students have been incorporated in the smiLE Therapy delivery model. What follows is a brief discussion of the key concepts within smiLE Therapy.

Deconstructing communication into small component skills

Social communication skills are by their very nature complex and intricate. Dismantling and separating out communication skills into teachable, manageable parts is essential for deaf students. For this reason, the communication task for each smiLE Therapy module is broken down into many small component skills (Schamroth & Threadgill, 2003). These are then taught in manageable sections, which all include an approach or entering ‘start’ to the interaction and a leaving ‘end’ to the interaction. Indeed, the simplest modules look at the small component skills belonging to these entering and leaving sections only (Modules 2 and 3), while the other modules have additional sections in the ‘middle’.

By breaking down a task in this way, students can first appreciate the complexity of the communication task (‘What? I have to remember all those things!’) and then realise that these are the skills that need practising so they can remember them. It also gives them the chance, after having watched themselves on video, to identify which skills they already know and which they need to still acquire. It makes the task tangible and quantifiable in a way that they are unlikely to have considered before. The task no longer seems so daunting when students can see that it is made up of small skills, especially if they know some of them already: ‘I know up to here, but I’m not sure about from here’, one student said, pointing to the Communication Skills Checklist (words and symbols) to illustrate her point (student aged 13 with specific language impairment, including word-finding difficulties, in a mainstream school in Haringey, London). Breaking down the skills gives students a quantifiable goal, a manageable challenge to see if they can remember all the skills and an opportunity to develop memory techniques that work for them.

Colleagues have observed 13-year-old deaf students, nervously waiting outside the local shop to go in independently to buy a packet of crisps, following the practice from therapy sessions. They were spontaneously and quietly rehearsing to themselves the skills needed by counting them on their fingers with a quick sign: (1) Eye contact; (2) Smile; (3) ‘Hello’, and so on. This is clear evidence for the practitioner that the therapy is working and the student is on their way to taking responsibility for their own communication.

Test–teach–test method

Before a skill is taught by the practitioner, it is necessary to first establish what the student knows about that skill already, in order to focus therapy more effectively on areas that need developing. For this, the practitioner tests the student for that particular skill or knowledge before teaching begins and again tests what students have learned at the end.

This is modelled on the test–teach–test method routinely used by teachers of English as a foreign language. In smiLE Therapy, this testing stage is the initial recording of the student carrying out the communication task, before any teaching and practice. This then informs the next ‘teach’ stage, where skills that were not observed,are directly taught through role-play techniques. The final test phase provides evidence for whether the new skills have been learned or not. In smiLE Therapy, this happens with the final recording of the student, post-therapy, carrying out a similar communication task, providing clear evidence of progress.

Filming and self-evaluation

In smiLE Therapy, filming is used for several purposes. Students are filmed before and after therapy in the chosen communicative situation as a way to record progress. It is used for assessment and feedback to students, an approach considered important for social skills intervention (Brackett, 1983; Ducharme & Holborn, 1997; Rustin & Kuhr, 1989, cited in Alton et al, 2011). It is also effective in facilitating vicarious learning (Dobson et al, 2002, cited in Alton, 2008). As one 13-year-old student reflected at the end of a smiLE Therapy module, ‘I learned most things from the group. I could watch and learn from other people’s video, so I knew what to do next time’. Another important use of filming is as a tool within the therapy session itself, to facilitate the students in the task of self-evaluating (Murphy & Hill, 1989).

Students evaluate their own performances in the communication task ...