Introduction
In the United Kingdom, speech and language therapists (SLTs) work in the national health service, and teachers work in schools funded by local educational authorities. Health and education are two large and powerful public services, each with its own way of operating, which converge in their joint aim of meeting the needs of school-age children, including those with disabilities. There is a general understanding that these needs might best be met by collaborative, co-operative, cross-professional approaches, rather that by services operating independently. This session aims to review current issues for health and educational staff engaging in joint working, loosely here called collaboration, to see how far we have come and what remains to be done. Since both professions are concerned with language and communication, which is central both to children's well-being and social development and to accessing the curriculum, joint approaches seem appropriate to make the classroom a good language-learning environment.
A systems approach
I will use a systems framework to explore the issues and to tease out where some of the problems and possible solutions lie. A systems framework can look at:
Barriers to Collaboration
Using this approach, we can examine some of the barriers to collaboration between teachers and SLTs (McCartney 1999a). Some of the main difficulties are in:
Functions: problems in policies; in prioritisation of children ; in educational differentiation versus deficit models of practice; and in models of inter-professional working and social interaction.
Structures: problems in timing and location of service delivery; in management structures; and in curriculum structures. Process: issues around opening records of special educational needs, and working in individualised education plans (IEPs). Systems Environment: differences in social expectations about services, from voluntary organisations, parents and families.
Patterns of Collaboration
Although there are differences and problems, there is also evidence of rapid development in collaborative working in the UK. The systems headings will be used to look at how this can be developed, and some ways in which good collaboration can take place.
Functions
Functions are the aims of a service, and collaboration itself can be considered an aim.
Policies on Collaboration:
Service aims have fortunately received considerable attention over the last few years, leading to policy developments. Public services in the UK have been given a 'duty of collaboration' to establish 'joined up thinking' amongst services. (McCartney 1999b). The need to collaborate has been incorporated into service aims, and public services have become accountable for their collaboration practices. Specific policies regarding teachers and SLTs are related to this overall impetus in public services to actively require collaboration and joint working.
In England, this has led to a joint DfEE/DOH Working Group on Provision of Speech and Language Therapy Services to Children with Special Educational Needs. This working party is due to report later this year, but has adopted the policy that: 'future arrangements should emphasise the importance of collaborative working with parents and children' (DfEE/ DoH 1999).
The working party will also aim to resolve the thorny problems of funding SLT input to schools, and may also make recommendations about recruitment and retention of SLTs.
In Scotland, policy work on SLTs in schools started earlier. In 1991 the Secretary of State gave funds to Scottish educational authorities to purchase SLT services for those children with a record of needs where SLT input was considered to be a special educational need. HMI looked at language classes and units in Scotland for children with specific language disorders in 1990-91, resulting in a report in 1996 (HMI 1996). Further work was commissioned on the issue by the Scottish Office, resulting in a detailed report by Reid et. al. (1996) on SLT/teacher working practices.
More recently, the 'Manual of Good Practice in Special Educational Needs' (SOEID 1998) has published guidelines which can be used as a framework to ensure that good collaboration is taking place. It reviews the relevant policy and legislation, and offers guidance and support procedures on collaboration [Key Area A : Working Together (Section A4)]. The manual states that it is essential that:
'The authority has identified the range of services provided by them, by relevant voluntary agencies, and by the health services in the area; a co-ordinated inter-agency approach is adopted where there is common involvement with client groups'.
Professional bodies have also made commitments to collaboration. The Royal College of Speech and Language Therapists in 'Communicating Quality - Professional Standards for SLTs' (1996 p 54) states that SLTs:
'aim to provide a service which involves a high degree of shared knowledge, skills, expertise and information among all those involved with the child', and offers extensive discussion of work in schools and collaboration.
The National Association for Special Educational needs, who are co-hosts of this conference, also recognise the need for good links, and in their policy document on early years (NASEN 1999) note that there should be: 'good links between different service providers rather than a series of uncoordinated inputs offered in parallel'.
It is difficult to over-estimate the importance of these policies, which have provided a real boost to collaborative working, and there has been a resulting increase in integrated planning across the country (McCartney 1999c). One key issue will be to monitor the effectiveness of collaboration as a function, using the normal quality assurance procedures for health and education, such as inspection (schools) and audit (health). Such developments should be useful in ameliorating difficulties in joint decision making which act counter to much good work with children. The policies mean that collaboration will now be expected and monitored, and that there is a policy framework in which it can flourish.
Prioritisation of Children:
It helps collaboration if the need for service can be predicted, and service levels planned jointly. Educational psychologists can help by estimating the numbers of children needing support, and services can plan the amount of input. Above education authority and trust level, national/regional planning discussions are useful. SLT services can help considerably by publishing their prioritisation policies (McCartney 2000). A combination of these approaches should mean that realistic staffing estimates and plans can be made.
Differentiation versus Deficit Models:
There is some residual tension in how NHS services and education conceptualise children's needs. This is between the health service 'medical' model, which locates disabilities within the child and tries to alleviate them; and the educational model which aims to adapt the learning environment to meet children's needs. As Norwich (1996) argues, this tension may be more apparent than real, as both models are important in meeting children's needs. Sharing perspectives can be creative and can contribute to a holistic account of a child's well-being. It is probably more productive for staff to know about and understand other professionals' conceptualisations than to engage in a battle to establish a 'correct' model. Indeed, collaboration is being encouraged so that the ideas and information brought by a variety of professionals can be synthesised to a child's benefit. Nonetheless, some explanation and discussion will probably be needed to help understanding.
Models of Inter-professional Working:
The model to aim at is probably inter-disciplinary collaboration. Good indices of this are where egalitarian relationships are made and joint goal setting occurs. For this to happen, some in-service work and team-building may be necessary, where SLTs and teachers discuss ways of adapting the curriculum. However, there is not too much time available for team building, and information sheets which explain how each service works are very helpful.
Structures
In many organisations, .structures need to be modified for better collaborations to take place.
Timing and Location of Service Delivery:
SLTs have moved much of their work into classrooms, and there is a pressing need to secure teacher/SLT planning time, and in-service education to establish some common frameworks.
Management Structures:
Management issues can be dealt with by service level agreements, which detail when SLTs will be in schools, where they will work and with whom, and the in-service work which will be offered by SLTs to teachers and by teachers to SLTs. Sometime these agreements can be based at school level, but so many schools are involved that a 'template' agreement negotiated at authority level may be needed.
Curriculum Structures:
It is possible for SLTs and teachers to work within the curriculum, if it is sufficiently differentiated to allow for the individual problems which many children show - for example, to allow work on language forms (such as speech sounds and syntax). Developing the curriculum into a structure which can meet the needs of children with difficulties is possible, given its focus on listening and talking, and is a recognised part of educational work.
Processes
There may be fewer problems at the process level, where teachers and SLTs are both used to planning and recording progress. Nonetheless, some issues remain.
Opening a Statement or Record of Need
SLTs have a formal role in opening a Statement or Record of Need, where again there is RCSLT policy on fitting their contribution into a collaborative framework, so that the nature and type of advice SLTs offer should be helpful. However, SLTs are very concerned to work with the majority of children in need of services who do not have a Record or Statement. Their ability to do so will depend largely two things. Firstly, the removal of the distinction (which is almost impossible to make) between SLT as an 'educational' and as a 'non-educational' need. In fact, this has already been agreed by the Working Party. Secondly, the introduction .of appropriate funding mechanisms.
Planning for an IEP:
SLTs can plan within the IEP, so that an IEP can be used to plan both educational and 'therapy' goals. Getting a single set of planning documents based round an IEP may be one of the most important keys to collaboration.
Systems Environment
Health and education services have to consider how they are perceived by service users and other interested bodies.
Social Expectations:
There is an need for public documents to co-ordinate references to SLT and educational services, to show how collaboration takes place. There is a large job of work to be done explaining how collaboration works, via conferences such as this.
Voluntary Organisations:
Voluntary organisations such as AFASIC and NASEN regularly look to their work on collaboration, and have been instrumental in encouraging change through joint conferences, policy and good practice documents etc.
Parents:
It is clearly essential to secure regular contact with parents, and to explain how collaboration works, and to involve parents in setting IEPs.
Conclusion
Policies are now in place for good collaboration to take place. Recent policy developments have been helpful in 'closing the gaps' and putting collaboration on the agenda. Problems remain:
Time: collaboration takes time, which is not always built into planning, nor into workloads.
Staff: may have limited expertise in collaboration, and feel threatened by it, especially if it is to become an expected way of working, not a personal choice (Hargreaves1998).
Examples: we are just beginning to publish examples of how collaboration can be made to work.
However, a 'sea-change' has taken place, and the opportunities for collaborative working are ongoing and long-term. The dialogue amongst professions has lead to a healthy sharing of opinion and expertise, and to identifying points of disagreement and difficulty. Collaborative working is now a normal and expected aspect of work with school children. SLTs may have made the most change, by moving into the classroom, but national educational policies are now welcoming this move. We need many more local examples of good practice to take our thinking forward.
References
DfEE/ DoH (1999) Joint Working Group on Provision of Speech and Language Therapy Services SLTWG 99 (9) at http://www.dfee.gov.uk/sen/therapy/index.htm
Hargreaves, A. (1998) Contrived Collegiality: the Micropolitics of Teacher Collaboration. In Bennett, N., Crawford, M. and Riches, C. Managing Change in Education. London: Chapman
HMI (1996) The Education of Pupils with Language and Communication Disorders Edinburgh: SOEID and HMSO
McCartney, E. (1999a) Barriers to Collaboration. International Journal of Language and Communication Disorders: 34: 431 - 440
McCartney, E. (1999b) Scoping and Hoping: the Provision of Speech and Language Therapy Services for Children with Special Educational Needs. British Journal of Special Education: 26: 196 - 200.
McCartney, E. (1999c) Speech/Language Therapists and Teachers Working Together. London: Whurr
McCartney (2000) Include Us Out? Speech and Language Therapists' Prioritisation in Mainstream Schools. Child Language, Teaching and Therapy: 16: 165- 180
NASEN (1999) Policy document on Early Years. 2nd October 1999, NASEN: Tamworth
Norwich, B (1996) Special Needs Education or Education for All: Connective Specialism and Ideological Impurity. British Journal of Special Education, 23, pp. 100 - 104
RCSLT (1996) Communicating Quality: Professional Standards for Speech and Language Therapists London: The Royal College of Speech and Language Therapists.
Reid, J. et al. (1996) The Role of Speech and Language Therapists in the Education of Pupils with Special Educational Needs. Edinburgh: Centre for Research in Child Development
SOEID (1998) Professional Practice in Meeting Special Educational Needs (The Manual of Good Practice).
SOEID (1999) Raising Standards - Setting Targets
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