Children's Speech & Language Therapy in Buckinghamshire


New National SLT Outcome Measures

The Buckinghamshire Speech and Language Therapy Service will be joining a national initiative from the beginning of the Spring Term 2016 to use the Enderby and John, (2015) Therapy Outcome Measures for Rehabilitation Practitioners, TOMs, to evaluate children’s progress in a more holistic, functional way.

Over the Spring and Summer Terms 2015, the Buckinghamshire SLT Service trialled the use of Goal-Based Outcomes with children from Key Stage 1 to Key Stage 5. For the younger children with more impaired communication skills, the Speech and Language Therapists selected a range of suitable targets from which the children could select up to three which they particular wanted to work on. The older children and young people were given more freedom about the selection of therapy targets. All of the children were asked to rate the targets in terms of their perceived level of difficulty at the beginning and end of each term. The SLTs completed separate ratings at the same times.

On average, the children’s ratings improved over time. The SLTs, however, expressed concern over some of the students’ inability to accurately judge the level of difficulty of the task both before and after therapy e.g. some children initially thought that the target was an easy one, but after having worked on it for a term, they discovered that it was a lot more difficult than they had anticipated. Although the SLT may have rated their skill as having improved, the child may have rated themselves more poorly. Some children, particularly those with more impaired communication skills, viewed the rating scales with smiley and sad faces as a reflection of their mood and not their ability. For this reason some of the children’s and Therapists’ ratings were very different for the same target.

The Buckinghamshire SLT Service recognises the importance of providing children and young people with an opportunity to select their own targets and for this reason the SLTs will continue to offer them a chance to select their own targets as much as possible. Because of the difficulties described above, the SLT Service has decided to move over to the use of Therapy Outcome Measures, TOMs, from the beginning of the Spring Term 2106.

TOMs was devised by Pam Enderby and Alex John, two highly respected Speech and Language Therapy researchers, in collaboration with highly specialist clinicians in each of the clinical areas, for use by a range of health professionals: SLTS, OTs and Physiotherapists etc. It aims to provide practitioners with a tool to evaluate the child’s needs holistically. It therefore includes rating scales for:

  1. Disability e.g. Autistic Spectrum Disorder, Cleft Lip and Palate, Child Language Impairment etc.
  2. Activity i.e. level of independence within the home, setting
  3. Participation i.e. the child’s ability to interact socially
  4. Wellbeing i.e. the emotional impact of the above

TOMs, which has been endorsed by the Royal College of Speech and Language Therapists, will enable the Buckinghamshire Speech and Language Therapy Service to report on changes which have taken place as a result of therapy, not only in terms of changes to scores on standardised assessments, but also in a more functional way e.g. a child’s disability, like a sensory-neural hearing impairment, may remain the same, but as a result of therapy, his/her level of activity may increase e.g. s/he may be able to ask a peer for a rubber in the classroom. S/he may be more able to participate in activities outside of the classroom e.g. s/he may be able to join the school’s breakfast club. The child’s wellbeing may improve too e.g. s/he may be feeling a lot happier because s/he is able to make her/himself understood to a wider range of people.

An evaluation of the TOMs will take place at the end of the Summer Term 2016 and will be published on the Bucks SLT website.

Glynis Haines

Last updated: 18 February, 2016