Planning your intervention with Alex Kelly

Here are a few of my top tips for making your intervention work..

I like to put any intervention into the following four-step plan before I start my group or one-to-one sessions. This will help you to work out how best to work with someone on their social skills difficulties.

Step 1: The behaviour … what is it?

Make sure that you choose the right behaviour or skill to work on first. So, having assessed the person, you need to consider the hierarchy and the complexity of the skill you want to work on with them. Ask yourself: are you setting up the person to succeed? Is the behaviour too complex?

Now consider whether the behaviour has a function or a reason. Maybe the person is behaving in this way because of an underlying problem that has not been addressed, eg a sensory need. Or they may be getting something out of the behaviour: for example, people leave them alone and they like this.

Finally, try to really describe what the person is doing – the more detailed you can describe the behaviour, the more likely you are to be able to help the person understand what they are doing wrong. You may need to add how it might make other people feel or what they may think to give them insight, although I would do this jointly with the person.

Step 2: The rules … what are they?

We need to help people to understand what they should be doing instead – what are the rules?

What should be happening? So many adults I have worked with have asked me why they were never taught the rules as a child. Of course, before we can do that, we do need to know them ourselves, so that is where I hope the Talkabout resources will help you out!

Step 3: The motivation … what is it?

Every person you work with will need to be motivated at some level to come to your group, change their behaviour, and become more socially skilled. Often the key to success is to work out what the motivation is going to be for the person to want to change.

We cannot assume that all people are motivated by ‘being friendly’ or ‘friendly behaviour’ or ‘people will like me’ or ‘mum will be pleased’. It may be better to reward them with something: for example, an activity, a smiley-face chart or just saying ‘This is the polite thing to do’ or ‘This is the grown-up thing to do’. If we don’t consider the motivation, the intervention may fail.

Step 4: The strategy … which one is best?

There are many different ways of helping people to improve their social skills and usually the best intervention is the one that includes a number of them. There are eight main ways in which we can help someone.

1 The environment – in the school or at home. It is essential that the environment backs up what is being taught as much as possible. Think about getting all of the teaching staff on board with what you are working on. Making sure that everyone is encouraging and discouraging in the same way can go a long way to helping someone transfer those skills out of a group and into their everyday life. This doesn’t mean I wouldn’t work with someone if I can’t get the environment to back us up, but it may explain a slower progress. You may see people beginning to get the behaviour in certain situations but not all of them. This is OK. It shows you that the person has the ability to get it right when the environment is conducive.

2 Talk it through with them or use comic strip conversations. With many skills and behaviours, it is very helpful to talk it through with the person or to draw it using stick figures and speech bubbles. You will gain an insight into how they may describe what is happening and why it happens, which will help with your intervention.

3 Social storyTM. Carol Gray developed this approach in the early 1990s and I often use stories to help teach social skills. A social story gives someone insight into  their difficulties and helps them to know what they can do instead. It also contains perspective sentences about what other people may be feeling or thinking which can be very useful for people with ASD.

4 A visual cue or schedule. It is important to remember that many people are helped by working visually, so the worksheets and activities in this book will help, but people may also be helped by a prompt card or a poster displayed in the classroom. At our Day Service, ‘Speaking Space’, in the UK, we use a lot of ‘now and next’ symbolised strips which can work well to cue people in to what is expected of them in certain situations.

5 A reward system. Rewards can help if the motivation is very tangible: for example, stickers to get a financial reward or do an activity, or a certificate of achievement. Other rewards can include a special time with someone to talk about something specific – for example, 20 minutes at the end of the day to talk to their mum about dinosaurs. Any reward needs to work for the person, so you need to refer to their motivation.

6 Use of other media. Using DVDs and clips of cartoons or television programmes, or even video clips of you modelling behaviour, can really help to teach social skills. Many people find visual methods of learning much easier and showing a video will usually motivate most people. I often use this method in groups as well as in one-to-one sessions. The Talkabout DVD includes video clips of actors modelling inappropriate and appropriate behaviours for all of the key skills covered in Talkabout (Kelly, 2006).

7 Role play and modelling. In this book I often suggest using role play and modelling to help teach skills. Modelling is when the facilitators model a behaviour, both inappropriate and appropriate, and role play is when the group members practise the behaviour themselves.

Here are a few important points to remember when modelling:

• Keep it short and simple.

• Model one behaviour at a time.

• Start with bad behaviour and end with good.

• Never use the group members to help you model behaviours.

• Keep the situation as ‘real’ as possible – it is better to model a normal conversation between two group facilitators than to pretend that one is a child, shopkeeper or teacher.

• Ask the group what they thought was bad about the behaviour. What should have happened?

Here are a few important points to remember when role playing:

• The group members are asked to act a scenario or to practise a skill.

• It is a stressful experience for some people.

• Try a ‘getting into role’ exercise such as the magic carpet or twisting into a role like ‘Superman’.

• Remember to de-role, especially if the group members have played the part of someone else.

• Consider using puppets.

8 Social skills group. This is my favourite way to teach social skills and the Talkabout programme should give you all the resources you need to run a successful social skills group.

The advantages of group work over one-to-one work are as follows.

• It is a more natural and comfortable environment in which to learn.

• We learn from each other.

• It is easier to problem solve, play games and to set up role plays.

• It gives the opportunity to try out new skills in a safe environment.

• There is an opportunity to transfer skills to other staff, improving the chance of carry-over into the environment.

Extract from Talkabout 2e - LOOK INSIDE

Alex Kelly 
Speechmark author of TALKABOUT

Get 20% off when you pre-order today! Hurry though this offer ends on the 30th April, enter code TA20

The Theory Behind TALKABOUT

TALKABOUT was first developed in the early 1990s when I was working as a speech and language therapist in London, UK. I was particularly interested in social skills but was frustrated by two aspects of my work as a therapist. First, there was nothing in the literature to guide me on where to start intervention following assessment; and second, my experience showed me that I was not always successful in what I was trying to teach and I could not always predict which children were going to improve and which were not. I set about to solve these two problems over a period of four years.

I started my investigations at a college of further education where I was working with 60 students who had a mild to moderate intellectual disability. We assessed all of the young people I was working with using an adapted social skills assessment from the Personal Communication Plan by Alex Hitchings and Robert Spence – now published in Kelly (2000). The students were involved in this assessment which gave us some insight into their own awareness of their difficulties. From these initial results, we grouped students into their main area of need: body language, conversational skills and assertiveness. We evaluated success through retesting on the original assessment and also compared students with poor and good awareness of their needs.

The results were fascinating. They showed that the students who had been working on their conversational skills progressed more if they had good existing non-verbal skills (ie body language), and students who had been working on their assertiveness progressed significantly more if they had good existing non-verbal and verbal skills.

In addition, we found that students who had poor self and other awareness struggled with all aspects of the work. From this, we established a hierarchy which forms the basis of the Talkabout resources.

Over the next four years, we piloted this programme using different client groups and a group of willing therapists from throughout the UK. We all found consistently that the success of intervention increased if non-verbal behaviours were taught before verbal behaviours, and if assertiveness was taught last (Kelly, 1996).

This original hierarchy then formed the basis of the first Talkabout book (Kelly, 1996) but it has been adapted over the years to include self-esteem and friendship skills. The hierarchy now looks as follows.

Using this hierarchical approach, teachers and therapists can start work with the person at a level that is appropriate to that person’s needs. They can then progress up the levels to enable the person to reach their full potential, ensuring that basic skills are taught before the more complex ones. So a student who needs work on all areas of his social skills would start work first on his body language skills and then would progress to working on his paralinguistic skills, then his conversational skills and, finally, his assertiveness skills.

If this student also had poor self-awareness and low self-esteem, he would need to work on this before working on his social skills. And if a student also had difficulties with his friendship skills, he would only work on developing these skills if he had good self-awareness and good nonverbal and verbal skills.

Of course, success is not just about what you teach first; it is also down to how you teach it.

Extract from Talkabout 2e - LOOK INSIDE

Alex Kelly 
Speechmark author of TALKABOUT

Get 20% off when you pre-order today! Hurry though this offer ends on the 30th April, enter code TA20.

What do you think about when you have toothache?

Please consider that question before we move on?

I was in Bradford recently. Facilitating a team of workers who are on the frontline
and facing difficult behaviour and aggression daily. Yet they love the young people they work with.

Those who had been excluded from school, little response, little change and little sign of hope. Still each of the group yearned to be of developmental assistance to them.

I asked them that question:

'When you have toothache, what do you think about?'
No pause.
An immediate answer from one worker
as we all stood in the circle -
"Toothache"
was the answer.

If we have toothache we struggle to concentrate on anything else.
Restless as a wolf - we feel like the cheese is falling off our cracker. Nothing else really matters.

We can see a person's behaviour but we cannot see their experience.
We can be so preoccupied by their behaviour that we don't see
beyond behaviour.

Difficult behaviour can get under our skin.
Feelings rise within us.
As emotionally intelligent as we may be the feelings we have stimulate us, sometimes, to make a regrettable response.

This is applicable in the staff room, the classroom, the team meeting, the prison, the street, the office, at home, and certainly not only when we are transacting with humans with special needs.

The way I work on awareness and skill development is by using Experiential Exercises including Blob Tree Tools.

The objectives are:

•          Become more aware of our own feelings.
•          Becoming more able to get into contact with them.
•          Develop emotional literacy by being able to give each a feeling name.

So there in Bradford we throw the Blob Feelings Ball around the circle.
'Motion changes emotion' I say.

An activity, doing, is the best way to learn - to practise.
So the ball is thrown around the circle, the miss-catching it is part of the-bouncing-around fun as the ball creates smiles as humans live in expectancy as to who will receive the ball next.

The Blob figure nearest your right thumb -
'what does that Blob feel like?' I ask.
I ban the use of 'happy or sad' as all feelings can be tossed in those headings.
So minds are stretched - everyone engaging in the struggle to articulate.
Even seasoned professionals struggle to find the appropriate word.

I often ask more questions as 'right thumbs' develop their literacy.
'Describe a young person you know who feels like that?'

'When one of your youngsters feels like that, what behaviour does it drive?'

When a group is ready - the questions may become deeper and more personal-
'When did you last feel like that?'

Awareness always precedes skill.
By becoming aware of our own emotional literacy, or lack of, we can then be more sensitive to the feelings of others. More importantly, we can begin to see beyond behaviour to be more in touch with a person's toothache.

Next time I will click about working with special needs groups. I want to share some methods of how I engage them with the crisp objective of making available more tools for their life toolbox.

- Pip Wilson
Beautiful Human Person
Speechmark author of Blobs

Hearing Voices is Actually Like Being in an Abusive Relationship

Hearing voices is one of the most shocking mental experiences that a person can have because it immediately raises the question: Am I mad? Beyond this, voices are highly abusive, and attack the person’s self-worth. As such they are totally and instantly disruptive in the person’s life.

In my whole career as a clinical psychologist, I have never come across any other group of people who are so consistently battered by their mental experiences. However, following closely are those nearest to the person who is experiencing voices and who ultimately become their carers. Shock, confusion, anger and ultimately grief and hopelessness assail the carer.

Hearing voices will need specialist attention and here we discover the third group of people who are often floored by voice-hearing; the clinicians and other workers who get involved. There were many occasions that training was requested for clinicians in this area so that they could be equipped with some tools to assist their clients.

On the Frontline with voices speaks to all three groups and it is constructed to do so from within each group’s frame of reference.

One further objective of my book is to fit with early intervention, as the longer voices are present, the more they become embedded and the more they disrupt the person’s life. It is also true that within the context in which they commonly occur, it all becomes a family breaker and may in fact cause stress related mental health problems in carers as well.

For me it has always been a privilege to work with people troubled by voices as the experience is no less than someone trying to survive an abusive relationship. This then is my point of departure; strategies to deal with an abusive relationship so that the person can once again take up their rightful place in society.

Keith Butler 
Speechmark author of On the Frontline with Voices - A Grassroots Handbook for Voice-hearers, Carers and Clinicians

Preparation is all important

The Pre-verbal Skills of Language

Whether we are baking a cake or building a house, we all know that good preparation is critical to the desired outcome of the project. For a cake to be delicious, the ingredients need to be measured correctly and strong, solid foundations are essential to ensure the stability of a house.

 

The same applies to language development. For a child to develop language that is functional and communicative, they firstly need to acquire the pre-verbal skills, the skills that provide the foundations on which language is built. 

It is easy to assume that if a child is able to speak, they have already acquired the pre-verbal skills but this is not necessarily the case. A child can often use words but not use these words to communicate effectively with others. Being aware of the pre-verbal skills and assisting their development is very important for the development of a child’s language. This can be done by;

• Encouraging the child to look at you or in your direction, even briefly, when they speak to you or want to show you something.
• Gradually developing the child’s ability to focus and concentrate on a range of activities; those he enjoys as well as activities chosen by other people, such as a parent or teacher.
• Drawing the child’s attention to objects around them and showing them how to look at things both inside and outside, rather then just looking at objects directly in front of them.
• Teaching the child to listen to the sounds in their environment such as planes, printers, dogs barking.
• Encouraging the child to copy actions and sounds made which is done most effectively through play and action songs.
• Assisting the child to wait and take turns, which is a skill that can be taught at the playground or at home, waiting for a favourite activity or at school or pre-school during group activities with other children.
• Developing the child’s awareness and control of their face and mouth muscles by playing games in front of the mirror, encouraging them to copy different facial expressions and tongue and lip movements.

Have fun with these activities and remember it is always better to spend a short amount of time doing these activities regularly rather than hours every now and again.

********************

Francesca Bierens Speechmark author of Assisting Students with Language Delays in the Classroom

Tell a Story, to Get a Story…

Having just completed a fun, productive and interactive presentation on storytelling at a RCSLT Clinical Excellence Network workshop for children with language impairments, I asked the audience to reflect on all the information they had received at the workshop, and identify 3 changes or actions that they would put in place at work the next day.

One speech and language therapist said that she would tell her client a story. I was intrigued by that and asked her to say a little more about that. She continued, that she was often asking the children with whom she works to tell her stories, and whilst she would read stories from a book, she never simply told them a story during her storytelling sessions.

What an interesting observation and a great change to commit to making - and one that can so easily be put into practice. At the workshop, I had shared strategies to facilitate the elicitation of storytelling in children and young people with language and communication difficulties, and one strategy that I have found really effective is simply to take my turn first and share a story with the group, whether it be a personal story about something I have done over the weekend, or a wonderfully wacky and obviously fictional story about a princess, dragon or fire-eater! This gives the students the time to get comfortable, to settle down in the session and enjoy the delights of storytelling, whilst at the same time, also, getting to know a little more about me, their therapist.

It provides the children with practice in a range of essential skills related to storytelling, including listening, using appropriate body language and facial expression to show interest, or, when needed, even confusion, as well as asking focused and appropriate questions. It also, of course, gives me the valuable opportunity to model storytelling and provide them with a helpful template on which to base their stories, if required. Of course my story will have a definite beginning, middle and end, on which the children can map their stories.

Have a go and see for yourself, if you have a group of children reticent at telling stories, try and start by telling stories yourself. Involve the children in different ways, perhaps they can clap loudly or roar every time they hear you mention the monster; or they can count the number of characters in your story. Make your story exciting, fun and interesting, use props like swords and other attention-grabbing objects, and dress up like the characters in your story. Be the wizard, the witch or the dragon. And by the time you are at the end of the story, you may very well found that you are no longer the sole storyteller, but one part of a very satisfied collaborative enterprise.

Go on, try it, tell a story, or even two, to get a story… 

Victoria Joffe, Professor, Enhancement of Child and Adolescent Language and Learning

School of Health Sciences, City University London

Speechmark author of: Vocabulary Enrichment Programme, Narrative Intervention Programme, Favourite Idioms and More Favourite Idioms

Finding Ways to Develop the School Ethos

The 35 lesson plans provided in the No Outsiders book are only half the story; they will have little impact unless we create a whole school ethos where the moral code is reinforced and brought to life. The No Outsiders ethos must be seen to be relevant and real for children to sign up to it and the first three chapters in the book explain how to do this.

We look for examples to use in assemblies and class discussions to show that it’s not just us in our school believing in No Outsiders; lots of people in the UK and around the world also believe in No Outsiders and their actions every day demonstrate this.

The photo (above right), taken from the BBC newsbeat website, shows two unknown men helping out people affected by floods over Christmas. I have used this photo in assembly all week as it encapsulates the No Outsiders spirit perfectly.

I start by asking the children what is happening in the photo and the usually say, “They are helping the old man” so I ask why do you think he needs help? The two men on either side are wearing coats and hoods; it looks like one of them has rain on his hat; where do you think they might be? Has anywhere in the UK had lots of rain recently?

We talk about the floods in Northern England and how it affected people then I ask, so what are the men doing here? I tell them these men visited houses in Blackburn that had been flooded and offered help. They found this stranded man who had no lunch so they made him boiled eggs.

I then ask the children, how are the men in this photo different from each other? Children have answered the men have different skin colour, the two men on other side are Muslim and the man in the middle is not (to which I reply yes, that may be so but we can’t always know someone’s faith by looking at them; you can be white and Muslim, and the two men on either side may not identify as Muslim). I press on asking for more differences; are they the same age? Are there any disabilities evident?

Then I ask the children to consider, did the two men decide before setting out, that they would only help men? Or that they would only help people who were Muslim? Or that they would not help people who were gay? Or that they would only help people who were elderly?

We all agree that the two men clearly would have agreed to help anybody and everybody. The reason is because the two men, like us, believe there should be no outsiders. They didn’t care if the man they helped was white, elderly, wore glasses, had a different faith, didn’t care about his sexual orientation or indeed whether he was male or female! That is what is so great about living in the UK today – we are all different and we all help each other. It’s a wonderful place to be!

Andrew Moffat

Speechmark author of No Outsiders in our school: Teaching the Equality Act inprimary Schools