Speech and Language Therapist (SLT) Role and Ethics

Role Investigation

This essay will investigate a vocational role as a Speech and Language Therapist (SLT). It will cover the role, where the role may be needed and will operate, what qualifications are needed to become a SLT, and what psychological theories are used and applied when working as a SLT. The essay will then cover the ethics required of a SLT and the skills needed because of them.

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A SLT role requires working with people of all ages with various levels of speech language and communication problems. Such problems can occur when they have difficulties swallowing, drinking or eating. Typical clients they deal with have physical and learning disabilities, hearing loss/deafness, psychiatric disorders or dementia. They help by assessing and identifying the difficulties/disorders the client has and then create and implement a suitable treatment program. They will then continue to see the client on a one-to-one basis to assess the developments made. They will also teach the client’s family, social workers, and teachers on how to communicate effectively to help clients outside their therapy sessions (editors, 2012).

The average salary for a SLT could range from £21,176-£27,625 if they are part of the NHS, but you could go into a specialist role outside of the NHS and the salary range is £25,528-£34,184. Another option is the work as a freelance SLT. SLTs work within schools, hospitals, health centres, day care centres, rehabilitation unit, client’s homes, prisons and young offender’s institutions. SLTs work typically 9-5, and they could work in several locations (editors, 2012).

The training and qualification needed to be a SLT is a degree accredited by the Royal College of Speech and Language Therapists (RCSLT). A degree in Psychology will better the chances of getting onto the post-graduate 2 year course, which needs to be taken to get the accreditation. SLTs also need to be a registered member of Health & care Professionals Council (HCPC) (AGCAS, 2012).

Although a specialist speech and language therapist may require additional skills and training. For example a speech and language therapist in a special needs school may learn Makaton sign language because some children may not be able to communicate effectively. Using signs may help adults understand children which will relieve frustration and reduce anxiety which in turn should help facilitate communication (Enderby, et al., 2009).

Speech and language is something quite unique to humans so a lot research has been done into the acquisition and the development of language (Pinker, 1995). Theories are constantly evolving and adapting and speech and language therapists must recognise these and adapt their strategies accordingly (Latham & Miles, 2001).

The behaviourist approach to language development is that it is learnt in response to a stimulus that gives a pleasant reward (Latham & Miles, 2001). This is how a child will associate words with meanings and therefore reinforce the importance of communication and using words. For example Skinner proposed that a child will point and say “drink”, the child is then rewarded with the drink. The child then associates the word drink with getting a drink and will carry on using it whenever they want one (Skinner, 2014).

This is supported by Sundberg, Micheal, Partingtin, & Sundberg, (1995) who did a study on five children between two and four-years-old, four had moderate language delays and one typically developing child. They performed the targeted response, i.e. sound, word or phrase, after the conditioned reinforcement was established and then established new vocal responses. For example a subject wanted to be tickled (which was the reinforcement), so said the paired word “apple”, eventually she started saying “tickle”. However this study was only done on 5 subjects so its sample size is not relaible enough to generalise universally.

Although speech and language therapists could use positive reinforcement as a technique in their sessions, it could be particuarly helpful when working with children. SLTs use games where when they win or complete the task they are intrinsically motivated. Extrinsic rewards do help however the child may get too excited by the reward and their attention turns to the reward rather than the task. Also they may find that the child doesn’t have reward outside the session therefore doesn’t use the communication skills learnt in session outside, in classrooms or at home (Boyle, McCartney, Forbes, & O’Hare, 2007).

Also it is important if a SLT is working with someone with mutism or selective mutism to reward every type of communication, no matter how small, whether it be verbal or head shaking. A SLT will talk to teachers and parents/carers to see these small signs of commmunication and how to positively respond to them (Aberdeenshire Council, 2013).

This behaviourism technique is what allows children to associate words with meanings however if a child is impaired in this area a SLT may find other ways to allow a child to communicate. For example teaching Makaton signs or using symbols and pictures that they can point to (Roulstone, Wren, Bakopoulou, Goodlad, & Lindsay, 2010).

However Skinners approach was criticised because it does not explain how people come to put sentences together (Albery, et al., 2008). This point was made by Chomsky, he believed that language was a human instinct (Pinker, 1995) and that the sentence structure was very important in being understood and that a child through behaviourism alone could not learn all of the grammatical rules in his/her language (Chomsky, 1967). For example the sentence “the cat was on the basket” differs in meaning from “the basket was on the cat”, Chomsky believed that the order was essential to get a message across (Chomsky, 1967) (Latham & Miles, 2001). Chomsky believed that children could understand grammatical rules through their Language Acquisition Device (LAD) and universal grammar. They hear the language, through the LAD, they then pick up on the grammatical rules of language in their universal grammar and then it is put forward to the LAD (cited by Albery, et al., 2008). This can explain how children overgeneralise grammar for example when they say “wented” or “goed” (Albery, et al., 2008).

This can be supported by Berko, children were asked questions to find out whether they knew grammatical rules and could apply them to made-up words. For example they were showed a picture of a “wug” and asked what two were called. Instead of saying they didn’t know because they have never been told, they called them “wugs”. However this study was done on only English native speakers so it does not prove if children have access to universal grammar rules, it may just suggest children listen and remember grammar rules of the languages they have been exposed to (Berko, 1958).

Most people who have suffered from a stroke may know what single words mean but may struggle when it comes to putting sentences together. So it’s the SLT role to focus on tasks that will facilitate the patient’s ability to construct sentences. They could do this through arranging words on flash cards into sentences (Stroke Association, 2012)

Another theory that SLTs use are the stages of language acquisition. At around 7 week’s babies a thought to start the “cooing” stage, this involves sounds that include vowels like “ooh” and “aaaa”. At 7 months children are believed to start the babbling stage such as ‘bodadda” (Albery, et al., 2008).

SLTs will use this as guidelines to decide whether a child is developing their language normally. Latham & Miles (2001) created a framework which is used to assess where a child is in their language development and interventions to help the child move onto the next band. For example band one the child can express themselves through vocalising, facial expressions, pointing and gestures. The interventions suggested at this stage are for an adult to respond to the child’s attempts of communication and actively play turn taking games with them. This should then help the child move onto band two. The SLTs job will be to continuously assess and evaluate the child’s progress and put in place interventions that parents and carers can do at home to help the child progress.

This is a part of the SLTs ethics guide, they must ensure they are making fair and appropriate assessments, judgements, diagnosis and treatment interventions. They must ensure they put the client first and make decisions that would most benefit them based on knowledge and up-to-date research. They must also ensure they are keeping records of all the sessions they have with their clients so that there is a record of progression. It is important they maintain client confidentiality at all times. Above all they must protect their clients and themselves by maintaining a safe, appropriate, and professional environment and relationship (HCPC, 2014).

The skills needed to be a SLT because of the type of role are efficiency, to ensure you are on top of all paper work and recent research. They must be able to work with and enjoy working with lots of different types of people, from children to the elderly, and have the patience to listen and help clients. And they must be good at problem solving and creating effective and inventive interventions that will work for specific individuals.

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In conclusion SLTs have a very diverse job which is changing all the time, from the types of people who require their service, the research behind the service given and what they can do to help their clients. They must constantly be on top of whether their treatments are working and change them accordingly, this means they must be on top of research and take into account both nurture and nature sides of language acquisition. However the role seems creative, rewarding and it seems that they could do something and work with somebody different every day.

References

Aberdeenshire Council. (2013). Supporting Children with Selective Mutism. Aberdeenshire: Aberdeenshire Council.

AGCAS. (2012, December). Speech and Language therapist, entry requirements. Retrieved October 28, 2014, from Prospects: www.prospects.ac.uk/speech_and_language_therapist_entry_requirements.htm

Albery, I. P., Chandler, C., Field, A., Jones, D., Messer, D., Simon, M., & Sterling, C. (2008). Complete Psychology (2nd ed.). (G. Davey, Ed.) London: British Libuary Cataloguing in Publication Data.

Berko, J. (1958). The Child’s Learning of English Morphology. Word, 14, 150-177.

Boyle, J., McCartney, E., Forbes, J., & O’Hare, A. (2007). Language Therapy Manual: health technology assessment 2007. Strathclyde: University of Strathclyde.

Chomsky, N. (1967). A Review of B.F. Skinner’s Verbal Behavior. Readings in the Psychology of Language, 142-143.

editors, A. (2012, December). Speech and language therapist, job description. Retrieved October 28, 2014, from Prospects: www.prospects.ac.uk/speech_and_language_therapist_job_description.htm

editors, A. (2012, December). Speech and language therapist, salary and conditions. Retrieved October 28, 2014, from Prospects: www.prosoects.ac.uk/speech_and_language_therapist_salary.htm

Enderby, P., Pickstone, C., John, A., Fryer, K., Cantrell, A., & Papaioannou, D. (2009). Resource Manual for Commissioning and Planning Services for SLCN. Royal College of Speech and Language Therapists.

HCPC. (2014, June 11). Speech and Lanuage Therapists- Standards of Proficency. HCPC- health and care professions council. Retrieved January 21, 2015, from HCPC: Health & Care Professions Council: www.hcp-uk.org/assets/documents/10000529Standards_of_Proficiency_SLTs.pdf

Latham, C., & Miles, A. (2001). Communication, Cirriculum and Classroom Practice. London: David Fulton Publishers Ltd.

Pinker, S. (1995). The Language Instinct. London: Penguin Books.

Roulstone, S., Wren, Y., Bakopoulou, I., Goodlad, S., & Lindsay, G. (2010). Exploring interventions for children and yound people with speech, language and communication needs: A study of practice. Bristol: Department of Education.

Skinner, B. (2014). Verbal Behavior. B.F. Skinner Foundation. Retrieved from store.behavior.org/resources/595.pdf

Stroke Association. (2012, April). Communication Problems. Retrieved January 21, 2015, from Stroke: www.stroke.org.uk/factsheet/speech-and-language-therapy-after-stroke

Sundberg, M. L., Micheal, J., Partingtin, J. W., & Sundberg, C. A. (1995). The role of automatic reinforcement in early language acquisition. Analysis of Verbal Behavior, 13, 21-37.