Collaborative Working: Speech and Language Therapy and the Stroke Association RCSLT Conference September 2012.

Authors of the project Katherine Scantlebury – SLT - Specialist Stroke Team, Queen Elizabeth Hospital, West Norfolk Morag Bixley – Lecturer in SLT, De Montfort University, Leicester Gemma Smith – The Stroke Association Communication Support Co-ordinator, West Norfolk.

RCSLT policy statement 2007 “SLTs work in close partnership with other agencies such as voluntary organisations, social services, adult education services and other public and professional groups” (The specialist contribution of speech and language therapists along the care pathway for stroke survivors p12).

National Stroke Strategy (2007) “Specialised rehabilitation needs to continue across the transition to home or care home, ensuring that health, social care and voluntary services together provide the long term support people need” (Department of Health p10).

Our service in West Norfolk Specialist Stroke Services commissioned approximately 3 years ago Both Acute and Community Speech and Language Therapy and Stroke Association Communication Support Co-ordinator roles were commissioned.

Communication Support Co-ordinator “Communication Support Services work with stroke survivors and their carers living with the effect of communication difficulties. We work together to develop effective communication strategies and rebuild confidence” (Stroke association 2012).

Communication Support Co-ordinator “Working in collaboration with Speech and Language Therapists…the post holder will encourage clients to identify their personal goals and support their achievement through a programme of group activity or individual support as appropriate” (Stroke association 2012).

Partnership working in West Norfolk Close working in West Norfolk between Speech and Language Therapy and the Stroke Association Communication Support Co-ordinator (CSC) Developed and evolved with service A literature search (Sept 2011) revealed no published evidence examining collaborative or partnership working between SLTs and CSCs.

Aims of this pilot project Define and evaluate this partnership between the SLT stroke team and the Stroke Association CSC role in West Norfolk Identify factors which may contribute to successful joint working Explore the use of grounded theory as a mechanism to uncover the nature or and attitudes to partnership working between SLTs and CSCs.

Methodology - Grounded theory A method of analysing qualitative data developed by Glaser and Strauss in 1967 “Grounded theory as a methodology has much to offer speech and language therapists and researchers…The benefit of the grounded theory method…lies in its application to social processes and human interactions” (Skeat and Perry 2008).

Methodology - Grounded theory Using a grounded theory technique facilitates the researcher to develop a theory from the data collected in a study, rather than to use the data collected to test an already existing theory Simmons-Mackie et al (2007) describe this grounded analysis as a reflexive process through which common issues and threads can be sorted into natural groups and subcategories and contrasts can be identified.

Methodology – research design R&D approval gained 4 participants – the SLTs and CSC in West Norfolk In-depth interviews carried out with each participant. Questions were designed to be open and non directive. Interviews were recorded, transcribed and analysed using grounded theory.

Results Defining West Norfolk communication pathway Interview analysis identified a simultaneous, collaborative, reciprocal, joint communication pathway that started in the acute setting and continued past discharge into the community and through to long term communication support

Results Defining West Norfolk communication pathway

Results Evaluations were positive “I see their role as a way of actually enhancing what we are doing rather than substituting what we’re doing or something different to what we are doing, it’s something that gels everything together”

Results Evaluations were positive “I think it works extremely well and I hope it continues to work this well… I’m happy in the way the service works and I think it works well for the clients we have”

Results Factors that may contribute to successful joint working Facilitators

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals “There is always a door back into SLT if they want that if they need that they know where we are and that we all link together”

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship

Facilitators Results Factors that may contribute to successful joint working “I know that X really wants the best and to do the best she can for people with communication difficulties and so do I, so we have joint goals in that sense even if sometimes our ideas about how we provide that is different” Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care SA presence on acute ward

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care SA presence on acute ward Use of local SLT training expertise

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care SA presence on acute ward Use of local SLT training expertise Regular communication

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care SA presence on acute ward Use of local SLT training expertise Regular communication “We support each other, we refer to each other, we talk to people about each other’s jobs and services which can offer them the best support possible”

Results Factors that may contribute to successful joint working Facilitators Two way referrals and re referrals Joint projects Shadowing each other Positive working relationship Continuity of SLT & SA staff across acute and community care SA presence on acute ward Use of local SLT training expertise Regular communication

Results Factors that may be barriers to successful joint working Barriers

Results Factors that may be barriers to successful joint working Barriers Boundaries

Results Factors that may be barriers to successful joint working Barriers Boundaries “I think the most difficult thing is having clear identification of roles and where does SLT stop and CSC working start … I think that’s something that can only really be achieved by understanding each other’s roles and responsibilities”

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists “I think as an SLT it’s been a really useful learning experience, in terms of what SLT is and what requires a qualified SLT in terms of what we bring in our knowledge about speech and language and what we know about research and evidence therapeutically, what’s been published, what’s being researched into at the moment…So I think its been a learning curve for me in learning what’s precious to SLT and what are the things we should be doing”

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists Setting up the service

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists Setting up the service Lack of shared management

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists Setting up the service Lack of shared management “Our two services are commissioned and managed totally separately which means that if there are difficulties between the two roles, there isn’t a manager that can sort it out”

Results Factors that may be barriers to successful joint working Barriers Boundaries SLTs are specialists Setting up the service Lack of shared management

Conclusions Project defined and evaluated one example of service delivery involving collaborative working between SLTs and CSCs Grounded theory was found to be a good method of data analysis Factors which may contribute towards collaborative working and possible barriers to collaborative working were identified.

Conclusions Further work is planned to extend the project and encompass the views of more participants in stroke services providing different communication pathways For more details, please contact: