Management of Children with Selective Mutism – Pathway and Outcomes Judith Saunders Principal Speech and Language Therapist 20th October 2016

Learner Objectives Information about selective mutism (SM) Impact of SM on a child and their family Local pathway for SM in CTUHB Outcomes of intervention Barriers to effectiveness of intervention What next……….

Article 12 of the UN Convention on the Rights of the Child (1989) states: ‘Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child’.

Background to Selective Mutism DSM-5 (2013): Anxiety Disorder ‘Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g. at school) despite speaking in other situations’ 1:150 children 3 times more common in bilingual children Girls more likely to be affected than boys Usually begins under the age of 5:0 Selective mutism is not a choice

So What? Why does SM Matter? IMPACT EDUCATION AND LEARNING SOCIAL / FRIENDSHIPS CAREERS AND JOBS WORRYING FOR FAMILY EXPRESSING NEEDS AND FEELINGS WELLBEING

Comments From Parents (SMIRA) LEFT UNTREATED, SM STEALS HOPES, DREAMS, ASPIATIONS AND FUTURES TREATMENT IS A POSTCODE LOTTERY ‘SM HAS ROBBED MY DAUGHTER OF HER CHILDHOOD’ THE QUIET ONES GET LEFT ON THE SIDELINES AS THEY’RE NO BOTHER

Identification and Intervention ‘Together for Mental Health’ (Wales 2012) 1 in 10 children between the ages of 5 and 16 have a mental health problem. Early identification and intervention is crucial Services not taking responsibility, cuts in funding and pressures on CAMHS  frustration for parents, lack of support for children Intervention can be lead by a SM educated parent/ school or with support from SM trained SLT / psych worker (SMIRA).

Local Situation in CTUHB Increase in new referrals and re-referrals for older children 7;0 years + (2012) Entrenched difficulties and minimal progress Previous intervention limited or ineffective No local pathway in place Meetings with partners: CAMHS, LSS, EP Draft pathway developed SLT learning / training needs identified

FACILITATE PARENTS AND SCHOOLS TO WORK TOGETHER What Do We Do in CTUHB? CONSULTATIVE ROLE ASSESS AND DIAGNOSE EDUCATE FACILITATE PARENTS AND SCHOOLS TO WORK TOGETHER INDIRECT WORK MONITOR + ADVISE

Selective Mutism Pathway

CTUHB SM Referrals Jan 2013 – July 2016 According to Language of the School

Outcomes – Assessment to Treatment Complete

Outcomes – Treatment Length

Barriers to Effectiveness of Intervention Lack of knowledge and understanding Poor communication with key people Giving up too soon Expecting too much too soon Moving too quickly and not at child’s pace Not involving child as an active partner Environment

It’s lovely that my daughter is no longer known as ‘the one who doesn’t talk

What Next? TOMS Increase awareness of selective mutism Improve early identification of SM Training to early years settings including FS staff – early intervention Up-Skilling of band 5 SLT with interest in SM

Resources / Information SMIRA www.smira.org.uk The Selective Mutism Resource Manual 2nd Edition, Maggie Johnson and Alison Wintgens (2016) Tackling Selective Mutism: Guide for Professionals and Parents. B Rae Smith and A Sluckin (2015) National CEN for Selective Mutism

Thank you for listening.