1. Giving Voice: What is the role of the Speech & Language Therapist in Forensic Learning Disability Services? Yasmin Simpson Speech & Language Therapist NHS Fife Forensic Learning Disability Service

2. Communication Context  There are over 10 million people in the UK today who are described as having a disability  0.2% of the population will have a diagnosis of Autistic Spectrum Disorder  1.5 million people in the UK have a learning disability  27% of adults in Scotland have difficulties with reading and writing  4% of these adults cannot read at all

3. What is the main aim of speech & language therapy? To work with staff and service users to achieve effective communication strategies and environments To build the capacity of staff and service users to understand the impact of learning disability on communication To work with staff and service users in order to develop a shared understanding of the relationship between behaviour and communication difficulties

4. How are these main aims achieved? Assessment of functional communication skills Assessment of level of comprehension Basic assessment of literacy skills Provision of information to support the development of an appropriate communication environment Development and implementation of accessible communication strategies and resources Building the capacity of others to effectively manage communication support needs

5. What can speech & language therapists bring to the care planning process? A broad understanding of the most effective interaction styles Advice and support in implementing appropriate language levels Skills in the development and implementation of visual communication strategies and resources

6. Formal, informal and observational assessments Understanding of use of grammar and syntax Understanding and use of simple and complex vocabulary Assessment of auditory memory and language processing skills Provide information not only about what the person understands but also how they use their language skills to respond to questions

8. What can the speech & language therapist do to support staff and service users? Jointly develop strategies and resources to support the person’s communication environment in terms of  Expectations, guidance and protocols  Legal status and rights and responsibilities  Offence related interventions in terms of modifying language level, addition of visual supports  Provision of visual strategies to engage with the person around decision making, e.g. mind maps, talking mats

9. Communication context The Foundation for people with Learning Disabilities (2000) notes that: Up to 90% of people with learning disabilities have communication difficulties About 60% have some skills in symbolic communication, such as speech, signs or picture symbols

10. Communication Channels Content Actual words & Sentences ?% Visual Tone, pitch, volume, pace Non-verbal data- body language, gestures, facial expression Auditory ?% 100%

11. Communication Channels Content Actual words & Sentences 38% Visual Tone, pitch, volume, pace Non-verbal data- body language, gestures, facial expression Auditory 7% 55% 100%

12. Communication Channels? If only 7% of our messages are received via the actual words and sentences that we use why is so much of our communication with service users often through written and verbal means? Is there more we can do to try and ensure that we use more non-verbal means to communicate important information?

13. Why make information accessible? Many people with LD have literacy difficulties…what do they do with written information? “If I don’t understand I rip it up… I thought it was rubbish...I feel rotten but what can you do?” Lady with a learning disability, Leven “I get staff to read the letter, I’m not good at reading” Man with a learning disability, Dunfermline Big words…take me a wee while to figure them out Man with a learning disability, Dunfermline

14. Why make information accessible? For service users accessible information helps:  engagement  understanding  expression  decision making For staff accessible information helps you:  to be person-centred  to provide a good quality service  to demonstrate competence and understanding of your service users

15. Accessible information context Population – broad spectrum of partial or non readers –will support people either significantly or in part Personalised –designed around needs of a specific individual –takes communication needs into account Even when information is made easier to understand, many people with LD will still need to support to use it.

16. Examples of good and bad

17. Care Programme Approach Pathway Working well Not working well Support Keeping safe Relationships Health & Wellbeing Activities What’s important to me? How do I want my life to be? Action Plan

18. Care Programme Approach Pathway Working well Not working well Support Keeping safe Relationships Health & Wellbeing Activities What’s important to me? How do I want my life to be? Action Plan Family. Animals – dogs. Looking into the future. A house in the community. A better future. Driving lessons. A job looking after animals. Trying to make progress. Talking to people. Keeping myself clean. Knackering things up, everything I’m working towards. Not seeing other family. Support to talk to other people. Support keeping a job. Support to keep me out of trouble. Watching what I’m doing. Not getting into trouble with the Police. Not mix with the wrong people. Have a good relationship with Staff and family. Not to play up with them. Take up a sport. Walking and cycling. Watching what I eat. Say what I should be saying. Good behaviour. Helping old people. Gardening. Going to work. Playing football. Therapet.

19. People with Learning Disabilities and the Criminal Justice System SLT brief was to  Participate in the development of the guide and provide information about the communication support needs of people with LD  Make the various sections more accessible for people with LD  Ensure that the guide was accessible to a wide range of people who may have communication and/or literacy difficulties

20. Structure of the accessible guides Introduction:  Information about the guides and why they were developed  The Same as You? principles  A brief explanation of the criminal justice system  Where to get further information Information about the Police Information about Prosecution and Defence

21. Structure of the accessible guides Information about Court Information about Criminal Justice Social Work Information about Prison Information about Health and Social Work Services

23. How have the guides been made accessible? Use of simple language to describe what happens when someone with a learning disability comes into contact with criminal justice services Use of appropriate visual imagery to support understanding of the text Involvement of a wide range of service providers and users during the development

24. Pitfalls? Very difficult to write something suitable for everyone! Some information is simply too complex to simplify without losing some of the message Initially attempted just to make sure that what was in the written guide was made accessible in the easy read guides Clear that this is not what was wanted Need to go back to the guides to check that the information is sufficiently detailed Further input from service users needs to be sought to ensure that the information is sufficiently detailed and at an appropriate level for the majority

25. What next? Lots of feedback received already Hopefully more feedback still to come Some actions identified with regard to some of the guides Further review of the content before the end of the year Sustainability issues – guides will need updating periodically to reflect any changes

26. Accessible Information Database www.nhsfife.scot.nhs.uk/easyread

27. Accessible Information Database www.nhsfife.scot.nhs.uk/easyread