A Day in the Life of our Makaton Tutor and Senior Speech and Language Assistant

1. Hi Emma! Congratulations on just qualifying as a Makaton Tutor! Could you tell us how this fantastic qualification will be beneficial to Hollybank Trust? 

Thank you! So, my focus as a Makaton tutor now is to roll out Makaton workshops to as many staff as possible! This includes not just our residential support workers, but also managers, amenities staff, therapy staff, IT staff, administration staff, HR staff, nursing… anyone who may have an opportunity to communicate with any of our service users. A simple ‘good morning’ sign could have a massive impact on someone’s day! Having a working knowledge of the Makaton core vocabulary, and adding signs alongside speech not only helps to model this sign to the service user, it can also help them to understand what is being said. The English language is vast, and we have lots of words for the same thing. Standardising the signs we use can help to aid comprehension and reduce anxieties or worries.

Once our service users become familiar with signs and start to attempt these signs, a world of opportunities is open to that person. Once they become more confident in expressing their needs, wants, interests, opinions, that person can develop their sense of agency, a feeling of being able to control what happens in their life. And all this could start from a singular ‘good morning’ sign.

2. What originally inspired you to become a Speech and Language Assistant? 

My previous role before working at Hollybank was as an Early Years Practitioner based at a nursery in Bradford. Whilst working there, I supported my first child who needed additional communication input and I was hooked! I attended many Speech Therapy appointments with the family and found myself thoroughly interested in the techniques and knowledge shared by the therapist. As I worked with more children with communication difficulties, I became more aware of alternative communication methods and started to explore roles in speech and language therapy.

When I saw the role for Speech and Language therapy assistant at Hollybank three years ago, I was very excited to come work here as my dad visited frequently years ago in his role in the mounted section of West Yorkshire police and shared lovely stories of the people he met on his visits.  

3. Since coming to Hollybank Trust, what are some ways in which you have seen technology and/or Makaton improve the lives of individuals living with disabilities? 

My most recent success story is a service user who uses a paper-based symbol book. Previously, the symbol book would mostly be used to explain where the young man would be going or what was happening next. After months of working alongside staff and the young man, he is now able to use the symbol book to request an item, to control an activity or person and to share how he is feeling. My sessions with him have regularly consisted of me running around a room, and the young man laughing and telling me to ‘stop’ and ‘go’.

The consistent approach of myself and his supporting staff, offering opportunities to communicate, has meant he is able to use his symbol book for various reasons, which is increasing every day!  

 4. What does a typical week in your role as a Speech and Language Therapist look like for you? 

My typical week consists of a mix of individual sessions and group sessions, between our school setting and residential services.  

My Monday morning consists of two individual children’s sessions, one based around building listening and attention skills and comprehension activities, and the other is based around exploring the use of a powered communication device, accessed through eye gaze. On Monday afternoon, I go to Willow Court alongside one of our speech therapists to see three different adults, depending on who is available. With one person who we support, we are working on switch scanning, with the intention that he may be able to use an eye gaze device in the future. With another person who we support, we are engaging her with an intensive interaction approach. This resident has been known in the past to struggle with people in her space.  

My Tuesday consists of group sessions. The first two are groups in school. The first is an early communication group, were most of the children are working on one, two or four switches, alongside symbol use. The sessions consist of fun, person-centred activities where we encourage the children to choose activities and to control what happens in the session. My second group consists of single switch use, but the group is for children with visual impairments. At the moment, we are exploring a sensory story.

During the week, I visit two different off-site homes. These visits are different every week, and although I have some specific adults to work with, I enjoy joining in with any activities happening on that day and helping the adults to communicate and engage!

I also have two individual children’s sessions, and a children’s powered AAC device group.  

5. Could you tell us a bit more about the Makaton Sign and Sign Sessions?

Tuesday afternoon is when our weekly Makaton sing and sign session takes place. Here, we identify popular songs to sing to, but focus on songs that have functional, simple language, are repetitive and most of all, fun! This session not only focuses on modelling and sharing Makaton signs to our residents, but also to share those signs with staff who accompany our residents to the session.  

Thursday afternoon is our children’s songs and rhymes group. Similarly to Makaton sign and sing, we introduce Makaton signs and symbols not only to the children, but also for staff to continue to model these signs in class.  

6. What happens at the weekly Communication Café?

On Thursdays we have communication café, where we invite all adults with powered communication devices to meet. Here, we have a variety of activities and adults can meet others with similar alternative communication. This also gives us a chance so support staff in setting up, maintaining and using residents’ communication aids. 

7. Person-centred care is core to us at Hollybank Trust. Multi-modal forms of communication such as signs, symbols, objects, and other communication aids are all effective ways to build relationships with individuals. Could you tell us about any other ways that support workers and the speech and language teams build trust with individuals at Hollybank during communication sessions? 

During my sessions, an approach I use frequently is intensive interaction. In simple terms, this is having a conversation with an individual in their own language. We recently ran an intensive interactive roadshow, where we visited specific homes in Hollybank to share how staff can engage service users. This technique involves observing an individual’s movements, vocalisations and facial expressions and mirroring these back to the individual. In doing this, you are valuing their unique language and communicating in a way that is meaningful to them. This technique can make people feel ‘silly’ but when done consistently with an individual, you are demonstrating you value them, and relationships and trust can start to build. At this point, we can start to build on aspects of early language development, for example, turn taking, shared attention, eye contact, imitation and vocalisations.  

8. Supporter Workers often attend communication sessions with the Speech and Language Therapy Team. How do you ensure that a new Support Worker feels supported on how to use any technology or other multi-modal forms of communication? 

When anyone joins Hollybank as a new staff member, they will attend a week-long induction. The speech and language therapy team have two slots in induction, communication and eating and drinking. In the communication induction, we explain what Speech and Language therapy is and what our role is at Hollybank. We explain the fundamentals of communication, show examples of different types of AAC (augmentation and alternative communication) and allow attendees to share their weekend plans using different types of communication methods!  

9. Swallowing Awareness Week is an important date in the calendar for disability care homes. Could you explain some ways in which eating, drinking, and swallowing has an impact on communication?  

This is an additional qualification for our Speech therapists, but working at Hollybank I can see links in the overlap of anatomy. When somebody struggles to eat and drink safely, this can mean a difference in their anatomy, that may also affect their ability to speak.  

As with most people, food is a topic very often on my mind! Whether it be what time is lunch, what am I eating today or what is someone else eating, food is a motivating topic and frequently mentioned in communication. This is the same for a lot of our service users, and exploring motivating topics such as food, can provide a person a reason to communicate. I have had many a session paused or ended by requesting a biscuit!  

Mealtimes are a social activity, so for people who cannot eat or drink safely and therefore do not always join mealtimes, this can mean that they miss out on this opportunity for communication.  

10. Could you talk us through the sensory story sessions and 1:1s that you hold with individuals?  

We are currently enjoying a sensory story with a group of children in school. This group of children are working on using one single switch and all have visual impairments. We have repeated the same story for a term, and we are seeing our children start to anticipate the story and show consistent preferences for parts of the story. We have also seen some children use a multi model approach, using their switches and vocalisations to make choices and request an item.  

11. What would you say are some key signs that an individual is enjoying a communication session?  

So we mostly see smiles, laughs, giggles, ‘more’ or ‘like’ requested frequently on a communication device. But a successful communication session is not just about the smiles. If a service user decides they have had enough of the session, shares their opinion about something that they did not particularly enjoy about a session, that is also a successful session! We want to value and champion any type of communication shared by a service user.   

Our sessions are always person centred; they need to be motivating for that individual to work towards their chosen goals. Our sessions are always flexible and can be planned for the best time of day for that individual. If they’re not a morning person, no problem!  

We always value knowledge of support staff about the individuals, as they work our service users day in, day out. They can tell us how their day has been or anything we need to know before starting a session.  

12. What specific areas of working with people with disabilities do you find particularly interesting? 

My favourite part of my role is watching the people I work with improve with every session. Focusing on what we can achieve and allowing people to reach their full potential instead of focusing on their disability or their limitations is wonderful!