Article written collaboratively with Steph Hammond, Team Manager for Adult Community SLT and Highly Specialist Speech & Language Therapist in Mental Health and Criminal Justice (Dorset, UK), Secretary of Mouthcare Clinical Excellence Network (RCSLT CEN)
Q: Tell us a bit more about your journey so far - what has led you to this varied role? 👣
Genuinely, it has all happened by sheer coincidence!
I think I just got lucky and as I say I have a really supportive manager. The team manager role happened following a secondment and I was persuaded to “just try it out” for 6 months, which I did. Then it was extended by another 6 months. After the year had passed, it was offered out as a permanent position and I realised I didn’t want to not do it! So that’s how that happened and goes to show that taking chances really pays off. I would encourage anyone to just try things out because you never know where you may end up or learn.
The mental health role came about after I realised, a few years ago now, that SLTs have a real place here – something that I think is not realised or understood properly (but that’s changing – which is fab!). I became really frustrated that people with mental health needs were not offered our service despite a need which could be evidenced (and that’s growing).
I feel very passionate about creating health equity / addressing health inequalities, it is the thing that drives me on the really hard and busy days because, ultimately, we all deserve a voice to be heard, or to be able to safely eat and drink/enjoy oral intake.
We proposed a business case for a mental health SLT but this was sadly rejected, because we needed to prove more of a need. That was valid feedback, so we have been piloting a service and working hard to create the evidence needed. But, most importantly, finally supporting patients who have mental health and SLT needs. There is far more work to be done here, but I am so happy that we are able to offer this. Finally, my criminal justice role was offered out within the Trust as a two-year secondment following some funding gained by the criminal justice liaison and diversion service. This really aligned with my passions and professional development, so my manager agreed I could interview for it and I did! Thankfully I was successful! I am nearly a year in now and I work alongside another fab SLT.
Q: What are your favourite bits about each of your roles? ✨
For me, it’s being allowed to pursue my passions and create meaningful change – I feel so fortunate to highlight how SLTs can support people, and what we can offer and bring about, whilst also supporting others to do this. I enjoy enabling human connection or facilitating someone to enjoy food and drink. To have the time to listen to others and ask how I can actually help them and advocate for this – this is within all my roles. I also love meeting new people and creating relationships, learning from others and figuring out the best way forward – both from a clinical and leadership perspective.
Q: What is a piece of advice you would like to share with those who are starting out as NQTs and wondering what to specialise in? 💭
I would say my vision and ideas about my career have changed over time and this is from being exposed to different things, situations and people.
My best piece of advice is to say ‘yes’ (within reason of course!), take advantage of the opportunities offered and seek these out too, as well as always asking ‘why’. I am always curious and I think this helps to open doors in terms of your own development or learning, support your patients better - plus allows networking with others – which is also a great way to learn and promote all that we do.
I also think to ignore the noise a little, stick with your gut and work through things in your own time and way – be open to feedback and take time to reflect. It can be a lot when you first start out - things will come together though.
I remember my NQT days and I was super lucky to have someone take an interest and develop me in that first 6-12 months and also pushed me, so I think perhaps I have taken this and ran with it all the way to this point.
Q: Can you share what your typical week looks like? 🗓️
Busy!! 😉 But very fulfilling – I am so lucky to be in such a varied role and to be involved with things that really interest me, this is due to having a really supportive and innovative manager and working within a Trust that enables us to do this.
In general, my working pattern is:
Monday: Adult Community SLT Service - Mental Health
Tuesday: Adult Community SLT Service
Wednesday: Criminal Justice Liaison & Diversion Service
Thursday: Adult Community SLT Service
Friday: Study Day
My caseload is really varied and has a mix of everything, but I like supporting neurological conditions such as MND and working with complex dysphagia. I really enjoy working with dementia – I find it rewarding because you really focus on humanised care and what’s the most important thing to the person and their loved ones. Of course, we should be doing this with every person we work with but for some reason, I find this appears to happen more when working in dementia.
My mental health day and criminal justice day is county-wide, so can include lots of travelling and liaising with different teams and building up those relationships, especially as they are quite new roles and I have been in my (general) Adult Community role within the same area for some time, so have great connections here. Luckily for me, I love meeting new people and learning from them / working collaboratively!
On mental health and criminal justice days, I am also creating and developing a service – so I am juggling a few things here: training, service pathways, networking, meetings and patients, all alongside my own professional development! As part of this work, we are reviewing all leaflets (including those provided by the Police) to create Easy Read versions.
My (general) Adult Community role means I see people within a large area of the county (but not the whole county!) who have communication and swallowing needs - usually in their own homes, but also via video calls or clinics. Adult Community SLT is also supporting people with SLCN by asking our Trust to have Easy Read information as standard on all their leaflets / websites etc. We are also asking that all staff complete Communication Access Training from the RCSL. This is a big project and is being led by my manager which I am also supporting with.
The other part of my role within Adult Community is managing a team – I love this aspect of my role and it was something I never saw for me! I thought being a manager was all about meetings, emails and paperwork and, don’t get me wrong, that’s definitely part of it!! But for me it’s about coaching, developing, creating and enabling – something I really enjoy. It was a huge learning curve and continues to be – no day is the same, but it’s also really rewarding and I have learnt so much since starting in the role, including about myself as a person. And on top of all this, I am just finishing up (by summer time) a 2.5 years Master’s degree: I am completing an MBA and this has been challenging but really eye-opening, and I am so grateful that I have been offered this opportunity.
Q: How do the services you work with support people with SLCN?
Well, within mental health and criminal justice service, this is all coming together (slowly!), but we currently offer SLT input at our police stations for those in custody to be screened and assessed by an SLT. A report is then written with advice/recommendations and shared with the police, court, probation etc. This hopefully enables people who have SLCN to have better access to services and fairer justice, as their needs are supported. We plan to expand but only work one day a week so obviously that’s a challenge!
Mental health wise, we see anyone who is referred to us – this has really varied! Some have been due to dysarthria or aggressive behaviour, and supporting staff with understanding communication strategies and how best to de-escalate etc. A few have come about due to professionals’ (?)unmet needs and wondering if there is something underlying – so have asked for our opinion. The referrals we receive are mixed and some are for dysphagia input as well, but the communication referrals have been cropping up more recently.
My Adult Community role is again varied – lots of dysphagia! But communication difficulties occur due to strokes and long-term neuro conditions etc. I could be supporting with dysarthria and creating a therapy programme to increase speech intelligibility, assessing with the PALPA or CAT to complete aphasia therapy or supporting with voice banking. It’s the beauty of our job to have such variation!
Q: Have you noticed any crossovers with your services in terms of clinical need? If so, how do they crossover?
Yes, definitely – I feel very strongly about not separating people into parts, I absolutely understand why this is done, but I think it actually waters down the effectiveness of rehab and interventions / MDT support.
We know people with physical health needs will have mental health needs and vice versa, so I think we should all be approaching our patients with this mindset and thinking about who is this person, and what they specifically need.
I would say the main crossover is mental health and criminal justice, we know the two correlate and unfortunately, they can face the same barriers – this is seen in evidence. The Compounding Risk Model (Bryan, K) showcases this well, and I think it’s a really eye-opening tool to see how it all connects.
People with communication needs are at higher risk of facing inequalities across health / social / justice systems. They are also at risk of having mental health difficulties. We also know that mental health difficulties can impact communication, and this can be for a number of reasons. Sadly, this is sometimes “hidden” and that’s why I feel so strongly about SLTs being present where communication (and especially complex communication) happens – so yes, everywhere!!
Q: How does your service fit within the bigger picture of the criminal justice system?
A wonderful question!
We are of course still developing this and hope to have more evidence of what we bring and how this makes a difference. I cannot promote this as well as wonderful people like Clare Holland, Jacqui Learoyd, etc. do, but for me what it really comes down to is (and this is a summary):
If someone does not understand social situations, certain language, certain skills or requirements (e.g., telling the time, understanding emotions) or has conditions which impact on their abilities, then how can we ask them to fulfil a meaningful and effective life and fairly participate in society?
(This is before we even consider people caught up in negative situations and/or facing barriers!)
Everyone has the right to be supported in sharing their story and to be heard, so I think if we can create these opportunities, it will hopefully increase better justice outcomes and better social and health outcomes
Some people who have to participate in justice pathways don’t even understand the words being used, how to express themselves meaningfully, or how to tell the time (so turn up to court correctly or follow bail conditions). Therefore, it becomes a “vicious circle”. Even accessing certain programmes or talking therapy requires quite a high level of communication skills, yet these are put in place as “support”. But, if you don’t understand it then how supportive is it?
So, this is where SLT can help – we can identify this and create change, thus enabling better outcomes. We can also showcase “good” communication, raise awareness within other justice teams/services and support people in learning about communication and how to support this.
We have been really lucky to have people really wanting to engage with this so, hopefully, we can build on this.
We are so grateful for Steph who has kindly shared so much about her role and insights from her field. 🤩
Aside from her varied portfolio SLT career, Steph is also the RCSLT Mouthcare CEN secretary and does a lot of work in this area. She would love to share more about this. If you would like to learn more about her role, let us know!