The session is finished with the children singing a little song. The session lasts for around 30 minutes. They then join the rest of the children in the nursery.
I am now going to reflect on my observation, and look at what I think was effective and what I feel could have been done differently to assist the service user.
After the session with Mrs Robinson I began to reflect on what I had seen. As I have not seen a child like Sam before I have had to do some research in order to try and find ways of overcoming his communication barrier. Due to confidentiality I knew that the nursery staff were not able to tell me anything, other than what they felt I needed to know about him. The nursery manager told me that Sam has four brothers who had all been the same at nursery. She told me that it is only while in nursery that Sam refused to speak. The nursery’s staff said, “he refuses to speak when spoken to or when it is required”. This is about all they said about Sam, and I left my placement that day feeling like there must be more that can be done to assist Sam. I started looking on the Internet for information. I started looking at speech impairments, and discovered a condition called Selective Mutism. When clicking on the link it read:
Do you know a child that speaks freely at home but appears frozen in a social setting such as, at school or in public places? Do you know a child who seems so shy that they take a very long time to warm up in social situations, if at all? Does it seem out of the normal range of shyness you observe in other children? If so, you may know a child with Selective Mutism and you’ve come to the right place. (http://www.selectivemutism.org/)
I was shocked at the similarity between the child I had met in nursery and the information in front of me. I then looked at a number of websites and started to gain some knowledge of this isolating condition. I have found that there are lots of children who suffer from this condition. I have also found that there is little known about it in the professional world, and little help for the parents of children who are suffering from it. I have printed off some information on Selective Mutism and attached it to this assignment.
I have also began reading a book written by ‘Torey Hayden’, a special needs teacher who tells a story about her own experiences of children with Selective mutism. In her book Torey Haden describes the best way to get these children to speak. She said “a lot of these children, in my experience, seemed to stay silent from fear of the amount of attention they’d provoke when they started to talk again rather than anything else, and so it took a lot of work to gain the courage to try. And others feel they’d been defeated and somehow lost face by being persuaded to talk again. So it was very important to minimize the attention. After all, it wasn’t the act of speaking that should get the attention; it’s what people said that was important.” (Haden, 1991 p23)
I have since asked the nursery manager if Sam has a recognised condition such as Selective Mutism. She said” In the nursery situation yes he has” although she said “he does speak to other children now and again, but it is only ever on his terms.”
As professionals in any health or social care setting the patient/service user is always the most important person, and we are required to provide a level of service that enables the service user to reach their full potential (self actualise). This is shown in Maslow’s hierarchy of needs. I have shown my understanding of this in unit 6 assessment 2.
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The care value base is a standard of care that is provided to give guidelines to health care professionals on the service we are required to provide. In health and social care we have to provide our service users/patients with holistic care. This is care, which considers the ‘whole’ person rather than just concentrating on any obvious needs. Holistic care includes persons: Physical, Intellectual. Emotional and social well being.
Children need to feel valued in order to develop their self-esteem and self-image. On an intellectual level the way in which a child interacts with his/her teachers may have an influence on their self-confidence. Having a bad relationship with their teachers could give a child a sense of failure. Mrs Robinson made the children feel valued by talking calmly to them. She took the time to make them feel comfortable. I feel that there was I lot of frustration shown by the teacher when she could not get the service user to speak. This was shown in the tone of her voice. This will have been felt by the service user, and may have made him feel anxious. As carers, our communication with service users should involve understanding and we should respond to the emotional needs of our service user. Children suffering from Selective Mutism find it almost impossible to speak in social situations. Making it hard for teachers to build up an understanding of the service user. Creating a ‘caring presence’ is almost impossible as the service user creates a barrier between themselves and the people that are there to help them. When using Charles Burners communication cycle, this interaction causes a barrier at stage 8. The child is unable to reply to the message. I have shown my understanding of this in unit 1 assessment 1.
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In this speech therapy session there were many positive communication skills used to assist the service users. There were also some things I thought could have been done differently. For example:
The use of a Human Aid. Having a ‘role model’ in the group was very effective. The role model in this group was a little girl who could speak clearly; she was confident and helped the other children to enjoy the game. She encouraged them to shout out when their pictures were held up. Although on this occasion Sam did not speak this is the kind of help that he needs to get the confidence to speak in a social situation.
The service user may have found a group of people sitting around a table looking at him very intimidating, and as this is a situation that Sam is put in every week, he could also be anxious when entering nursery knowing that he will be having this session. For group communication to be effective it is important that everyone wants to be involved. Sometimes the thought of having to speak in front of others may cause us to feel threatened and anxious other children in the nursery are able to tell the teaching staff if they are unhappy with anything. This child is unable to put his own views across. His behaviour and body language is very submissive he just goes along with Mrs Robinson; he is withdrawn from the group and looks worried. Throughout the session the child sits with his head down, he makes no eye contact with his teacher, his body looks tense and he sits sucking on the collar of his polo shirt. From this non-verbal communication it is obvious that the child is uncomfortable with the situation. May be it would be better to work on a one-to-one with this child. This could reduce the amount of pressure on him and he might be able to build up some form of trust with the teacher, this would feel less like a social situation and eventually the child may feel he can speak to her.
Time is a barrier to Sam’s communication difficulty as he is only in nursery for a few hours each day and to work effectively with him one a one-to-one would take up a great deal of time. This is a mainstream school and Mrs Robinson is the only special needs teacher in the nursery, she also has other children with speech/language needs to work with and spending this amount of time with Sam is not possible.
Touch is a way of communicating with out the use of words. The children held hands as they walked to the session room. This would help the children to feel less nervous and make them feel valued and cared for as an individual as well as feeling part of the group.
Knowledge is needed to assist a service user. In Sam’s case it would be good for all of his teachers to increase their level of knowledge on selective mutism. They should all be aware of the emotions and anxiety involved with this condition and should know as much as possible in order to help themselves to help him.
The setting of the session was excellent. The room was bright and welcoming, but was small enough to feel cosy. There were no noises distractions, which meant the children, were able to hear their teacher as well as each other, and were not being distracted by other children running around. The lighting was good. Due to the blinds being tilted, the sun was not shining in keeping the room cool, as a hot stuffy room can often cause people to feel tired. The children were easily able to make out facial expressions. Sitting the children around in a circle was good as they could see each other clearly. The children each had enough space to place their work in front of them, but were sat not to far apart, which made playing the game easier for them as they could all look at each others game card, and enjoyed pointing out each others pictures as well as their own!
The cards that were used in the game were very bright and colourful. The pictures were big enough for the children to see from across the table. The other children in the group liked the game and responded well to the pictures, they were able to see what the objects were and could tells Mrs Robinson where in the home these were kept or would be found. It was a great way of getting the children to talk freely for example, telling us that their mum/dad does the hovering or cooking. It was quite funny listening to the things they said!
Being supportive as a care worker involves being aware of your own behaviour and understanding the effect it has on the service user.
The way in which Mrs Robinson offers Sam a chocolate and then says he can only have it if he says please, I feel is an abuse of her power. She knows that the child is unable to speak in a social situation therefore is not able to say he would like a chocolate. She then seems to forget that Sam can hear and turns to me and speaks as if he were not there. This child will be feeling upset that he took part in this group session and did not get the same praise as the others. He will be feeling worthless as Mrs Robinson talks about him as though he were not there. As a care worker we should never discuss a service user with anyone else while they can hear, unless they are going to be involved in the conversation, talking as if they weren’t there is disrespectful. To overcome this they could use flash cards, one card with a tick on and one card with a cross. He could show his card to say either yes or no.
I don’t know whether these sessions will ever do this child any good, as his problem is not the same as the others in the group. This session is aimed at children who have delayed speech and problems pronouncing words. I feel that putting this child in this situation is emphasising the fact that he does not speak. Therefore, making it harder for him to start talking. I know that this is just my opinion and that the staff at the school has a lot of experience dealing with learning difficulties and children with problems. Through my health and social care course I have learnt that we must watch and listen to other staff without letting our own feelings and views get in the way. This involves thinking about what you have heard and seen and reflecting on it. I think that there are a number of other ways that this service user could be assisted for example:
A communication passport would be great for Sam as this could be his way of introducing himself to new people. He could have great fun making this and he could do this at home with his parents who he is able to talk to. A communication passport is usually a small-personalised book. It contains information about the service user and their likes and dislikes as well as information about there condition. If Sam was in a new situation where he felt he was unable to speck then a communication passport could save him from being embarrassed and anxious.
Technical aids could be useful in building up a relationship between Sam and his teacher for example, a computer game. Sam could sit with his teacher and she could ask him to do some work with her such as a number game or the same type of game that they play in he group session. This would enable Sam to participate with out having to speak; this could build up his confidence in his teacher and might result in him talking to her, as I have found that a child with selective mutism will only speak when in a situation where they feel comfortable.
Makaton could be a communication tool to try with Sam. Makaton is a system used for developing language; it uses speech, signs and symbols and helps people with difficulties in communication over come barriers. This would enable Sam to tell his teachers if he needed to use the toilet or if he would like a drink these could be simple signs that were easy to remember but could make such a difference.
Advocates are a way of communication for people like Sam with a communication barrier, which prevents them from being able to speak for themselves. In many of the cases I have read, the parent of a child with selective mutism acts an advocate for them while in school where the child is unable to communicate.
Psychologists work with service users with problems such as depression and anxiety. They provide assessment and therapy. It may be a good idea to refer Sam to an educational psychologist work in the field of learning and human development.
