Transcript for
Supporting the communication needs of children with complex trauma – part one

Narrator [00:00:02] Welcome to the Emerging Minds’ podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and in today’s episode I’m joined by Kate Headly, a speech pathologist from the Links Trauma Healing Service in Newcastle, New South Wales, to talk about the role that speech pathology plays in supporting children who’ve experienced complex trauma. Kate has worked extensively as a speech pathologist in the disability sector throughout New South Wales, providing direct therapeutic services as well as clinical supervision and community capacity building projects. Her work at Links involves working as part of a multidisciplinary clinical team delivering trauma focussed interventions to children living in out-of-home care, which she combines with private practice and work as a primary school teacher.

Sophie Guy [00:00:50] This was another one of our longer conversations in the series, and so we’ve divided into two parts. In this first part, Kate gives a rich description of the role of speech pathology in complex trauma intervention and also spend some time laying out what she sees as the important elements in that first session with the child.

Sophie Guy [00:01:10] Hi, Kate, and welcome to the Emerging Minds’ podcast.

Kate Headley [00:01:13] Thank you. Hi.

Sophie Guy [00:01:14] So we’re here today to explore your work as a speech pathologist and how speech pathology fits within a complex trauma healing service. And so I just wondered if to start off with, you could tell us a little bit about your background and how you came to work at the Links Trauma Healing Service.

Kate Headley [00:01:35] Yes, sure. So I’ve worked as a speech pathologist for a long time now and predominantly for many, many years that was with the New South Wales State Government disability services in western New South Wales. And I guess across my time in working with people with disability, I started to learn that a lot of people with disability had also been exposed to complex trauma in their childhoods. And my work with the New South Wales government started to diversify a little bit as we headed to the rollout of the NDIS in New South Wales. And it saw me partnering with some NGOs around different projects they were working on. And that exposed me to different clinical populations and further kind of drove that interest for me in how when children are exposed to adverse childhood experiences, the impact that has on their development and then specifically for my role, the development of their language literacy and communication skills. So I think I had this kind of simmering interest and was starting to build my clinical knowledge. And then all the stars kind of aligned a little in that when my family and I moved from western New South Wales to Newcastle, it coincided with the start of the Links Trauma Healing Service, which was originally funded as a three year research project. And they were advertising a speech pathology role within that service that was specifically working with children delivering trauma treatment for children who were living in out-of-home care. So it was just a really timely opportunity to build on that existing interest and knowledge that I had in the background at the time.

Sophie Guy [00:03:37] And how long have you been at Links for then?

Kate Headley [00:03:41] Yeah, so I’ve been there for three years now. In October this year, we completed the three year research phase of the project and currently have had that funding extended for a further 12 months.

Sophie Guy [00:03:57] OK. And perhaps you could just tell us a little bit about what the research project looks like. What are the questions you’re trying to ask and how are you measuring things?

Kate Headley [00:04:06] So the project was being externally evaluated and it was measuring that across a range of different outcomes that related to the young person themselves who’d experienced complex trauma that related to their placement stability, to have a carers were feeling in regards to their capacity to care for that young person. And then some also some related data in regards to reports of risk of significant harm for that young person, their hospital admissions, their school suspensions, and their contact with the criminal justice system. And that was measured as the young people came into the Links Trauma Healing Service, mid-treatment, at the end of their mental health treatment, six months post-treatment and 12 months post-treatment. So the three year evaluation report was really positive in showing that there was really significant, statistically significant change across a range of domains for the young person themselves, but also their carers and also some of those really measurable qualities such as decreased reports of risk of significant harm, decreased school suspensions, and decreased contact with criminal justice services up to 12 months post-treatment.

Sophie Guy [00:05:42] Wow, that’s fantastic.

Kate Headley [00:05:44] Yeah, it’s been a really fulfilling experience to be part of such a thorough research program that actually allows you to see the data associated with clinical outcomes. Because I think sometimes as a clinician, either it can feel hard when you’re in the trenches to actually see change for people. Or even if you see that qualitative change, you often don’t get the feedback whether that is sustainable change for a young person once they leave your service. So to be able to reflect on that data six months and 12 months post that young person receiving the treatment has been a really powerful experience.

Sophie Guy [00:06:34] Yeah. Wow. And I just wonder, for those who aren’t familiar, if you could give a definition of what is complex trauma?

Kate Headley [00:06:46] So complex trauma refers to exposure to multiple traumatic events, and they’re often sustained over a period of time and generally are very interpersonal in nature. So that includes all forms of abuse, including neglect. And if those experiences occur in childhood, they can be incredibly impactful because it’s such a developmentally sensitive time for children, particularly in regards to their neurological development. And so, you know, we really are focussed in the Links Trauma Healing Service on understanding what experiences children have gone through across their childhood years.

Sophie Guy [00:07:40] OK. Right. And then I did also want to ask you if you could help us understand what is the role of a speech pathologist? I understand it’s really a multidisciplinary team and it’s a holistic service approach. So what is the role of a speech pathologist in addressing complex trauma within the service you work?

Kate Headley [00:08:03] So I guess it’s really very multifaceted. So, as you said, we do work as that holistic kind of service around a young person. But obviously we also have our own clinical kind of domains and areas of specialised skills. So for me, the role has kind of been split across working with individual children and young people. And we have endeavoured to ensure that the communication skills of all the young people who come through our program are screened. And that’s because overwhelmingly the literature shows that, you know, approximately, if not upwards of about 80 percent of children who experience complex trauma will have difficulties with some of their language literacy and communication skills. And yet the vast majority of those young people, those difficulties don’t get identified for them because often they’ve developed really adaptive coping skills which can mask those difficulties. Perhaps they’re having high levels of school disengagement. So the difficulties with achieving academically identified as being related to the school disengagement, but maybe not some other underlying difficulties. It could be that because they’re moving between different carers, they don’t have adults in their life who are getting to know them well enough to recognise the level of difficulties the young person’s having. So there’s lots and lots of different reasons why often these support needs aren’t being identified for children and young people. So a big part of my role is touching base with all the children and young people who come through the program and identifying whether they do have support needs around their language and communication.

Kate Headley [00:10:17] And then more holistically, another key part of my role is ensuring that the mental health interventions that the children and young people are accessing to address their complex trauma is actually accessible to them from a language point of view. Because obviously we’ve got this real dilemma for all medical and allied health professionals in working with children who have communication difficulties, they still absolutely need to be able to access the right interventions. But if those interventions are highly steeped in talking therapy or, you know, language and communication, how do we make that accessible so the child still gets the benefit of that intervention? So some of my work in the team would be around consulting with the mental health clinicians around individual cases and the different interventions of the mental health clinician is using and delivering with a young person and working together to go, well, how do we simplify the language associated with that without losing the intent and the the effectiveness of the intervention? And and often that means maybe making a task a lot more visual for a young person or making the task something that the young person can participate in through doing rather than talking. And sometimes that even looks like I might do joint appointments with the mental health clinicians and a young person. And prior to the appointment, the mental health clinician and I will have collaborated around what the mental health clinician’s goal for the session is. And I might do some work in the background as to, well, what if we had a PowerPoint slide and we presented it like this and we made it a sorting task or whatnot? So I’m kind of bringing that expertise on how we simplify the language and more visually mediate the language so that the mental health clinician can still deliver the intervention that’s needed.

Kate Headley [00:12:48] And then I guess finally I would say my role involves a lot of advocacy work as well, a lot of advocacy and education. So that can look like anything from helping caseworkers and maybe teachers and and carers and mentors and support staff around a young person to really come to understand that a young person is having difficulties with their communication skills and understanding the service system and knowing how to link the young person with the right supports. And also tasks like supporting my organisation, my employer, as as a broader service with ensuring that the information that say on our website, the information that’s in some of our documents for consumers is accessible for them. Once you understand how complex trauma impacts communication skills, what you then go on to understand is that holds across a person’s lifetime. So sometimes, you know, I’m really mindful that I’m working with carers who’ve also experienced complex trauma themselves and consequently, you know, simplifying written information that we provide as a service, adding visual supports to information we provide as a service, is actually just going to be helpful and good practice for all of our service users, be them specifically the child in front of us or be them the team of people around that child.

Sophie Guy [00:14:33] Yeah, well, that sounds so important and certainly helping me to see how valuable that role of speech pathology is and the need for sort of a multidisciplinary approach. And it just makes me wonder how many children and adults are sort of out there struggling with this when they go to access services because there isn’t speech pathology there or an understanding of the impact of our adverse experiences on communication.

Kate Headley [00:15:05] I really do feel very passionately that it’s huge. And I think sometimes, you know, generally people who are working in qualified positions because they have the skills and the expertise to understand more formal language and more technical terms. And I think sometimes we even overestimate what simplified information is. And I think we don’t think to check in with people in a way that feels comfortable for them to let us know that they haven’t quite understood something or they didn’t really understand that consent form we gave them or, you know, all that kind of stuff. So like I often find in talking to carers, and these are just skills I’ve developed over the years, but, you know, I know that for some people to suggest that they’re not literate can drive a sense of shame. And I would never want to do that to somebody. So to me, it’s not really helpful to ever say to a carer, now, are you literate? You know, can you read? Can you read this note? However, what I might say to a carer is something along the lines of now, you know, are you somebody who likes to read things or are you more someone who likes someone just to tell you something? Or would you rather watch it in a video? What’s your kind of style? [Mm hmm.] And in that more casual approach, often people then will start a conversation where they say, ‘oh, yeah, no I’m not much of a reader. I’d much rather you just tell me what it says’. Or ‘no, that’s cool. If you’ve got a video, that’d be great’. So I think there’s ways that we can support people to comfortably let us know whether information has been accessible to them or not.

Sophie Guy [00:17:11] Yeah, that sounds like quite a simple approach that anyone could start to implement just to account for the fact that there may be a variety of communication needs in any family, I suppose, anyone that we encounter.

Kate Headley [00:17:23] Exactly. So let’s shift now to some of the questions that we had around trying to sort of really understand what goes on in a session with a child as a speech pathologist and working in a complex trauma service. I wonder if we could just sort of imagine when your first meeting with, say a 10 or 11 year-old and I’d like to know, what are you thinking about? What are you most mindful of in that first meeting in session with the child?

Kate Headley [00:17:54] Yes. So I love the fact that you said a 10 or 11 year-old, because I must admit that is a big bulk of my referrals, the children around that age. And and I think it speaks a lot to the fact that from a speech pathology point of view, when children enter the upper levels of primary school and the curriculum really increases in complexity, particularly around literacy expectations, that is often sometimes when people start to realise that children are having some more difficulty. So it is really common for me to be working with children around that age group. And for me, the absolute primary priority that I have in around that first session is transparency. Because I’m critically aware that it is highly likely that this child has had experiences through their life where they have experienced maltreatment and relationship ruptures from adults in their life. And so I think, you know, from the get go, I’m really always trying to acknowledge that if that young person’s even prepared to meet with me, that shows a real character of bravery and and resilience that I’m always really acknowledging of and appreciative of in children. And I think some of the ways that I try to build that transparency from the get go is that before I meet with a young person, I if possible and it’s not always possible, but if possible, I like to send them a little introduction letter or a little introduction video. [Right.] And what I’m trying to do there is just to I guess, first of all, make sure that they feel a sense of control, that they understand that they’ve been referred to me, that they understand what I’m going to ask of them in that first session. That I’ve started to build a little bit of familiarity. They’ve seen my face. And then what that’s going to do, as well as, I guess, help their understanding and their sense of control is also hopefully reduce the anxiety that they bring to that initial session. So it’s going to be more comfortable for them and a nicer experience. But also anxiety impacts our ability to communicate effectively, so are more likely to get a better representation of the young person’s skills if they’re not feeling as anxious when they are come in to the appointment.

Kate Headley [00:20:49] And so in everything I do in that first session, my real focus is on transparency. So I want that young person to understand why they’ve been referred to speech pathology. And that is often a really, really foreign concept for children. [Yeah.] And, you know, I think there is a general public perception that speech pathologist work with people who can’t pronounce their speech sounds properly. And nearly every young person I work with will actually say to me, I don’t know why I’m here. And they can acknowledge that they can talk normally and that their speech sounds fine. And so I always provide the young person with some of that education, like we were just talking about earlier, about how having difficult experiences when you’re a kid can impact the way that your brain’s learning different skills. And what’s really remarkable about that is that when I start to give practical examples in the words that other children have fed back to me, the number of children who kind of light up and they suddenly feel so validated and they’ll start to say things like, ‘yeah, that’s me. That’s what happens to me. That’s yeah, I get that, too.’ So they might be even descriptors like, you know, I know some of the children I work with. They tell me that sometimes when the teacher’s talking helps in the classroom, it can be really hard to tune in and follow what the teacher’s talking about. And kids will go, ‘yes, like that happens to me.’ And you can see this real almost relief that it is a shared experience that they have with somebody else. So I do try and build the transparency with that introduction letter or video, then I reiterate that same information, continue to build that transparency. So, you know, as I meet with them, I might again say, ‘oh, you know, did you get my letter? Did you get my text message? Thanks so much for coming. So like I said in the letter, the things that I thought we could talk about today are’. And we might shut them down in a list or pop them on some post its, put them on a whiteboard so that all along I’m building that trust and transparency with the young person. And they know that there’s some boundaries for that session.

Sophie Guy [00:23:26] This brings us to the end of part one of our conversation about supporting the communication needs of children with complex trauma. Tune in again in a fortnight to catch part two.

Narrator [00:23:39] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.