Transcript for
Supporting the communication needs of children with complex trauma – part two
Narrator [00:00:03] Welcome to the Emerging Minds’ podcast.
Sophie Guy [00:00:09] Welcome back to part two of our conversation about supporting the communication needs of children with complex trauma. You’re with Sophie Guy and in the second part of my conversation with Kate Headly, a speech pathologist from the Links Trauma Healing Service, she talks about how she works with the child to identify what their goals are for speech therapy, as well as how to ensure that the work is grounded in collaboration and equal partnership. First, though, we pick up again with the conversation about what Kate sees as the important elements of a first session with the child. Here’s Kate.
Kate Headley [00:00:43] And then really, from the young person’s perspective, that first session for me is yes, they understand why they’ve been referred. Crucially, they understand the confidentiality and privacy boundaries of that relationship. I think that’s really, really important because all our work, we’re trying to build trust with the young person, but they will feel a breach of that trust if we find ourselves in a mandatory reporting situation. And we haven’t previously explained that to the young person in a way they can understand. So I will always use that first session to explain my responsibility so that everything we talk about is confidential. But there’s a couple of times where there might be things we talk about, where I do have to let other people know that information and I might even sketch that out with the young person. Or with really quite young children, I might use say little toys or we might build some clay models and we might act that out with the models so that if into the future, I find myself in the position where I do need to share information from our appointments, I can talk to the child or the young person about that and it’s, I guess, related to a previous conversation that we’ve had and it’s not just coming out of the blue. [Mm hmm.]
Kate Headley [00:02:18] And then finally, my real focus for that first session is just to understand what’s really important to that young person and for children to begin with that might just be a discussion around their favourite activities or stuff they find really cool. Stuff that they want to do on their school holidays. It mightn’t in any way be relationship based. It might be more activity based. But what that allows me to do is to have an anchor and I guess a point to come back to. So, for example, you know, a young fellow that I was working with, he was really, really into skateboarding. And so we were able to use the activity of skateboarding in future sessions to start to talk about all the different communication skills you need to buy a skateboard, go to the skate park, learn new tricks from other people, and then from there get some engagement into some communication goals that were important to him. So they’re yeah they’re kind of my main focus whenever I’m having that first engagement with a child about that age.
Sophie Guy [00:03:37] Yeah, that’s really clear. And I’m wondering, I mean, does it sometimes take more than one session to I mean, it certainly, it must do to build trust for a lot of kids. When do you sort of shift to starting to collaborate with the child to work out what they might be wanting to change and their goals might be around communication? What does that look like?
Kate Headley [00:03:57] Surprisingly, it often can even happen in that first session. [Okay.] You’re right, there are some young people who are more reluctant to engage with me or maybe because of the context of their life at the time, they’re having a bit more difficulty with identifying things that they enjoy and things that they want to be able to do and to be that bit future-focused. So, you know, there is a lot of variability, but generally by the second session, I’m getting a feel for the areas that are easier and more difficult for them. And we’re starting to shape up, even if it’s some preliminary discussions along the lines of, oh, cool so, you know, I can really hear that maybe being able to follow the conversation when everyone’s chatting in the playground, that’s something that, you know, you’d like to feel a bit easier with. So some of the strategies that I use that I find really, really helpful is if for a young person who maybe isn’t so future focused and he’s finding it hard to identify goals per say, not that I necessarily call it that with children and young people, but, you know, identifying what they would like to have feel easier is a term I often talk about, but often they can identify what’s difficult for them.
Kate Headley [00:05:36] So sometimes I might use a strategy where I do something like have a pile of Post-it notes where on each Post-it note I jot down different types of communication behaviours. So it might be talking with your friends in the playground, listening to the teacher in the classroom, reading the books that my teacher asked me to read, and then we might just use a continuum-type system on the table or a whiteboard, and I might try to engage them in that process by saying, ‘okay, so if this end of the continuum is things that are super easy and you can just do them and they never feel tricky, what what picture could we draw at this end of the continuum that shows that?’. And often, which is really interesting, they’ll choose a picture of a task that they find really easy. So they might say, well, you know, skateboarding, because to them that’s their internal representation of something that’s easy. And then likewise for the bottom of the continuum, for things that are difficult. And then we might just go through each of those post-its and the the young person will just pop it on the continuum for how easy or difficult that task feels for them. And that straightaway starts this really helpful discussion of going, OK, so I can see there’s heaps of stuff that it’s really feeling good for you. I can see there’s a few things that don’t feel so easy for you. Are these things that you would like to have feel easier for you? And, you know, I’m yet to have a young person saying no to to that offer. And then what we might do then, if not yet quite ready for engagement in how we might improve those things. I might just engage the young person in a bit of a plan for some further assessment of those skills. Some might say, you know, I think we need to know a bit more about why these things are tricky for you. Would you mind if I came and hung out in your classroom? Would you mind if I spoke with your teacher? You and I could do some activities together that would help me to understand why these things are tricky. So we might even just try that initial shift into engagement with the assessment process and then the information from that assessment process. We might start to shape up into some goals of intervention.
Sophie Guy [00:08:15] And are you and how do you check in with them about how they’re going and sort of the pace for them and whether they’re feeling comfortable and happy about where things are going? Are you doing that and what does that look like?
Kate Headley [00:08:31] Yeah, absolutely. I’m doing it because, I mean, best practice for all speech pathology work is that as a clinician, that we’re addressing the person’s goals. That they are the person who is driving what they’re working on and how they’re working on that. But I find even more so in working with people who’ve experienced complex trauma, that having that sense of equal partnership in that and that collaboration just really is important for maintaining trust in the process and trust in the relationship. So there’s lots of ways that I do that. But importantly, one of the primary ways I guess I’m doing that is I always make sure that the goal of the intervention we’re working on is really explicit. And I’ve articulated that to the child or the young person in a way that they understand. So they really understand what it is that they’re working towards. And then we will work on a measurement scale that they understand so that we can jointly review their progress towards that goal. So I predominantly as a therapy outcome measure use goal attainment scaling in my work at the moment with the Links Trauma Healing Service. And that’s a scale that you can actually develop with young people so that you’re using a range of descriptors that kind of show progress towards the goal. And what I have found is that the children and young people I’ve worked with, they just really love that really visible learning. To the point that often, like I’ve had experiences in therapy where children will say to me, now you watch this, I’m going to get to step zero on the ladder today because they’re really clear on what they need to do in order to make the progress to that next step towards the goal. And so I think that is a really, really effective tool for being transparent around the learning and collaborating on that.
Kate Headley [00:11:02] But then sometimes I also want to hear from children outside of the progress towards the goal, how they are actually just feeling about working with a speech pathologist, the way we’re working together, you know, all the other kind of factors of that therapeutic relationship. So I will always check in with a child if I notice through their behaviour anything that might be indicative that things aren’t working for them. So, you know, if they were to miss sessions or be a reluctant participant in the session, if their body language or their level of verbal engagements different, I will always talk to a child about that. I’ll always say I notice that you don’t seem to be enjoying what we’re doing today. You’re turning your body away from me a bit. I’m wondering what that’s about. If they have difficulty engaging in that kind of conversation, again, I’ll look to really visually mediate that. So there is a communication strategy that’s called talking mats. And for people who are trained in that, they’ll understand that that’s a way that you can use a visual continuum to allow children to give a opinion on a certain issue. So I might use a strategy like a talking mat or a visual continuum again to kind of look at the features. So I might break down what a therapy session is. It’s after school, is one of the features. It’s in my office, is one of the features. A transport service brings you to the appointments, one of the features. The games we play, is one of the features. And then I’ll get the child to use that visual continuum to show me their opinion on those features so that if something’s not working for them, I now know that. And we can look to negotiate that and work out how that might need to change so it’s more comfortable and working for them as the recipient of the service.
Sophie Guy [00:13:10] And do you find that those techniques usually are enough for a child to feel comfortable to share their opinion? Because I’m aware how hard it is for adults as well, let alone children to sometimes disagree or correct or say no. Is there anything else that is sort of needed to help set it up so it’s safe for a child to really express where they’re at?
Kate Headley [00:13:36] Overwhelmingly, I do find that children are quite honest with me in their opinions, but I think part of that is throughout my work with children and young people, I’m consistently supporting them with their autonomy and decision making and modelling to them how I advocate for their opinion to be heard with their caseworker, their carers, the broader service system. So, for example, when a young person has shared with me the things they’re finding difficult at school, children are often really good at letting me know what makes it easier for them to learn at school. You know, when are the times that are easier? And so I’ll say to them, ‘well can we work together and put that into this document so that I can share that with your teacher? And the teacher will know that these are your words. This is what you know works for you.’ And kids often respond really, really well to that. They love that opportunity to be heard. And I think particularly in a medium that, again, feels accessible to them. And I have a perfect example of this clinically. So I was working with a teenager last year who’d had a lot of difficulty engaging with schools and had changed schools a lot. And in getting to know her and work with her, I said to her, I really can hear from you that you understand what is helpful for you at school. You’ve been able to give me all these examples that show what helps you in the way teachers talk to you, in the opportunities where you can go in the playground. And I said, you know, have you ever had a chance to let teachers know that? And she said, well, they always ask me. But she said, my mind just goes blank when they ask me. I can’t get my words out to tell them. And so I said to her, what if one of the things we do together in speech pathology is we create a little booklet and you can use photos, you can use pictures, you can use comics, whatever you want. We’ll work together to put all of that in a booklet so that when you start at your new school, you don’t actually have to tell them. They can read it in your booklet.
Kate Headley [00:16:08] And she engaged so well in that task and she absolutely loved it and put so much effort into it because I think it was validating, enormously validating for her to feel heard. And we were able to reinforce that she is the expert on herself. But also she could do it in a way that was accessible. It wasn’t putting that demand on her verbal language system at a time of high anxiety. She was able to work on that when she was feeling calm and regulated and could actually think the process through.
Sophie Guy [00:16:48] And so thinking about the service that you work in and obviously having professionals with a variety of sort of disciplinary backgrounds and so like, is there sort of a sequence to how the speech therapy part of it works? Like do you, do you find you normally see them before they do some other part of a therapy or where does it fit in with everything else?
Kate Headley [00:17:11] One of the challenges of setting up a system from scratch, as we have done with the Lknks Trauma Healing Service, is absolutely that working through all those different kind of team processes. We have recently moved to a model which we’re feeling really positive about, which is where, as young people are referred to the Links Trauma Healing Service at the point of being accepted into the programme and allocated to the mental health clinician. We are also doing speech pathology screening as part of those very initial appointments with the service. And the reason, as I think you’ve kind of inferred, the reason we’re doing that is because the mental health clinicians, through their assessment process with the young person and the people around that young person, are doing lots of clinical formulation and lots of intervention planning. And having a good understanding of the young person’s language and communication skills is a really critical part of that formulation and intervention planning. And to date, that has been super, super helpful.
Kate Headley [00:18:32] The other process stream is sometimes based on just an initial screening a young person might, you know, present as having, you know, real strength with their language skills, however, the mental health clinicians might be progressing through the mental health intervention, and they might hit a bit of a wall, some barriers with that. And it might be at that time that they come and collaborate with the speech pathologist and say, you know, we were travelling well for the early stuff, but now we’ve hit this barrier and I’m wondering if actually there might be some higher level language difficulties that didn’t show themselves initially. And so at that point, we might do some more detailed assessment and work more collaboratively with the mental health clinicians around that young person. And I didn’t mention earlier, but another one of the roles that the speech pathologists bring to the team is also around differential diagnosis for young people. Because outside of communication difficulties, what we also see sometimes is young people who haven’t had significant disabilities previously identified, and that sometimes starts to be able to be identified through our multidisciplinary services because we have those overlapping lenses of complex trauma, mental health, and then developmental lens. And so sometimes through the occupational therapy screening and the speech pathology screening, with that focus on the developmental lens, we are starting to be able to work together as a team a lot around that differential diagnosis for children who may have fallen through gaps previously.
Sophie Guy [00:20:34] What are some of the other difficulties that you identify in children?
Kate Headley [00:20:39] Do identify that there are children with foetal alcohol spectrum disorder whose support needs haven’t been previously identified. And the strength of the multidisciplinary team is we’re able to really draw together very broad information. So rather than an individual OT identifying some coordination difficulties and the speech pathologist identifying literacy and learning difficulties, and then in the background, you might have a mental health clinician who’s starting to work with family and and get a better picture of some of the vulnerabilities when mum was pregnant and in the early days of life for that young person, collecting all that information as a teen and being able to put that together does really help with some of that diagnosis. We certainly see a lot of young children who have chronic middle ear dysfunction that hasn’t been well identified. Intellectual disabilities that haven’t been identified. And as a team, we are constantly reflecting on how sometimes when a young person has behaviours of concern, it’s really hard for people to think more broadly around the developmental diagnosis for that young person. And some of their support needs get a bit lost in the focus on the behaviours of concern. So we do find that as a multidisciplinary team, one of the real benefits has been the opportunity to also support children to understand why they’re having difficulties as well.
Sophie Guy [00:22:28] Thank you. You’ve been explaining things so clearly and been so generous with everything that you’ve shared. And I’m just wondering, is there anything that we haven’t touched on that you would also like to share before we wrap up this conversation?
Kate Headley [00:22:44] My overwhelming reflection on the past few years in working specifically with the Links Trauma Healing Service has been that I am really hope filled by the growing interest and body of knowledge specific to complex trauma experienced in childhood. I know within my own discipline, but I also try and read really broadly and I can see that growing knowledge base across all disciplines because it really, really is impactful on children and interventions can be hugely beneficial. But the more we understand, the more proactive we can be. And, you know, I sometimes think about their first 1000 day data and information that we we have, and I think we can think really proactively in terms of early intervention. We are now getting to a point where we know what children are at risk of developmental impacts from those adverse experiences, even pre-conception in utero and in their early days of life, and really be looking to put those very proactive interventions in place to help change the trajectories of children’s lives.
Kate Headley [00:24:11] I do some work with working with other speech pathologists and and I guess sharing what I’ve learnt through my experience. And what I also kind of try to emphasise at those times, too, is we need to be mindful that children who’ve experienced complex trauma grow up to be adolescents, adults and older people who’ve experienced complex trauma. So we really do also need to apply a life span framework to our thoughts around complex trauma, although the bulk of information at the fore is really focussed on children. We need to think about how does this impact people across their lifetime?
Sophie Guy [00:24:54] Yes, yeah, I totally agree with that. And it really sounds like the work that’s going on within the Links Trauma Healing Service is so valuable and I hope it continues.
Kate Headley [00:25:07] Thank you. As do we. I think you can tell from when I talk about it, I do love the opportunity to share my learnings to date and really advocate for what a powerful role speech pathology can play in trauma treatment services.
Sophie Guy [00:25:23] Yes, absolutely. And I think that that will be really valuable. And I think people find it really fascinating to hear you talk about it as well. So thank you very much for your time today, Kate. And I really appreciate it.
Kate Headley [00:25:34] Thank you.
Sophie Guy [00:25:36] 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.