Lisa, can you tell us about a little bit about you?
I trained at Newcastle University on their 4-year Speech and Psychology degree programme. I initially worked in a Stroke unit and a Head injury unit in Brighton where we were encouraged to meet and spend time with all the therapists in the team. My interest in Dementia started here as one of the therapists was really ahead of her time in terms of thinking about assessment and therapy for people with dementia back in 1996. Unfortunately, at that time there was a general feeling that because people with cognitive impairment couldn’t always remember what we’d done in the sessions there would be no carryover into their everyday lives.
Over my career I’ve worked in a variety of settings from neurology wards to community teams working with adults with a learning disability. My special interest has always been in how we assess and treat people with dementia. I think the extra challenges that brings are very rewarding as a therapist.
I currently work in what I would consider to be my dream job where rather than squeezing people with dementia into a busy caseload I only see people with dementia and can focus completely on their needs at diagnosis and beyond.
Lisa, why did you want to be a speech and language therapist?
I was actually inspired to be a speech and language therapist by a paediatric therapist working with children with cerebral palsy who first demonstrated the magic of a communication aid. I was working in a respite care unit and had looked after a particular child for many weekends before one week being asked to take him across for his Speech and Language Therapy session on a Monday morning. The therapist took some simple cards out of the back of his chair that we’d never noticed and started having a conversation with him eye pointing at various choices for his day. I was 16 at the time and it made a really big impression.
Lisa, what is your current role as a speech and language therapists in Argyll and Bute?
I am the Speech and Language Therapist with the Community Dementia Service. I cover the 3 areas making up the Health and Social Care partnership, that’s 88,000 people over 2668 square miles a lot of single track road and some ‘intermittent ferries’! Each area has a dedicated multi-disciplinary team (MDT) made up of Community Psychiatric Nurses, Alzheimer Scotland Link Workers, Occupational Therapists, Social Workers and Health Care Support Workers. We are all led by a Consultant Psychiatrist.
I aim to assess and help manage the communication and swallowing needs of patients coming into the service. This can involve anything from piecing together a profile of an individual’s communication impairment, which feeds directly into the diagnosis process, to putting together a communication profile to help people communicate effectively with an individual who is transitioning into a nursing home.
Lisa, what does a typical day look like for you?
Over a typical day I might start with a MDT meeting sharing the results of my assessments, discussing any issues that have come up for people and going through new referrals. I will then head out across Argyll and Bute meeting people and their families newly diagnosed with dementia and help explain what is happening to them in terms of their communication. I carry out an assessment of their abilities and also their needs and hopes in terms of communication and for their future. People often have a lot of questions at this stage and it’s really important that I don’t go straight into all the questions I want to ask! Our role is particularly important for those with language led dementias such as primary progressive aphasia, as establishing which variant they have makes a difference to the type of therapy you offer and potentially might help establish which drugs could be effective.
I might then be running a group session at the Alzheimer Scotland resource centre back in Oban. These can either be therapy groups (made up of people with similar needs in terms of their communication therapy) or ‘Better Conversations’ groups that I run for carers, relatives and professionals working with people with dementia. I feel working with the professionals that come into contact with people with dementia in their work helps really helps people access healthcare more effectively.
I can then be called to a nursing home or ward to look at producing communication profiles or to assess people experiencing swallowing difficulties. I might be asked for advice about a very basic AAC device or for advice around oral intake and oral care in an ‘end of life care’ situation.
Lisa, what’s the most inspiring part of your role?
I feel deeply privileged and humbled by those first visits to someone just after diagnosis. People open their doors to me and allow me into their homes to meet their family and carers. They place their trust in me that my assessment, which can be hard work for them at times, and our plans together for any therapy input will be beneficial in the future. I’m inspired by how bravely people and their families face their diagnosis and how willing they are to channel their need to take back some control over their situation into constructive work to retain their communication skills for as long as possible.
Lisa, what advice would you offer other speech and language therapists working in post diagnostic support?
Don’t be afraid to use all your existing skills, assessments and therapy ideas with this client group. Therapy works! We have so many transferable skills that are invaluable in this area, detailed assessment, listening to patients and carers wishes, attention to all aspects of a person’s life, designing individualised therapy, sensitivity around eating and drinking advice, working in a big MDT and all our AAC knowledge. My only other piece of advice would be to work covering a slightly smaller geographical patch with more dual carriageway and fewer ferry journeys!
Lisa, where can people with lived experience find out more about your role as a speech and language therapist?
The Royal College of Speech and Language Therapists has recently published new guidelines, a position paper and a useful section focussed on public guidance that you can read here
Tips for eating and drinking that can view here
Tips for talking that you can view here
but if people are experiencing any difficulties with communication or swallowing, they can contact their GP and ask to be referred to their local speech and language therapist.
Contributor.
Lisa Fox, Specialist Speech and Language Therapist, Enhanced Community Dementia Service, Oban, NHS Highland
