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The first LGBTQIA+ panel at the Royal college of Speech and Language Therapists discussing how to make services accessible and welcoming to LGBTQIA+ staff and service users.Dr Sean Pert discusses this important issue with the UK SLT Pride Network.

A proportion of all children (7.58%: RCSLT) have significant difficulty acquiring language, irrespective of whether this applies to their first and only language or to two or more languages acquired in a multilingual setting. These children have developmental language disorder (DLD) and once identified are supported in school by speech & language therapists working with SENDCOs and other school staff. The majority are slow to develop language in the preschool years and identification and intervention at that point is crucial for later education including literacy. This poses a problem for professionals if the child is bilingual; distinguishing overall language delay from lack of familiarity with the majority language and providing intervention in the home language are both problematic. This work is part of a larger project (LIVELY) investigating the effectiveness of an early language programme for 3-4 year olds who are at risk for DLD. The programme focuses on early word combinations and sentences of increasing complexity. We are conducting a number of case studies with children who are acquiring a home language and expected to learn English. For these children, the programme will be conducted in their home language. This involves adaptation of both language assessment and intervention material to this language, with the possibility of remote working with the child if dictated by the pandemic situation. In this presentation we describe the strategies used to make these adaptations to Polish and to Mirpuri (Pakistani Heritage language), both of which are spoken widely in the UK. While sentence structure differs across languages, the focus is on the unique events that can be communicated through early sentences, universal to all linguistic contexts. Specific issues that we have encountered in developing these adaptations will also be discussed. Language Intervention in the Early Years (LIVELY): https://research.ncl.ac.uk/lively/aboutlively/ Royal College of Speech & Language Therapists (RCSLT): https://www.rcslt.org/

The LIVELY project (Language Intervention in the Early Years) aims to compare the efficacy of three different intervention approaches, each with a goal to improve the oral language skills of children (age 3;05 – 4;05) with severe language difficulties.The three approaches include Building Early Sentences Therapy (BEST), the Derbyshire Language Scheme (DLS) and Continued Classroom Support (CCS). BEST uses ‘usage-based’ linguistic theory to support more flexible understanding and use of a range of sentences. An adapted version of the DLS is also considered. The DLS supports children’s understanding and use of language by increasing the number of information carrying words that the child needs to understand. This approach has no explicit theoretical underpinning and has had limited evaluation. These approaches will be compared to CCS, where children will continue to receive the support that their school normally provides.Treatment fidelity has been an important consideration in the research process of the LIVELY project, to ensure that the research assistants can carry out the interventions consistently. Key areas of consideration are manualisation of the interventions, consistency of resources, development of treatment fidelity checklists, and methods of supporting parents to access and engage with homework. Research assistants have kept weekly reflections and sessions have been video-recorded and monitored by supervisors.In this presentation we reflect on the challenges, processes and importance of standardising interventions to be used reliably by different researchers and ideally in the future by varying teaching staff, in differing locations, and with a range of children. Key are issues of developing approaches that can be individualised to support children’s specific needs. We discuss the importance of creating tools and interventions that can be evaluated and used in controlled research whilst devising a useful and impactful intervention for children and school staff in the real world.

Waiting lists for Gender Identity Clinics are extremely long for trans and non-binary people. Some clients wait over two years (Davis, 2019). Speech and language therapy is the fifth most important clinical service after diagnosis, hormone prescribing and monitoring, referrals for surgery, and hair removal (LGBT Foundation, 2018).Local NHS voice services may be reluctant to accept referrals for trans and non- binary people due to perceptions that the clinical work is highly specialised. This often leads to trans and non-binary people seeking advice from unreliable sources, such as YouTube. Private therapy is often inaccessible due to financial restraints, with almost one if five LGBT people reporting discrimination due to their sexual orientation or gender identity when looking for a job (Stonewall, 2018).In 2016 the University of Manchester in partnership with the LGBT Foundation, set up biannual weekend intensive voice and communication groups for trans and non- binary people. Aiming to provide a much-needed free service, the groups provided mutual benefit with opportunities for student speech and language therapists to work with a client group pre-qualification under supervision. Over 120 clients have attended to date (average 11.9 clients and 12.1 volunteers per group). Clients reported satisfaction with group therapy (98%) and student volunteers (100%), based on 69 responses.A survey of 97 student volunteers following eight successful groups elicited responses from 71 students (74%). This found that although 40 had met trans people previously (56%), only 3 had worked with a trans person on clinical placement (4%).Volunteers reported a better understanding of the client group (97%), voice assessment techniques (87%), and voice therapy skills (97%).Almost all of the volunteers (99%) reported the experience would make them more likely to want to work with trans people in the future, and all volunteers would recommend volunteering to their peers.

Royal College of Speech and Language Therapists’ guidelines state that speech and language therapists (SLTs) should provide assessment and therapy in both/all of the child’s languages (RCSLT, 2018). This is easier than in the past as more assessment and therapy packages in languages other than English (LOTE) are published. Normative monolingual data is emerging for LOTE for a range of languages. However, the bilingual child is not comparable to monolingual populations speaking eith of their languages. The aim of devising standardised assessments for language combinations seems untenable withou relying on estimated measures of language exposure. Use solely of standardised tests for identication purposes is in any case not recommended for any child and these are meaningless in the case of children who speak LOTE. Attempts at classifying clients as eectively monolingual or waiting until they ‘catch up’ with monolingual children perpetuates the misconception that bilingual speakers are two monolinguals in one person and cannot provide an accurate picture of overall language ability. Furthermore, standard toys and picture materials may be unfamiliar to children fr minority ethnic communities, or be otherwise unsuitable for cultural reasons. Bilingual children ma attempt to speak in only one of their languages and avoid code switching for pragmatic reasons (Stow, Pert & Khattab, 2012), leading to inaccurate results. SLTs must reject traditional ‘snapshot’ assessments and consider alternative approaches. For identication this should minimally include dynamic assessment and careful consideration of the child’s exposure and opportunities to use English. Diagnostic assessment will involve embracing an SLT-interpreter led approach, delivering descriptive and structured informal assessments as part of dynamic assessment cycle. Culturally adapted toys and pictures allow the child to be assessed fairly and to engage in therapy. Translation issues aecting meaning, syntax, phrase structure and morphology must be addressed. Only in this way can the profession truly provide an equitable serv with outcomes comparable to monolingual children. SLTs often feel under condent to implement this approach, citing time pressures, and preferring t reply on standardised assessments whilst acknowledging this as a awed approach. Despite eviden based RCSLT clinical guidelines promoting an equitable approach being available for many years, equitable practice is inconsistently applied. We will illustrate the process of using culturally and linguistically sensitive adaptation, in contrast to translation, drawing on the ‘Bilingual Assessment of Simple Sentences’ (BASS)(Pert & Stow, 2019), th ‘Multilingual Toolkit’ (Letts & Sinka, 2011), and the ‘Building Early Sentence Therapy (BEST) package (McKean, Stow & Pert, 2010). These examples will illustrate how an equitable service can be provide for these children, based on accurate and informative information gathering. They will also show th RCSLT clinical guidelines recommending double the time to achieve the same client outcomes are valid and cost eective. Three key learning outcomes 1. To apply RCSLT clinical guidelines on assessment and therapy to bilingual children. 2. To select culturally and linguistically appropriate stimulus materials to engage bilingual childr in assessment and intervention. 3. To show how equitable outcomes can be achieved for bilingual children and their families by adapting assessment and therapy procedures as appropriate. Brief outline of submission Despite RCSLT clinical guidelines, SLTs rarely feel condent working with interpreters, bilingual children and their families. This paper provides actual worked examples of how cultural and linguist adaptation of language assessments and interventions, in contrast to direct translation, can deliver equitable outcomes

Voice and communication therapy has traditionally been delivered to trans and gender non-conforming individuals at Gender Identity Clinics (GICs) and voice clinics. Trans individuals report difficulty accessing local speech and language therapy, as therapists did not feel confident to deliver such care. This has led to significant waiting times, an additional stress for clients (McNeil, Bailey, Ellis, Morton and Regan, 2012). Trans people are often socially isolated and potentially face significant negative reactions when transitioning gender. Trans individuals experience a high level of mental health difficulties and are often unlikely to be able to afford expensive private care. Clients are vulnerable to confusing, inappropriate or potentially harmful voice and communication advice via social media and video-hosting sites made by well-meaning, but ill-informed peers.The LGBT Foundation is a Manchester-based charity. Significant efforts have been made by the charity to include trans people by adding the term to its name and developing a dedicated Trans Programme. The charity received many requests for speech and language therapy, as there is no GIC in the Greater Manchester area.The University of Manchester has developed a trans voice and communication course in partnership with the LGBT Foundation as part of social responsibility activity. This course is delivered on a voluntary basis by pre-qualification speech and language therapy students trained and supervised by a senior lecturer. The Trans Programme staff provide students with trans awareness training.The twilight course offers care in a group setting with students and trans clients in partnership. The course consists of four, ninety minute weekly sessions on how the voice works, vocal hygiene, and how conversational partners perceive gender differences. A follow-up intensive course of four, ninety minute sessions over four consecutive evenings is then offered. This provides objective and subjective assessment as well as evidence-based care.Up to 35 trans clients have attended the introductory group sessions. Twelve clients are offered a place on the following intensive group. Both trans men and trans women have attended the groups, as well as gender non-conforming individuals. All found the group therapy format acceptable and would recommend the course to other trans people.Outcomes for students included an increase in skills for working with trans clients. All would recommend volunteering to their peers, and the experience made them more likely to want to work with trans clients in the future. This is crucial if more therapists are to assist in supporting trans clients post-qualification. Between fifteen and twenty students have taken part in each group session.This model, rather than provide an alternative to NHS care, has supplemented that care. The LGBT Foundation Trans Programme sees the intervention as part of their offer to clients in Greater Manchester.Three key learning outcomes for your submissionLearn the advantages of a group model of therapy delivery for trans and gender non-conforming individualsUnderstand the benefits to students in being involved in voice and communication therapy for trans individualsSee how volunteering and social responsibility activity can enhance the student experience and forge links with charities for vulnerable groupsBrief outline of submission for the conference programmeTrans individuals reported difficulty accessing voice and communication therapy outside Gender Identity Clinics. The University of Manchester and the LGBT Foundation, a local charity, have collaborated to provide advice and group therapy, involving student volunteers. Outcomes for both clients and students are discussed.Three key words to describe your submissionTransVoiceStudentsReferencesMcNeil, J., Bailey, L., Ellis, S., Morton, J., and Regan, M. (2012) Trans Mental Health Study 2012. Scottish Transgender Alliance, Trans Resource and Empowerment Centre, Traverse, Sheffield Hallam University and TransBareAll. Available from: http://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdfTopicsClinical educationMental healthAdditional InfoSubmission category: Audit/service evaluation

The University of Manchester has responded to the pressures of placement provision with an initiative that is seeking to consider the contribution of alternative approaches to improving the availability and quality of practice education. A qualitative study was designed to:identify the characteristics of good practice education, as perceived by learners and educators,explore alternative options for practical learning.The outcome of the study will inform the development of a strategy to enhance the quality and quantity of learning opportunities, including technology to facilitate practical learning.Using a social constructivist theory of learning to frame our study, we set out to explore student SLTs’, practice educators’ and university tutors’ understanding of practice learning. Two research questions were posed:What do students and educators believe contributes to successful learning in placement?How do students and educators perceive their roles in practice education?Interviews and focus groups were used to elicit the views of practice education from 12 student SLTs, 6 practice educators and 2 university tutors. Results were coded and themed using thematic analysis.Early findings indicate that practice educators regarded their role as teaching students to undertake practical skills, engage in reasoning relevant to client’s needs and encourage professionalization through reflection and discussion. Practice educators expected student SLTs to be prepared, with a theoretical understanding relevant to client group, good interpersonal skills and capable of building relationships with clients.Students frequently referred to gaining confidence in interacting with clients, often regarding managing the consultation as their greatest challenge. Inexperienced students tended to focus on learning the technical skills of what SLTs do, whilst more experienced students referred to learning how to investigate the complex interplay of issues presented by clients. Students reported considerable variability in the opportunities to learn on placement, influenced by educators’ expectations and approach, as well as the range of clients and contexts available.Findings suggest there may be a discrepancy between students’ and practice educators’ priorities for practical learning. Students focused on building their confidence in managing client-professional relationships in everyday contexts and learning technical skills such as doing assessments. In contrast, practice educators emphasised enabling learners to develop clinical reasoning through reflection, discussion and reference to evidence, often as part of a collaborative process between student and educator. Both student SLTs and educators believed preparation and readiness for learning with specific client groups was essential. The possibility of using alternative learning solutions such as e-Learning and campus based activities to enhance students’ readiness to learn in placements offers an important avenue for future development and evaluation.Three key learning outcomes for your submissionStudent views on clinical learningClinical educator / Practice educator views on clinical learning and expectations of studentsSolutions to enhance clinical learning, including e-Learning and blended learningBrief outline of submission for the conference programmeClinical placement is a key aspect of training pre-qualification students. However, not all students are equipped with the skills they need prior to commencing placement. Focus groups and structured interviews with practice educators and students identified their priorities. Alternative learning included blended e-Learning will be informed by the findings.Three key words to describe your submissionStudentsPlacementLearningReferencesKear, K.L.(2011). Online and Social Networking Communities: A Best Practice Guide for Educators. Oxon: Routledge.TopicsClinical education

A round table consisting of presentations and panel discussion led by Professor Barbara Dodd, City University, London.