Kim Turner, HMP & YOI Feltham [email protected] … Turner, HMP & YOI Feltham [email protected] Helen Clarke, Sutton & Merton Community Services [email protected]

Kim Turner, HMP & YOI [email protected]

Helen Clarke, Sutton & Merton Community [email protected]

Level of Need YOI Brinsford and Werrington - 55% of males (15-17yrs) in

a YOI scored poor or below on Test of Adolescent and Adult Language compared to 9% of controls Bryan (2007)

YOI Huntercombe- males (17-20yrs) had an average age equivalent of 12;04 on language assessment and 11;01 on vocabulary Pryor (1998)

Leeds YOT – 78% of males required input, 12% of females

Bradford Youth Offending Team – 74% performed below average but only 5.2% had previous contact with SLT

SLCN and Offending Receptive and expressive language functioning children at

kindergarten predicted later conduct problems (Hooper, Roberts, Zeisel, & Poe, 2003).

Linz, Hooper, Hynd, Isaac, & Gibson (1990) found that receptive language problems were predictive of disinhibited behaviour in adolescents with conduct disorder.

Ripley & Yuill (2005) cited multiple studies that demonstrated that excluded boys had undetected language impairments and performed significantly below their peers, with higher levels of behavioural problems in those with both receptive and expressive language impairments.

In a psychiatric clinic sample of 7-14year olds, two thirds of those diagnosed with conduct disorder also had a language impairment (Cohen et al,1998).

Current Access to Services YOI

17 in the UK

1 with full time provision

2 with part time provision

1 with possible

YOTs

32 in London

5 with current part time provision

Case Studies

Youth Offending Institute

Callum, 19yrs, social communication difficulties

Youth Offending Team

Andy, 17yrs, expressive language and social skills

ESBD School

Ben, 13yrs, SLI

Callum - Background Referred by Offender Manager in 2nd week of

admission

Possible in response to phone calls from mother

Difficulties in interaction skills

Also concerns from Unit staff

Difficult, rude, isolative

Additional referral made to CMHT

Information gathering Nocturnal enuresis to age 10

Statemented age 12 – given 1:1 support in classroom

Expelled from school x2

Seen by Educational psychologist

WAIS Non verbal IQ – 80, Verbal IQ – 108

High levels of cannabis usage

Escalating use of violence and aggression

Family history of mental illness

Assessment Seen immediately following altercation with Prison

officer, highly aroused

Angry and hostile after being called ‘rude’

Unaware how behaviour may have been interpreted as such

Language assessment

Expressive language – above average

Receptive language – within normal limits

Verbal memory – mild impairment

Assessment Results Clear social communication difficulties

Reduced meta awareness

Unable to read people

Unable to read situations

Queries over Aspergers, OCD, anxiety disorder

Joint assessment completed with CMHT

Other possible diagnoses discounted

Interventions Kelly hierarchy used Self and others awareness

Non verbal communication

Real life communication breakdowns What happened?

Who was involved?

What did you do? How did they react?

What did they do? How did you react?

What could be done differently next time?

Results E level prisoner

Reduction in concerns from staff

Reduction in anxiety for Callum

Acquitted before therapy complete

Meta awareness improved, recognising communication difficulties, requesting input

Onward path Does not attend Probation as acquitted

Does not fit CMHT referral criteria as no specific mental health issues

Does not fit Autism services as not a complete triad

Age 19 can not access paediatric SLT services, does not fulfil criteria for adult services

Asked local YOT SLT for involvement but SLT manager would not allow exception

Mother and prison staff fear that may re-offend in part due to communication difficulties

Andy - YOT Andy referred by YOT worker: “There’s something going Helen but I’m not sure what”

No history of behavioural difficulties or statement for educational need

Strategy at school was to keep his head down

Few friends

Assessment indicated poor expressive language, limited vocabulary and difficulties processing extended pieces of information

Poor awareness of difficulties

Outcomes Report influenced sentencing outcome - 18 month

DTO instead of 2+ years in custody

Diverted to a YOI with SLT access (which then closed), sent to therapeutic wing and had educational support

On release back to YOT is getting substantial support from SLT on assertiveness and social skills, work skills and language support

Providing the time - SEBD Nightingale is a school in Wandsworth for primary,

secondary and sixth form students who have social, emotional and behavioural disorders.

Traditionally only had ad hoc SLT input to the primary school.

Luckily the need was realised and a service was set up for the school - 3 days a week

Nightingale - Ben Had been known to SLT in the mainstream service since very

young

Engagement had been difficult due to his behaviours

Avoidant of work

Refusals

Lashing out

Poor peer relationships

Transferred to SEBD setting in year 4

I got to know him in year 7

Assessment… …difficult to pin down for substantial formal assessment…

In class - poor attention, avoidant of the pencil, often out the window

Staff were worn out by him, found him “immature” at times “sulky” others “clingy”, would kick, bite, scratch and spit when distressed

Trigger points appeared to be around “justice” and needing to explain his side but being unable to

Still very interested in others, lots of natural curiosity, great visuo-spatial processing, keen to try new tasks, small group of good friends

Tended to process the end of an utterance

Keen to engage with others despite significant difficulties with expressive language

Intervention… 3 sessions a week!

Initially focused on space building and relationship building over task completion Created a safe space behind my cupboard for thinking time

Spread out on the floor

Had an open door at breakfast and lunch time

Made use of the on-site farm and carpentry workshops

Set up projects that capitalised on his manual skills so language learning appeared incidental

Shared knowledge with key staff so that class tasks were differentiated but more importantly so that de-escalating was more effective.

Outcomes…? Using a pencil in class and sounding out letters in

front of others

Term and a half of good class attendance

Staff taking time to modify their language following incidents One question at a time

One focus to the question

Giving thinking time

The gaps are closing None of these young people would have accessed SLT without

the commissioning of specially tailored services

But gaps still exist …

The Bercow report indicated the need for each YOT to have access to an SLT and for each YOI to employ an SLT

Paediatric services need to find creative ways of delivering services to those hard to reach clients (SureStart)

SLTs need to educate other services on how to identify and refer those in need (The Box, The Communication Trust)

LinksThe Box e-learning, RCSLT

http://www.rcslt.org/thebox/open

The Box viral advert

http://www.youtube.com/watch?v=5XKtTK4i2hM

The Communication Trust website

http://www.thecommunicationtrust.org.uk/

Information on the Youth Justice System from the YJB

http://www.yjb.gov.uk/en-gb/yjs/