Pioneering Telemedicine Therapy For Adults Who Stammer

Airedale

Welcome to our blog and our exciting pilot to deliver therapy to adults who stammer via telemedicine. Please follow us to keep up to date with all our latest news.

For more information about our project, click here.

If you are a person who stammers looking to access therapy, click here to join our trial.

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Journey’s End

Summertime, but the work goes on here at the project.  Five months in, Project Manager Jody and I have definitely settled into the swing of things. All of our technical issues have been ironed out, our admin systems are working, and we’re focusing on the important task of helping people to live the lives they want to live. We’ve now got thirty-six people signed up,  with participants at all stages of therapy. A couple of people have dropped out, which we expected, but it’s frustrating that we don’t always find out why.  Was it not the right time for them? Was it not what they expected? Could we have done things differently?

Most of our first cohort are coming to the end of their therapy journey with us, although hopefully that doesn’t mean that their learning stops.  The main aim of therapy for stammering is to help people to equip themselves with the tools and strategies to manage their stammer on an ongoing basis and feel comfortable about it long-term; effectively, to become their own therapist. Supportive friends, family and colleagues can all help to play a part in this.

Magical mystery tour

I wish them all well with wherever life takes them next, and it’s great that they’ve got what they wanted out of therapy, but I’ll miss them. Therapists are given a privileged window into people’s lives for a while and travel with them on a magical mystery tour of discovery,  learning and change. There’s definitely a sense of loss for me once my part in their journey is at an end. Hopefully they’ll keep in touch!

Scale It Up

A few weeks ago I attended a workshop run by Haelo, in partnership with the Health Foundation, which focused on ‘Scale Up and Spread Improvement’ for some of the Health Foundation funded projects.

This was an excellent opportunity to meet with the other projects in our round of Health Foundation funding to see how they are getting on and share any learnings we have made in our projects so far.

The speaker for the day was a very knowledgeable and enthusiastic Brendon Bennett. Brendon is an Improvement Advisor who started his career as a volunteer with the US Peace Corps in Uganda. He has since worked with the Institute for Healthcare Improvement and as a consultant in Improvement Science across a wide range of countries and various sectors.

I was really impressed with the insight and experience Brendon brought to the day. His enthusiasm was almost tangible and quite infectious. The day itself was great, speaking to other groups about how their projects were going and any hurdles they had faced was useful and brought home just how successful the Airedale NHS Foundation Trust project really is. We seem to be on track and seeing results for our participants already and this is great.

The academy showed me a few things that I need to work on for the project though. Sometimes, it’s so easy to get immersed in the day-to-day running of a project that you forget about the analysis or the measurement required – WE may know that the project is great but we need to be able to show external audiences how great it is!

So on that note, I am now busy beavering away on our Change Package, Measurement Tree and Driver Diagrams…wish me luck!

 

Driver Diagram

Telemedicine Stammering Project Takes to the Airwaves

 

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“Stammering…It’s not bad; it’s not wrong; it’s just different.”

Our Speech and Language therapist, Steph Burgess, was on Radio Leeds on Friday 14th July talking about our Telemedicine Stammering Project.

 

You can Click Here to listen (1.46.50).

In the interview Steph discusses the Stammering Therapy project; Airedale NHS

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“Stammering is just a different way of talking.”

Foundation Trust’s Telemedicine reputation and a bit of background into why Steph wanted to carry out the Stammering Therapy Project.

She also discusses a little about the negative impact stammering can have on a person’s life and the science behind stammering.

It’s great that the subject can get the attention of the local media and hopefully reach a wide audience. For Steph to be invited onto the  radio shows how important the project really is!

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“What we try to do in therapy is to build people’s confidence. To make them realise that you can stammer and say what you want to say.”

Reflections from a fellow therapist

Telemed

Hi, I’m Moira, and I’m Speech and Language Therapist in a supporting role for the Airedale telemedicine pilot. Steph invited me to sit in on some sessions recently. Firstly my thanks to Steph and her clients for letting me sit in, and now here are some my reflections of the day.

Seeing clients on their own turf made for a more relaxed and less formal session, and allowed a window into their everyday lives.  Our first client logged in from work and was very soon telling us about her talking challenges there, and her hopes and dreams for her future career. She and Steph could work with what mattered in the here and now. There was a great sense of immediacy and relevance in the session. I was also impressed with this lady’s openness and ability to reflect on her skills and progress after just a handful of sessions.

Another client logged in from his car. Again, in his own space, he could talk about his talking at home, work and hopes for the future. The discussions that followed seemed better aligned to the client’s everyday life. This gentleman seemed curious about and to take comfort from hearing about others’ experiences of stammering.

What surprised me about the Telemedicine day were the many advantages of seeing people in their own environment, both for the client and the therapist. What might have been regarded as a compromise to get around geography and other issues might well come into its own!

Otherwise, but still important, a message to any tentative clients out there, it was a very positive and at many times, a fun day. Yes, sessions can occasionally be challenging, but there is laughter in-between.

“Everything you want is on the other side of fear.” Jack Canfield

Overcoming-Social-Anxiety

It’s proving to be a great week for the project!

One of the best moments of the project so far has been watching a video of one of our participants give a wonderfully moving speech at her local Toastmasters club. Laura got great feedback from her audience and was awarded best speaker. She has kindly agreed to share the video, so you can watch it here. It’s a great example of the rewards that come from being brave.Taking a leap

From a personal point of view, I am delighted that we have found a better platform to deliver the sessions – appear.in.  It’s free to use, the video and sound quality are excellent with no lagging, and it’s really easy to use. There’s no software or apps to be installed, and no wrestling with the audio and video functions – you just share a link and it works straight away! And importantly for us as an NHS Trust, it’s secure and encrypted, with no data being stored on their server. Thank goodness I can now focus on the therapy and not waste the first ten minutes of every session trying to sort out the technology!

When we first proposed this project, we said we would aim to see between forty and sixty participants over the course of the year, but we were slightly concerned that we would not be able to get that many referrals. We needn’t have worried – less than three months in, we are already up to thirty-two, with four new referrals in the last two days! One of the things our wonderful project manager, Jody, is working hard on at the moment is looking into how we can continue this service after the life of the project, as there is clearly a demand. Watch this space….

 

Argh….help please!

So the project has been live for over 2 months now. We have 15 current clients who are actively undertaking therapy and another 6 who are at the beginning of the referral process.

This is fantastic as we had an initial aim of 40-60 clients throughout the whole year of the project so we’re nearly half way there, only 2 months in…

The client feedback we have had has been great, everybody seems to really benefit from the therapy and appreciate being able to access it in areas where there has been previously been no therapy provision for adults who stammer.

The one issue we do seem to be having time and time again is the technology. We are using a web-based platform called WebEx. This seems to be fantastic for B2B users. It is an industry leader in online conferencing but it doesn’t seem to have the stability or reliability for our usage.

We often find that either the video or the audio, or sometimes both, stops working. This can be despite having good internet connection, and even if the users have previously had no problems and the settings are the same.

We had some quick testing of another web-based platform (appear.in) last week and this did seem to be a lot easier to use and didn’t seem to have any of the stability issues from our limited testing.

We now need to speak to our Information Security department to ensure it meets the NHS’s strict security guidelines.

So, my question for you all is; have you got any recommendations of a system/platform/website we can conduct our therapy over? It needs to be free, easily accessible and secure, offering both video and audio capabilities.

I’m hoping we can get some good ideas of things to try to ensure we’re getting the very best out of this project.

Thanks,

Jody

Why does therapy work?

Peanuts

Some of our participants have now had several sessions and are approaching the end of their therapy journey with us, so it feels like a good time to reflect on how therapy can help people to make changes in their lives. It’s very easy to sit in our little comfort zones and never push ourselves outside of it, but every single one of the people I am seeing at the moment is being brave, pushing themselves to try new things and seeing the benefits that can result.

When I asked one participant what was helping him so far, he said, “You helping me to know I’m in control. I’m not scared any more.”  Most of our participants have said that understanding the mechanics of speech and being able to relate this to what happens when they are stammering has been really helpful . Others have said they’ve found it helpful having a technique to use, which can increase fluency, but which also provides a safety-net effect, helping to reduce the anxiety around stammering.  Talking to other people about stammering and about coming for therapy is also proving very useful for many of our participants, and helping to challenge some of their assumptions about what other people might be thinking.

thoughts feelings behaviour

I’ve had a few discussions this week about how to overcome fears and anxieties and about different psychological approaches.  The great thing about being a speech and language therapist is that I’m not tied into any one particular approach, and can cherry-pick the bits I feel would be useful for each individual. So I use elements of Cognitive Behavioural Therapy, Solution Focused Brief Therapy, Acceptance & Commitment Therapy and Mindfulness, to name a few!

There is no consensus about which therapeutic approaches work best, but various meta-analyses of scientific studies (e.g. Wampold et al, 1997, 2002) have concluded that no one approach is more effective than any other. There seem to be other factors which influence whether therapy is effective, e.g. the therapeutic alliance between therapist and client, the client and their situation, their readiness for change, other support systems, etc.  And then there are those things that the therapist brings. Wampold’s Qualities and Actions of Effective Therapists lists fourteen qualities of effective therapists. I’m not convinced I fulfil all of these, but I do constantly strive to improve, and what I learn from the amazing clients I work with helps me to do this. I particularly like number 10 – for me, hope and optimism are a huge part of therapeutic change. As far the rest, I’ll leave it to our participants to judge!

  1. Effective therapists have a sophisticated set of interpersonal skills.
  2. Clients of effective therapists feel understood, trust the therapist, and believe the therapist can help him or her.
  3. Effective therapists are able to form a working alliance with a broad range of clients.
  4. Effective therapists provide an acceptable and adaptive explanation for the client’s distress.
  5. The effective therapist provides a treatment plan that is consistent with the explanation provided to the client.
  6. The effective therapist is influential, persuasive, and convincing.
  7. The effective therapist continually monitors client progress in an authentic way.
  8. The effective therapist is flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate progress.
  9. The effective therapist does not avoid difficult material in therapy and uses such difficulties therapeutically
  10. The effective therapist communicates hope and optimism.
  11. Effective therapists are aware of the client’s characteristics and context.
  12. The effective therapist is aware of his or her own psychological process and does not inject his or her own material into the therapy process unless such actions are deliberate and therapeutic.
  13. The effective therapist is aware of the best research evidence related to the particular client, in terms of treatment, problems, social context, and so forth.
  14. The effective therapist seeks to continually improve.