[00:00:02] Speaker A: Welcome to the Emerging Minds Podcast.
Hi everyone, my name is Jackie Lee and you're listening to the Emerging Minds Podcast. I'd like to begin by recognizing the traditional custodians of the lands on which this podcast is being recorded. The Kaurna people of the Adelaide Plains. I pay my respect to them, their ancestors and elders, past, present and emerging, and to all Aboriginal and Torres Strait Islander peoples joining us today. And I also acknowledged that sovereignty was never ceded. This always was and always will be Aboriginal land.
Today's episode is one from the archives. A conversation with speech pathologist Kate Headley about how supporting children's communication skills is central to supporting their wellbeing, especially in cases of complex trauma. Kate has worked extensively across the disability sector in New South Wales as a therapist, educator, clinic clinical supervisor and service manager. At the time of recording, she was working as part of a multidisciplinary team at the Links Trauma Healing Service in Newcastle, delivering trauma focused interventions to children living in out of home care. The strategies and approaches Kate explores in this episode align with the principles of neurodiversity affirming practice that we've explored in other resources.
They can be applied beyond cases of complex trauma to benefit any child who presents to you with communication differences. Thank you for listening. We hope you enjoy this episode.
[00:01:33] Speaker B: Hi Kate, and welcome to the Emerging Minds podcast.
[00:01:36] Speaker C: Thank you. Hi.
[00:01:37] Speaker B: So I just wondered if, to start off with, for those who aren't familiar, if you could give a definition of what is complex trauma.
[00:01:46] Speaker C: Complex trauma refers to exposure to multiple traumatic events and there are often sustained over a period of time and generally are very interpersonal in nature.
So that includes all forms of abuse, including neglect.
And if those experiences occur in childhood, they can be incredibly impactful because it's such a developmentally sensitive time for children, particularly in regards to their neurological development.
And so, you know, we really are focused in the Links Trauma Healing Service on understanding what experiences children have gone through across their childhood years.
[00:02:39] Speaker B: And then I did also want to ask you if you could help us understand what is the role of a speech pathologist? I understand it's really a multidisciplinary team and it's a holistic service approach. So what is the role of a speech pathologist in addressing complex trauma within the service you work?
[00:02:58] Speaker C: Yes, so I guess it's really very multifaceted. So as you said, we do work as that holistic kind of service around a young person, but obviously we also have our own clinical kind of domains and areas of specialised skills. So for me, the role has kind of been split across working with individual children and young people.
And we have endeavoured to ensure that the communication skills of all the young people who come through our program are screened.
And that's because overwhelmingly, the literature shows that, you know, approximately, if not upwards of about 80% of children who experience complex trauma will have difficulties with some of their language, literacy and communication skills. And yet the vast majority of those young people, those difficulties don't get identified for them because often they've developed really adaptive coping skills which can mask those difficulties. Perhaps they're having high levels of school disengagement. So the difficulties with achieving academically identified as being related to the school disengagement, but maybe not some other underlying difficulties.
It could be that because they're moving between different carers, they don't have adults in their life who are getting to know them well enough to recognise the level of difficulties the young person's having.
So there's lots and lots of different reasons why often these support needs aren't being identified for children and young people.
So a big part of my role is touching base with all the children, young people who come through the program and identifying whether they do have support needs around their language and communication.
And then, more holistically, another key part of my role is ensuring that the mental health interventions that the children and young people are accessing to address their complex trauma is actually accessible to them from a language point of view, because obviously, we've got this real dilemma for all medical and allied health professionals in working with children who have communication difficulties.
They still absolutely need to be able to access the right interventions. But if those interventions are highly steeped in talking therapy or, you know, language and communication, how do we make that accessible so the child still gets the benefit of that intervention?
So some of my work in the team would be around consulting with the mental health clinicians around individual cases and the different interventions that the mental health clinician is using and delivering with a young person and working together to go well, how do we simplify the language associated with that without losing the intent and the effectiveness of the intervention?
And often that means maybe making a task a lot more visual for a young person, or making the task something that the young person can participate in through doing rather than talking. And sometimes that even looks like I might do joint appointments with the mental health clinicians and a young person, and prior to the appointment, the mental health clinician and I will have collaborated around what the mental health clinician's goal for the session is, and I might do some work in the background as to, well, what if, you know, we had a PowerPoint slide and we presented it like this and we made it a sorting task or whatnot. So. So I'm kind of bringing that expertise on how we simplify the language and more visually mediate the language so that the mental health clinician can still deliver the intervention that's needed.
And then I guess, finally, I would say my role involves a lot of advocacy work as well, a lot of advocacy and education.
So that can look like anything from helping caseworkers and maybe teachers and carers and mentors and support staff around a young person to really come to understand that the young person is having difficulties with their communication skills and understanding the service system and knowing how to link the young person with the right supports.
And also tasks like supporting my organisation, my employer, as a broader service with ensuring that the information that's, say, on our website, the information that's in some of our documents for consumers, is accessible for them.
Once you understand how complex trauma impacts communication skills, what you then go on to understand is that holds across a person's lifetime.
So sometimes, you know, I'm really mindful that I'm working with carers who've also experienced complex trauma themselves.
And consequently, you know, simplifying written information that we provide as a service, adding visual supports to information we provide as a service, is actually just going to be helpful and good practice for all of our service users. Be them specifically the child in front of us, or be them the team of people around that child.
[00:09:29] Speaker B: Yeah. Wow, that sounds so important and certainly helping me to see how valuable that role of speech pathology is and the need for sort of a multidisciplinary approach. And this makes me wonder how many children and adults are sort of out there struggling with this when they go to access services, because there isn't speech pathology there or an understanding of the impact of our adverse experiences on communication.
[00:10:02] Speaker C: I really do feel very passionately that it's huge.
And I think sometimes, generally people who are working in qualified positions because they have the skills and the expertise to understand more formal language and more technical terms, and I think sometimes we even overestimate what simplified information is.
And I think we don't think to check in with people in a way that feels comfortable for them to let us know that they haven't quite understood something or they didn't really understand that consent form we gave them, or, you know, all that kind of stuff. So, like, I often find in talking to carers, and these are just skills I've developed over the years. But, you know, I know that for some people to suggest that they're not literate can drive a sense of shame, and I would never want to do that to somebody. So to me, it's not really helpful to ever say to a carer, now, are you literate? You know, can you read? Can you read this note?
However, what I might say to a carer is something along the lines of, now, you know, are you somebody who likes to read things or are you more someone who likes someone just to tell you something, or would you rather watch it in a video? What's your kind of style?
And in that more casual approach, often people then will start a conversation where they say, oh, yeah, no, I'm not much of a reader, I'd much rather you just tell me what it says, or, no, that's cool, if you've got a video, that'd be great.
So I think there's ways that we can support people to comfortably let us know whether information has been accessible to them or not.
[00:12:07] Speaker B: Yeah, that sounds like quite a simple approach that anyone could start to implement, just to account for the fact that there may be a variety of communication needs in any family, I suppose, anyone that we encounter.
[00:12:19] Speaker C: Exactly, yeah.
[00:12:20] Speaker B: So. So let's shift now to some of the questions that we had around trying to sort of really understand what goes on in a session with a child.
As a speech pathologist and working in a complex trauma service, I wonder if we could just sort of imagine when you're first meeting with, say, you know, a 10 or 11 year old and glad to know, you know, what are you thinking about? What are you most mindful of in that first meeting and session with the child?
[00:12:50] Speaker C: Yeah, so I love the fact that you've said a 10 or 11 year old, because I must admit that is a big bulk of my referrals, the children around that age. And I think it speaks a lot to the fact that from a speech pathology point of view, when children enter the upper levels of primary school and the curriculum really increases in complexity, particularly around literacy expectations, that is often sometimes when people start to realise that children are having some more difficulties. So it is really common for me to be working with children around that age group, and for me, the absolute primary priority that I have around that first session is transparency, because I'm critically aware that it is highly likely that this child has had experiences through their life where they have experienced maltreatment and relationship ruptures from adults in their life. And so I think you know, from the get go, I'm really always trying to acknowledge that if that young person's even prepared to meet with me, that shows a real character of bravery and resilience that I'm always really acknowledging of and appreciative of in children.
And I think some of the ways that I try to build that transparency from the get go is that before I meet with a young person, I if at possible, and it's not always possible, but if possible, I like to send them a little introduction letter or a little introduction video.
[00:14:42] Speaker B: Right.
[00:14:44] Speaker C: And what I'm trying to do there is just to, I guess, first of all make sure that they feel a sense of control, that they understand that they've been referred to me, that they understand what I'm going to ask of them in that first session, that I've started to build a little bit of familiarity, they've seen my face, and then what that's going to do, as well as, I guess help their understanding and their sense of control, is also hopefully reduce the anxiety that they bring to that initial session.
So it's going to be more comfortable for them and a nicer experience.
But also anxiety impacts our ability to communicate effectively. So. So I'm more likely to get a better representation of the young person's skills if they're not feeling as anxious when they come into the appointment.
And so in everything I do in that first session, my real focus is on transparency. So I want that young person to understand why they've been referred to speech pathology. And that is often a really, really foreign concept for children.
And, you know, I think there is a general public perception that speech pathologists work with people who can't pronounce their speech sounds properly.
And nearly every young person I work with will actually say to me, I don't know why I'm here.
And they can acknowledge that they can talk normally and that their speech sounds fine.
And so I always provide the young person with some of that education like we were just talking about earlier, about how having difficult experiences when you're a kid can impact the way that your brain's learning different skills.
And what's really remarkable about that is that when I start to give practical examples in the words that other children have fed back to me, the number of children who kind of light up and they suddenly feel so validated and they'll start to say things like, yeah, that's me, that's what happens to me. That's, yeah, I get that too. So they might be even descriptors like you know, I know some of the children I work with, they tell me that sometimes when the teacher's talking heaps in the classroom, it can be really hard to tune in and follow what the teacher's talking about.
And kids will go, yes, like that happens to me. And you can see this real almost relief that it is a shared experience that they have with somebody else.
So I do try and build the transparency with that introduction letter or video.
Then I reiterate that same information, continue to build that transparency. So, you know, as I meet with them, I might again say, oh, you know, did you get my letter? Did you get my text message?
Thanks so much for coming. So, like I said in the letter, the things that I thought we could talk about today are. And we might jot them down in a list or pop them on some post, its, put them on a whiteboard so that all along I'm building that trust and transparency with the young person and I know that there's some boundaries for that session.
[00:18:25] Speaker A: In this episode, you've heard Kate discuss the benefits of working as part of a multidisciplinary team. This idea of a holistic service approach is something we're very passionate about at Emerging Minds. We believe that to truly improve child mental health outcomes, workforces must be able to operate within a comprehensive and coordinated system of care. Our vision for this new mental health system is explored in a recent three part webinar series intended for both organisational and systems leaders and practitioners with an interest in workforce development. It looks at the needs of the workforce, the role that organisations and sectors can play in a comprehensive system and the research and data that back up this new way of working. If you want to join us in building adaptive workforces and systems that can meet children's and families needs, follow the link in our show notes. Now back to the episode.
[00:19:21] Speaker C: That first session for me is, yes, they understand why they've been referred.
Crucially, they understand the confidentiality and privacy boundaries, 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 responsibilities, 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.
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 favorite 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 kind of my main focus whenever I'm having that first engagement with a child about that age.
[00:22:12] Speaker B: Yeah, that's really clear. And I'm wondering, I mean, does it sometimes take more than one session?
I mean, 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?
[00:22:32] Speaker C: Surprisingly, it often can even happen in that first session. Okay, you're right. There are some young people who 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 se, 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. 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 and 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 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 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, okay, so I can see there's heaps of stuff that'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 say no to that offer.
And then what we might do then if we're 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.
Intervention.
[00:26:50] Speaker B: 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?
[00:27:06] Speaker C: 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 a goal.
So I predominantly, as a therapy outcome measure, use goal attainment scaling in my work at the moment with the Lynx 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, young people I've worked with, they just really love that really visible learning to the point that, you know, 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 my 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.
But then sometimes I also want to hear from children outside of the progress towards the goal, how are they 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 engagement is 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.
[00:31:44] Speaker B: Yeah. 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?
[00:32:10] Speaker C: 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 in 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 will 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.
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.
[00:35:23] Speaker B: And so thinking about the service that you work in, and obviously it 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?
[00:35:46] Speaker C: So one of the challenges of setting up a system from scratch, as we have done with the Lynx 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 LINCS Trauma Healing Service, at the point of being accepted into the program 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. The other process stream is sometimes based on just 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 traveling 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 I know another one, 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, what are some of the
[00:39:10] Speaker B: other difficulties that you identify in children
[00:39:13] Speaker C: do identify that there are children with, you know, 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 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 team 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.
[00:41:03] Speaker B: Thank you. You've been explaining things so clearly and been so generous with everything that you've shared, and I'm just wondering if, is there anything that we haven't touched on that you would also like to share before we wrap up this conversation?
[00:41:19] Speaker C: 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, think about that first 1000 day data and information that 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.
I do some work with, working with other speech pathologists and I guess sharing what I've learned 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 lifespan framework to our thoughts around complex trauma.
Although the bulk of information at the fore is really focused on children, we need to think about how does this impact people across their lifetime.
[00:43:29] Speaker B: Thank you very much for your time today, Kate. I really appreciate it.
[00:43:32] Speaker C: Thank you.
[00:43:37] Speaker A: Thank you for listening. If you enjoyed this episode, please give it a rating and review on Spotify, Apple Podcasts, or wherever you're listening. And make sure you're subscribed so you never miss an episode. We'll be back in your feeds next month with strategies for incorporating children's voices into processes and practice. But in the meantime, you can find over 200 episodes exploring infant, child and family wellbeing on our website. So dive in and we look forward to connecting with you again soon.
[00:44:06] Speaker C: Visit our website
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[00:44:25] Speaker A: Youth Mental Health Program.
