Inequality

Inequality was something that I noticed first as a student on placement, but has been a persistent theme throughout my work to date.

As the human race is made up of individuals, it makes sense that there are differences between everybody. People have different abilities and strengths, and this is what makes life exciting. It’s one of the reasons I love my job – adapting constantly to best support different clients rather than trying to foist a ready made program onto all. That's not satisfying for anyone.

Demographic difference

One of the things I’ve found hardest to experience is the inequality between the children on my caseload. I work in two London boroughs that have areas of extreme wealth and areas of extreme deprivation: Lambeth and Southwark have some of the highest rates of poverty and domestic violence in the country. I deal with clients from a huge range of backgrounds – from children in huge comfortable homes with many luxuries, to those living in very unpleasant and frightening settings. Some have stable, supportive families, while many have suffered loss, neglect or trauma from a very young age. I want to take the latter children home with me when they are tiny, as the impact of deprivation during the formative years has become so apparent.

I find it hardest working in my mainstream schools, with the year 4-6 children. By this age, the difference between them and their peers is so pronounced.

Different abilities.

At age 2-3 we see children with a language delay. We run parent-child interaction groups, and this can remediate these effects. For many children, this input is enough, their parents learn to facilitate and support their language development, so they catch up with their peers. But for others,  by age 6, children are struggling to learn to read and write at the same rate as their peers; their attention and listening skills are often delayed and academically they are already falling behind. We are training staff to run language enrichment groups, offering blocks of therapy to target specific skills such as understanding concepts and key word instructions; narrative input to develop receptive and expressive language; attention and listening groups to help them develop self-help skills in class. Again, this supports some more children and allows them to achieve their potential. 

But for some children, this isn't enough. By 8 or 9, the gap between them and their peers is huge. These children are academically unable to access the curriculum without a lot of differentiation and adult input. Socially, their language is immature and they find it hard to mix with their peers and make friends. They might not be very good at turn-taking, and find it very hard to problem-solve issues in the playground  and resolve conflict independently. Personally, their self-esteem is rock bottom. They have little to no confidence in their abilities. They are give up trying because every day in class builds on assumed knowledge they didn’t acquire in previous years. They miss out on the lessons that they may excel in that could build their confidence - PE, music, drama and art - because they are constantly in interventions for maths and literacy to catch them up.  I’ve noticed children regressing in daily living skills such as getting dressed for PE because they have become so accustomed to having 1:1 with them all the time.

In a lot of these situations, what makes me so heartbroken is that with a different experience at home these children wouldn’t be in the situation they are in now. And I have felt lost trying to work out what my role is in supporting them. I don’t want to take them out of class as they are already out all the time. I try and train their TAs and increase expectation to develop their independence, and offer pre-teaching vocab programs that can be done before lessons to help them access more of it. I model strategies in class that can help them continue to follow the lessons – using visuals and teaching the children to identify their own needs and plan their time. 

A lot of my motivation is that I want to show these children that I care and I will keep coming to support them and trying new things until I find something that works because many of them haven’t had that consistent cheer-leading from an adult in their lives. My mum constantly reminds me that I am making a difference by being a role model who is nice to them, who smiles at them and listens to them. And I know that IS important in their lives, and that I remember so clearly adults from my childhood who did that for me, and the little things they said that gave me the resolve and confidence to believe in myself and achieve as much as I have today. But I want to be MORE than that too. I want to fix these children. 

Inequality of professional experience

This is where my anxiety about the final area of inequality seeps in – the inequality of the professionals these children interact with. These unlucky lot are lumbered with me, an NQP,9 months out of uni. They could have had someone with years of experience and specialism in the field. That person could have made better choices than me, chosen better targets, known of better interventions.

I was struggling on this topic in supervision, not knowing where to start in terms of targets for these children, worrying I was letting them down. My supervisor pointed out that yes, there are many potential target areas. And in a way, it doesn’t matter which I work on. They have a range of needs, and targeting anything and helping in that area will make a difference. I can’t fix everything, but I can focus on the little things where I can effect change. 

Since this revelation, I have had more confidence to know that I am supporting in the right way, that I am not letting anybody down. I continue to turn to my team for advice and support, and love to hear about what others are doing so that I can incorporate new interventions into my own practice. This is how I even out that inequality of experience.

And on days when it does all feel too much and I’m just trying to keep my head above water, I just focus interacting positively with my young caseload, modelling good communication and listening to them, because if that’s all I do some days, that’s OK, because that’s what they need – and because on other days I do a lot, lot more.

7 months in...

I’ve now been working as an NQP Band 5 SLT for exactly 7 months. It is also exactly 11 months since I was offered the job – this time last year I was writing the application form, preparing for the interview and not thinking I had a flying chance at getting a job in the exact areas I wanted to work in 10 minutes down the road from me. But get it I did – so SLT students, apply early and keep positive! I was worried it would go against me that I wasn’t yet qualified and needed to wait for my HCPC etc. However, it turns out NHS recruitment processes are so slow that I actually started in the same week as someone else from my interview day who was already qualified and just waiting to start… references, CRB, occupational health really put the brakes on things!

Family, friends etc. have been asking if the job is what I expected. I think  the answer is yes – I don’t recall feeling shocked at any point so it must have been what I was expecting! There are a few things that placement didn’t prepare me for – the emails! The meetings! The phone messages! How are there so many?! – but overall I felt set up and ready to go. Learning the ropes obviously takes a bit of time, but settling in to any workplace you need to find out where the photocopier is, where to find the code for said photocopier,  how to navigate the tricky office politics of a “hot desking” system where some of the “hot desks” (which allegedly anyone can use) are actually not really available  so it is hard to tell if you are going to offend your new colleague by sitting in 'their' place.

Another contrast to placement was discovering that no one was interested in looking at my session plans or even wanted to know what I was vaguely doing in said sessions. “You’re qualified, we trust you!” my manager announced. Daunting. What if no one watches me for years and it turns out I’m going wildly wrong?! I could do anything I like in those sessions! Having to rely on gut instinct and  trust my knowledge and degree has been really important. Also, discussing my ideas with anyone who will listen – particularly other band 5s during peer supervision - has helped to reassure me that I’m doing things right. Peer supervision is also good to find out new ideas and get to know about resources I didn’t know existed.

I am spoiled in my setting as it is a huge team (one of the biggest in the country I believe) and as a result there is a massive pool of resources - both on the computers and also in clinic and the resources cupboard. Taking the pressure off having to search for or make anything has definitely helped me in the first few months. I am going to be brave and say it – I am an SLT and I hate laminating. Making resources is not something at which I excel. So not having to use that part of my brain is definitely a plus as with everything else I am juggling I think it would have been a step too far.

I work in early years clinic and mainstream primary schools. I love having a split post – the experience of each helps the other (I know how/when to transfer into the schools service; I have a better awareness of what the children being transferred to me may have received already). I also move around quite a lot – I have a main base but work in a different clinic and can hot desk (although this can be risky, as outlined above) at other clinics near my schools to write up notes at the end of the day on my way home. I love not being in the same place two days in a row – when I do have a tough day it’s good to have physical space before returning there, and having time to reflect on the experience before I do go back! It does require some extra organisation to check I have everything for the next day, but I’m not really a resources heavy therapist anyway, and I think it’s good for my development to learn to adapt to use available resources instead of being thrown if I don’t have something specific for a certain session. The weeks also go by quickly, and I get to mix with different therapists (and other healthcare and educational professionals) each day as I move around.

Although I’ve had a couple of low periods, where I feel that I’m fighting a losing battle and not making the difference I would like, overall I feel energised and positive about work. I don’t mind getting up in the morning. I feel well supported at work through line management and supervision, and informal support from colleagues, which I think makes a difference. I’m naturally reflective anyway after years of writing reflective essays both in my undergrad and of course during the PGDip, but I do find it more important during these “down” points to reflect on how far I’ve come. Last week I had a school visit to see one of my clinic caseload in his nursery class. Afterwards I met with the SENCo, and also caught up about a few other children I work with who attend that school. I came out 45 minutes later and realised I’d just given advice about SA2s, IEPs, referring to other professionals, long term prognosis, how to support these children best in the classroom – without preparing in advance, because I didn’t need to. That information is fresh in my head now, and I’m confident to share it. 6 months ago I didn’t even know what an SEN panel was. That realisation, along with the fact that the teacher would turn to me for that advice, really helped me see how much I’ve learned in a relatively short space of time.

How are you other NQPs getting on in your positions? Would love to hear about the highs and lows and any tips and tricks you’ve picked up along the way!