title: Factors influencing indirect speech and language therapy interventions for adults with learning disabilities: the perceptions of carers and therapists.
abstract: BACKGROUND
  The working context for speech and language therapists (SLTs) delivering interventions to adults who have a learning disability has changed following the reorganization of care provision from hospitals to the community. Consequently, SLTs often deliver their care within a social model of disability through indirect intervention in collaboration with carers. However, there has been little research into how this approach works in practice.
  
  
  OBJECTIVE
  To gain insight into the working context by identifying the key factors that influence indirect SLT interventions as perceived by SLTs and by paid carers from a range of service providers. To explore the implications of the results for the delivery of indirect SLT interventions and provide direction for further research.
  
  
  METHODS
  Semi-structured interviews were used to collect data from an opportunistic sample of five SLTs working in Community Learning Disability Teams (CLDTs) and 12 carers from residential and day care services who had had experience of working with SLTs. The data were analysed inductively using a grounded theory framework.
  
  
  RESULTS
  Two broad themes emerged for SLTs: roles and expectations, and changing carer behaviour through training. The key themes for carers were roles and values, awareness of communication needs, and motivation and opportunity to implement interventions. Four broad factors are suggested as having the potential to influence indirect interventions: diversity in the working context; possible conflict between the guiding values of SLTs and carers, particularly residential carers; collaboration and support for implementation; and SLT doubts about the effectiveness of formal carer communication training.
  
  
  CONCLUSIONS
  The results add to the evidence that the delivery of indirect speech and language therapy interventions to people with learning disabilities is a complex activity demanding specialist skills from SLTs. The findings suggest that these should include expertise in professional collaborative and relational skills, and training methods and strategies. Action research is needed to test the validity of the findings and document their impact on indirect interventions in day-to-day practice. More research is needed on the effectiveness of modelling or demonstration as a training technique with carers.
authors: Forest CLDT, Belle Vue Centre, Cinderford, UK. judy.graves@glospart.nhs.uk
authors: Judy
authors: J
authors: Graves
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001364:Awareness; D002983:Clinical Competence; D003153:Community Health Services; D004496:Education, Continuing; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007808:Language Therapy / Q000379:methods / Q000523:psychology*; D007859:Learning Disabilities / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010348:Patient Care Team; D012380:Role; D013070:Speech Therapy / Q000379:methods / Q000523:psychology*