FEATURE: HOW I

How I meet my inf

What motivates you to ask questions and seek answers? How do you develop your own information literacy and encourage it in your clients and colleagues? What happens when it all gets too much? Editor Avril Nicoll talks to speech and language therapists Katie Cullinan, Rebecca Matthews, Kerry Wreford-Bush and Alison Hodson to find out more.

s speech and language therapists, we have a huge need for information. This may be about the client in front of us, the prevalence of a communication impairment, how to empower individuals and families, the influence of political context on practice, health and safety, approaches to assessment, caseload management, fixing computer problems, organising transport to a conference, taking care of ourselves to name but a few. We also recognise our role in making good quality information accessible to our clients and their families so they can make informed choices about their care. At the same time, we are keen to get information out to other professionals who are in a position to make a difference to our clients by improving their day-today communication environments. While this is done largely through discussion or training courses, developments such as sophisticated software, colour printers, e-mail forums and DVD burners have given us all the opportunity to become prolific publishers of information. But there is a downside, and it affects everyone. Indeed, Wikipedia has a section dedicated to the term information overload, explained as a state of having too much information to make a decision or keep up with a topic (http:// en.wikipedia.org/wiki/Information_overload). The continuing increase in communication channels for search and dissemination (the internet, e-mail, mobile phones, instant messaging) is an obvious cause, but Wikipedia also points to the problem of contradictions and inaccuracies in what is available and the need to have the skills to compare and process different kinds of information. Learning more about our own information needs and how we meet them should therefore help us to: a) be more aware, focused and creative, and do more of what works in meeting our own information needs b) understand the information needs of our clients and our gatekeeper role c) improve our skills in liaison and training. In his comprehensive survey of research on information seeking, needs and behaviour, 26

Case (2006) says that information behaviour is a difficult area to study because it varies hugely from person to person and much of it goes on inside our head. Our information behaviour can include information seeking (a conscious effort to acquire information in response to a gap in knowledge), unintentional or passive behaviours (such as glimpsing or encountering information), and choices (like actively avoiding information). I asked four readers about their information behaviour. Katie Cullinan is a specialist paediatric speech and language therapist with UCLH NHS Foundation Trust working mainly with pre-term infants. I dont like not knowing something. I try to do my best by my clients, so its only fair that I should be up-to-date. My information behaviour has been shaped by the circumstances of my first job based in Stornoway on the Hebridean Isle of Lewis in the early 1980s. I was the only full-time speech and language therapist there, with just one very part-time colleague. While I had support from the team in Inverness and met up with them three times a year, I was relatively isolated in speech and language therapy terms. However it was a brilliant multidisciplinary experience as the team included educational psychologists, occupational therapists, physiotherapists, district nurses, teachers, and many more. Being isolated, I actually made more of an effort, and this has always stood me in good stead. Its ingrained in me to make links with relevant people because sharing ideas and information makes for a better service to clients. I have to know where to look, how to look and not be afraid to say I dont know something. In addition to the usual reading, I have always used the telephone for peer discussion and I still do that now, for example calling other therapists who work in this specialist

field for advice and discussion. I get a lot from ringing people up, although I also use the internet to look up journal articles and information sites visited by parents and can speak to the librarians at UCLHs Bloomsbury Health Care Library if I need extra help. Following a spell in Glasgow and an MSc in 1986, I moved to work in the Camden and Islington areas of London. The management style of people like Lena Rustin and Diana Moir offered fantastic opportunities for continuing professional development. I was able to go to important conferences, to change direction within the profession, to have 3 maternity leaves and be redeployed, always being hugely well supported and enjoying seeking new information. Islington PCT, as it is now, has very good staff retention so, even when I moved out of a speciality, I kept important links. There are support groups so staff meet on an area-wide basis, across acute and community services. This informal but organised opportunity sparks ideas from snippets of conversation, and enables problem-solving and networking. While the groups are primarily for support, a by-product is meeting people and deciding who is an appropriate person to approach with questions. Last year, University College Hospital decided to manage its therapists directly, so the speech and language therapists said goodbye to Islington PCT. However, I am continuing to attend management seminars offered by Islington PCTs Claire Topping where I learn more about a strategic, whole organisational approach to fostering and supporting an enquiring mind. Certain individuals have been a fantastic source of information. I work with Gillian Kennedy, a NIDCAP (Newborn Individualized Developmental Care and Assessment Program) observer and trainer in training. I had worked with adults at UCLH before preterm infants and was lucky to have somebody there if I needed to ask anything. It was like doing an apprenticeship! Sometimes, though, this is not available and you have to form your own networks. I cant imagine not wanting to seek information but I choose not to use e-networks other than e-mail. They are very useful for some people but I find them impersonal and prefer to have a conversation. I like being able to talk directly to someone so that you can seek immediate clarification if needed. I think many therapists feel confident giving advice to clients but are more reticent about sharing their expertise with peers. I am now, with experience, very keen to give information if I feel I have something to contribute. I put

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2008

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FEATURE: HOW I

forward suggestions for the joint BAPM (British Association for Perinatal Medicine) Neonatal Dietitians and Speech and Language Therapists consensus statement on weaning pre-term babies. A number of my handouts were used for discussion, which was very rewarding. I like the teaching aspect of my job, and train other professionals and students. I usually feel a bit apprehensive if it is a huge audience but enjoy it when it comes down to it. Such ventures produce different information needs, such as finding out how to put videos into PowerPoint! Speech and language therapists are encouraged to be enquiring. We never say well thats it then! We never know it all and learning really is life-long. Rebecca Matthews is an independent speech and language therapist in Reading and a PhD student. Unlike a therapist in a team who has more colleagues to consult with, I am reliant on library and internet resources. Independent therapists dont enjoy the same ease of access to literature as those in the NHS, but I have this privilege through being a PhD student. I also read regular publications like the International Journal of Language and Communication Disorders, Child Language Teaching and Therapy, Speech & Language Therapy in Practice and the Royal College Bulletin.

I belong to an ASLTIP (Association of Speech & Language Therapists in Independent Practice) group, which meets once or twice a term and is really invaluable for sharing and gathering information. As an example a member talked about a Michael Palin Centre course they had attended and shared their reference list; there were a lot of things from her information that could influence practice. I wasnt searching for it, but it came my way. Ive noticed information can often reach me in a rather random way. A lot of my information behaviour comes from my clients they inspire me. I find myself asking questions like: What does this mean? What have I got to be aware of? Is this an issue I need to investigate? I am another one of these people that Googles and finds the internet a great resource. When I qualified 25 years ago parents werent getting hold of information independently, but now I have to be on top of it as expectations have changed. When a controversial approach such as Dore (www.dore.co.uk) comes along I need to be able to give a professional view. I think it is important to review my opinions on such topics regularly through re-checking I have the latest information. Parents want to know whats going on. I use carbon paper to ensure families have a copy of case notes. My caseload is potentially a biased group but there is still a wide variation in communication need and income. What they have in common is a motivation to access help for their child. Their aspirations can be as humble as wanting their child to have friends. When people stand at playgrounds and talk with oth-

ers there is a lot of information exchanged. In my experience this isnt a middle class phenomenon, or associated with money, but a need driven by personal values and priorities. Parents of potential and current clients e-mail quite a lot and I want to answer competently. I suspect that many people use e-mail to make enquiries as a way of managing information before they make a commitment. Im sure I drive my family mad as switching off is a problem. My parents are however a great back-up team. They cut out lots of interesting newspaper articles, which often parents and people I meet in the course of my work have read too. It influences their perceptions of what they will get from me so, if I am aware, I can make a judgement. Recently I saw a piece on genetics and autism suggesting that it can be passed on by mothers; to me this wasnt new but it was being presented as the latest thing. Its clear to me that what appears in the press is what grabs the journalists eye. As a profession we need to think about how we can influence this. Some people such as Paula Tallal (Fast ForWord) are particularly good at recognising the need for the drip, drip of repeated publishing to get an idea known about. When I worked for I CAN, the Teach Speech project came out but the evaluation wasnt published in journals and publications more available to speech and language therapists and so a good idea died a quiet death. We also need to encourage people to publish negative information as it is helpful to know when something doesnt really work. My PhD was inspired in a round about way by my clinical practice. An 11 year old boy had been prompted to ask for speech and language therapy having seen and heard himself talking on MSN to his friends. I also wanted to do less driving to my clients and these two factors prompted a casual investigation into using videoconferencing. Now I am studying for a PhD at UCL looking into what other people have done with videoconferencing that I can learn from before investing in equipment and trying it out for real. Kerry Wreford-Bush is a speech and language therapist at Craig-y-Parc, a residential school in Cardiff run by Scope for children and young people with severe physical disabilities aged from 3 to 19. I work in a very small area of speech and language therapy so it is often nice to be part of something bigger, to be involved with other 27

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2008

FEATURE: HOW I areas to keep my professional knowledge up and not get stuck in my own world. I spend a lot of time on Google, not just finding information but making decisions on its value. I start with a broad, random search and refine the search terms as I read through the results. Once I find an article I google the source to check it out, and am particularly careful to investigate further if the content of one article seems to be at odds with the others. University reading lists on the internet are useful for seeing if a writers work is viewed as best practice within academic circles. Google really is a worldwide resource, another reason why checking the source of information is so important. There is a massive difference in research and practice between the United States and Europe, partly created by the way they are funded. While some of the US material is innovative, the different environments can mean it is not applicable here. On the other hand, when I heard at a study day about Botox being used in the salivary glands to decrease excessive drooling, I searched and found a large study is underway in Australia. I was able to get in touch with the researchers by e-mail and am now being kept up-to-date with progress. The stimulus for my information behaviour is often a client. When Intrathecal Baclofen was introduced to one student to try to reduce his spasticity, I did a lot of research on it. Because this included how the treatment was going to affect the student and his family, I gained a much more holistic view of the client, his family and their communication. Im quite a 3D visual learner. If I see someone live they pique my interest and need to seek more information. Even a discussion with somebody is more likely to lead me into 2D research, although occasionally reading something inspires me to go on a course. I read the Royal College Bulletin and Speech & Language Therapy in Practice. I especially like book reviews, and they definitely influence my buying behaviour. I prefer to hear what another therapist thinks rather than trying to work out from a catalogue description if it would meet my needs. I am really motivated if I have experienced something physically, and find I am more likely to remember it. An interactive DVD is very helpful, as are activities within articles where the author enables you to link experiences to theory. Following a suggestion to drink with my stomach pulled in, legs in the air and head back was a real aha! moment for me. Experiential learning is also huge for the children and perhaps that is what attracted me to the job. I have learnt so much about the link between environmental movement and communication through unplanned involvement in Power Rangers, a very early learner drivers course for wheelchair users. Coping with simple instructions for a physical movement is an amazing feat. This shows that sometimes going off at a tangent can be a great opportunity for finding information you didnt realise you needed. 28 Alison Hodson is an independent speech and language therapist who, in addition to her independent caseload, is employed directly for 8-9 sessions a week by a non-maintained special school in Cheshire. There are always things I want to find out about. A chance comment is enough to set me thinking so my family frequently catch me day dreaming. Generally a problem presents and I either need to find a solution or to know more about it. Recently the school I work at has doubled in size. Although my workload hasnt doubled it has increased, so I am looking at the capacity issue. Do we need someone else? Do I need to work differently? Do I need to accept I cant do as much? To discover things, I like to read a book. Sometimes I do an internet search and I also talk to someone who knows. When I find information, I need a sounding board to make sense of it and sometimes I even do this to myself in a mirror. Courses, Special Interest Groups and face-to-face discussion are all helpful. As I work as an independent therapist, the ASLTIP Yahoo! group has been a lifeline for me. Without it I would have been all by myself in speech and language therapy terms. I work with some brilliant teachers, inspired classroom assistants, independent psychologists and physiotherapists, but it is great to have the opportunity to talk to other speech and language therapists as we share the same language and clinical skills and can therefore get through the subject more quickly. However, where I go depends on the information I am seeking; if it is a behaviour problem it can be more effective talking to the teacher. When you work in the NHS you automatically get dissemination of information like Agenda for Change and updates on public policy. It is very easy as an independent therapist to lose touch with the public sector but it is important to seek out enough of that information to have some idea of where it is at. Some people very naturally make connections and analyse information quickly - you see this reflected in their work and the way they live their lives. I have always sought information and, when I went into speech and language therapy training, I was very good at regurgitating facts but not so competent at analysing or applying them. While I also had interpersonal strengths, the speech and language therapy course taught me critical thinking skills which I then applied to other areas of my life. I am interested to see that my children, now 14 and 17, have both been taught much more significant study skills such as mind mapping from an earlier age. This means that, instead of learning something, they know where to find it and they do something with it. This is great if a person has the capacity for good thinking skills but if they are hovering towards autism spectrum disorder or have specific language impairment, or even if they are just a more concrete thinker, they can no longer get by through learning facts. There is so much information out there that you get swamped if you dont know how to filter it. I realise I have become swamped when the words no longer make sense or my thoughts go round in a circle and dont change. I tackle it by removing myself from the situation and doing something else such as going to the gym. I sometimes seek someone else to talk to but find the best thing is to sleep on it as its always clearer in the morning. I will even scribble on a piece of paper overnight. Talking about something completely different takes the stress level down but accepting that it is not only OK but essential to leave the problem took me a long time to learn. I am heading towards 50 and am nowhere near retiring. I want to build on the first half of my professional life without just repeating it. I am beginning to throw away 25 year old articles that I havent read yet. I couldnt bear to do this before just in case I needed them one day. Computers have changed things though and I am thinking about scanning and storing key items to give me my study space back. I will continue to ask what do I really need to know? What is safe to ignore? What do I need to deal with? And how am I going to focus on it? Case (2006) concludes his survey with lessons from Information Behaviour Research, which seem to fit with the experiences of our interviewees. It is important that we are aware of them not only to understand our own information behaviour but to help us engage with clients and other professionals: a) Formal sources and rational searches are only one part of information seeking. For most of us, other people generally satisfy our need for information on a day-to-day basis. b) More information is not always better, and we need to develop strategies for avoiding information overload. c) If we cant see the relevance of information, we can miss out on something important. It can also be difficult to accept information if it means we need to change. Although this is not one of Cases concluding lessons, he refers (pp.270271) to studies involving nurses which suggest that getting the right people as change agents in a leadership position is vital. These people will be expert and confident information seekers. d)General information is not usually helpful we need it to be customised. e) Making all information available and accessible is impossible, so we shouldnt expect it. f) Information seeking is not linear; rather it is a dynamic process and our questions and needs change as we move through it. g) Information seeking is much more than solving problems, finding facts or making decisions it can also be about sense-making and creativity.
How does this fit with your own understanding of information behaviour? Let us know via the Spring 08 forum at www. speechmag.com/Members/. Reference
Case, D.O. (2007) Looking for Information A Survey of Research on Information Seeking, Needs, and Behavior. 2nd edn. London: Academic Press. SLTP

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2008