Support from management and BSA helped both adults and young children top get better therapy. Alison McLaughlin and Charmaine Burrow summarise the developments.

Two years ago, our service was given the opportunity to focus on and develop our service for fluency clients of all ages. The 'fluency team' was created. We were three enthusiastic speech and language therapists given the time to look at the needs of our service, and the needs of the wider speech and language therapy team. We looked at local models of service delivery and developed our care pathway.

For many years we have been grateful to be allowed to encourage early referral and also to be able to prioritise our initial assessments and interventions for children. We have been particularly advised by the BSA's preschool dysfluency campaign and are grateful for BSA's guidance, resources and research findings.

In January 2006 we invited adult clients to attend a monthly evening group, initially for four months. As of now (January 2007) our group has gone from strength to strength, grown in size and continues to meet monthly.

We have enjoyed the much less formal way of engaging with our clients and been inspired by their willingness to be involved in the group activities and the progress they make.

Our meetings include group discussion and the opportunity to practise strategies as well as sharing talents and skills.

In one session we asked everyone to think about their stammer in a different way. A variety of craft materials were made available and the group was asked to use them to represent their stammer. This idea evolved from the interesting research by Dr. Trudy Stewart and her work using art with adults who stammer (1997).

Here are some of the pictures produced and some reflections made by the group members.

Mussarat In my picture the flowers represent my belief that I am a very confident person inside, but then it's this fear more than my stammer that gets in the way inside of me. I chose this orange tissue paper and scrunch it up as a ball because I feel that this orange ball, which feels so rough, is like my feelings about my stammer. It represents my fear, my embarrassment. I am frightened at the thought of stammering. As I push myself through this ball, I face a big black block which is there because of this ball of fear. I have to push through this block. The sky-blue paper which I have put underneath, above the block, shows that I will have to fight with my feelings of fear and one day I will say to myself "I can do it!" But before that I chose to put on a purple felt above the sky-blue paper which feels so smooth. This shows that I am doing my best, trying very hard and things are going smooth just like the purple felt. Hopefully one day I will get rid of the black block, the fear and the hesitance, that still remains inside of me, completely. The purple felt will shrink in size too. The shredded paper at the end shows that I can then celebrate what I have achieved - My Confidence! And control over my stammer! "Control your stammer, don't let your stammer control you!"

Rachel The feather means I'd like my speech to be light and fluffy, the netting is hiding the clouds behind it showing I'm scared. The pink shredded paper shows sometimes my speech is muddled or fuzzy and it's covering the words I can say smoothly - these are shown in silver and bright orange. I chose the pink and blue colours because they are soft as well as "cool". To stammer always makes me angry Scared of what people think Annoyed that I can't pronounce each word If only they knew how it felt... (Full poem below)

Michael My name is Michael, I have been stammering most of my life from the age of 8 years up to the present, I am now 47 years of age. I don't think it is a bad stammer. The chart shows how it feels for me when I stammer. The blue shows about average - an average stammer. The red is when I feel embarrassed when I stammer a lot, when I'm talking to people. The orange, again I feel as if I stand out because of my stammer. The blue is a rough material and can be uncomfortable. That is how I feel, rather uncomfortable when I stammer. The green is bright and that shows how I feel on a good day when I can control my stammer and speak slowly.

Marilyn This represents my stammer. The ribbon is the tight feeling in my stomach before I speak. The black is the fear, anger, ahead of speaking. The flowers represent my goal, success. They inspire me. The stickers are the letters, sorting them out in my head, they are all flashing and I sort them out. In the future I want to loosen the knot and move the black to show more of the flowers. The black will always be there, I know that. I want to work on moving the black and the ribbon to the side and let more of the flowers show.

Paul, we discovered is an excellent photographer and he kindly produced all these illustrations including our Christmas group photo.

I think you will agree we have a creative membership. We hope you can see how considering stammering in a different way such as art can be both enlightening and an excellent way of sharing with others how it feels to stammer that often words alone cannot achieve.

If any speech and language therapists out there would be interested in knowing more about our service we would love to hear from you , and to anyone reading this who lives in the Burnley, Pendle and Rossendale area and would like to attend our monthly meetings please contact us. We alternate our meetings in our new health centre facilities in Burnley and Pendle.

Charmaine Burrow & Alison McLaughlin (Speech and Language Therapists, East Lancashire PCT) Tel: (01282) 644360
Or email us: Charmaine.burrow@eastlancspct.nhs.uk, Alison.Mclaughlin@eastlancspct.nhs.uk

References
Stewart, T., and Brosh, H. (1997) The Use of Drawings in the Management of Adults who Stammer. Journal of Fluency Disorders 22, 35-50.

From the Summer 2007 issue of 'Speaking Out', pages 10-11