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ACQ Volume 11, Number 3 2009 147
pathology narrative work may assist with the integration of
client’s traumatic experiences and with self-reflective
information processing. Psycho-education given to the carer
and key stakeholders about modelling emotional language
and how to explicitly label the strategies used to regulate
emotions can assist with generalisation.
Competency phase of intervention
When the young person has reached the competency
phase, they are in the space to participate in more
developmentally and academically focused speech
pathology therapy. Speech pathology can work to enhance
pro-social interactions through development of social
information processing skills. There needs to be focus on
pragmatics, social skills and problem-solving as these
children have had a history of poor pro-social interactions
modelled to them. Psycho-education to carers about the
importance of modelling new skills will assist with
generalisation to other contexts.
Therapeutic progress with this population can be
slow because the child can continually move across the
continuum of attachment, regulation, and competence
phases. Many factors have an impact on how effective
intervention can be including the number of placement
changes and the age of the child. As we know early
intervention is best; however, intervention can also occur
with adolescents working with their environment and their
strengths.
Conclusion
This study showed that the speech pathology service was
valued by the mental health clinicians. They acknowledged
and understood the importance of communication and the
implications of communication impairment in the recovery
process of the client. However, not all clinicians found it easy
to modify their practice and communication style; or
understood the co-morbid nature of communication and
mental health problems, indicating the need for ongoing
speech pathology consultative liaison and psycho-education.
All clinicians agreed that clients identified as having
communication impairments should receive the service of
speech pathology intervention within the complex trauma
treatment team, thereby enhancing communication skills and
positive psycho-social functioning.
Acknowledgment
The authors wish to acknowledge Dan Sullivan, previous
evaluation and research coordinator, for his assistance with
the National Ethics Application, Meredith Waugh for her
assistance with editing, Narelle Anger for her supervision,
Evolve Therapeutic Services, CYMHS and the Mental Health
Research Committee for their support.
References
Allen, R. E., & Oliver, J. M. (1982). The effects of child
maltreatment on language development. Child Abuse &
Neglect, 6 (3), 299–305.
Bilaver, I., Jaudes, P., Koepke, D., & George, R. (1999).
The health of children in foster care. Social Science Review,
73, 401–417.
Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005).
Developmental language disorders: A follow-up in later
adult life. Cognitive, language and psychosocial outcomes.
Journal of Child Psychology and Psychiatry, 46, 128–149.
Coombs-Orme, T., Chernoff, R., & Kager, V. (1991).
Utilisation of health care by foster children: Application of a
5. relational engagement
6. positive affect enhancement
These six goals are incorporated into the attachment,
self-regulation, and competency (ARC) intervention
framework. ARC intervention involves systemic, milieu-
based interventions with an emphasis on understanding
and intervening with the child in context. It incorporates
individual, familial and systemic changes (Kinniburg et
al., 2005). The mental health workers in the complex
trauma treatment team utilise a bio-psycho-social model
of intervention incorporating the treatment goals within the
ARC model. Speech pathology was able to contribute and
work within this framework of intervention at each level, as
outlined below.
Attachment phase of intervention
Establishment of safety is essential during the attachment
phase of intervention. Safety for the child incorporates both
their surroundings and feeling safe within themselves
(Kinniburg et al., 2005). When providing intervention to a
child with communication impairment it is vital that the
mental health therapist understands the communication
needs of the child. Speech pathologists can assist by
providing education about the child’s language level to the
clinicians so that the child is able to fully understand and
participate in mental health interventions. Visual resources
outlining daily routines, timetables, and calendars of events
can assist with the establishment of safety and predictability.
Provision of psycho-education to the carers about the
communication abilities of the child and the impact on
social-emotional functioning can support enhancement of
empathy the carer feels for the child and assist to foster the
attachment relationship.
During the attachment phase, accommodations for
communication difficulties may also include establishing
a common language of behaviour management to assist
with consistent limit setting that is predictable across
environments. The speech pathologist can provide the carer
with insight into the child’s behaviour and interaction style by
discussing implications of language results. For example, the
child’s perceived disobedience may be due to an inability to
understand the instruction. Psycho-education to the carers
and key stakeholders about the strategies the child may be
using to mask or copy with their communication difficulties
is often helpful in getting others to understand the reasons
behind the child’s behaviour.
Self-regulation phase of intervention
The regulation phase incorporates working towards being
able to adjust arousal and return to equilibrium (Kinniburg et
al., 2005). Children with a history of maltreatment have
reduced self-talk to regulate their emotions and their poor
high-level language impacts on their range of emotional
vocabulary necessary for self-talk and self-regulation.
Emotional literacy involves establishing the underlying
language processes to support emotional vocabulary
development. This supports the child to be able to name and
more deeply understand the expression and behaviour linked
to a full range of emotions, not just the stereotypical feelings
which are happy, sad and angry but also feelings related to
anxiety, grief and loss. Enhancement of emotional language
incorporates the use of visual plans to identify, describe,
name, and connect behaviour with emotion. Connecting
affect to behaviour can also be done through use of
therapeutic social stories, drawings and role plays. Speech