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172 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
Mental health
and anger management difficulties, to anxiety, depression,
developmental delays, and social withdrawal.
Frequently, these young people lacked the language
skills to verbally express their emotions and therefore
resorted to disruptive behaviour or social withdrawal. The
role of the speech pathologist is important in teaching the
communication skills to allow these young people to express
themselves. Speech pathologists also have a role to advise
those working with the young people of the best approach
to use when communicating with them.
My placement was spread across two distinctly different
CAMHS sites, the Port Adelaide community service and the
Adolescent Services Enfield Campus (ASEC). During my
days at the Port Adelaide CAMHS, there was an element
of the traditional speech pathology service, in that I saw
clients and their significant others individually once a week
for assessment and/or intervention. However, that was as far
as the “traditional” element went, as the client’s behavioural
and emotional issues directed the assessment, goal planning
and therapy approach in most cases. For example, I found
creative ways to assess the language skills of a client with
selective mutism and developed tactics to contain a 3-year-
old who was notorious for running away in a therapy room.
On the alternate days, ASEC landed me into a world of
contrasts. Each minute was completely different to the next.
For example, one day the morning group session was running
smoothly and then … the duress alarm rang throughout the
whole building, sending all available staff to the location of the
shouts. There was confusion and outbursts of abusive language.
The glass door was smashed. The young person was very
upset and torn between going back to the house where he
doesn’t even have a bed and staying at the refuge of ASEC
where he struggled to control his emotions and behaviours.
Amid the management of behaviour, emotional arousal and
critical incidences, I was given many opportunities to develop
my speech pathology skills. I learned how to break down the
language barriers to communicate with the young people in
highly emotional situations. I led social skills groups,
administered language and social skills assessments, and
implemented voice therapy with a client with schizophrenia.
Within the space of 40 days, I was astonished at the array
of clients I managed, programs I took part in, and projects I
successfully completed and presented. It was a rollercoaster
of emotions for not only the clients but also myself. I am,
however, extremely grateful to both my supervisors who
provided me with a wealth of knowledge, ongoing support
and guidance, and the opportunities to extend myself in
such a fascinating area of speech pathology.
Reflections from a clinical educator
When I’d decided to offer a student placement
at Adolescent Services Enfield Campus (ASEC), I was excited
about the learning opportunities and about being a support
for an upcoming professional. I had some of the (probably
usual) anxieties about how I would perform in this role;
manage my workload; and the possible challenges that lay
ahead. Additionally, questions arose, such as: “What kind of
experience can our service offer a speech pathology student?”
Child and mental health service (CAMHS) speech pathologists
rarely work on speech pathology issues in isolation because
we work with complex clients in the context of their mental
and emotional wellbeing. At ASEC our clients are generally
aged between 12 and 16 and present with a variety of issues,
including a history of “failure” socially and academically; school
refusal/non-attendance; learning/language issues and
exposure to domestic violence. Subsequently, the young
people often present with low self-esteem and can present
as angry or withdrawn. The clinical placement for the speech
pathology student was split between the Port Adelaide
Community CAMHS team and ASEC.
Rather than worry about what specific speech pathology
work ASEC could offer the student, I began to see that
this placement could offer some broader experiences. It
could provide opportunities for the student to learn how
communication and literacy problems link in with mental
and emotional well-being, attachments with caregivers, and
connections with broader systems such as schools, and
other agencies. I also realised that a student placement in
CAMHS offers a great opportunity to increase one’s self
awareness of work–life balance and emotional well-being.
There were many opportunities to be creative in order to
provide suitable learning experiences for the student, such as
preparing and running social skills groups, using visual supports,
working closely in a multidisciplinary team, working on projects,
and managing difficult behaviours. I found that it was important
to be organised and open in communication across both
clinical educators and the student – what one side of the split
placement couldn’t offer, the other one could make up for.
In the end, I think the student had a unique opportunity
to work with toddlers to adolescents in a holistic way,
strengthen her generic skills, and learn to work in
partnerships with clients and systems. Lucky for us,
this speech pathology student was a very capable and
competent person – we wish her all the best for the future!
Reflections from the student
There is a lot of stigma attached to the label of mental illness,
such as hallucinations or confinement in observation cells. For
me, when I found out I was placed at CAMHS, my first reaction
was “How can a speech pathologist help people with mental
illness?” My misconception of mental illness was dispelled the
first week into my placement. What I had been considering
mental illness was only seen in a very small proportion of the
clients presenting at CAMHS. The majority of young people
at CAMHS did not have psychotic disorders; rather they had
complex emotional and behavioural issues. Most young people
had a history of physical, emotional or sexual abuse combined
with a family history of mental illness. The presentation of the
young people’s mental health issues ranged from behaviour
The clinical education experience
in Child and Mental Health Service
Melissa Saliba and Carly Littlewood
Melissa Saliba is the Senior Speech Pathologist at Adolescent
Services Enfield Campus (ASEC), Child and Adolescent Mental
Health Service (CAMHS). Carly Littlewood is a student speech
pathologist at Flinders University, South Australia.
Correspondence to:
Melissa Saliba
Senior Speech Pathologist
Adolescent Services Enfield Campus (ASEC)
Child and Adolescent Mental Health Service (CAMHS)
email:
Melissa Saliba
(top) and Carly
Littlewood