narratve

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 +o

THE PLOT
Narrative has been described as the way in which
we as human beings render actions and events
meaningful (Lyle, 2000). Whether we are at home,
at work, in the shops or at play, the events of
everyday life are woven together by the stories
we tell each other. It is therefore an essential skill
that children need to master to be able to under-
stand and talk about their world.
At the same time, speech and language therapists
are increasingly being encouraged to link therapy
targets to the educational curriculum. With a
steady move towards inclusion, the classroom is
more commonly the place where therapy is deliv-
ered and reinforced. This means that therapists
are having to become more flexible in adapting
therapy ideas to fit in with methods of classroom
teaching and working together with teachers to
meet the needs of language impaired children in
the classroom. Narrative therapy is gaining in
popularity with speech and language therapists,
who are keen to find out more about the impact
it could have on our daily practice and the provi-
sion of speech and language therapy to children
in mainstream schools.
THE SCENE
There is now a great deal of information about
the way in which young, normally developing
children acquire narrative skills (Bamberg &
Damrad-Frye, 1991; Botting, 2002). This shows us
that even reception aged children, given the right
context, are able to convey adequate informa-
tion, taking into account the listeners knowledge
and organising the content of what they say to
demonstrate that they have some knowledge of
story structure. There is also widespread agree-
ment on the emergence of childrens narrative
skills according to agreed developmental stages
(figure 1). One of the benefits of having this nor-
mative data is that it has enabled us, as clinicians,
to compare the narratives of normally developing
children to their language impaired counterparts.
We know that the narratives of language
impaired children are shorter, include fewer
causal and temporal relationships to tie events in
the story together, and lack the same degree of
structure (Roth & Spekman, 1986).
This information becomes important to speech
and language therapists and teachers when we
consider the close links between narrative ability
and later academic success. Botting (2002) sug-
gests that, oral narratives may serve to inform
clinicians about the risk of literacy problems and
Reynolds (1998) reports that childrens narrative
ability is of vital importance in determining later
academic and social outcomes. Therefore, the
answer to the question, Why is narrative so
important?, is that it could offer clinicians a way
to work with language impaired children to build
on their narrative skills and, in so doing, offer
them an increased chance of participation in class-
room learning.
There is a growing amount of information in the
Only a
story?
Note:
In this article, the educational
stages referred to roughly cover
children of the following ages:
Foundation level includes
Nursery (3-4 years) and
Reception (4-5 years)
Key Stage 1 includes
Year 1 (5-6 years) and
Year 2 (6-7 years)
you woud be ost wthout
stores, taes, yarns, gossp,
ttte-tatte, news and
anecdotes
want more structure to
your therapy
beeve everyone has
stores n them
Read ths
Once upon a time, a fairy godmother
(in her day job as a speech and
language therapist called Becky
Shanks) weaved her magic on children
in Stockport schools. From that day
(actually, eight weeks) on, the children
were never short of a story again, and
they all lived more happily ever after.
So is this the end, or just the
beginning? Dear reader, you decide...
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 ++
narratve
literature that highlights the different ways that
narrative can be assessed and then analysed.
Many studies focus on the story grammar
approach developed by Stein & Glenn (1979)
(Dimino et al, 1995; Hayward & Schneider, 2000;
Botting, 2002). This approach provides the overall
thematic organisation of a story in terms of causal
and temporal relationships (figure 2).
Children from the age of four years can be seen
to demonstrate some understanding and use of
the structures in figure 2. Between the ages of
five and six, childrens stories typically consist of
abbreviated episodes (an initiating event,
attempt and consequence); and by eight years of
age children are beginning to produce complete
episodes including internal goals, motivations and
reactions that are largely absent in stories pro-
duced by younger children. Hughes et al (1997)
report that 16 per cent of four year olds stories
consist of complete episodes compared to 60 per
cent of stories typically told by eight year olds.
Research based around using the story grammar
approach as an effective intervention has tended
to focus on older children (seven and above) with
the main aim being to improve their written nar-
ratives (Dimino et al, 1995). Fewer studies have
targeted their intervention at improving the oral
narratives of younger children with the exception
of Hayward & Schneider (2000) who reported that
the language impaired children included in their
study clearly benefited from narrative interven-
tion using the story grammar approach.
THE CHARACTERS
Speech and language therapists in Stockport have
been piloting the use of narrative therapy in pri-
mary schools as a way of developing childrens
oral language skills within the classroom (Shanks,
2000). In collaboration with the local education
authority, six schools took part in the original
pilot between September 1999 and July 2001.
The intervention was primarily aimed at schools
situated in areas of considerable social depriva-
tion. Teachers in these schools were becoming
increasingly concerned regarding the numbers of
children both in the foundation stage and key
stage 1 who were experiencing receptive and
expressive language difficulties, but who were
not receiving speech and language therapy.
Typical comments from teachers were, She just
rolls around on the floor at carpet time; He can
never tell me what he did at the weekend; She
rarely contributes to class discussions. Teachers
concerns varied widely from poor attention and
listening, restricted vocabulary and inability to
follow instructions to limited skills in recount-
ing/describing. The task for the speech and lan-
guage therapist was to devise an approach that
encompassed all of the teachers concerns whilst,
at the same time, complementing activities
already taking place in the classroom as part of
the speaking and listening curriculum.
Each school was offered an eight week block of
intervention from the speech and language ther-
Figure 1 Developmental sequence for storytelling (adapted from Hughes et al, 1997)
Level Type/Age Description
1 heap Unconnected components.
2 years
2 sequence Action sequences are described, sometimes following the order in which
2-3 years they occur. Events are centred around a particular character, topic or setting.
3 primitive Cause and effect emerges and sequences of events are causally linked.
narrative Individual components are related to a central character or theme in a
3-4 years way that indicates why events occur in a particular way.
4 focused Include a central character and true sequence of events but lack a true plot
chain due to limited understanding of character motivation and goal. As a
narrative result the ending of the story may be unrelated to events set up at the
4-5 years beginning of the story. Story structures emerge - an initiation event,
attempts, consequences, although episodic structure may be incomplete.
5 true Emergence of true plot and events connected around central character and
narrative theme. Understanding of the need to provide explanations for events and
5-7 years behaviour and so the plot results from the motivations and goals of the
main characters. Consequently the end of the story is related to its
beginning. Episodic structure develops to include intentions and internal
responses of the characters.
Figure 2 Story grammar components (derived from Stein & Glenn, 1979)
Setting Introduces the main character and describes the context of the story (Who,
Where, When).
Initiating Event The beginning of a goal based episode in the story that causes the main
(Problem) character to respond.
Internal Response Describes the main characters thoughts, intentions or emotional responses
to the initiating events.
Internal Plan Statements referring to the main characters strategy for reaching a the goal.
Attempts The main characters overt action towards resolving the situation or
(To solve problem) achieving the goal.
Consequences Represents the outcome of the attempts and indicates the attainment
(Outcome) or non-attainment of the characters goal.
Reactions Descriptions of how the character feels about the attainment or non-
attainment of the goal.
apist and the local education authority funded
four hours of learning support assistant time per
school. The school selected six children from
either reception, year 1 or year 2 (in some cases a
split year 1 / 2 group), whom they felt were strug-
gling to access the curriculum as a result of poor
receptive and expressive language skills.
The speech and language therapist met with the
special educational needs co-ordinator and the
class teacher(s) before the intervention began, to
agree on the appropriacy of the children selected,
the form that the intervention would take and
the level of collaboration required from both par-
ties for the children and school to gain maximum
benefit. The time taken to plan at this stage was
later found to be crucial to the success of the
intervention as it allowed both school and the
speech and language therapist to agree on time
needed for liaison between the learning support
assistant, class teacher and speech and language
therapist, and for the class teacher to plan an
observation of at least one of the therapy sessions.
Parental consent had to be gained for most of
the children taking part as in the majority of cases
the children were not already receiving speech
and language therapy. Parents were also invited
to meet the therapist to discuss their child and to
allow the therapist to share ideas and activities
that could be reinforced at home should the par-
ents be interested.
THE ACTION
Baseline measurements were taken by the speech
and language therapist using the Renfrew Action
Picture Test and The Renfrew Bus Story. The chil-
dren were then reassessed post-intervention and
the information shared with school and parents.
Having four hours learning support assistant
time per week for the eight weeks meant that the
children could receive an intensive block of therapy:
narratve
SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 +
the therapist carrying out one session a week and
then the learning support assistant reinforcing
the therapy ideas and activities at two other times
in the week. With each group session lasting for
approximately 45 minutes, it left ample time for
the learning support assistant and speech and lan-
guage therapist to plan the further two sessions
in the week and ensure that the school had all the
necessary resources with which to do this.
Narrative therapy offers an approach that is
highly structured yet easily adaptable for differ-
ing levels of ability. Based on meaningful activities
that are commonplace in every classroom, the
narrative approach addresses receptive and
expressive language difficulties in a way that com-
plements literacy hour activities. More detailed
information regarding therapy ideas, sample ses-
sion plans and carryover ideas for the classroom
are available in a published resource pack (Shanks
& Rippon, 2003). Children are taught first to
understand and then to use a story framework
through the use of colour coding, symbol and
sign. Coloured cue cards and symbols are used to
represent each element of the story.
Corresponding signs are also used to reinforce the
multisensory approach:
orange red green yellow blue
The focus of the therapy changes each week,
working on the story components individually at
first, then gradually developing the childrens
skills at retelling familiar stories and eventually
giving them the confidence to generate ideas for
stories of their own. The first few
weeks aim to develop active listening
skills as well as the childrens under-
standing of the concepts of who,
where and when. Games include
identifying deliberate errors in familiar
stories, identifying who, where and
when in books, quiz games, and sorting
pictures according to who, where
and when. As the weeks progress,
the children are encouraged to think
about why events happen in stories
and make their own predictions
about what they think might happen
next. Familiar classroom texts, nursery
rhymes and tales are used to see if the children
can devise their own endings. Puppets, the tape
recorder and role-play are important in developing
childrens confidence at retelling and, together with
the cue cards, act as prompts to enable children to
use the narrative framework for themselves. The
children are able to use their position of being the
special children chosen to attend the weekly
group to show the other children from their class
the colours and signs associated with the story
framework and in doing so increase their confi-
dence in their own abilities. This also aids the
transfer of the approach from the small group to
the whole class.
THE DENOUEMENT
Thirty children took part in the pilot study and the
results were striking (see case example in figure
3). When re-tested following a three month period
of intervention, the changes recorded using the
Renfrew Action Picture Test and the Bus Story
proved to be highly statistically significant. A
detailed account of the measures used and the
specific methods of analysis can be found in
Davies et al (2002). Qualitatively, teachers
observed marked improvements in the childrens
confidence and ability to participate in classroom
activities. The therapy session that the class teach-
ers observed provided the opportunity for them
to see how the children functioned in a different
environment and how the therapy ideas could
carry over into the classroom. The fact that the
teachers were able to see the therapy in practice
increased their chances of incorporating the therapy
ideas into their teaching. The learning support
assistants and teachers involved in the pilot
reported that they had a greater understanding
of the role of a speech and language therapist
and felt more confident in using the structured
narrative approach in the classroom to support
other children with speech and language difficulties.
As well as the benefit to the six children involved,
each school had a learning support assistant
trained in using the narrative approach with
other children. Two of the schools were so
impressed they decided to use the narrative
approach across the whole of key stage 1.
Following the success of the pilot study, the local
education authority agreed to fund two sessions a
week for the speech and language therapist
to continue the narrative approach as
long as schools were prepared to fund the
four hours learning support assistant time
from their own budgets. Far from putting
people off, schools have been volunteering
readily and there is now a waiting list for
interested schools. A further three schools
have received the intervention over the
past year with similar results. The main-
stream support service is now bidding for
further sessions to allow the approach to
become part of the speech and language
therapy service offered to mainstream pri-
mary schools in Stockport. Further funding
from the local education authority targeting early
years has enabled another speech and language
therapist from the department to adapt the current
narrative pack for use with children at the foun-
dation stage (Broughton et al, 2002), and early
analysis of that data suggests equally good results.
THE SEQUEL
Narrative therapy has proved itself to be an effective
intervention, with far-reaching benefits not only
WHAT
WHO WHERE WHEN HAPPENED THE END
therapists are
having to
become more
flexible in
adapting
therapy ideas
to fit in with
methods of
classroom
teaching
Figure 3 Case example
This boy in year 2 had recently moved to the school and had English as an additional language. His
class teacher felt that he was an able child but very lacking in confidence and reluctant to contribute
verbally within the classroom. These are the two narratives he generated unsupported using the text-
less book Two Friends by L. Miller.
Pre-intervention (chronological age 6;8y)
Once upon a time there were two friends. They played along together. Then they thought theyd
have a race. The cat won.
Then he was running on another race but then the dog get lost so he was thinking where was the
cat so he ran away.
He thought he was....it was that way in the hills. In the hills he saw a dragon and then he ran the
other way and there was a dinosaur. Then he got up and from the roof then above him was a lot of
water so he went over it. He swam down. The water was going after him. Then he ranned and
ranned really far away. Then he ranned. He saw his best friend.
Analysis
Linking ideas sequentially through time. Providing setting information and initiating event but not
developing a goal based episode. Lots of action based sequences without causal links. Probably at
primitive narrative stage.
Post-intervention (chronological age 6;11y)
Once upon a time there was a cat and a dog and they were talking each other. The cat said I will
scare you away with my meow and the dog said I will scare you away with my woof. So they
both made funny noises, woof woof, meow meow. But the cat stopped meowing cos he was
too tired so they decided to have a race. The cat was winning because he was forwards but the dog
lost him on the hills. He said woof woof. So he thought it was down the hills, quickly speeded
down the hills and under the hills he met a dragon and he said to him Have you seen the cat? I
want to play with him. But he didnt know where he was. Then he met a dinosaur Have you seen
the cat? I want to play with him. No I havent seen him anywhere. When he got up he saw a river
going really fast. He went following the river. When he got onto the end of it, he saw a tail and he
saw the cat and when he met the cat he at last got back into the finishing line and then they had
another race down the hill and they did that again and again.
Analysis
Linking ideas temporally and causally. Goal based episode consisting of setting,
initiation events, attempts and consequences. Ending relates to initial problem in the
story. Uses dialogue and more formal story language. Good example of a true narrative.

SPEECH & LANGUAGE THERAPY IN PRACTICE SPRING 2003 +

narratve
Hot o the press!
vn Speakng 8 lstenng Through Narratve (
nd
ed.)
Becky Shanks article appears just as the second edition of her highly acclaimed
Speaking & Listening Through Narrative is published. To mark the occasion, Black
Sheep Press is offering CD ROM copies to FOUR lucky Speech & Language Therapy
in Practice readers - absolutely FREE (normal price 45)!
For your chance to win, send your name and address to Speech & Language Therapy
in Practice - SLTN offer, Alan Henson, Black Sheep Press, 67 Middleton, Cowling,
Keighley, W. Yorks BD22 0DQ by 25th April. The winners will be notified by 1st May,
and are asked to let Black Sheep Press know what they think of the resource.
Speaking & Listening Through Narrative consists of 125 photocopiable pages
including instructions and sample lesson plans, illustrated worksheets, games
and exercises and carryover ideas for the classroom. It is available from Black
Sheep Press, see www.blacksheep-epress.com, or telephone 01535 631346 for a
free catalogue. Other narrative resources are Language Through Listening
(14), Nursery Narrative Pack (45) and Reception Narrative Pack (45).
for the children involved, but also for the
wider school population including teachers
and support staff. Future studies would
need to focus on collecting more longitudi-
nal data to look at the long-term benefits of
the intervention and possibly the implica-
tions for childrens written narratives.
Within our own profession, this study
highlights the need for more sensitive
assessment tools if narrative therapy is to
become part and parcel of speech and lan-
guage therapy intervention with language
impaired children.
The proven links between oral narrative ability
and future academic success only go to support
the view that speech and language therapy is best
delivered as part of the curriculum with teachers
and therapists working together to meet the
needs of language impaired children.
THE END - but only of the beginning.
References
Bamberg, M. & Damrad-Frye, R. (1991) On the
ability to provide evaluative comments: further
explorations of childrens narrative competencies.
Journal of Child Language 18, 689-710.
Botting, N. (2002) Narrative as a tool for the assess-
ment of linguistic and pragmatic impairments.
Child Language Teaching and Therapy 18 (1) 1-21.
Broughton, H., Carey, J., Shanks, B. & Rippon, H.
(2002) Nursery Narrative. Black Sheep Press. Yorkshire.
Davies, K., Davies, P. & Shanks, B. (2002) Improving
narrative skills in young children with delayed
language development. Paper presented at The
American Educational Research Association Annual
Conference. April 2-5, New Orleans (available from
Peter Davies at p.i.davies@staffs.ac.uk).
Dimino, J., Taylor, R. & Gersten, R. (1995) Synthesis
of the research on story grammar as a means to
increase comprehension. Reading and Writing
Quarterly. 11, 53-72.
Hayward, D. & Schneider, P. (2000) Effectiveness of
teaching story grammar knowledge to pre-school
children with language impairment. Child
Language Teaching and Therapy 16 (3) 255-284.
Hughes, D., McGillivray, L. &
Schmidek, M. (1997) Guide to
Narrative Language: Procedures for
Assessment. Eau Claire, WI.
Lyle, S. (2000) Narrative Understanding:
developing a theoretical context for
understanding how children make
meaning in classroom settings. Journal
of Curriculum Studies 32, 45-63.
Reynolds, D. (1998) Schooling for
Literacy: a review of research on
teacher effectiveness and its implica-
tions for contemporary educational
policies. Educational Review 50, 147-162.
Roth, F. & Spekman, N. (1986) Narrative Discourse:
Spontaneously generated stories of learning dis-
abled and normally achieving students. Journal of
Hearing and Speech Disorders 51, 8-23.
Shanks, B. (2000) Telling Tales. Bulletin of the Royal
College of Speech & Language Therapists 583.
Shanks, B. & Rippon, R. (2003) Speaking and
Listening through Narrative: a pack of activities
and ideas. 2
nd
ed. Black Sheep Press. Yorkshire.
Stein, N. & Glenn, C. (1979) An analysis of story
comprehension in elementary school children in:
Freedle, R. (ed) New Directions in Discourse
Processing. Norwood, NJ.
Resources
The Renfrew Action Picture Test and The Renfrew
Bus Story by Catherine Renfrew are available
through Speechmark or Taskmaster.
Becky Shanks is a speech and language therapist at
the Childrens Therapy Centre, St. Thomas Hospital,
Shaw Heath, Stockport SK3 8BL, tel. 0161 419 4301,
e-mail becky.shanks@stockport-tr.nwest.nhs.uk.
The first few
weeks aim to
develop
active
listening skills
as well as the
childrens
understanding
of the
concepts of
who, where
and when
Do we take the tme needed to pan
to reach our goa - ke the ox wth
the Gngerbread Nan'
Do we, ke the od woman wth the
Nagc Porrdge Pot, eed n enough
to our cents'
Do we ensure ndereas get to the
ba'
Reectons
news extra...news extra...
Funding for useful technology
The government is planning to make more funding
available to allied health professionals researching
the provision of useful technology for clients.
Previous funding has focused on medical staff, and
a Department of Health seminar will provide the
opportunity for allied health professionals to suggest
ways of opening up this support. Fiona MacAulay
(author of Communication - an inalienable right
in the Winter 2002 issue of Speech & Language
Therapy in Practice) is to represent the Royal
College of Speech & Language Therapists at the
seminar. Fiona is a clinician at Ninewells Hospital,
Dundee, and part of a multidisciplinary research
team from the department of applied computing
at the University of Dundee. The team won a
medal from the British Computing Society at their
annual IT awards for the development of ICU-Talk,
a system designed for intubated patients in an
intensive care unit.
www.computing.dundee.ac.uk/projects/icutalk
www1.bcs.org.uk
One solution to recruitment
difficulties?
When you draw up your equal opportunities policy,
do you give thought to the needs of left-handers?
The results of a non-scientific study on the left-handers
day website suggests left-handers may have to be par-
ticularly tenacious when pursuing jobs in education
and health, as physical environments are geared to the
majority right-handed population. Challenges faced
include documentation layout, computer equipment,
phone handsets, scissors, rulers and even black and
whiteboards.
The left-handers club is calling for the perceived
link between career choice and left-handedness to
be studied more scientifically. Left-handers Day for
2003 is on August 13.
www.left-handersday.com
For left-handed products see www.anythingleft-
handed.co.uk.
Cooperation needed
The government has been warned that its plans to push
through new measures to tackle delayed discharges
risk undermining existing care for elderly people.
The Community Care (Delayed Discharges) Bill has
prompted a joint response from the Local
Government Association, the Association of Directors
of Social Services and the NHS Confederation. In it,
they emphasise their shared commitment to ending
the misery caused by delayed discharge from hospital
and recognise that more needs to be done to provide
integrated health and social care services. However,
they feel the governments plan to charge local
councils for delayed discharges is likely to introduce
adversarial rather than cooperative relationships, and
that the timescale of six months for implementation
is unrealistic. The group believes that the key to tackling
delayed discharges lies in an incentives regime which
spans all local agencies, with joint targets and a
shared performance management framework that
ensures local cooperation and more integrated care,
delivering the services that older people need.