Lorraine Britton, the lead speech and language therapist at Trent Regional Cleft Service, asks why the impact of COVID-19 has felt particularly difficult for many SLTs.

As we enter another period of lockdown I would like to reflect on why the impact of COVID-19 feels so hard for many SLTs.

I am the lead SLT of Trent Regional Cleft Network. The bread and butter of my work, like many SLTs, is assessing speech and delivering therapy to young children with speech sound disorders.

Since March we have been doing our best to deliver advice and therapy virtually. Embracing a myriad of new technologies, different platforms and alternative techniques, including setting up YouTube channels, inventing virtual therapy games, and investigating green screens.

After eight months, seeing children face to face still remains rare. Face-to-face options so far include seeing children while wearing masks (transparent ones if you are lucky) and/or from either side of a surgical screen. Some of my colleagues tried a few garden visits in the summer.

So why does it still feel so difficult?

Well, I think it is partly the nature of our work. We are all communicators striving to help others to communicate more effectively. Everything about COVID-19 (the masks, the social distancing, the reduced opportunities for social interaction) makes this harder.

But the bigger issue is that, unlike other professions such as surgeons or orthodontists, we are having to change our whole professional practice. Surgeons continue to operate wearing PPE, but for therapists working on speech, we are trying to deliver our whole professional and therapeutic role differently – and we can only do so much.

Current restrictions mean it is challenging to deliver articulation therapy virtually or face-to-face – either option is a compromise. It is difficult to assess speech disorders accurately online because sound quality is rarely good enough. In cleft, this may impact on surgical decision-making. We cannot deliver therapy virtually to many children because we cannot hear their errors properly, or their age/attention span make it difficult to engage them via a screen. Some ‘digitally poor’ families don’t have the technology or wifi for teletherapy.

For years, we have discouraged too much screen time for young children, and yet here we are trying to get 2-4 year olds to engage with us on a screen, or coaching parents to deliver the intervention through a medium that makes it almost impossible to hear exactly what the child is saying: ‘I can’t hear pharyngeal fricatives over teletherapy,’ they cry.

Similarly, face-to-face therapy is restricted. We want the child to see, hear and feel the sounds they are learning. We want the freedom to interact through play; to demonstrate and to engage the family. We want to be face-to-face and close to our patients. Sometimes we want to hold their noses. Our therapy involves enhanced respiratory particle exposure over periods of 30 minutes to 1 hour at a time – which may put everyone at increased risk of sharing the virus. The Perspex screens, masks and social distancing there to protect us fundamentally interfere with our work.

It feels like someone has taken all the tools of our trade away from us, and then asked us to continue to do our job or to advise someone else how to do it. A bit like a plumber trying to work without their tools.

Many therapists are putting on a brave face but grieving for the job they used to love. We also know that the longer this goes on, the bigger the hidden need.

Recognising why I have been finding the impact of COVID-19 so hard has helped me to cope. I hope that writing this will help others to do the same. There are no easy solutions but I am in awe of the resilience with which my SLT colleagues have adapted and changed.

Lorraine Britton, lead SLT Trent Regional Cleft Service
Email: Lorraine.britton@nuh.nhs.uk