RCSLT response to questions asked in the webinar: Behind the Prison Walls – what do speech and language therapists do?

The RCSLT is aware that Airedale NHS Foundation Trust provided speech and language therapy via telehealth to adults who stammer in prison. Read the evaluation report. 

The RCSLT has guidance on telehealth. Whilst there are benefits of telehealth, there are limitations which need to be considered when deciding whether to use telehealth. Whilst it might support one-to-one assessments or interventions, it may not enable the speech and language therapist to provide support to staff working in prisons, such as delivering training, developing support strategies and making adjustments to written materials and modifying verbally delivered programmes.  

Yes, there are speech and language therapists working with women in prison, but the numbers will be lower. Women make up 4% of the total prison population. As of November 2023, there were 12 women-only prisons.  

A job was advertised working with women in HMP Low Newton in January, so it is worth keeping an eye on the job websites.  

The speech and language therapy service offered varies depending on the commissioned service model.  

We asked speech and language therapists who work in prisons what they provide, and they all said that they support both communication and dysphagia.  

It is important to note that older people are the fastest growing group in the prison population and older people are likely to have a range of health conditions. Dysphagia is a prevalent difficulty among ageing adults as well as being associated with a range of conditions commonly found amongst adults in prisons. This suggests that a robust dysphagia service will be required in the future to meet the needs of people in prison.  

The speech and language therapy service offered varies depending on the commissioned service model. 

 We asked speech and language therapists working in prisons what they provide, and they all said that they support both communication and dysphagia. However, they all said that they do more communication work, but a person with dysphagia would be seen earlier and prioritised due to the urgency of this need.  

In the youth secure estate, the comprehensive health assessment tool (CHAT) is used. This is a standardised tool carried out on all young people and includes a section on neurodisability which collects information on speech, language and communication impairment.  

In adult prisons, there is not a specific prison screening tool used to identify the presence of speech, language and communication needs. On entry into prison, everyone has a reception healthcare screen carried out by a primary care nurse, to identify any immediate health needs or risk, and this includes some questions relating to learning disabilities. There are a range of screening tools commonly used in prison healthcare to identify learning disability and this includes the learning disability screening questionnaire (LDSQ). The score from this would flag a possible need and a referral to speech and language therapy.  

A high proportion of people coming into prisons have an additional screening by someone in the mental health team. This can be delivered by psychiatric nurses if there are signs of mental illness, or it can be administered by a member of the mental health team if there are general flags for mental health (but no established mental illness). A referral to speech and language therapists may be made following this screening assessment. 

Referrals may also be made at other times. Probation can pick up communication needs when discussing risk, release, licence conditions or offending work and they would refer into speech and language therapy. Prison officers might also observe people with difficulties on the prison wing. Other services, including education or learning and skills, may also make referrals. People can self-refer too.

There is no national data on the number of people in prisons needing augmentative and alternative communication (AAC).  

Funding for AAC in prisons would be sought as in the community, however there may be some limitations around the use of high-tech devices due to internet connectivity/security. 

There is inequity in service provision across the secure estate as there are not speech and language therapists employed in all sites, this will impact the ability of prisons to support individuals to meet their communication needs. Unmet and unsupported communication needs also impact on people on release, when misunderstanding around licence conditions can result in failure to comply and being recalled back to prison.  

Speech and language therapy is however a growth area and there is an increasing understanding of the role of speech and language therapists in this space and the value added that we bring. 

The RCSLT recommends that you choose to work with clients that you are passionate about and interested in. As we heard from Kim, Eve and Midge they started their careers in very different areas.  

The glory of speech and language therapists is that we are qualified to work across the lifespan and many skills are transferable.  

In terms of numbers, the RCSLT recommends that every prison has access to speech and language therapy, which we are lobbying for.  

The RCSLT justice mapping gave us some useful data. It examined the number of speech and language therapists per prison, their working pattern and the band that they were employed at. The mapping didn’t look at speech and language therapist numbers per service user. The RCSLT is planning to publish this data in May. 

We would love to hear if any speech and language therapists have any other modelling data. 

This is such an important question, and we are so pleased to see this asked. The RCSLT has local influencing guidance to help you influence decision makers.

If you can convince a commissioner to fund you, even for a short-term project, the data you collect will be essential to help you make the subsequent business case.  

The RCSLT continues to lobby nationally for more speech and language therapy prison posts. Do get involved with our lobbying work – contact RCSLT at claire.moser@rcslt.org  

We really hope so. Over the past few years there has been an increase in the number of posts, which is positive to see. The RCSLT continues to lobby nationally for speech and language therapy to be available in all prisons.  

The RCSLT Criminal Justice and Secure Settings CEN (Clinical Excellent Network) holds a number of CPD study events through the year and psychological safety could be discussed in more detail.  

If you are not a member of the CEN, find out how to join. 

The RCSLT recommends that you choose to work with clients that you are passionate about and interested in. As we heard from Kim, Eve and Midge they started their careers in very different areas before entering prisons. 

The glory of speech and language therapists is that we are qualified to work across the lifespan and many skills are transferable. 

It is worth looking locally at the job sites of NHS Trusts. Posts can also be advertised on the CEN, so this is worth a look. Speech and language therapy prison jobs may also be advertised on the following links:  

NHS JOBS 

Find a job

NHS Jobs.com

Some of this will be dependent on the needs of your population. Are you working with people with swallowing difficulties? Are you supporting people with speech, language and communication needs?  

Do capture what you cannot do and use this to make a business case for investment in speech and language therapy. 

In the RCSLT justice mapping project we asked services what they provided, and the greatest majority responded that they provide the following; 1. assessment; 2. advice on adaptations and reasonable adjustments; 3. support staff with consultation and advice and 4. train other justice colleagues.