The Speech Pathologist's Referral Handover Checklist

This library ends each clinical series with its handover, and the speech pathologist's version is the only one that is not just a "person's" handover. For the people the library describes, it often has to represent them, since the ability to brief a new worker, to explain to someone how they communicate, to correct an error, or to protest a misguided assumption, is what the disability is preventing them from doing.

A newcomer to a communication disability, undocumented, will build a representation of that person's understanding and expression in a shift, and that representation, typically a huge underestimate, is the relationship. The purpose of the handover is to establish the correct model immediately, and for this population it is also a communication profile which has been acquired and is to be carried by the person with them at all times, this document being the support-arrangement version.

The checklist

The communicator, prior to the communication. The library's normal opening, plus some extra, with extra weight: who this is, their interests, their humour, their preferences, because the underestimation this document exists to prevent starts with workers meeting a diagnosis. Constructed with the person, wherever feasible, in any manner of building.

Understandings of this person. Receptive communication first because the most common error in communication is assuming understanding, at what pace, with what supports, short sentences, one idea at a time, key word sign, extra seconds, and the standing rule stated plainly, assume understanding and speak to the person, daily; the cost of underestimating comprehension is dignity.

The way this person expresses himself or herself. The order of the person's preference: speech and how it is understood by strangers, the device and its function, signs and gestures, behaviour as a means of communicating (where applicable), and the interpretive keys that familiarity alone may give: this sound means yes, that reach means finished, distress usually begins with this. These keys are the handover's pearls, the total fluency of all who knew the person, written down for the stranger.

The positive and negative effects. The partner behaviours outlined in the training article in this series, compressed: the pause, the responses, the opportunities, and the never-items with reasons, no finishing, no guessing aloud, no talking over, no addressing the companion instead of the person.

Mealtime status, gated. If there is a mealtime management plan in place, this section states one thing: a current plan is in place, it is safety critical and no meal support will be provided until the briefing and gate is completed, as this series' second article explains. Never summarize the plan on the handover, they go wrong by doing a summary.

The reporting frame and the line. The observations worth sending, communication attempts, initiation, avoidance, device use, red flags where apropos, in observational language, and the boundary paragraph of the fourth article of this series: reinforcement always, therapy never, delegation only where separately arranged.

Scope of consent and date of review. The library's normal closing, what the person agreed travels, in their mode where applicable; the triggers that force a re-read, any clinical review, any new device or plan, any new worker.

The double life of the document

The handover, written once, is used beyond the purpose it was created for: it's used as the basis for a communication profile sent to day programs, respite, hospital admissions and places where a person with communication disability is most likely to be misread, and where one accurate model (on a single page) has been the difference between care and misadventure. The speech pathologist who is responsible for keeping it alive as a living document per the library's rules of currency has provided the person something quite close to a voice on the go about their voice, which, after reflection, is pretty much at the centre of what the profession is for.

How this plays out in practice

Imagine a man in his 30s who has cerebral palsy who is understandable to people he knows but nearly no one else, who uses a device only under certain circumstances, and whose regular worker suddenly decides to quit, a replacement beginning on Monday. If there were no handover, Monday goes just as usual: the worker builds the underestimate and explains to him in a slow and loud voice about the simple things, and he, physically exhausted by the correction project before they start, lets the model stand. With it, the worker read the two pages in the car, his sharp humour, the instruction to speak normally and wait, the interpretive keys, the device's real job, the never items. The first exchange is within the correct model, he tests his worker with a joke, as advised by the handover, and the relationship starts in the same way as his previous worker ended: with a person. The document required the therapist twenty minutes, the majority of which was transcription of what all those who knew him believed and knew.

Next steps

Write the handover for the client who is most misunderstood by strangers, this month. Then double its life: copies to the arrangement, family and front of any travelling file.