The Therapeutic Workshoppe: Speech-Language & Occupational Therapy

Tie-tongue. Lisp. Stutter.

These are the words that immediately come to mind when we think of ‘speech problems’ — but the field of speech-language therapy is far deeper and more diverse than these.

Paediatric feeding issues, difficulty with swallowing, dysarthria (disturbance of muscular control affecting speech) and dysphasia (difficulty in comprehension or expression of meaning) are only a few of the lesser known speech, language and swallowing disorders — the list is extensive.

Speech disorders don’t automatically mean only with children

“We also tend to forget that speech disorders don’t automatically mean only with children,” adds Keisha Lindsay. “Adults who have had strokes or motor vehicle accidents — they don’t just need physiotherapy, but also a speech-language or occupational therapist for full rehabilitation.”

Keisha Lindsay is the owner of The Therapeutic Workshoppe, a speech-language and occupational therapy practice located just off St. John’s Road in St. Augustine, east Trinidad.

She is also the Chair of the Occupational Therapy and Speech-Language Therapy Board under the Council of the Professions Related to Medicine, the body responsible for regulating the professions of Speech-Language Therapy and Occupational Therapy in Trinidad and Tobago.

A Marriage of Two Passions

“As a teenager, I thought about becoming a nurse or doctor,” she admits. “But my mother, who is a certified occupational therapy assistant, gave me a quick reality check: ‘You don’t like the sight of blood, the long hours won’t work since you like to sleep’… and she was right!”

For Keisha, the path to becoming a speech therapist emerged out of a natural passion.

But what Keisha did love — and had always loved, since the age of a toddler with a blackboard instructing her dolls — was to be a teacher. Speech therapy allowed her to combine both passions: education and medicine.

After completing her Bachelor’s at New York University and her Master’s degree in Speech Therapy and Audiology from the City University of New York’s Queen’s College, Keisha began working at the United Cerebral Palsy – Nassau County. Here, she was exposed to children with severe disabilities, and worked in a collaborative environment alongside physiotherapists, occupational therapists, teachers and teacher aides.

Unless you are literally ‘flat out’, you have to go to school and get an education

She later went on to work as a speech and language pathologist in the New York City Public School System, and was also an independent evaluator for New York City’s Early Intervention programme. These experiences opened her eyes as to what was lacking in her homeland.

“In the U.S., unless you are literally ‘flat out’, you have to go to school and get an education — even if it may not be a typical experience, at the very least some aspects of learning and socialisation would apply,” she explains. “Whereas in Trinidad, many children with such disabilities remain at home, and miss out on such opportunities because public resources are not yet in place for disabled children and adults to live full lives.”

Inspired to make a difference, she returned to Trinidad and began doing volunteer work as a speech-language therapist. This limited practice soon led to the birth of The Therapeutic Workshoppe.

The Therapeutic Workshoppe

Now celebrating its fourth year of existence this July, The Therapeutic Workshoppe is staffed by four speech-language therapists — Keisha and her colleagues Fayola Granderson, Marilyn Derrick and Laura Johnson; and one occupational therapist, Natasha Sexius, who also operates her own practice: The OT Sanctuary, which was established in 2013.

Today, the Workshoppe provides therapy for over 45 families including children from orphanages and foster care homes. All staff are registered in Trinidad and Tobago, and qualified to work with both children and adults.

Traditionally, therapies of this type were only located in Port of Spain. Unlike most other practitioners in the field, The Workshoppe is situated in St. Augustine to be more accessible for those who live as far east as Toco.

The added benefit of clustered services

The multidisciplinary team also has the added benefit of clustered services — i.e. those who need both services can arrange to have occupational and speech-language therapy back-to-back in the same visit.

Therapeutic intervention is provided in private practice at the Workshoppe, on a limited basis for home visits in the Port of Spain area, and on a consultation basis in public service schools and hospitals on both the islands of Trinidad and Tobago.

“The idea was originally to have public/private partnerships, which we still need to see a lot more of,” Keisha says.

Through her role as the Chair of the Occupational Therapy and Speech-Language Therapy Board, Keisha advocates for the practice of the therapies and their role in our Trinbagonian society.

Speech-Language and Occupational Therapy in T&T

“We are still largely a culture that believes only in physical disabilities,” she states. “There are so many ‘hidden’ disabilities; so many intellectual and developmental disabilities that we ignore as a country.”

There are so many ‘hidden’ disabilities

She notes that one key step is to have speech-language and occupational therapy in the public service. Under the direction of the Tobago Regional Health Authority, Tobago now has two speech-language therapists and one occupational therapist employed in the public service.

In Trinidad, however, there are no public service practitioners in the field of speech-language therapy, and just one occupational therapist working in the public service.

The Workshoppe and other therapists have been working with Social Work Departments to facilitate a programme to enable families in need to get therapy funded by the Government for a six-month period.

We can’t touch the kind of need we have unless we go into public service

But it is not enough.

“While it is more profitable for a therapist to have a private practice, the reality is that many of us are willing to have public hours part-time, which we can balance alongside a private practice — we just need to get a foot in the door, to demonstrate the real need out there,” she says.

“We can’t touch the kind of need we have unless we go into public service.”

The Way Forward

There has, however, been some recent positive change in the field of speech-language therapy.

First Master’s programme in the Caribbean region

2016 will mark the first cohort of Speech-Language Therapists educated in Trinidad and Tobago. It is the first Master’s programme in the Caribbean region for the field; previously, all practitioners had to be educated abroad. This would mean an increase of 11 or 12 therapists — to add to the current number, which stands at only 18.

“I should know — I’ve registered many of them,” Keisha adds, laughing. “And all women, to boot — we need some more men in there!”

Through her role as Chair of the Board, she has been advocating strongly for the importance of referrals, particularly for adults who have had strokes and other debilitating illnesses.

“Many elderly persons do not get the opportunity to work with the therapists they need to help rehabilitate from a stroke,” she explains. “The families may not know about the services, and the doctor may recommend only a physiotherapist, whereas the person may also benefit from a speech-language or occupational therapist.”

Awareness is key

Awareness is key — and it is a cause she continues to champion through her dual roles at the Workshoppe and on the Board. She is also concerned with the lack of research in the field specific to the nuances of Caribbean languages and cultures, and intends to be involved with building this body of research.

“As professionals, we are now coming together to establish regulations and ensure professional ethics to better serve our clients; and putting the checks and balances in place to ensure the family understands the services and to make sure the public knows the value of our services,” she states.

“There is a long way to go, not just for us as therapists but for the country on the whole as we deal with disabilities. Thanks to the work of various special needs communities, we are beginning to open our minds to the need for therapies to treat the ‘hidden’ disabilities — so there is a lot of room for growth.”

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Further Information

• Be sure to check with your employer — Speech-Language and Occupational Therapies are covered by some group medical insurance plans.

• If you want to ensure that your speech-language or occupational therapist is licensed and registered with the Council of Professions Related to Medicine, email otlspboard@gmail.com.

• The Workshoppe ensures that a significant amount of ‘parent and family training’ is done, not just therapy for the child or adult requiring their services. Progress meetings are held, and reports are provided.

• While not all disorders can be ‘cured’ through therapy, many conditions can be significantly improved — muscles can be trained, particularly if the intervention is done at an early stage of the child’s development. In some cases, children may need years of therapy, but the therapy ‘ages’ with the child: goals change from early-life development goals to academic goals as they grow and integrate better with their peers.

• If you are, or know someone who is, interested in pursuing speech-language as a career, these are the requirements in Trinidad and Tobago to be a registered practitioner:
  • From the UK, a Bachelor’s degree in Speech-Language Pathology & Audiology
  • From the USA and Canada, a Master’s degree in Speech-Language Pathology & Audiology; the Bachelor’s degree is gained first

Read more on The Ministry of Health’s website.