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pathology narrative work may assist with the integration of client’s traumatic experiences and with self-reflective information processing. Psycho-education given to the carer and key stakeholders about modelling emotional language and how to explicitly label the strategies used to regulate emotions can assist with generalisation. Competency phase of intervention When the young person has reached the competency phase, they are in the space to participate in more developmentally and academically focused speech pathology therapy. Speech pathology can work to enhance pro-social interactions through development of social information processing skills. There needs to be focus on pragmatics, social skills and problem-solving as these children have had a history of poor pro-social interactions modelled to them. Psycho-education to carers about the importance of modelling new skills will assist with generalisation to other contexts. Therapeutic progress with this population can be slow because the child can continually move across the continuum of attachment, regulation, and competence phases. Many factors have an impact on how effective intervention can be including the number of placement changes and the age of the child. As we know early intervention is best; however, intervention can also occur with adolescents working with their environment and their strengths. Conclusion This study showed that the speech pathology service was valued by the mental health clinicians. They acknowledged and understood the importance of communication and the implications of communication impairment in the recovery process of the client. However, not all clinicians found it easy to modify their practice and communication style; or understood the co-morbid nature of communication and mental health problems, indicating the need for ongoing speech pathology consultative liaison and psycho-education. All clinicians agreed that clients identified as having communication impairments should receive the service of speech pathology intervention within the complex trauma treatment team, thereby enhancing communication skills and positive psycho-social functioning. Acknowledgment The authors wish to acknowledge Dan Sullivan, previous evaluation and research coordinator, for his assistance with the National Ethics Application, Meredith Waugh for her assistance with editing, Narelle Anger for her supervision, Evolve Therapeutic Services, CYMHS and the Mental Health Research Committee for their support. References Allen, R. E., & Oliver, J. M. (1982). The effects of child maltreatment on language development. Child Abuse & Neglect , 6 (3), 299–305. Bilaver, I., Jaudes, P., Koepke, D., & George, R. (1999). The health of children in foster care. Social Science Review , 73 , 401–417. Clegg, J., Hollis, C., Mawhood, L., & Rutter, M. (2005). Developmental language disorders: A follow-up in later adult life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry , 46 , 128–149. Coombs-Orme, T., Chernoff, R., & Kager, V. (1991). Utilisation of health care by foster children: Application of a

5. relational engagement 6. positive affect enhancement

These six goals are incorporated into the attachment, self-regulation, and competency (ARC) intervention framework. ARC intervention involves systemic, milieu- based interventions with an emphasis on understanding and intervening with the child in context. It incorporates individual, familial and systemic changes (Kinniburg et al., 2005). The mental health workers in the complex trauma treatment team utilise a bio-psycho-social model of intervention incorporating the treatment goals within the ARC model. Speech pathology was able to contribute and work within this framework of intervention at each level, as outlined below. Attachment phase of intervention Establishment of safety is essential during the attachment phase of intervention. Safety for the child incorporates both their surroundings and feeling safe within themselves (Kinniburg et al., 2005). When providing intervention to a child with communication impairment it is vital that the mental health therapist understands the communication needs of the child. Speech pathologists can assist by providing education about the child’s language level to the clinicians so that the child is able to fully understand and participate in mental health interventions. Visual resources outlining daily routines, timetables, and calendars of events can assist with the establishment of safety and predictability. Provision of psycho-education to the carers about the communication abilities of the child and the impact on social-emotional functioning can support enhancement of empathy the carer feels for the child and assist to foster the attachment relationship. During the attachment phase, accommodations for communication difficulties may also include establishing a common language of behaviour management to assist with consistent limit setting that is predictable across environments. The speech pathologist can provide the carer with insight into the child’s behaviour and interaction style by discussing implications of language results. For example, the child’s perceived disobedience may be due to an inability to understand the instruction. Psycho-education to the carers and key stakeholders about the strategies the child may be using to mask or copy with their communication difficulties is often helpful in getting others to understand the reasons behind the child’s behaviour. Self-regulation phase of intervention The regulation phase incorporates working towards being able to adjust arousal and return to equilibrium (Kinniburg et al., 2005). Children with a history of maltreatment have reduced self-talk to regulate their emotions and their poor high-level language impacts on their range of emotional vocabulary necessary for self-talk and self-regulation. Emotional literacy involves establishing the underlying language processes to support emotional vocabulary development. This supports the child to be able to name and more deeply understand the expression and behaviour linked to a full range of emotions, not just the stereotypical feelings which are happy, sad and angry but also feelings related to anxiety, grief and loss. Enhancement of emotional language incorporates the use of visual plans to identify, describe, name, and connect behaviour with emotion. Connecting affect to behaviour can also be done through use of therapeutic social stories, drawings and role plays. Speech

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