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Treatment of Selective/Situational Mutism for children living in and attending mainstream settings in Buckinghamshire

Selective/Situational Mutism (SM) is where a child is consistently unable to speak in particular situations despite speaking freely in other situations.

Step 1: setting led work (for children with suspected SM):

School/nursery staff should review the information available in our Settings Packs (please ensure you have the up to date pack dated September 2022). These packs give initial advice and provide handouts for use during our training.

Step 2: training for setting staff

Where concerns have persisted for more that 6 weeks despite following the advice in the settings pack, school staff should attend our webinar: Introduction to Selective Mutism and Getting the Environment Right. No referral is needed to attend this webinar and parents are also welcome. Education staff will be supported to set initial targets at this training webinar.

Step 3: requesting further support

For some children (particularly those under the age of 5) following the advice given in the above webinar consistently for a term or two is usually sufficient and the Selective Mutism is likely to resolve without further input.

However, some children will need more support such as a formal Small Steps programme. How to know where this is the case will be covered during the first webinar. School staff should book onto a school advice session to discuss any continuing concerns with a speech and language therapist. Equivalent sessions are also available for early years children.

At these sessions, a referral will be made to the SM team where appropriate. NB a Language Link assessment should also be carried out prior to this school advice session.

If the child has or is being assessed for an EHCP please email the SM mailbox for further advice at this stage

Step 4: assessment by a therapist

Once a referral has been received and processed, you will be contacted by a member of the SM team for an assessment. This may be in the form of a phone call with parents and school and/or a face to face meeting with the child.

Step 5: further training in graded exposure

Further training will cover formal techniques: such as ā€œsliding inā€ or ā€œspeech shapingā€ and will include guidance on how to work on generalising speech to a range of situations. We also offer parent support groups and parent training. Please email us to register your interest.

Step 6: ongoing support

We offer bespoke meetings for schools and/or parents regarding particular cases. We encourage schools to book these in with the Selective Mutism team to ensure that targets continue to be appropriate and any issues can be resolved early. A child/young person should not be considered to have fully overcome SM until they can speak across situations:

  • In all settings
  • To a range of people and group sizes
  • When initiating interactions and discussing feelings
  • And transferring these skills when transitioning from one year to the next

If you feel progress has ā€œstalledā€ please do contact us to discuss ways forward.

Direct work:

Direct work with a speech and language therapist is not usually appropriate as the priority should be for the child to be able to communicate to those around them. However, in some cases such as where children are not in setting, or where there are other speech/language concerns we may do some direct work or an assessment block. Please contact us if you would like to discuss a particular case through the SM advice meetings.

We also offer group sessions for older children over the holidays. This provides a valuable opportunity for young people with SM to meet others in the same situation, and to learn more about their condition.

Please note:

Speech and language therapy should be the first point of contact for suspected selective mutism in Buckinghamshire. Other services such as CAMHS may also become involved if there are additional mental health concerns. Other professionals may need to adapt their approach when working with your child so please let us know if your child is seeing other services. We will seek a joined-up approach where possible.

Children attending settings outside of our commissioning agreement:

We do not see children for ā€œeducational provisionā€ where they attend specialist or out of county settings which we are not commissioned to cover. However, in these cases, parents are welcome to attend our online groups/training, and the child can attend our clinic based or holiday groups. Information regarding these are sent regularly via email. If you would like to remain on our caseload for this support, please let us know.

We recommend that the professional supporting or supervising a childā€™s SM intervention in a school is trained in Selective Mutism Masterclass modules 1 to 3 (or an equivalent level).

Questions or concerns?

Please email us at – most of our communications are sent by email so please do check your junk box and add us as a safe sender.

Please see our website for up to date information about our service and referrals as these are subject to change.