The global pandemic has seen us all riding waves of change that have been uncertain and unexpected. Services have required rapid transformation in order to meet the needs of the staff, families and mentees who deliver and receive Auditory Verbal Therapy.  Malcolm Gladwell states “Transformation isn’t about improving, it’s about re-thinking”.  

What have we had to re-think and what have we learned as a result? What have we put in place to transform our services? How do we evaluate change at organisational and individual levels? AVUK was invited to discuss some of these questions at the AGBell 2021 virtual symposium. Views from clinicians, service managers, mentees and parents were shared. We would like to keep this conversation ongoing and invite you to join in the chat below.  The idea is to look at clinical work, service provision, mentorship, training and parental engagement in the face of the challenging circumstances of COVID 19 and a ‘new normal’.  

Working with a service model 


The essence and core values of our service approach hasn’t changed but we’ve had a bit of time to think about ourselves as an organisation and we’ve found it helpful to structure our thinking around a specific model. The Parent Infant Foundation based in the UK, introduced us to the Onion Model via a presentation that was given at the 2021  “Talk to Your Baby” conference. Below is a visual representation of the model which was first proposed by Schein nearly 30 years ago as a model of organisational culture.  

Right at the centre, we have the individual families that we serveat the heart of what we do and supported by the other layers. Surrounding the families, we have the culture and values of the organisation. We can think of this as layer 1. For AVUK, we might embed those values into family centredness, professionalism, respect and having high expectations but within this framework, we might also be thinking about the core principles that underlie the world view of individuals within AVUK. We are striving to value both inclusivity and difference. We are also practicing holding both the families with whom we work and colleagues in mind - trying to remember to walk in their shoes for at least a little of their day. 

Moving out one layer to layer 2, we can think about the support infrastructure. For our organisation, we have crucial roles played by our IT support, our Trustee Board and our Advisory Panel. Our Advisory Panel are renowned professionals drawn from a wide range of disciplines who we can call upon for advice in their specialist field. IT support has played such a crucial role in the last 15 months as we had to think about our infrastructure; the way we support our staff and families and the way in which we can deliver services differently to achieve the outcomes that families and professionals want. We also have an Employee Assistance Programme in place which is an external 24 hr counselling service that staff members may use for any reason in which counselling may be beneficial including financial worries, work or family related concerns. 

Layer 3 represents the Workforce. At AVUK we have different teams including clinicians, our family support, fundraising, operations, and public relations and communications. There is huge cross-fertilisation of ideas and engagements between teams and quarterly half day, whole-team meetings.  We needed to put in place new support for our team and place a much greater focus on our health and wellbeing as well as strategies for self-care during isolation and remote-working. We have found that creating opportunities to keep in touch with each other as a team was essential. These include both formal whole-team meetings as well as informal group chats on WhatsApp, a few Zoom games and a virtual AVUK Kitchen.  

Layer 4 is the external support which for AVUK would include things such as AG Bell Academy, the First Voice Network, Multi-agency working with children’s local professionals. External support also crucially includes grants and donations which allow us to function as a third sector organisation. 

On the outside of the onion, is the most visible part of our organisation, the visible support. So, this might include things such as our communications via our website and social media, initial consultations, therapy sessions and family events. LSLS from across the globe have shared how moving to a service that focuses more on telepractice has meant re-thinking how we view the method of delivery. Using telepractice was not about recreating the in-centre experience. We needed to hone in on our skills on parent training but it also saw the need for more support for the clinicians, in the amount of therapy we  deliver on a daily basis and in how we support each other.

Although moving to a telepractice service over the last year may appear as though it would affect only the families and clinicians, we can appreciate from this model how our organisation is so closely intertwined that major changes at a workforce level (level 3) impacts the layers both within and beyond this level. Nothing happens in isolation. We have needed to be aware of all our layers and would be interested to hear what other organisations have included.


Developing theory of change models

Theory of change models are helpful for teams and organisations – particularly for those involved in writing strategic documents for services and those who are involved in working with funders or working to influence governments. 

Find useful advice about how to turn your theory of change into a plan for measurement, the five types of data you will need to pay attention to, and how to prioritise what to measure in the links below. Please share other links relating to theory of change in the comments section.


Links for families and parents

Below are some links to organisations across the world who provide information and Auditory Verbal Therapy for families. Please add to our list in the comments.

The Toronto Hearing Infant Programme has lots of great and easy-to-use info to families:

Also the link to programs within Toronto Public Health, many are delivered virtually:


Links to First Voice Centres

Hear and Say, Queensland Australia

Telethon Speech and Hearing, Western Australia

The Shepherd Centre, New South Wales and Australian Capital Territory

The Hearing House, New Zealand

Next Sense, Australia

Can:Do 4Kids, South Australia

Carel du Toit, South Africa 


Links to organisations supporting families

Family Links

The Home Learning Environment