Better speech and language services
Tuesday, March 15, 2016
Speech and language services ensure children keep up with their learning, but cuts have hit provision hard. Joe Lepper looks at how some councils and partners are managing to deliver successful services.
Speech and language support services for children have suffered in recent years.
A survey by the Royal College of Speech and Language Therapists (RCSLT) found that 52 per cent of therapists reported cuts in their area in 2014.
Around seven out of 10 said cuts were expected to carry on each year for the foreseeable future and nine out of 10 said funding problems were having a negative impact on services.
This is despite the large number of children with speech, language and communication problems.
Communication charity I Can estimates around 1.2m children in the UK have long-term speech and language needs requiring specialist support. There is also a potentially larger group of children who have a delay in their speech and language development that requires lower-level support.
Access to support
Alison Huneke, helpline manager at support charity Afasic, says redundancies, particularly among senior, experienced therapists, are affecting access to support and the quality of assessments.
“Parents are telling us assessments are not as thorough and reports from therapists to parents and schools are quite poor, failing to describe the child’s needs or support clearly,” she says.
A “factory approach” is also being taken in some areas, says Huneke, which means children are matched to a limited selection of local support programmes “that may not be appropriate for all”.
Families are also waiting a long time for assessments – often several months – and in some areas waiting lists have been closed, according to Huneke.
I Can chief executive Bob Reitemeier fears funding cuts could mean children with a speech delay miss out on life-changing early support.
“When they enter reception they are already behind,” he says. “Without support at year one, they can be a few months behind. If nothing is done by the time they get to 11 they can be six years behind.”
The 2008 Bercow Report found just 15 per cent of children with speech and language difficulties achieved five good GCSE grades from A* to C, compared with 57 per cent of all young people that year.
Poor performance at school affects young people’s employment prospects and this pattern of poverty and low-self-esteem may well be perpetuated when they go on to become parents themselves.
Children’s earliest learning environment is crucial and they are at risk of falling behind if they are not exposed to reading and opportunities to broaden their vocabulary at home, explains Octavia Holland, director of The Communications Trust.
“In areas of high deprivation the proportion of children with speech and language needs goes up to 50 per cent,” she says. “In some of the areas we work in the figure is 80 per cent.”
Failing to act early has a high long-term cost to the public purse, argue campaigners pushing for more investment in speech and language support.
The RCSLT estimates that for every £1 invested in speech and language therapy, £6.43 is generated through improved earning potential.
There are also calls for more training to ensure teachers, nursery staff and others are better equipped to identify problem as well as deliver low-level support.
“The more the wider workforce can do, the better,” says RCSLT chief executive Kamini Gadhok.
One such workforce training and support package already in use is I Can’s Talk Boost. This offers primary school-age children a 10-week programme of group sessions, lasting around 30 to 40 minutes.
The latest evaluation data from I Can shows 79 per cent of children who took part caught up with their age group when it came to speech and language skills.
An early years version called Early Talk Boost is now being piloted by I Can in 34 nurseries, including the Ambleside Centre in Reading.
This involves structured group work with children, with storytelling and discussions in the nursery and activities for parents and children at home, explains centre manager Philip Armstrong.
“Children are enthusiastic, parents are positive and staff tell us they feel more confident at supporting speech and language needs,” he says.
As part of special educational needs and disability reforms, local authorities and clinical commissioning groups (CCGs) are expected to make joint commissioning arrangements for education, health and care provision for children with special needs or disabilities and this includes speech and language support.
But Ian Thomas, chair of the Association of Directors of Children’s Services resources and sustainability policy committee, concedes take-up of joint commissioning “will be variable” and there will be “tensions”.
A key challenge is the complexity of public sector organisation locally, with CCGs and councils operating across different areas. “This makes it hard to know who to talk to and makes commissioning a real challenge,” says Thomas.
One area hoping to meet such challenges head-on is Surrey. In April 2017 a new speech and language service will launch with local CCGs, co-ordinated by Guildford and Waverley CCG, working with Surrey County Council to ensure there is a uniformity of support across the county.
Through this new arrangement the CCG will commission early years support and specialist therapy, while the council will commission school support through a “hub and spoke” model where one school in each area co-ordinates support for neighbouring schools.
The CCG-commissioned services will go out to tender while the council support will be provided by a mixture of in-house therapists and those employed directly by schools.
Surrey County Council provision and partnership development manager Zarah Lowe, says working together in this way is vital because “there isn’t any consistency” under the current commissioning model. For example, at the moment children in the east of the county are more likely to gain access to a therapist than those in the west.
Anne Breaks, designated clinical officer for special educational needs and disability at Guildford and Waverley CCG, says the joint approach will see a “net increase in funding” and more therapists being employed.
Another consideration for commissioners is that from May this year Ofsted and the Care Quality Commission will begin inspecting local areas on how well they fulfil their responsibilities to children with SEN, including those with speech and language difficulties.
The focus of inspections is expected to be on support for children with education, health and care plans with long-term speech and language needs, so this new scrutiny may be limited in its scope.
“There’s still going to be a large number of children with speech delay who do not have a plan and therefore will not be looked at by inspectors,” says Reitemeier.
Nevertheless he hopes the new inspection regime will “galvanise local areas to invest in and prioritise speech and language support”.
Strategy engages wide range of professionals: Time To Talk, Warwickshire
Across Warwickshire more than 140 early years settings are signed up to the Time To Talk strategy, which aims to improve early identification and support for children with speech and language difficulties.
Commissioned by Warwickshire County Council, Time to Talk is delivered by a three-strong team of therapists provided by South Warwickshire NHS Foundation Trust.
Lead therapist Melanie Packer says a partnership approach across council services, education and health has helped reach a range of settings from nurseries, libraries, schools and children’s centres to community nursing and health visiting teams.
Settings and professionals involved gain access to training as well as advice on supporting children with their speech and language needs.
“We have our own training package in three levels,” explains Packer. “The first is an overview of speech and language development, the second is more in-depth and about how to support children’s speech and language needs and the third looks at how to use a screening tool to gain an overview of a child’s speech and language skills.”
The screening tool, called WellComm, is not a formal assessment but could lead to a referral to a speech and language therapist, who have the specialist training to carry out more advanced, diagnostic work.
Training for library staff is an important aspect of the team’s work. “There’s a close link between language and reading books and in developing literacy,” says Packer. “We and the library service have mutual aims.”
Libraries in the county are also a key partner in the Chatter Matters campaign to promote speech and language support. This features a branded bus that travels to locations across the county, such as shopping centres, and also links up with libraries for storytelling sessions.
Developing “speech and language champions” is another key aspect of the Time to Talk team’s work. This involves training one member of early years staff in each setting who can then support colleagues.
The champions also carry out WellComm screening and help ensure there is someone in each setting or professional team who can explain speech and language issues to parents.
“We have some champions that may leave one nursery setting and move to another that previously didn’t have a champion already in place,” says Packer. “In the new job they are able to convince the manager a champion is needed and take that role on there.”
Latest data from the WellComm screening carried out by champions shows Time to Talk’s focus on support within early years settings is already paying off, with the proportion of children achieving their full language potential almost doubling over the 2014/15 academic year.
At the start of the year, just 27 per cent of children at an initial screening were achieving their full language potential but this had risen to 51 per cent at a second screening, carried out after support was put in place.
Launched in 2009, the Time to Talk strategy was initially only used within children’s centres. A year later it expanded into nurseries and since then libraries, health visitor teams and other health professionals have signed up.
Packer says this expansion has created “an increasingly large network of support” that helps ensure consistency across the county in identification and support for the under-fives age group.
A key challenge in this county-wide, multi-professional work is dealing with different working cultures. “Children’s centres are different from early years and childminders,” says Packer. “They all work differently but what we focus on is the common aim of us all – to support the speech and language needs of all children.”
Investing in professional skills: Robert Mellors Primary and Nursery School, Nottinghamshire
Before a child joins the nursery or reception year at Robert Mellors Primary and Nursery School, staff carry out a home visit to assess their needs and meet their parents.
Such visits are particularly important when it comes to pupils’ speech and language as they allow any issues to be identified and support to be planned at an early stage, explains assistant head teacher Juliet Clarke. This may include referring the child to a specialist speech and language therapist or supporting them within the school.
“It is important we have this opportunity to talk to parents about speech and language development before their children start at the nursery,” she says. “It is also important for them to raise any issues with us.”
Early years staff also run sessions at local children’s centres, providing further opportunities for parents to discuss speech and language issues.
This focus on advance planning and outreach work helped the school win the Early Years Setting award at the 2015 Shine a Light Awards, run by The Communications Trust and Pearson to recognise excellence in speech and language support.
Another factor that helped the setting secure this accolade is a focus on training staff to support children with speech and language issues. Training packages used by staff include I Can’s Talk Boost programme and The Communication Trust’s Speech, Language and Communication Progression Tools, which help identify children who may be struggling.
Meanwhile, the Let’s Interact scheme, created by Nottinghamshire County Council’s speech and language therapy team, focuses on using conversational techniques to develop language skills and boost children’s confidence in leading discussions.
Half of the children at the school are eligible for pupil premium money and this has been crucial in ensuring staff have access to speech and language training “and have the time to spend with children and their families”, says Clarke.
Latest data from 2014/15 shows how the setting’s approach is significantly improving the speech and language skills for this young age group. At the start of reception that year there was a gap of 50 per cent between the expected level of speaking of those eligible for pupil premium and their peers. By the end of the year there was no gap.
What Works: Interventions for Children and Young People with Speech, Language and Communication Needs
Department for Education-commissioned research examining interventions that have a strong track record of success and are backed by evaluation.
I Can Evidence
Communication charity I Can has a range of the latest research on speech and language difficulties available to download for free. Papers cover topics including problems for secondary school pupils and support in early years settings.
The Communication Trust
The online resources hub of this communications coalition offers a range of advice and research papers for children’s professionals. This includes the
A Generation Adrift report on the importance of supporting speech and language in schools.
Supports parents with children who have speech and language difficulties, offering advice and training to families and professionals. A range of free resources for professionals can be downloaded from the organisation’s website.