Archived decisions

PROPOSED CHANGES TO THE SPEECH AND LANGUAGE THERAPY PAEDIATRIC CASELOAD

(1) Background Issues

(a) Preventative Work

Research has shown the benefits of Early Intervention with speech and language difficulties and much work is currently going on nationwide focusing on the preventative approach to reduce the likelihood of these problems occurring. The approach aims to ensure a reduction in the number of children with persisting speech and language delays. As a result fewer children will experience the disadvantage of delayed language skills as they progress through their school careers. This work is supported by additional government funding in the early years of the project (eg Surestart,) There is the expectation that clear benefits will be demonstrated and that the local health economy will be able to pick up or mainstream these projects to ensure the good work continues after the funding ceases. This approach is endorsed by the Children's NSF core standard "Promoting health and well being, identifying needs and intervening early."

(b) Inclusion

Currently mainstream schools are finding that they are supporting an increasing number of children with speech, language and communication disorders. The Education policy of inclusion of children with special needs in mainstream schools means that schools are now supporting children with a wider range of difficulties than used to be the case.

Speech and Language therapists supporting schools are aware that they have a large number of children on their caseload whom they are seeing individually and whose needs would best be met by enabling the whole school to develop broad environmental strategies and group work to enhance language and communication skills.

The result of these developments is that therapist's contributions are being requested in a widening range of arenas and as a result therapists are aware they are less effective.

(c) Portsmouth and South East Hampshire

Historically there have been huge pressures and demands for therapy time across all age groups. For some time the speech and language therapy service has been aware that time has been spent on working with children in schools in a way which has not been effective. The Royal College of Speech and Language Therapists professional code of ethics states that professionals have a responsibility to cease intervention where it has been found to be ineffective. It is important that the department delivers the most effective service to those children who will most benefit. It is also important to focus on those areas where the speech and language therapist's unique skills mean that they have a key role and where evidence indicates that they are most effective.

(d) Recent Figures

The difficulties that could be most easily supported by trained school staff are language delay, speech delay and pragmatic difficulties. These make up approximately 54% of the junior/secondary aged caseload. Other difficulties, (for example, Stammering, Dysphonia, Dysphagia, speech and language disorders) may continue to require individual speech and language therapy support. These other difficulties make up approximately 46% of the junior and secondary caseload.

(2) Service response

The Paediatric service has been involved in a major review over the last 18 months, this has included examining research evidence of effectiveness and the current approach to our caseload across the local Health Economy. It has also involved comparing our service to others locally and nationally and discussions with Local Education Authority staff to ensure best use of our resources.

The resulting view is that we need to support schools to manage a range of communication difficulties, and also to focus time on working with children as early as possible to prevent long term difficulties for the future.

(3) Proposed action

In order to develop the effectiveness of our service to preschool children and in supporting schools we will release time by changing the way we currently work in schools. We will focus on developing our working partnerships with Education colleagues in Hampshire and Portsmouth City to support schools to support appropriate children.

It is proposed that we offer more support and training for schools in their management of all their communication impaired children. The time for this will come from the time we would have spent in individual sessions with children who have communication difficulties which evidence indicates are best supported by a more general whole school approach.

We have used research findings and professional consensus to develop evidence based criteria which will clarify which school children are best supported with a general/environmental/ group approach and which children will require more individual support at specific times during their education. This is expected to vary as they progress through their school

career.

(4) Proposal Specifics

(a) Each child on our caseload of junior and secondary age will be assessed with reference to these evidence based criteria when they are reviewed during the academic year beginning Sept 2005 and a decision will be taken as to how they will be most effectively supported.

(b)Junior and Secondary schools will be offered training to develop their skills in adapting the environment / setting up groups etc to ensure the communication needs of all children in the school are met.

(c) Following review in the next academic year management will be as follows:

(i) Secondary aged children:

To see only once in their transition year except for children meeting specific criteria indicating a course of intervention for

    · Stammering

    · Dysphonia (Voice disorder)

    · Dysphagia (Swallowing/eating difficulties)

    · Post craniofacial surgery

    · Alternative and Augmentative Communication

    A one-off assessment may also be arranged for specific issues. For example, assessment to request particular help for a child sitting a national exam.

(ii) Junior Age Children

To see only once for transition except for those meeting specific criteria for intervention for

    · Stammering

    · Dysphonia (Voice Disorder)

    · Dysphagia (Swallowing / eating difficulties)

    · Post craniofacial surgery

    · Language disorders

    · Speech disorders

    · Alternative and Augmentative Communication

    · A one-off assessment may also be arranged for specific issues

The length of time a child will require intervention will depend on the type and severity of the problem. For example, the course of treatment for children with a voice disorder or stammering is relatively short.

Transition year extends from the January before the summer change from junior to secondary school and the December after the change.

(5) Consultation with service users

(a) Parents and schools

A briefing leaflet will be distributed with an invitation to comment.

Special Needs Coordinators in schools will be interviewed during the trial period, some have already been involved in preliminary discussions.

Parents will also be contacted to explain our plans and to gain their feedback and ideas for development.

(b) Local Education Authorities

We have had preliminary discussions with some of our colleagues in Education who have been supportive of the project proceeding and we plan more detailed discussion with them during the summer if we have approval to move forwards.

(6) Evaluation

The following quantitative and qualitative measures will be undertaken :-

    (a) The change in the proportion of junior and secondary aged children being supported individually.

    (b) The change in the number of areas having access to pre-school and preventative projects.

    (c) The change in the number of schools accessing training from the Speech and Language Therapy service.

    (d) The change in the number of schools developing communication-enhancing groups. (eg Narrative Skills, Social Skills)

    (e) The views of parents, pre-schools, schools and Local Education Authorities will be investigated specifically via questionnaire/interview and informally via ongoing liaison.

    REFERENCES

    (1) Department of Health and Department of Education Working Group on the provision of speech and language therapy services for children with Special educational Needs (2000)

    (2) Evidence based policy and practice as applied to the treatment of children with speech and language difficulties - James Law (2003)

    (3) Speech and Language interventions for children with primary speech and language delay or disorder - Law et al. (Cochrane Review 2003)

    (4) Law, J.,Boyle,J.,Harris,F.,Harkness,A.,Nye,C.(1998). Screening for speech and Language delay: a systematic review of the literature. Health technology Assessment:2 (9)

    (5) Glawgowska,M.,Roulstone,S.,Enderby,P.,Peters,T.J.(2000) Randomised controlled trial of community based Speech and language therapy in preschool children. British Medical Journal,321,923 -926

    (6) Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay. Gibbard,D.,Coglan,L.,MacDonald,J.(2004) International Journal of Language and Communication Disorders, 39, 229-245

    (7) Monitoring the effectiveness of the national Surestart programme in England - James Law (2003)

    (8) School Caseload review - Ginny Blackoe AHP Bulletin 2003

    (9) National Service Framework for Children, Young People and Maternity Services. Department of Health 2004

TJB/10/06/05