“talking
together
”
Report of the Integrated Speech Language and Communication Service
Project, Flintshire and Wrexham, May 2008
‘Communication and language skills are essential to survival. At every twist and
turn of the way, therefore, children try to make sense of what they have heard and
to respond in a way that they hope will be at least vaguely appropriate and useful.’
Bridges (1997).
‘Language is the key enabler to learning. Provide that key and you unlock the
learning.’ Bishop (1998).
Final Version
16 May 2008
Index
1. Introduction
o
o
o
o
o
o
Purpose of Report
Project Origins
Project Focus
Policy Context
Speech and Language and the all-Wales Projects
ISLACS Target Group
2. Assessment of Need
o
o
o
o
o
Page 9
Research and Evidence
Integrated Services
Models of Joint Working
Demographic Data
Service Model
3. Current Provision
o
o
o
o
o
Page 3
Page 17
Overview and Finances
Availability of Services
Service Pathways and Processes
Planning and Commissioning
Local Good Practice
4. Local Good Practice
Page 30
5. Stakeholder Views
Page 34
o
o
o
o
Pupil Views
Parent Views
School Views
Views of Professionals
6. Conclusion: Themes and Issues
o
o
o
o
o
o
Page 45
Information
Early Intervention
Involvement
Integration
Communication
Service Gaps
7. Recommendations
Page 51
8. Appendices
Page 56
o References
o List of Available Appendices
o Glossary
2
1. Introduction
Purpose of the Report
1.1 This report is the result of a project funded by the Welsh Assembly Government
(WAG) to explore the development of integrated speech, language and
communication services across Flintshire and Wrexham. The project became
known as ISLACS.
1.2 The project involved the North East Wales NHS Trust (NEWT), Flintshire and
Wrexham Local Health Boards (LHBs) Flintshire and Wrexham Local Education
Authorities (LAs) and the voluntary organisation Afasic.
1.3 The report sets out to describe current planning, practice and provision and to
assess the potential for more integrated services for children with speech,
language and communication needs.
Project Origins
1.4 The ISLACS Project was developed following an invitation for bids as part of a
WAG initiative on speech and language. The project was approved in the second
phase of funding, awarded in March 2006 and commenced in Autumn 2006 with a
completion date of March 2008.
1.5 A Project Board was formed at that time, with representatives from the LHBs and
LAs together with Parent and Voluntary Association representation.
1.6 The initial aims of the project, as stated in the project bid, were to move towards a
future service which would look like the following:
o “It will be delivered to children and young people at transition stages within
the 2-19 age range who have speech, language and communication
needs.
o The action plan will specify the children and young people to be targeted
by the Service.
o On completion of the pilot project the Service will be jointly commissioned.
o It will be delivered by collaborative services that are jointly commissioned
by the Local Health Boards and Local Education Authorities of Flintshire
and Wrexham.
o Service delivery will be seamless with a single point of access for all
service users.
o There will be explicit referral, prioritisation according to need and
discharge/exit criteria, and care pathways.
o The budget will be managed according to Value for Money and Best Value
principles.
o The Service will actively promote seamless and collaborative working.
o A core value of the Service will be to concentrate on early intervention and
preventative methods and will refrain from discrimination on the basis of
age, cultural background, gender, language, race, religion or any other
consideration. Intervention will be based on relevant individual information
and accepted standards of best practice and professional guidelines.
3
o To establish an integrated joint team which will provide a single, effective
and coherent pathway for services for children and young people who
have speech and language needs.
o To develop equitable services across the county boundaries.”
1.7 The emphasis on transition within the project bid and initial specification was
included because it was felt that the transition stages can be a vulnerable time for
children and young people. If the service had capacity and was comprehensive at
these stages then it was seen as reflecting a general robustness.
1.8 The project was co-ordinated through WAG by a Pilot Project Co-ordinator and, as
part of the process across all Wales, three central meetings were held during the
life of all the Welsh projects which enabled the sharing of information.
1.9 Towards the final stages of all the Welsh projects, WAG commissioned an
independent evaluation which was undertaken by CRG Associates in November
2007, with a final report due to be delivered in the summer of 2008. The initial
findings have been made available through WAG.
Project Focus
1.10 Prior to December 2005, there was an established and successful commitment to
joint working practice between NEWT Speech and Language Therapy Services,
Wrexham and Flintshire LAs and schools. Despite this commitment there was also
a mutual recognition of the rising demand and of the considerable challenges in
relation to identifying the best way of mutually meeting these needs.
1.11 In common with other projects across Wales, the specific aim of ISLACS was to
use the 1999 Health Act in order to develop an integrated service for children and
young adults with speech and language and communication difficulties.
1.12 The Act amended the law regarding arrangements between local government and
the NHS, allowing joint commissioning, joint funding and joint provision of services.
The ISLACS project set out to take advantage of the Act by:
o Identifying current and future (next 10 years) need/ demand for speech,
language and communication support across the two Local Authorities
o Identifying current resources devoted to speech, language and
communication services, assess their capacity to deliver (for example
current provision, workforce availability) and identify any unmet need
o Identifying good practice locally and nationally using both research
evidence and consultation with local professionals, parents and young
people.
1.13 Furthermore it was intended to use the information from the above and in
consultation, advise on the structure, management and resourcing of a single
equitable service for the delivery of support to children and young people (2- 19) in
North East Wales who have speech, language or communication needs (SLCN).
1.14 It was anticipated that the data produced would have a high level of impact and
potentially involve radical changes to service delivery. Such changes were likely to
be founded on existing good practice both locally and nationally. It was also
anticipated that changes would be made within existing resources.
1.15 The ISLACS project spanned a period of eighteen months and this placed some
time limitations on the nature of the audit and the development of proposals. This
4
was recognised to be the case for all second wave pilots and resulted in the
suggestion that projects narrow their focus somewhat. This report therefore may
be seen as a platform to further develop the initial remit of the project submitted
with the original bid.
1.16 The project was overseen by the Project Board and the work undertaken by three
half-time coordinators, selected and appointed on the basis of their experience and
local knowledge. They were:
o Specialist Educational Psychologist, Flintshire
o Senior Educational Psychologist, Wrexham
o Speech and Language Therapy Service Manager, (Sept 2006-Summer
2007)
o During the autumn term 2007 a Project Administrator was appointed on a
term-time basis and in February 2008 an external advisor, was appointed
by the LHB to facilitate completion of the report.
1.17 An initial project action plan was drawn up and this was developed and amended
throughout the project. Regular meetings were held throughout the project to
agree tasks and share perspectives.
1.18 During the first term of the project there was a focus on agreeing the remit, finding
accommodation and appointing administrative support. During the Spring and
Summer of 2007 wide-ranging consultation was undertaken with service users,
parents, school-based referral agents and co-providers. This consultation covered
most of those directly involved in speech, language and communication work but
due to time constraints did not include some wider stakeholders, such as health
visitors or GPs.
1.19 Throughout the project the coordinators sought to gather information via their own
professional knowledge, literature research and discussions with selected
professionals working in the field.
1.20 The final stage of the project involved writing up the data collected into a report
and the development of proposals for further action locally. The report will also be
submitted to WAG with a view to developing good practice guidance on the basis
of the project outcomes across Wales.
Policy Context
1.21 There are a number of policy drivers influencing change. Some of these are
shared by all agencies; others are more specific (and it is sometimes these
differences which make the alignment of priorities across agencies difficult).
1.22 In many ways the recent policy context makes work on integration both more
necessary and more possible. Educational policy and practice have long stressed
the importance of social, economic and health factors upon educational
attainment. Similarly Health policy increasingly stresses the importance of close
working with universal services to improve health outcomes.
1.23 Recent legislative initiatives such as the Children Act (2004) and the Health Act
(2006) also provide the tools with which to promote this culture and practice of
integration.
1.24 At a national level all agencies have a key role in all aspects of development to
achieve the seven core aims for children and young people set out by WAG:
5
1.
2.
3.
4.
5.
6.
7.
Have a flying start in life
Have a comprehensive range of education and learning opportunities
Enjoy the best possible health and are free from abuse victimisation and
exploitation
Have access to play, leisure and cultural activities
Are listened to, treated with respect and have their race and cultural identity
recognised
Have a safe home and a community which supports physical and emotional
wellbeing
Are not disadvantaged by poverty.
Policy Drivers: Children and Young People
Health
Shared
Global
WHO
UN Convention
on Rights of the
Child
National
Local Authority
UNESCO
NHS Act
Children Act
2004
Code of
Practice
Access Targets
Working
Together
Early Years
Foundation
Curriculum
National Service
Framework
NHS policy
Professional
Local
Welsh Language
Communicating
Quality 3
Local Needs
Estyn
Teacher Status
Standards
C&YP
Frameworks
Single
Education Plan
1.25 These policy drivers and national strategic aims have been translated into local
priorities for children and young people. Overseeing this process are the
Framework Partnerships in each Authority.
Wrexham
Flintshire
C & YPS The Promise:
CYPP Priorities:
Learn and achieve
Be safe from harm
Be healthy and active
Enjoy and participate
Support parenting
Reduce behaviour and conditions that put
children and young people at risk
Support vulnerable individuals and groups
Safeguard children and young people
Raise children and young people’s
attainment in learning settings
Inclusion of all children and young people
Reduce impact of poverty & deprivation
Workforce: a skilled, competent and
knowledgeable workforce
Information: available and accessible to all
Single Education Plan:
Raising educational achievement
Increasing inclusion and participation
Improving the educational environment
Improving the coordination of services
6
Speech and language and the all Wales projects
1.26 Within the context of these multiple policy drivers, numerous reports have
highlighted the importance of speech, language and communication, both to child
development generally and to educational attainment specifically
1.27 In Wales WAG attempted to progress the recommendations of a UK Joint Working
Party, published in 2000.
1.28 The Speech and Language Therapy Action Group (SALTAG) was established in
2002 in response to concerns over the escalating demand for speech and
language therapy and the lack of a coherent approach by the statutory agencies to
meet this demand.
1.29 The outcomes of the SALTAG deliberations were presented in the consultation
document ‘Working Together’ (WAG, 2003) which contains a wide range of
recommendations. A key recommendation was that Local Health Boards and Local
Authorities should work together within partnership arrangements for the delivery
of speech, language and communication services to children and young people.
1.30 ‘Working Together’ stated that: ‘Mechanisms and structures need to be
established that support true collaborative working, with joint planning, joint
training, joint prioritisation and shared sense of responsibility to meeting needs’
1.31 Consequently, as part of progressing some of the recommendations of the
‘Working Together’ document, pilot projects were established across Wales to
establish joint commissioning services for children with speech, language and
communication needs. The remit stated:
“For effective integrated working, the providers need to have resolved that
there are clear management structures, professional accountability, clear
performance management of the service and a joint location of the service
and proper administrative support.”
ISLACS Target Group
1.32 It was envisaged that integrated services would focus much of their involvement
and intervention on home and educational environments. However, in order to
ensure that there was a shared understanding of the target group for integrated
services, the following list was compiled. This represents the groups most likely to
need speech, language or communication support. It was acknowledged that
some of these would lend themselves to integration locally, while others (such as
cleft palate services) might be part of more specialist regional networks (N.B.
Children may fall into more than one category):
o Pupils experiencing a developmental SLC delay
o Pupils having a specific speech and language impairment
o Pupils with speech, language and communication needs, including:
 Autistic spectrum disorder
 Sensory impairment, in particular hearing disorder
 Learning difficulties (severe and moderate)
 Selective/elective mutes
 ADHD
7
o Pupils with cleft pallet and velopharyngeal abnormalities (many regional
acute services provided by Alder Hey)
o Pupils with disorders of feeding, eating, drinking and swallowing
(dysphagia)
o Pupils with disorders of fluency
o Pupils with acquired motor speech disorders e.g. dyspraxia
o SLCN following trauma
o Pupils with voice disorder
o Pupils with aphasia
o Pupils with progressive disorders affecting speech and language.
8
2. Assessment of Need
Research and Evidence
2.1 There is growing evidence on the importance of speech and language
development generally and delivering services in an integrated fashion in
particular.
2.2 For example, there is considerable researched evidence that educational
outcomes for children and young people with SLCN are considerably lower than
their peers. Without the right help between 50% and 90% of children with a
persistent language difficulty go on to have reading difficulties; exam pass rates
are lower and fewer young people with SLCN difficulties go on to further or higher
education. (See Rutter et al (1992), Snowling et al (2001), Stothard et al (1998).)
2.3 Additionally there is significant evidence of the relationship between behavioural,
emotional and social difficulties and SLCN which may not have been recognised at
an earlier stage in the young person’s education.
2.4 In 1997, the Green Paper ‘Excellence for all children’ drew attention to difficulties
in securing speech and language therapy services for children with special
educational needs.
2.5 In the UK a Joint Working Group into the provision of speech and language
services, involving both the Department of Health and the Department for
Education, was established to reflect the perspectives of providers and users.
Their report was published in 2000. ‘Report on the Provision of Speech and
Language Therapy Services to Children with SEN (England)’
2.6 The principal recommendations of this report around the role of the Speech and
Language Therapist (SLT) working with school age children was that:
“Therapy for children of school age is best carried out collaboratively within
the school context;
The traditional tasks undertaken by SLTs, that is, assessment, diagnosis and
therapy should be carried out in conjunction with teachers and parent carers.
SLTs should provide active support to schools to help them differentiate
content, teaching style and curriculum outcomes for children with speech and
language difficulties with a particular focus on language in the classroom
context of both peers and teachers”
2.7 The report recognised that some children may need specialist interventions
outside the school environment:
“Where appropriate, clinic based options should remain for those requiring
specific specialist interventions over a time-limited period.”
2.8 It also recommended that:
“SLTs can also be expected to provide education and training in aspects of
language, language acquisition and speech and language difficulties… there
must be a flow of information from teachers to SLTs” and
9
“There should be clear published guidelines as to what is expected of SLTs,
schools and LEAs. These might be expressed in the form of local partnership
agreements.”
2.9 The so called Standards Funds Pilot Projects carried out at the time were
evaluated independently in 2000/1. The evaluation report indicated that there had
been a ‘culture change’, leading to improved strategic partnerships in the delivery
of therapy. The evaluation also describes delivery of speech and language therapy
in inclusive classroom settings and a move away from clinic based models of
delivery (Barber et al 2002).
2.10 More recently the Department of Health and the Department for Children, Schools
and Families commissioned, under the co-ordination of John Bercow, a review of
provision. An interim report was published in March 2008 with the aim of providing
the Government with recommendations at strategic planning levels, with regard to
commissioning to meet needs, and also with regard to good practice.
2.11 The Bercow review surveyed professionals and service users through a range of
means, including questionnaires, visits to provisions and focus groups.
2.12 The interim report has identified good examples of working practice at the
operational level but failure at strategic level which have been described as
‘profoundly unsatisfying’. In particular, Bercow stated that “Communication is very
low priority for commissioners and that has to change” (Bercow 2008).
2.13 Bercow states that the review recommendations to the UK government to be made
in July are likely to include the following:
o A national project to highlight and raise the profile of the importance of
communication in the development and well being of young people
o That the problems with commissioning needed to be addressed through a
stronger central lead
o Workforce development needed to be addressed both at specialist
intervention level and at the wider universal levels
o And that the accountability of LAs for the provision of SLT for pupils with
statements should be reviewed. Within this, the accountability for
delegated resource provision needed to be strengthened through
guidance to schools and inspection processes and the clear ring fencing
of specific budgets
o Regional commissioning of specialist Services should be considered in
some detail.
Integrated Services
2.14 The move to integrated services for children over the last six years, has
sometimes raised questions within differing professional groups as to their identity
and purpose, leading to a scrutiny and a re-examination of roles and the
organisational structures in which the professions are practised.
2.15 Collaborative work between children, young people, families and professionals is
key within the aspirations of the government’s long-term strategy to promote the
well-being of children as set out in “Rights to Action”.
2.16 Partnerships between children and young people, parents and professionals are
clearly very important in meeting needs but the challenge is to move beyond the
10
rhetoric and develop responsive and effective working arrangements between
relevant agencies and even to agree which agencies are relevant in the first place.
2.17 Where a range of agencies are working with families, schools and with individual
children, the notion of collaboration can get translated into the idea that integration
of services is, by definition ‘a good thing’. Working towards this ideal throws up
issues around professional standards and professional accountability, finance and
responsibilities which are often difficult to resolve.
2.18 Most importantly, while the idea of integration has superficial virtue and coherence,
there is very little evidence to show that it actually does lead to more effective
work. There are very few agreed ways to measure and to demonstrate that if
integrated services did work better, then what would we see that was different. In
recent years, many Local Authorities in the UK have dedicated immense resources
towards developing the integration of their Children Services but there is anecdotal
evidence from the English experience to indicate that some are now giving up
exhausted, with depleted coffers and depleted motivation. (Robinson, 2008)
2.19 So within the ISLACS project, which has the stated aim “to develop an integrated
service for children and young adults with speech, language and communication
difficulties” and to “establish an integrated model of delivery in line with the
Children’s National Service Framework”, care is needed to assess what integration
of service is desirable, what is possible and what is just too entrenched and has
little demonstrable cost and outcome benefit.
2.20 The Position Paper of the Royal College of Speech and Language Therapy with
regard to the role of staff within integrated
children’s services (Gascoigne, 2006) sets
out a framework for integration spanning
the realms of governance and strategy right
through to frontline delivery and outcomes
(see diagram opposite).
2.21 Gascoigne formulates fifteen
recommendations for SLT services
operating within an integrated context.
These include:
o Working as part of a multidisciplinary team
o Exploring new ways of working
within “trans-disciplinary” models
o Training others, including parents is central to the SLT role
o Service planning should always be done in partnership with other
agencies
o Staff should undertake professional development across health, education
and social care to develop knowledge for cross-agency working.
2.22 She goes on to stress that the Royal College “regards trans-disciplinary working as
central to work with children”. And that “For this model to be successfully
implemented, it is essential that there is clear understanding about the individual
professional contributions.”
2.23 Gascoigne argues that perspectives of different professional roles vary and should
be discussed and agreed by the teams around a child. However, this does not
11
mean that roles and skills are blurred into a composite whole which reduces the
professional skills of individual contributors. We need to ensure that we protect the
essentials in our roles and skills and that these are reflected through identified
need, skills, training and continued professional development.
2.24 So that, as Norah Frederickson (2004) put it, we make up a crispy salad where
individual ingredients have a clear identity, flavour and purpose and we do not end
up with a composite mushy soup with no particular identity, purpose or flavour.
2.25 The recent Bercow review in England (discussed above) stressed the importance
of integration, making joint working one of its five key themes emerging from the
research and consultation:
o Communication is crucial
o Early identification and intervention are essential in order to avoid poor
outcomes
o A continuum of services, designed around the family, is needed
o Joint working is critical
o The current system is characterised by high variability and a lack of equity
2.26 As we will see in the section analysing stakeholder views, these themes have
much resonance locally.
Models of Joint Working
2.27 A wide range of models exist across Wales and the wider UK for the provision of
services to children and young people with speech, language and communication
needs.
2.28 One of the Services for children and young people with SLCN scrutinised by the
Bercow team as part of that review is that operating within the London Borough of
Hackney.
2.29 Services within Hackney are distinct in their delivery to children by the clear
agreements that are in place and the levels of input / criteria of need which map
from the universal level to the targeted specialist levels of input. All primary
schools in Hackney have an allocation of SLT time based upon a formula which
reflects factors such as existing case loads, pupils on roll, etc. This allocation of
time is applied on a half term on / half term off basis which enables schools to run
programmes and to embed and extend input from the SLT.
2.30 Each SLT has an allocation of approximately six schools where those with the
highest level of allocation have 2 days input per week ranging through to 1.5 and 1
day per week. This time is used for everything that is needed in the school
including some specific training although there is a Local Authority wide training
programme which comes out of core SLT Service time. The levels of support
available for children with for example, SLI are explicit and emphasise enabling
and supporting school staff and parents in the delivery of programmes. (Appendix)
2.31 The model of service delivery used in Hackney has the advantage in that it uses a
‘dynamic model’ of a child’s learning potential to contribute to the assessment of
specific language impairment, looking at learning potential as well as needs. The
use of standardised tests to support a discrepancy model of impairment is
problematic. The inequalities generated from this have been noted in the
Professionals audit.
12
2.32 While, over the last ten years, there has been a general move for SLTs to base
much of their work with children within the school environment, schools can be
unfamiliar, even slightly alien, working environments for some SLT. The Knowles
Edge Standards Funds Project, (see Roulstone, Owen and French (2005))
identified a range of low key suggestions to help make the SLT a part of the school
team. These included:
o
o
o
o
o
The SLT has her own pigeon hole and gets included in all staff circulars
The SLT was invited to staff meetings
The SLT pins her timetable up on the notice board in the staffroom
The SLT works through issues with the SENCo
Therapy items are included on the staff meeting agenda
2.33 The evidence with regard to budget management is that pooling or aligning
budgets is often highly dependent on positive relationships with the key players
involved. Where successful arrangements have been established for a period,
these may have subsequently broken down when those involved have moved to
other posts/responsibilities (Levens, 2007).
2.34 Research from change management shows that the importance of colleague
relationships is all too often ignored when changes in strategy and organisational
structure are being considered / implemented.
2.35 A clear training structure appears to have paid dividends within the London
Borough of Barking and Dagenham and eased the way from the operational level
towards multi-agency working.
2.36 Responding to the ever increasing demand for SLT input, together with unfilled
SLT posts a multi agency speech and language strategy group was established.
This group co-ordinated the delivery of the Joint Professional Delivery Framework
training (ICAN). This was complemented with termly training which contributed
towards Cambridge accredited qualifications. This emphasis on training has skilled
up the local workforce, but more importantly, Barking and Dagenham report that
‘doing things together helped enormously’.
2.37 Other models of good practice are also cited in Gascoigne’s paper and include:
o Medway Pooled Budget: PCT and council funding for primary school
children with SLCN is pooled and funds a multi-disciplinary team of
Therapists, Advisory Teachers and Technicians
o Glasgow ADS Service: Integration at a number of levels including planning
(a Framework Group) and joint assessments together with an information
pack for schools and support groups for school staff.
o Northern Ireland COMET (Communication and Education Together):
specialist Advisory SLTs are employed to support teachers and other
school staff.
Demographic Data
2.38 Using national prevalence rates and population figures we can put together a
picture of the broad levels of need for speech and language services that might be
expected in the two Local Authorities.
2.39 At the broadest level, there are a large group of children who have transient SLCN.
A Basic Skills Agency Survey showed that school staff believed that around 50%
13
of children start school lacking some of the communication skills that are vital for
learning.
2.40 However, many of these children gain the necessary skills as they develop or
through early education. It is now generally accepted that around 10% of the
school age population have a speech, language or communication need that could
affect their ongoing educational attainment.
2.41 Half of these children will be classified as having Specific Language Impairment,
that is poor language skills with no evident neurological, sensory or physical
impairments and no pervasive developmental disorder.
2.42 Other children will have speech, language or communication difficulties associated
with another condition. Prevalence rates are known for speech and language
difficulties associated with a number of the conditions listed in the Target Group.
2.43 This information is set out in the table below. The table is based on latest mid-year
population estimates (2006). It should be noted that it is projected that this
population may well fall over the next five years and that some children may fall
into more than one of these categories.
Difficulty
Prevalence Wrexham Flintshire
Cleft Palate
0.06%
17
20
Dystrophy
0.09%
25
30
Cerebral Palsy
0.11%
31
37
Hearing Impairment
0.12%
36
42
Head Injury
0.16%
48
56
Stammering
1.00%
298
349
Autistic Spectrum Disorder
1.16%
346
405
Learning Disability
1.38%
410
480
Other (balancing figure)
n/a
280
327
Specific Language Impairment
5%
1,491
1,744
Overall SLC Need
10%
2,983
3,489
(of which: Persistent SLC Need)
6%
1,790
2,093
2.44 Thus it is likely that there are around 3,000 children in Wrexham and 3,500 in
Flintshire with some level of SLCN – half with an underlying physical or sensory
disability. This need will persist over time in around 1,800 children in Wrexham and
2,100 in Flintshire.
2.45 This data needs to be viewed with some caution. It is generally accepted that
prevalence rates vary in response to local conditions including deprivation and
other socio-economic factors. The RCSLT suggests that factors such as
urbanisation, numbers of Looked After Children, the presence of preventative
services and local assessment practices also have an impact.
2.46 It is also known that need varies with age. Perhaps the most comprehensive
analysis of need was undertaken by Law et al in 2000. This reviewed literature
over a thirty year period to assess need at different ages.
14
Median Prevalence (from literature review, 1967-1997)
Age
2
3
4
Speech and Language Delay
5.0% 6.9%
5.0%
Language Delay
16.0% 2.6%
Speech Delay
Expressive and receptive language
delay
3.0%
Delay in expression
16.0% 2.3%
Delay in comprehension
2.6%
5
11.8%
6.8%
7.8%
6
7
5.5%
14.5%
3.1%
2.3%
2.1%
4.3%
3.9%
2.0%
2.8%
3.6%
2.47 Other local factors may also have an impact. For example SLT services have
identified 8 Welsh speaking children with Significant Specific Disorder in each of
the two Local Authority areas.
2.48 As a result of high levels of employment, both Flintshire and Wrexham have seen
significant recent additions to their schools of pupils for whom the first language is
not English or Welsh. There are clearly implications for service planning around
developing the specialist skills required for the identification of SLCN and related
needs and for workforce training in this area.
2.49 It is known that only a fraction of those with SLCN will be the subject of a
Statement of Educational Need. Latest figures are contained in the graph below.
Primary Reason for Statement
100%
Other
90%
SLCN
80%
70%
60%
777
735
63
109
Wrexham
Flintshire
50%
40%
30%
20%
10%
0%
2.50 Although it may seem straightforward to take account of the number of children
with statements with SLCN, caution is needed in interpreting these figures.
Recording patterns differ between the two Authorities and certainly there are
children with SLCN for whom this is not recorded as the primary need within the
Statement. Therefore, to base planning and development of integrated services on
figures such as these is unreliable.
2.51 An ongoing review of the Statementing process in Wales is also underway which
may affect the Statutory Assessment process and any prediction of needs based
on this.
15
Service Model
2.52 The following working model from, Gascoigne 2006 has been adopted by the
Project Team as a starting point to map the audit outcomes and to describe a
possible balance of services within integrated provision.
2.53 The diagram below shows how different services might play a role within this
pyramid. Because of the emphasis in the original project brief on prevention and
early intervention, the diagram highlights services at the pre-school level as well as
at school age.
Specialism
Specialist Interventions (e.g. Resources)
Individual Interventions (e.g. SLT)
Group Work
Outreach Services
Multi-Agency Programme Planning
Staff Training: Staff Training:
Early years settings
Teachers, Teaching Assistants
Training for Families
Support Groups:
Parents & Young People
Self Help Programmes
Prevention
Preschool
Information for Families
School
Age
2.54 The pyramid is used to demonstrate the number of children seen as services
become more and more specialised. At the bottom of the pyramid we have
preventative measures such as information, self help and support for families. Next
comes training and resources for professionals in universal services (child-care for
the pre-school age and schools for school age children). For a small number of
children referral to dedicated and specialist services will be required.
2.55 By considering the balance of services in this way we can assess whether or not
given services are available in each location (see next section).
16
3. Current Provision
3.1 This section describes the range of services available in the two Local Authorities
and the degree of integration between services. It concludes by assessing current
provision against the model set out at the end of the previous section.
Overview and Finances
3.2 A range of speech, language and communications services are currently provided
by a variety of agencies and in a range of settings and contexts.
1.5
NEWT
SALT
Specialist
Services
Afasic
Disability
Services School staff
CAB
Talk for Talk
Self Help
1.1
Voluntary
Services.
Specialist
Teachers &
Advisors
Educational
1.3
Psychologists
Schools &
LEA
Service
3.3 The NHS acts as primary provider of Speech and Language Therapy services, in
this case through the North East Wales Trust. However, all services share a
responsibility for the welfare and development of children. It is, for example the
Local Education Authorities who have the ultimate responsibility for ensuring that
provision of services is made for children whose Statement of Educational Needs
specify that this is an educational requirement.
3.4 This is the case as a consequence of a judgement handed down in 1989 and
known as the Lancashire judgement, where it was ruled that a child’s need for
speech and language therapy was an educational provision since speech,
language and communication skills were central to educational development in the
broadest sense.
3.5 The Code of Practice for Wales (8:49) states that “since communication is so
fundamental in learning and progression, addressing speech and language
impairment should normally be recorded as educational provision unless there are
exceptional reasons for not doing so”
3.6 In effect this means that the two Local Authorities have ultimate responsibility for
services over which they have little direct control. In order to make this provision
17
the two authorities have service level agreements to buy in packages of SLC
support from NEWT for a number of children who have statements. This funding is
over and above the level of provision funded by the NHS and stands at £52,000 for
Wrexham and £10,000 for Flintshire.
3.7 In addition to this the Local Authorities fund the costs of NNEBs, Teaching
Assistants, and Out-of-County placements for children with SLCN.
3.8 NHS funding for Speech and Language, through the NEW Trust currently stands
at £1,379,650, although this figure includes services to adults as well as children.
3.9 The remainder of this section describes the range of services available to children
with SLCN. It should be remembered that in addition to these specialist staff, a
range of staff in other targeted services (e.g. Portage and Educational Psychology)
and in universal services will contribute towards childhood speech and language
development, including:
o
o
o
o
Early Years workers
Teachers and classroom assistants
Health visitors and other primary care staff
School nurses.
3.10 There are also a number of other potential sources of funding for relevant services
including voluntary sector funding and the Better Schools Fund.
Availability of services
3.11 To assess the overall availability of services within Flintshire and Wrexham we can
map current services against the pyramid model set out in the previous section,
starting at the base of the pyramid with preventative services.
Information and Self Help
3.12 The 'Talk for Talk' group in Wrexham has established an effective support
structure for parents and a more effective and engaged partnership between
parents and school staff. 'Talk for Talk' is seen as being supportive and
empowering by parents of children with Specific Speech and Language
Impairment, who can perceive themselves as being isolated and de-skilled. It is a
collaborative, multi-agency group, involving first and foremost, parents and pupils,
together with Health, Education and the Voluntary Sector. There is no equivalent
service in Flintshire.
3.13 A very limited amount of local information is available on council websites and at
the Children’s (Family) Information Centres.
3.14 More generally, the voluntary sector, for example AFASIC and ICAN, provide an
important information and signposting role with extensive information on their
websites. Materials are also available from these organisations for parents and
professionals.
3.15 Independent support for families including those with children undergoing the
statutory assessment process is available through the CAB’s Parent Partnership
Service.
3.16 SLT staff distribute a range of their own materials and those of voluntary support
groups such as the British Stammering Association and others.
18
Training and Support for Families
“Training of others, including parents should be viewed as a central activity for
SLTs to maximise impact for the child and their family.”(Marie Gascoigne 2006)
3.17 Parents and carers are offered access to "drop in" appointments to discuss homebased strategies to support children and young adults with speech, language and
communication difficulties. This service is provided by SLT services.
3.18 SLT also provide a range of training, support and workshops for families including:
o Parent only workshop and an initial assessment for under 7s with
stammering
o “Demonstration” sessions of helpful techniques/strategies for specific
pupils
o Makaton Signing with parents/carers for specific pupils
o Paget Gorman Skill Sharing opportunities
o Additional contact/therapy sessions are offered by the SLT Education
Service Teams to parent/carers during school holidays
o Guidance in supporting home-use of PECs
o Parent workshops for children receiving group therapy
o SLT Training for parents in Flying Start
o Parent Child Interaction therapy to empower parents (see below)
3.19 The Portage Service, delivered through the LA Educational Psychology Services in
Wrexham provide support and information to families and preschool children who
are identified as having some additional needs. Many of these needs will include
language and communication.
Training, Support and Workforce Development
SALTAG Key Objective 2003
“The continuing development of an appropriately skilled workforce in both health
and education services to meet the needs of monolingual and bilingual children
and young people.”
3.20 A number of developments at a national level currently impact upon the nature and
availability of training..
o The move towards Children’s Services leading to a range of providers and
new needs being identified within a multi professional working context.
o Children's And Young Peoples Workforce Development Network the
purpose of which is to ensure that children’s services in Wales are
provided by a skilled and effective workforce).
3.21 At the local level the key drivers are:
o Both Local Authorities have identified training as a key objective
o School Improvement Plans identify training priorities.
3.22 An audit of the training available to professionals working with pupils in the target
populations in Flintshire and Wrexham and parents of pupils with SLCN is based
on:
o Information provided by professionals concerned with the training of staff
working with pupils with SLCN
19
o Research into resources available, eg training packages.
o
Further information regarding training is available in the Stakeholder
Section regarding the outcomes of the questionnaires to parents, school
based staff, Educational Psychologists and Speech and Language
Therapists
“If there is to be an increase in the skill mix and the number of assistants available,
identified solutions need to be found and quality training programmes need to be
developed and in place to support this. Local initiatives need to be reviewed in
terms of their appropriateness, effectiveness and quality.”
3.23 Within Education a range of courses are available for the specialist, targeted and
universal level workforce. At the universal level, the curriculum itself has a key
role. For example the Foundation Curriculum identifies communication, language
and literacy (CLL) as one of the key strands of the curriculum.
3.24 There is initial professional training, input from school staff such as mentoring and
discussion with SENCo/ANCo and advisory staff, school staff twilights and also the
drop – in sessions provided by SLTs. Early Language Intervention is also provided
by SLTs (see the section on Good Practice).
3.25 At a targeted level, there is for example, the Communication and Language
Advisory Support Service (CLASS ) which is a pilot service based in Flintshire the
purpose of which is to develop Speech and Language Friendly Schools (see
Appendix).
3.26 Teachers and support workers are offered access to "drop in" appointments with
SLT staff to discuss classroom-based strategies to support children and young
adults with speech, language and communication needs.
3.27 At the early years level, SLT staff, educational psychologist and advisory staff also
provide support, advice and training into both Flying Start and Sure Start.
3.28 At the specialist level teachers in both Local Authorities including some
mainstream staff with existing specialist skill and including teachers in Key Stage 1
and 2 Language Resources in Flintshire have attended the distance learning
course based in Sheffield on Language and Communication in Children. The
course is a three year course leading to a certificate in the first year, diploma in the
second year and masters in the third year.
3.29 A range of training for staff is provided by the SLT service. Training for school staff
was initially promoted via the Local Authority but experience has proven that
advertising courses directly to schools helps to promote a higher take up. A
selection of the courses offered, together with latest take up figures is provided in
the graph below (take-up had previously run at around a quarter).
20
SLT Training: % School Take-up
100%
90%
91%
80%
70%
67%
60%
50%
62%
68%
49%
40%
30%
32%
20%
10%
0%
Makaton
PECs
Social Shape Coding Cued Word Finding
Communication
Articulation
3.30 Elklan (see Appendix) is an accredited programme which has been widely adopted
across Wales . The core courses offer comprehensive , detailed and practical
training for SLTs to deliver to education and health professionals . Some modules
have been translated into Welsh. A number of SLT and education support staff in
both Wrexham and Flintshire have been trained as trainers of Elklan.
3.31 The ICAN Joint Professional Development Programme (JPDF) was delivered in
Wrexham in 2004. However, the emphasis on a more integrated children’s
workforce development plan has led to the recent launch, through ICAN, of the
Speech, Language and Communication Framework, (SLCF), which is described
as ‘a revised and extended JPDF’ which is available as an online training tool.
3.32 This defines competencies around speech, language and communication at four
stages:
o
o
o
o
Universal
Enhanced
Specialist
Extension.
3.33 The stages range from the skills and knowledge that everyone working with
children and young people should have through to the specialised learning around
SLCN at a postgraduate level. The programme was launched in March 2008 and
will be refined over the next year as a result of advice and input from those using
it.
Direct Interventions
3.34 The model set out in the previous section divides services into a range of
interventions. This was done to emphasise the importance of skill mix within
services and the achievement of a balance between universal, targeted and
specialist provision. There is a core assumption of inclusion underlying this model.
3.35 In both Wrexham and Flintshire there is a range of provision to address a variety of
SLC needs. Services are delivered into a full range of settings including home,
preschool provision (nursery, Flying Start, Sure Start) and schools. At the more
21
specialist end of the pyramid there are also dedicated “Resources” for SLCN
together with specialist Health services as necessary.
3.36 Much of this provision is delivered in a multi-disciplinary way, reflecting an
understanding of the importance of placing speech and language within the wider
context of overall child development. There are several examples of good practice
in joint provision with SLT services and Education.
3.37 A brief description of the main services for children with speech, language or
communications difficulties are set out below.
Advisory Teachers
3.38 The SALTAG report discussed above noted the contribution which could be played
by teachers specially trained to support schools in their speech and language
work:
“The role of specialist teachers should be encouraged further to ensure
effective collaborative working across agencies, to avoid duplication and
share the responsibility for the delivery of programmes to children with SLCD.
Consideration needs to be given to a parity across LEAs by increasing the
provision of these specialist teachers.”
3.39 Each of the LAs employs a single specialist advisory teacher to advise and support
schools on language and communication issues.
3.40 An example of this is the CLASS service in Flintshire which is a support service to
pupils in mainstream primary schools experiencing difficulties accessing the
curriculum due to speech or language difficulties. In Wrexham there is a single
advisory teacher who works in Key Stages 1 and 2 with additional input to Flying
Start.
Language Outreach
3.41 Some degree of skill mix has already been achieved. This is perhaps most notable
in a number of Outreach Services.
3.42 The Language Outreach Service is for children who might previously have
attended a language resource. The service consists of NNEBs working with
children in the local mainstream school on a programme designated by a specialist
Speech and Language Therapist. A Welsh medium service is also in place.
3.43 The success of the outreach service has exceeded expectations: frequently
children previously designated as needing language resource placement progress
to the point where it is no longer required.
3.44 There are currently 24 children in Outreach in Flintshire and 24 in Wrexham.
3.45 There is also a Hearing Impairment Outreach Service supported by SLT. The aim
of this service is to offer an in-school service to Hearing Impaired pupils in
mainstream schools. Staff from the Hearing Impaired Resource based within a
primary school in Flintshire will use their expertise and work in collaboration with
the Speech and Language Therapy Service to support staff in mainstream schools
who are working with Hearing Impaired pupils.
3.46 At June 2007 there were six pupils receiving Outreach for Hearing Impairment
across the two Local Authorities.
22
Language Resources
3.47 Wrexham and Flintshire each support a series of multi-agency specialist services
known as Language Resources. There are separate resources at Key Stages 1, 2
and Stages 3/4.
Pupils in Language Resources
Key Stage 1
Key Stage 2
Key Stage 3 & 4
Pupils in Hearing Impairment Resources (receiving
SLT)
Key Stage 1 & 2
Key Stage 3 & 4
Sub-Total
Other SLCN Statements: TA support
Other SLCN Statements: Language Outreach
Other SLCN statements
Grand Total (SLCN Statements)
Flintshire Wrexham
7
12
14
13
13
16
10
4
48
27
24
10
109
13
10
64
24
88
3.48 In addition, there are also dedicated Resources for Autism and of course special
schools. These cater for children with complex disabilities and all have support
from SLT to address children’s communication issues. Such input is an essential
part of providing a wrap-around service for children with the most complex long
term needs.
Out of County placements
3.49 If pupils with HI and ASD are included, there are a significant number of very high
cost out of county placements where it has been deemed that the pupil’s needs
cannot be met from local resources. Some of these children might have a SLCN
as a primary need while others will have complex disabilities or behavioural issues
with associated SLC difficulties.
3.50 Anecdotally, some parents see access to dedicated Speech and Language
Therapy as an attractive component of some out-of-county independent special
schools.
Speech and Language Therapy Services
3.51 The Speech and Language Therapy Department is run by NEWT and is funded
through the NHS (although supplementary funding is provided by the local
authorities).
3.52 The department is managerially divided into three teams and comprises 22 whole
time equivalent staff working in the two children’s teams:
Head of SLT
Adults
Health Team
Education Team
23 PT posts
24 PT posts
23
3.53 The SLT Department supports the training, self help and Outreach described
above as well as undertaking direct interventions with children and young people.
3.54 Within the Service the Health team addresses the needs of those children who
have a primary health need or are currently seen within a clinic context. The
Education Team sees children who require a service tailored to their educational
environment. Data on referrals and activity is summarised in the table below.
Activity 2007 (from PAS)
Referrals
Health SLT Team
918
Education SLT Team
276
3.55 In addition to seeing new referrals the SLT staff also see existing children for
follow up appointments (and of course conduct training and support staff in other
services). The graph below shows the split between the number of new referrals
and follow-up appointments. Follow-up appointments constitute around 94% of
face-to-face appointments.
SLT Cases Seen 2007/8
Follow Up
1400
New
1200
1000
800
600
400
200
N
O
ct
ob
ov er
em
b
D
ec er
em
be
Ja r
nu
a
Fe ry
br
ua
ry
M
ar
ch
r
t
m
be
gu
s
Se
pt
e
ly
Au
Ju
ne
Ju
M
ay
Ap
ril
0
3.56 It is also worth noting that there is inevitably a gap between referrals and the
number of children seen. Some referrals are returned because they are
inappropriate or because insufficient information is included. Others Do Not
Attend. This “DNA Rate” for new referrals is around 10% and around 7% for
Follow-ups.
3.57 So for the 2007/8 financial year there were just over 1,000 referrals with 713 of
these being seen. There were also 10,406 follow-up appointments attended. This
relates to the overall levels of need identified above of 3,883 children with
persistent need (and 6,472 falling within the 10% of children with some level of
SLCN).
3.58 The SLT service provides a wide range of interventions across the entire age
range. Many of these are provided as part of other multi-disciplinary teams such
as:
o Home Advisory Service - a multi disciplinary team, working with children
under the age of five in Wrexham and Flintshire, who have complex
developmental delay across more than one area of development, or have
a recognised genetic condition which has associated complex
24
developmental delay. The SLT may work with he child directly or may
support the health care workers in delivering the service. Each child
referred to the service is reviewed on a six monthly basis and the goals
are jointly agreed by the family and the professionals. The children may be
seen individually or as part of a small group, they can be seen at home, in
the children’s centres, or at nursery/playgroup.
o The Maelor Children’s Centre (Wrexham) provides Assessment, Therapy
and intervention to children under five years of age. These include SLCN,
behavioural and emotional needs, physical difficulties and complex needs.
Key teams include the developmental assessment team and the under
fives family team. Children are seen for individual or group therapy and in
a variety of locations (home, nursery, MCC) according to their needs.
o Work into both Flying Start and Sure Start
3.59 A range of services are also provided into schools. These include:
o Junior-Secondary School, School Based Service – A service for school
based children who have needs at, 'School Action Plus', and Statement
levels. The Service can offer assessment; reassessment; advice;
programme planning; programme delivery; review of progress;
consultation; IEP formulation; involvement at Special Needs Review
meetings; training. School follow up appointments are usually available a
minimum of twice per academic year. In response to IEP feedback,
ongoing assessment or programme monitoring may be required resulting
in additional sessions being offered at shorter time intervals.
o Special Needs Outreach - Specialist assessment, programme provision,
demonstration therapy (to empower education colleagues and parent
carers) training and support and consultations are offered by a Team of
Highly Specialist, Specialist and Generalist Therapists, in conjunction with
Technical Instructors. Each family of schools (secondary school and
feeders) has an assigned named/link Therapist who acts as their
consistent point of contact from infant to secondary school. There is a
“pool” of available therapists for schools to ensure that all pupils can have
access to the Therapist with the most appropriate skills and/or for a
second opinion for individual pupils.
o Input into specialist Educational Resources including Language
Resources, ASD Resources and Special Schools.
o Outreach services as described above.
3.60 In addition SLT provide a range of dedicated intervention services including:
o
Dysphagia - a service to all children with dysphagia living in Wrexham and
Flintshire. This includes an assessment of swallowing (including
videofluoroscopy with the consultant radiologist), eating and drinking, and
treatment and ongoing support around feeding issues and dysphagia. This
includes children with severe cognitive or physical delay, complex cardiac
problems and other medical conditions, sensory problems, and children
who are moving from non-oral feeding to oral feeding or vice versa.
o Community Special Needs – a service for children under 5 who do not
meet the criteria for other services (see above). They are in practice many
of the children who are placed in resourced nursery provision. Children
are referred to this service via SLT sorting panel, or by schools. The S&LT
provides assessment, reports and programmes for each child and
25
o
o
o
o
o
o
contributes to the IEP’s and school reviews. This is primarily a programme
based service.
Hearing Impairment Service - a highly specialist service encompassing
unique expertise on assessment, diagnosis and management of all
aspects relating to hearing impairment. It provides a service for children
with moderate to profound sensory neural hearing loss across Wrexham
and Flintshire in schools and at home and also gives support and second
opinions to children for whom hearing loss is not their primary need, and
advice to adults with hearing impairment. There is close liaison with the
wider multidisciplinary team.
Cleft Service – a specialist service to children and adults with cleft lip
and/or palate, or non-cleft VPI, attending multidisciplinary clinics in
Wrexham. This includes the provision of specialist therapy and
investigations, including nasometry, videofluroscopy and nasendoscopy.
The service works in collaboration with the North West of England, North
Wales and IOM Cleft Lip/Palate Network to provide a high quality service
in accordance with nationally agreed standards.
Community clinics - This service is for children aged 0 –18 across
Wrexham and Flintshire counties, based in community clinics. Therapists
provide assessments, up to 8 week blocks of therapy (one 30 minute
session of individual therapy per week) and 3-6 monthly reviews.
Technical Instructors provide therapy under the supervision of the
caseholder therapist. Home and school programmes of work are also
provided. For school age children liaison with class teachers and
SENCo/ANCo, to contribute to Individual Education Plan target setting and
share information, is generally made by telephone. For high priority
children, the therapist may attend annual review meetings in school.
Groups - Group therapy is provided by a Speech and Language Therapist
and Speech and Language Therapy Technical instructor and is divided
into three categories, (sound awareness, multiple sounds and higher level
language). Children are allocated to a group depending on their age and
type/s of difficulty. Benefits of group therapy are social learning and
support and the method of delivery allows a key emphasis to be placed on
parental involvement (with observation sessions, information leaflets about
groups and weekly homework to support therapy sessions) so that
progress is maximised.
Parent Child Interaction Therapy - The PCI service provides baseline
therapy for all pre-nursery children presenting with speech and language
delay/disorder and nursery-age children with language skills below a 3
Key Word level. It provides support to carers, empowering them to
develop their child’s communication skills. PCI is based on video feedback
to parents/carers and PCI+ targets language development more directly
through play-based activities.
Joint Voice Clinic – a GP referral based clinic for children with voice
problems that could require surgery.
3.61 The quality of these services is governed both locally and nationally. The Royal
College of Speech and Language Therapy publish Clinical Guidelines and also a
compendium of advice and guidance on best practice, “Communicating Quality 3”.
3.62 In addition Marie Gascoigne’s paper discussed above contains recommendations
on quality assurance and continuing professional development.
26
3.63 Local services can demonstrate many examples of good practice in meeting these
standards including:
o
o
o
o
Mentoring of all new staff
A commitment to Continuing Professional Development
Good staff retention
Cross-disciplinary training, including some staff also trained as teachers.
Welsh Language Services
3.64 A Specialist Specific Language Resource and Outreach Service has been
established in Flintshire by the LEA and similar numbers are likely to be served in
Wrexham. This provision currently equates to 3-4 sessions per week compared to
an estimated need of 1 WTE staff member (as identified by the SLT service).
3.65 The Welsh Service offers assessment, therapy (and training to relevant
stakeholders) for children whose first language is Welsh. Advice and support for
colleagues who encounter children who are in Welsh medium education (regarding
interpreting assessment results, therapy/IEP recommendations etc).
3.66 A Welsh Language clinic-based service is also available through the SLT Health
Team.
3.67 The SLT service has been commended for the development of its “Codio Siap a
Lliw”. This is an innovative Shape and Colour Coding system which supports the
development of language and sentence structuring.
Service Pathways and Processes
3.68 From this description of existing services it is apparent that support for some
children may be delivered by services at different levels of the pyramid at different
times and as their needs change.
3.69 To avoid undue delays (and the frustration that goes with them) these “pathways”
need to be designed in a way that matches resources to need and which avoids
“hand-offs” (that is a transfer of responsibility from one professional to another)
and “bottle-necks” (parts of the process where progress is slowed, often waiting for
a particular test or access to a scarce resource).
3.70 For example there have historically been delays in the process in transferring from
community based therapy to Outreach. The latter being dependant on the issue of
a final statement which can be a lengthy process. Work is currently underway to
address this in the hope of avoiding undue delays.
3.71 Pathways are also strongly influenced by the degree to which different professions
can and should work in an integrated fashion with others. A recent publication on
pathways within the NHS suggests that pathways need to be integrated wherever
possible.
3.72 Currently there are joint pathways for access to Language Outreach and
Language Resources.
3.73 As part of the ISLACS Project, pathways for each common condition were mapped
within Speech and Language Therapy services. These are contained in the
Appendices.
27
3.74 In parallel with this process is the education process of assessing Special
Educational Needs. This process follows the ‘pathway’ of the Special Educational
Needs Code of Practice for Wales. This sets out a graduated response, namely
School Action (SA), School Action Plus (SAP) and Statement. These processes
are formally recorded in documents at SAP and Statement level (see Appendix).
3.75 This highlights the issue of how health and education pathways can be integrated
to provide a seamless service to children with additional needs.
3.76 There has been extensive interagency work on developing these ‘pathways’ to
achieve the above before the project and during the initial stage of the project .
Suggestions were made as to how this could be achieved but unfortunately this
work has yet to bear fruit.
3.77 The criteria for issuing a Statement of Special /Additional Needs for SLCN in both
Local Authorities (Appendix) consist of general process criteria which relate to the
work of the school and in addition, specific criteria relating to Speech Language
and Communication or Interaction and Communication. These criteria provide the
basis around which decisions are made regarding which pupils should receive
additional support from the LA for SLCN.
3.78 Accurately and sensitively prioritising the specific needs of individual pupils with
SLCN can be a challenge. It is well documented that SLCN can present in a
complex way with associated difficulties and needs. All professionals involved,
therefore, need to be clear regarding the purpose of additional support and
programmes and to evaluate the outcomes from this.
3.79 In order to evaluate the provisions offered, currently data is collected by the
Inclusion Service on all SLCN pupils in Flintshire who have a statement or are
placed at School Action or School Action Plus in secondary phase. This data is
also collected on all children with statements and who are placed at School Action
Plus in the primary phase whether they are taught in a resource provision or
mainstream school.
3.80 The agreed outcome data consists of standardised scores for reading and spelling.
Teacher assessed National Curriculum levels are also recorded. There are no
specific data relating to the pupil’s SLC needs. In both Authorities, data relating
more specifically to the pupil’s area of need is recorded for all children with Special
Educational Needs in the child’s IEPs which are reviewed at least twice a year.
Planning and Commissioning
3.81 Commissioning processes both within Health and Local Authorities are complex
and can sometimes be bewildering for the public. This was an area highlighted by
Bercow as being in need of attention.
28
3.82 The process for commissioning can be summarised below.
3.83 This framework could be used to undertake a formal self-assessment of joint
planning and commissioning activity. This was not within the scope of the ISLACS
project, but a few of the current strengths and weaknesses can be summarised as
follows:
Strengths: current joint structures
Weaknesses: current joint structures
Service level agreements in place for
outreach and resources
Aligning clinical governance with flexible
delivery
Clear auditing and accountability within
individual agencies
He who pays the piper does not call the
tune
Local accountability through elected
members
Lack of understanding of respective
systems and the constraints
Confused stakeholders
29
4. Local Good Practice
4.1 At the operational level, there are existing and acknowledged areas of successful
and integrated practice which were further highlighted through the audit of
stakeholders.
4.2 Wherever possible these will form the basis for future integration.
Training and Self Help
4.3 Talk for Talk: This project was established in Wrexham in 2003 (and at that time
was known as SPEC, “Supporting Parents of Exceptional Children”).
4.4 This was a partnership established between parents and pupils, AFASIC, Parent
Partnership, schools and SLTs. This comprises a group of parents / carers, with
participating partners from the voluntary agencies, Health and Local Authority who
meet regularly with the aim of supporting, informing and empowering parents of
children with SLCN.
4.5 Talk for Talk has been evaluated, extended and widely disseminated both locally
and nationally. Talk for Talk operates through their own fund raising efforts and
through funding for their meeting venue from the Local Authority.
4.6 The active sharing of skills and practice is generally recognised to be one of the
most effective ways of rehearsing and embedding new skills and approaches. This
model of skill sharing has been implemented through the “Accelerated Learning”
programme (now the Effective Learning Programme) established in 2002 and coordinated through Wrexham Educational Psychology Service. This particular
programme specifically supported the raising of standards by improving thinking
and learning skills.
4.7 Centre based day or twilight training sessions have been continued through
networked schools hosting demonstrations and models of the principles, together
with a resource ‘bank’, IT networking and some additional Teaching Council for
Wales funding to the established networks.
4.8 AFASIC provided training in selective mutism which was jointly funded and
attended by a range of professionals from both counties as well as parents.
4.9 A further example of good practice is the training provided by the SLT Health team
to Early Years workers (playgroup, childminders etc.). A 2 hour evening training
session was provided for 5 weeks focusing on early language skills and how to
promote these and identify children who have difficulties requiring referral to SLT.
20 places were available and filled in 4 days.
4.10 Evaluation of the course was very positive with all 16 participants saying they
would recommend it. Specifically they felt it raised their skill levels, as shown in the
graph below.
30
Participants' Confidence to Help Children:
14
Before
14
14
12
After
10
9
8
6
4
2
1
0
0
Who don't
understand them
Who can't be
understood
0
Who aren't talking
yet
4.11 Training is also provided into specialist health resources. An example of this is
dysphagia training provided into Hope House hospice for children with swallowing
difficulties. The entire staff group of 40 was trained SLT and sessions were very
well received. One participant stated:
“It was one of our best training sessions – really relevant and positive – gold
star”
Assessment & Care Pathways
4.12 Moderation Panel - In Flintshire SLTs are members of the statutory assessment
panel . They contribute as equal partners regarding the nature and level of support
which should be provided to pupils with SLCN . This contribution is felt to improve
the decision making process and additionally it enhances mutual understanding.
4.13 The provision of extra support for children with learning difficulties with literacy and
numeracy at School Action Plus in both LAs ensures that once a need is identified
support can be provided quickly without the need for the lengthy process of
statutory assessment .
4.14 The system operates criteria against which both previous school based
intervention and pupils levels of attainments are carefully moderated. There is a
rigorous review system to ensure that the support results in progress for the pupil.
For example, the figures below for Flintshire illustrate the small number of pupils
for whom a statement is now necessary for pupils with specific learning difficulties
as compared to SLCN in KS 1 and 2.
Statements
SLCN
74
BESD
10
SPLD
3
Joint Provision
4.15 Flying Start provides an example of good practice in joint working at the “coalface”. SLT provide a Flying Start therapist who works into all Flying Start provision
providing advice, support and therapy. This therapist meets monthly with the
specialist Advisory Teacher and they provide a joint training package for staff.
31
4.16 The joint Autism Services in Wrexham are another good practice example. These
were jointly planned and are jointly implemented as a trans-disciplinary team
including SLT, Technical Instructors, Specialist Teachers and Specialist NNEBs.
They provide services in ASD resources at Infant, Junior and Secondary levels.
This is an innovative service providing intensive joint input to these clients in a
small group setting.
4.17 Language Outreach: comments from stakeholder interviews (see below) indicated
that outreach is a service where sometimes we are getting it right:
“My views and concerns were listened to with great interest and respect while
my child was being assessed” and
“We all worked as a team”
4.18 The Educational Psychology Services in both LA’s provide a regular consultation
service to all schools. Central to the principle of consultation is that all
professionals who have information and problem solving skills to contribute are
invited. SLT’s clearly form part of this group and joint working between SLT and
EP is common practice at the frontline.
Joint Planning
4.19 Autistic spectrum disorder: The Educational Psychology Service in Wrexham has
recently completed a project with the support of funding from WAG, (April, 2008).
The project consisted of the establishment of a small working group, to look at
existing good practice in Education with regard to meeting the needs of children
with ASD and implementing WAG published guidelines. SLT’s have also been part
of Flintshire’s review of services for children with
ASD.
Hearing Impairment
4.20 There was positive feedback from parents in
Wrexham who particularly reflected that the flexible
approach of the Local Authority in attempting to meet
children’s needs was appreciated.
4.21 Parents felt that they were involved in the
assessment and decision making processes to do
with the Statutory Assessment of their children and
felt that their views were taken into account. A range
of resources were identified by the Working Group
which were relevant and useful to staff working in
schools.
A joint project group
looking at working
together to prioritise
needs within scarce
resources.
Members of the
working party are
SALT, Sensory
Advisor teacher,
Specialist Teacher,
Audiologist, EP.
4.22 In addition, a Special Interest Group (SIG) has
evolved from the project and will continue regular
meetings through different host schools across the Local Authority.
4.23 The Student Assistance Programme has been implemented in Wrexham schools
since 2003, across all secondary schools and within an increasing number of
primary schools. The Programme provides a structured system and framework to
help school staff and pupils manage to overcome the emotional challenges that
can exist.
4.24 The Student Assistance support strategy was set up with a group of Year 6 pupils
who were already receiving support through the Language Outreach Team in
32
Wrexham. The outreach workers had been trained in the Student Assistance
Programme approach.
4.25 Pre and post measures within the group reflected a
high shift from low self esteem and feelings of being
helpless to strong measures of empowerment and
confidence after participating in the SAP Group
sessions .
Student Assistance
Programme
Before: “I felt
nervous. I was
unhappy because
people made fun of
me and said that I
was thick”
After: “I know that
people like me just
the way I am”
“I learned how to talk
to people”
33
5. Stakeholder Views
5.1 Ascertaining the views of stakeholders has been a central component of the
ISLACS Project. The process used to gather the views of stakeholders can be
summarised as follows:
o The first stage of the consultative process involved providing a wide range
of stakeholders with information regarding the project.
o The second stage involved gaining the views of key stakeholders
regarding the service currently received and aspirations for future service
via semi structured interviews and questionnaires as follows:
 Pupils receiving a service - Semi Structured Interview
 Parents – Questionnaire
 School Based Staff – Questionnaire
 Educational Psychologists – Semi Structured Interview
 Speech and Language Therapists - Semi Structured Interview
 Specialist Provision Staff – Informal discussions.
o A number of focus groups were planned to include, for example, health
based referral professionals. Due to the change in staffing during the
project these were not completed.
o Finally it is intended that a wide consultation will take place with regard to
the draft proposals. This would ensure all stakeholders are able to
contribute to the final outcome. The method with regard to this will be
dependant on time and finance.
5.2 Information regarding the project was initially provided to a wide range of
stakeholders between February 2007 and May 2007.
5.3 A number of presentations were offered to professional groups. Most groups
accepted these invitations (appendix).
5.4 A stakeholder report (appendix) and booklet (appendix) were distributed at
presentations. The booklet was also distributed via the SLT Department to all
parents whose children at the time received SLT input and to a proportion of
parents/carers whose children had previously received therapy.
5.5 In addition, booklets were also distributed to groups and individuals who did not
attend the presentations. Copies were placed in Children’s Information Centres
and all libraries in Flintshire and Wrexham to maximise the number of stakeholders
receiving information etc. An early opportunity was provided via a response slip in
the booklet for recipients to voice their views on current services (see Appendix).
5.6 During the autumn term 2007 a sample of school staff were asked to discuss the
work of the project with pupils who received support for SLCN using a prepared
script. Staff then gave pupils an opportunity to participate in the project via a semi
structured interview.
5.7 The table below summarises the stakeholders surveyed for the project:
34
Research Method
Questionnaire to school staff (Flintshire)
Questionnaire to school staff (Wrexham)
Questionnaire to Parents
Interviews with pupils
Interviews with Educational Psychologists
Interviews with Speech and Language Therapists
Number
Involved
74
60
210
22
16
17
% Response
Rate
32%
35%
34%
n/a
100%
59%
5.8 Responses to these surveys are analysed below. For pupils, Educational
Psychologists and Speech Therapists, semi-structured interviews were used to
provide “qualitative” information and to draw out broad themes. For other groups a
statistical analysis of some replies has been included to also provide a
“quantitative” analysis of responses.
Pupil Views
5.9 Pupils interviewed attended two resources in Flintshire and one resource in
Wrexham. They represented both primary and secondary pupils and included
pupils from two target populations i.e. hearing impaired and specific language
impairment.
5.10 A semi structured interview was prepared to provide an opportunity for a sample of
pupils from the target group to discuss their experiences of current services.
5.11 Following agreement from the Head of the respective school, key members of staff
were identified to provide pupils with information about the project and seek pupils’
agreement to participate.
5.12 Participation was optional and pupils were given the choice of talking to project
staff individually or in groups. Two of the three project staff conducting interviews
had attended training provided by Dynamix.
5.13 Interviews took place in a room which the pupils were familiar with and which was
distraction free. This was arranged by the key member of staff from the school. As
all pupils chose to participate in groups in reality the interviews became focus
groups. An independent signer was available to assist where necessary.
5.14 There was no attempt to discuss discrete aspects of service e.g. individual therapy
sessions. The coordinators took the view that pupils would not be fully aware of all
aspects of the support provided. The aim was therefore to gain a view as to how,
overall, the pupils felt supported and the extent to which they felt they had had a
say.
5.15 The discussion with pupils covered four main areas:
o
o
o
o
Inclusion
Locus of control
What is working well
Getting stuck / support in the classroom and outside.
5.16 A short summary feedback booklet was provided to pupils. The recording log was
used to analyse the responses into the four areas which had been the focus of the
group.
35
Inclusion
Locus of Control
Q. How do you feel in school, Do you like it Q. Do you feel listened to, How do you
here, Do you feel part of the class?
know you are making progress?
“The whole school is just fine to be honest”
“We’re classed as spaz and they’re the
cool people. The biggest problem is that we
get classed as lower than them or we’re not
as good”
“We’re all close, we stick together”
What is working well
“I had a meeting with my mum and
teachers and they gave me good reports”
“Teachers give us targets”
“They tell us how we are going on”
“Targets are on the board”
Getting Stuck
Q. How does the day go for you, what is Q. What do you do when you get stuck,
working well at school?
What helps?
“I like to sit next to my friends in class. Mrs
G sorted out my friends”
“I like every single bit of school”
Q. What would make a difference in
school?
“If all pupils listened in class that would
make it better”
“I’d like to go to (school name), all my
mates go there. My mum chose (school
name)”
“Like it exactly as it is”
“Canteen food”
“We have a teacher that comes and helps
– it makes me feel comfortable, if you don’t
know, you don’t know”
“I do some stuff on speech; we go to a tiny
room”
“She will help me if I put my hand up. I
arranged this with Mrs G”
“I feel OK when she helps because I
understand more”
“Sometimes I see (name of SLT) but I’m
OK with my speech actually. I come out
once a month and we recap things”
“I prefer to ask the teacher, they know what
they’re doing”
5.17 The pupils’ language difficulties did not seem to present as any obstacles to their
ability to voice their opinions. Pupils were very willing to contribute.
5.18 The enthusiasm with which the pupils participated surprised all project staff and
the feelings of all involved were that the pupils benefited in terms of their self
esteem. Although pupils were rewarded with certificates and letters of thanks it
was felt that the taking part was in fact possibly the most rewarding experience.
5.19 The outcome of the above consultation reflects that of the Scottish Borders Study
“Access All Areas” (2007) in that it shows the huge importance that this sample of
pupils placed on friendships and relationships in considering their wellbeing at
school.
5.20 These findings also support previous research described by Gina Conti–Ramsden
(2006) that there is a need for services to concentrate on language skills and
academic support but this, although crucial, is not sufficient. An integrated
approach including the young person is needed to ensure that services support the
development of social self esteem and consider ways to facilitate friendships.
36
5.21 Pupils talked positively about their schools and the helpfulness of staff. There are
examples of good practice in the schools we visited where pupils are able to
express their views and teachers negotiate the way in which support is delivered
and support for friendships provided.
5.22 Within the sample of pupils interviewed it was clear that although their needs were
broadly similar, they had strong individual preferences regarding how their
programmes of support should be provided.
5.23 With regard to Individual Education Programmes, overall the evidence from pupils
suggests that older pupils knew what their targets were but may not recognise any
input they have had into deciding or prioritising what those targets are. This
reflects the comments of the vast majority of school staff who described means by
which pupils are informed of their targets. There was a much smaller sample of
responses that illustrated more active participation i.e. where the pupils
“ascertainable” view is considered in the decision.
5.24 There is considerable evidence from the questionnaire responses from both
parents and school based staff that many children are considered too young or
unable to communicate their views due to their communication difficulties.
Parent Views
5.25 Parent views were ascertained by use of a questionnaire. In all 210 parents
responded, representing users of both the Health and Education SLT Teams, and
a full range of presenting needs, including autism, learning disability, and speech
and language impairment.
5.26 Parents were first asked when their child’s problems were first identified and by
whom. Half (49%) reported that problems were identified before the child was two.
In many cases (40%) it was the parent themselves who identified the issue.
5.27 Parents were then asked a number of questions about how easy it had been to
contact various professional groups. The results are summarised in the table
below.
How easy was it to
access:
Readily available
After one enquiry
After several enquiries
Not available
Other
Number of responses
SLT
29%
28%
20%
20%
0%
109
SENCO
41%
22%
9%
27%
1%
90
LEA
26%
23%
28%
23%
1%
80
Advisory
Teacher
44%
19%
10%
25%
2%
63
Teacher
58%
16%
11%
13%
1%
106
Teaching
Assist’nt
54%
8%
15%
22%
2%
65
5.28 Not surprisingly parents found teaching staff easiest to contact followed by other
education staff. The LEA and SLT are seen as less accessible.
5.29 On a more positive note well over 50% of parents reported that they could contact
each of the professional groups either immediately or after one enquiry.
5.30 Views were also gathered on how long families had waited for referral to Speech
and Language Therapy, for a first appointment and for therapy/advice to actually
begin. The results of these questions are summarised in the table below.
37
EP
47%
15%
15%
21%
2%
66
Decision Referral to
to referral
first seen
33%
14%
17%
19%
12%
14%
10%
16%
8%
13%
5%
7%
14%
16%
0%
0%
162
166
SLT Waiting Times
0-6 weeks
7-12 weeks
13-18 weeks
19-24 weeks
25-30 weeks
31-36 weeks
37+ weeks
Other
Number of responses
Accepted to
Intervention
28%
19%
18%
10%
9%
5%
11%
0%
155
5.31 This implies that a typical case could wait nearly six months for advice or therapy
to commence (six weeks, twelve weeks then six weeks). Some parents reported
waiting for around a year and felt this was counterproductive:
“the longer it takes to assess the child the more they become frustrated.”
5.32 To put this in some kind of context we can plot parents’ perceived wait for
treatment against actual reported waits for the whole of Wales.
40%
35%
Waiting Times for Treatment
35%
30%
28%
32%
28%
Wales Actual
NEWT Parents
27%
25%
19%
20%
14%
15%
11%
10%
7%
5%
0%
0%
<6 weeks
6-12 weeks
13-24 weeks
24-36 weeks
>36 weeks
5.33 Parents were asked whose views had been included in their child’s assessment.
The results were as follows (NB many parents listed more than one professional).
Whose observations are included in your child's assessment?
Parent/Carer
Speech & Language Therapist
Teacher
Educational Psychologist
Special/Additional Needs Coordinator
Support Worker/Teaching Assistant
Paediatrician
Other
GP
Don't know
85%
78%
55%
25%
21%
20%
17%
10%
9%
3%
5.34 Parents were also asked whether they and their child had been involved in
subsequent IEPs (NB some parents did not respond).
38
Involvement in IEPs/Programmes
Yes
No
Don’t know
Parent
32%
42%
14%
Child
11%
42%
47%
5.35 Subsequent questions asked whether parents knew their role in supporting
programmes, and whether children knew the targets they were to achieve.
Yes
No
Don’t know
Parent knows what to do to
make child’s IEP work
39%
45%
15%
Child knows their
targets
19%
49%
33%
5.36 This lack of involvement in assessment, planning and therapy left some parents
feeling they could offer more help if they only knew how:
“We would like to know about how to approach teaching at home so we can
support what happens in school”
5.37 On a more positive note many parents reported receiving support which had
proven to be helpful. About a third (32%) of all parents had received training which
was helpful and fully 70% found the advice given helpful. There were a number of
positive comments about the process including:
“My views and feelings on this subject were taken very seriously.”
“Discharge was fully discussed with us and we were asked if we agreed with
this decision which we did”
“Always been informed of progress, always been able to put my views across”
“Materials supplied by speech therapist have helped”
5.38 Some parents also indicated a high level of commitment to the process with nearly
a half (46%) saying they would always make time to discuss their child’s
assessment.
School Views
5.39 Staff in schools were also consulted using the questionnaire. A quantitative
summary of their responses is attached in the Appendix. In total 74 staff in
Flintshire replied, and 60 staff in Wrexham. This included a wide range of staff, as
shown in the table below.
39
Category
Class Teacher
Deputy Head
Head Teacher
NNEB
SENCO/ANCO
Specialist Teacher
Subject Teacher
Support Worker in Resource
Support Worker/Teaching Assistant
Teacher in Charge of Resource
Not Known
Grand Total
Number
22
1
20
4
51
8
1
4
6
14
3
134
5.40 The survey revealed a wealth of information about how education staff deal with
speech and language difficulties. A range of tactics were employed by staff to
address issues within the classroom context. These included:
Method Employed
Using a different teaching approach
Using specific materials
Working with pupil on confidence and other issues
Providing additional support
%
34%
20%
19%
14%
5.41 Many staff had used some form of assessment tool or checklist to assist them.
These included the following:
Tool or checklist
Have used Found it useful % Found it useful
Travelling Together
51
23
45%
Recorded Observation
43
14
33%
AFASIC Checklist
28
25
89%
Any other checklists
28
18
64%
Neales Analysis
60
32
53%
Standardised Tests
62
42
68%
Other
7
6
86%
5.42 A wide range of other professionals were also involved with children, including
Educational Psychology (25%) and Health staff (21%).
5.43 Access to SLT was generally regarded as straightforward with 50% saying it was
readily available and a further 29% saying it was available after one enquiry.
Furthermore 61% said they always received written feedback when they provided
information for assessments. On the other hand, though a third said they had had
a referral returned by SLT.
5.44 It was also clear that staff had been supported by a wealth of training and support
materials. Generally about two thirds of training and materials had been provided
by other educational staff and about one third by SLT. When asked which
materials were useful staff responded as follows:
What Materials are Useful?
School materials
Materials from SALT
Materials from Language Outreach/CLASS
%
25%
21%
17%
40
5.45 When asked what would help further, over half (57%) wanted more training,
particularly on Inset Days. A quarter wanted access to more assessment or
intervention materials and 18% requested more information about available
services.
5.46 A number of areas for development can be inferred from the responses. For
example, when asked when an IEP was drawn up for children with speech and
language difficulties 39% said immediately. A service which promotes an
emphasis on early intervention might hope to see this figure improved.
5.47 A similar figure (32%) said children were actively involved in IEPs or meetings
relating to them, with another third (37%) saying it depended.
5.48 On the issue of training, roughly a third of respondents had received a relevant
CPD course, a third had experience of skill sharing, but a quarter (23%) had
received no training or skill sharing at all.
Views of Professionals
5.49 Roughly half of all Speech therapy staff were interviewed and all Educational
Psychologists. Staff responses have been analysed in a qualitative rather than
quantitative manner, allowing us to identify key themes and issues.
Speech and Language Therapists
5.50 Seventeen staff were interviewed (including three Technical Instructors) from both
the Health and Education Teams within the NHS Speech and Language service.
5.51 Several themes emerged, notably:
o
o
o
o
Links to schools
Links to Educational Psychologists
Clarity over roles
Information sharing.
5.52 There was a general sense amongst interviewees about the importance of close
working with schools. Where cases worked well it was often because of good
working relationships with staff in schools. Where SLT staff wanted to work
differently it was often to improve their working with schools (particularly amongst
the Health Team).
5.53 Where SLT staff worked with pre-school age children they emphasised the
importance of working closely with parents (or in one case the successes involved
working within Flying Start). When the children reached school age, Health Team
members generally wanted to work more in schools.
5.54 When asked specifically about issues with Educational Psychology the main issue
was about access. Staff were aware how busy EPs were and that they often
worked in schools, but this made communication difficult.
5.55 Staff also reported a reluctance to share information and assessments. This was
particularly difficult for SLT staff who felt they often needed information from
cognitive assessments to determine whether a child’s problems were just about
speech or about more than this.
5.56 Regarding clarity of roles, this took several forms. Some staff felt their own role
was not understood. In particular they wanted to take on a more consultative
41
model, providing training, support and advice to other staff (especially teachers).
When asked what they would like other professions to do differently, the most
common theme was actually to allow SLT staff to provide them with training.
5.57 On other occasions SLT staff felt they did not understand the role of Educational
Psychologists or that the different roles of SLT and specialist teachers had not
been properly thought through. As one SLT put it:
“I think there is a lot of baggage about educational psychologists…we have a
lot of baggage about them and there are a lot of preconceptions about how
we think they should work and how they think we should work.”
5.58 Sharing information and being unclear regarding extended consents across
Services was also identified as an area for clarification and one that would improve
communication and information exchange.
5.59 Information sharing was a strong theme. SLT staff reported not being routinely
invited to reviews, nor being routinely sent statements or assessments.
SLT Views on Integration
5.60 The interview specifically asked staff for their views on an integrated services.
Most respondents had an understanding of what this might mean and recognised
potential benefits.
5.61 Staff mentioned developing a more collaborative culture and working more closely
with schools and parents. They also mentioned a range of staff who could be
included in an integrated service.
5.62 Generally, collaboration was identified as having the potential to optimise
communication between agencies and also parents. However, effective
collaboration requires that the full range of practical and conceptual issues be
addressed and resolved. As Palikara et al (2007) observe, it is not enough to focus
on structures and processes, effective practice is concerned with outcomes.
5.63 Potential benefits cited included improved referrals, a more open flow of
information between professionals and a more holistic approach towards children.
5.64 One respondent in particular had past experience to draw on:
“I came across a service where there was a team with two educational
psychologists, two speech and language therapists and two speech and
language therapy teachers. They had a joint caseload and did shared
assessments and had joint weekly meetings about the caseload. That was a
really helpful way of working for getting a holistic picture of children.”
Educational Psychologists
5.65 The interviews with EPs were undertaken in a three week period at the end of
October and November 2007. The interview schedule was drafted and trialled with
4 representatives from the Educational Psychology Services. A copy of the
questionnaire was provided to the interviewee some days in advance.
5.66 Educational psychologists were interviewed by members of the project coordinators, but not by members of their team.
5.67 Responses to the EP interviews were analysed using a coding frame which
identified key themes and category headings. Agreement was reached regarding
42
the relevance and economy of the coding that most efficiently accommodated the
data provided. These responses are categorised as follows:
o
o
o
o
Practical issues
Approaches to work with children
Approaches to work within schools/settings
What would an integrated service look like.
5.68 A number of practical issues were raised by EPs. These included:
o
o
o
o
awareness of each others’ structural and organisational backgrounds
expectations of other services
contact details for services and individuals
ease of contact.
5.69 In terms of approaches to work with children generally, and assessments
specifically, the EPs reflected their use of a wide range of approaches. Many
indicated that contextual observation and criterion referenced approaches were
pivotal in their assessment.
5.70 A percentage of EPs had concerns regarding the frequent requests for cognitive
assessments from SLT colleagues and felt that these could lead to inequality and
discriminatory or discrepancy based approaches to allocation of scarce resources.
5.71 The rationale has been highlighted in a study undertaken by Dunsmuir et al
(2006), where the debate on predicted outcomes from therapy based on nonverbal IQ measures is examined. Botting et al (2001) indicate that IQ is a reliable
outcome measure but other studies challenge the reliability of this (Dockrell and
Conti Ramsden 1996, and others) Botting et al 2001 and Bishop and Edmundson
1987)) describe other language measures which provide stronger indictors of
therapy outcomes.
5.72 The paradox here is that SLT felt that a cognitive assessments was necessary in
order to clarify whether or not a child’s needs were related to an intellectual
disability (in order for the LA to determine the most appropriate service to address
the child’s needs). This is evident for example in Flintshire’s Language Resources
where the criteria for entry is average or above average ability.
5.73 A number of EPs reflected that more training in the identification of specific
language disorders would be welcome, if only to enable conversations with SLT to
be based on a shared a common understanding.
5.74 Many EPs had received the JPDF programme of training designed through ICAN
but this was generally given a low appraisal.
5.75 Shadowing colleagues in SLT Services was identified as being a useful way of
establishing understanding of differing approaches.
EP Views on Integration
5.76 In common with the Speech and Language Therapists, the Educational
Psychologists were asked about what an integrated service could look like. This
elicited a number of comments including:
o Clear pathways
o One service rather than school/clinic split
o The will to do things together.
43
5.77 Both EPs and SLTs identified joint consultations as a way forward to achieving
integrated services and that EPs and SLTs shared many elements in their work
and approaches but that time and work pressures did not allow the communication
which would actually facilitate integrated working. As one EP commented:
“If we only had the time to talk together we would probably make more time
for more efficient ways of working but the problem is to just start it off. I can
never get my diary together with the SLT who might be involved and we
always miss each other on the phone.”
Summary
5.78 It is clear from the stakeholder analysis that a number of common themes are
emerging. These are discussed in more detail in the following section and include:
o
o
o
o
o
Information
Early Intervention
Involvement
Integration
Communication.
44
6. Conclusion: Themes and Issues
6.1 Taking together the evidence from stakeholder consultation, and national research
and best practice we can identify a number of key themes which will need to be
addressed. These are discussed in more detail below.
Information
6.2 Many stakeholders requested more (or better) information. This reflects the
position in the rest of the UK. The Bercow Review for example found that 77% of
parents reported that information was difficult to access.
6.3 This was not an implied criticism of any one profession, more a recognition that
with certain limited pieces of extra information they themselves would be able to
tackle some issues without recourse to a referral.
6.4 This is an important means to bolster early intervention, to strengthen prevention
and to assist families with self-help strategies. Some quotes from parents and staff
reinforce this:
“A bank of useful ideas, tips and tried and tested resources”
“A SALT simple booklet for parents/teachers outlining problems and where to
get help, simple strategies to try”
“Details of activities used by therapists which can be adapted for use in
school”
“I have valued any guidance/resources shared by SALT – would welcome
more of the same in the future”
6.5 This was also an issue in terms of the support provided by both Education and
Health for Welsh schools:
“Knowing who are bilingual therapists so I can contact the individual without
any time wasting”
“More resources in Welsh/support/instructions e.g. resources we receive are
in English, meetings are in English and we have to wait for unacceptable
periods for translation of reports etc”
“Opportunities for In-service training and focus based discussions through the
medium of Welsh on different aspects of requirement and SLCN”
6.6 School staff want information not only on addressing needs but also on pathways
and processes, for example who is who and most especially feedback on where a
child is up to in the pathway/process.
Early Intervention
6.7 A recent national report stressed the importance of language to early childhood
development:
“Promoting children’s speech and language development is especially critical
to enabling them to learn well in school. All staff in [children’s] centres need to
understand the importance of providing a language-rich environment, and
45
have the skills and understanding to be able to interact well with young
children”. (DCFS, 2008).
6.8 Early Intervention was identified as an area for concern amongst both staff and
parents. Some were keen to point out the importance of acting quickly to ensure
good progress in a child’s development. Other noted a perceived increase in
issues around language:
“Speech and language is an ever increasing area of growing concern, more
and more children are arriving in nursery with poor or no speech and
language”
6.9 Stakeholder consultation revealed some success in early identification and
treatment. Half of parents reported that their child’s problems were identified
before the child reached two years old.
6.10 Similarly over a third (39%) of schools reported that an IEP to address speech or
language difficulties has developed immediately that issues were identified.
6.11 Some examples of good practice are also available locally – especially around
Speech and Language Therapists working into Flying Start services.
6.12 However perceived difficulties still remain. Half of parents reported waiting more
than 12 weeks to be seen by SLT services. A similar proportion then waited more
than 12 weeks for advice or intervention to begin. Data on waiting times is shown
in the table below. (It is worth remembering that national waiting times targets are
currently 24 weeks and were previously 36 weeks).
Average Waiting Times
Education SLT Team
Health SLT Team
Overall Average
July 07
28.0
23.2
23.7
Aug 07
N/A
23.7
23.7
Sep 07
19.6
18.8
18.9
Oct 07
26.7
16.2
16.9
Average
23.4
19.8
20.0
6.13 Having said this, figures compiled by the SLT department suggest that waiting
times have reduced over recent years. Indeed the SLT department was the first
therapy department to win a national award for innovation in addressing waiting
time. The graph below shows average waiting times for the Education Team within
SLT.
80
72
Waiting Times for Education SLT
70
Weeks Waiting
60
50
42
40
32
30
22
20
10
0
2003
2004
2006
2007
46
6.14 Nonetheless, there is still a willingness for further improvement. This would be
welcomed by schools. As one school respondent put it:
“Waiting list for SALT professionals is too long. So much damage is done in
their early education in this time - alternative may be to train school staff in
SALT strategies”
6.15 One way to tackle this might be through better information and training for staff.
This would require agreement between agencies about what training is needed
and mechanisms for school staff to be released.
6.16 Another suggestion was to streamline pathways so that a wider range of supports
can be offered without a statement.
6.17 For many other conditions (e.g. behaviour or literacy problems) there are criteria
for children to access support at SAP(S) and also at statement levels. For children
with speech and language needs, some services can only be accessed at
Statement level. This is seen as problematic as it causes unnecessary delay.
6.18 For example, in Flintshire access to a Language Resource has been only via a
statement and as there are insufficient places those on the “virtual waiting list”
receive Outreach instead.
6.19 An alternative approach would be to have new criteria for Outreach and for this to
be provided at SAP(S). This may well be quicker for families and provide a more
appropriate use of both Outreach and Language Resource. As already mentioned
work is in progress to address this, which could yield benefits to children in need.
6.20 This was backed up by one school surveyed who requested:
“A less troublesome (and often unnecessary) system of going through a
STATEMENT (statutory assessment) prior to receiving the help (small) which
is required for the child.”
6.21 While access to SLT is not dependent upon a Statement (only 2-3% of the SLT
caseload have a statement), it is clear that pathways to different levels of service
are not always well understood by staff.
6.22 It is also clear that with national changes to the statementing process pathways
will need to be refined. Work is already underway on this with agreement in
Wrexham to a SAP level service in schools.
Involvement
6.23 Family and child involvement in the assessment, IEP planning and therapy
processes is not just a matter of principle. Evidence suggests that assessments
are more accurate and programmes more effective if children and families are fully
involved. This is also identified as good practice in the Code of Practice, 2002.
6.24 Some school staff and parents reported limited levels of child involvement in IEPs.
Perhaps most worrying only one in ten parents said their child had definitely been
involved in developing their IEP and less than one in five reported that their child
actually knew what targets they were trying to achieve.
47
Integration
6.25 The evidence on integration was more positive. Most staff interviewed had some
conception of integration and a view about who could be involved.
6.26 Some staff had previous experience of models of integration – either from previous
workplaces of from training placements.
6.27 Factors which were cited as core components of integration included:
o
o
o
o
o
o
o
o
o
Working more in partnership with parents
Closer working with schools
Gaining a better understanding of each others’ roles
Developing a multidisciplinary team
Taking a holistic view of children, including their strengths
Joint assessments
Better sharing of information
A shared base for staff
Developing a shared culture and value base.
6.28 On the latter point a number of staff stressed the importance of developing an
open approach to working together and sharing information:
“I think that a greater collaborative working ethos could be achieved. There
are barriers to this on both sides and I find that quite frustrating because it’s
barriers to helping the children.”
6.29 Returning to Gascoigne’s discussion of integration, we can plot a range of different
models for interagency working. These represent a spectrum from alignment and
co-operation through to more complete integration within the context of the child’s
world.
6.30 From interviews with staff it is clear that most felt that closer working was possible
in a number of areas. Some staff seemed to be describing a move towards multidisciplinary working, while others clearly had a view more akin to the model of
inter-disciplinary working.
48
6.31 The model described by one SLT of an integrated team of professionals from
different agencies could form the basis for a more integrated approach in each of
the two Local Authorities.
6.32 While this could provide a single access point and the basis for co-location,
integrated pathways and joint assessments, care would be needed to ensure that
this integration does not “cut across” other integrated services such as children’s
disability services or Home Advisory Services. Nor should integration force a
fragmentation of SLT departments which need to maintain a critical mass and
ensure staff access to continuing professional development.
Communication
6.33 Professionals on all sides mentioned problems contacting each other. They talked
about how this often meant that weeks passed with little progress as professionals
left each other telephone messages.
6.34 Some felt this could be overcome by more joint assessments, or some mechanism
to contact each other when out of the office, such as greater use of email and of
mobile phones. Joint consultations to schools by SLTs and EPs were also
suggested.
6.35 As previously mentioned access to the assessments and reports of other
professionals was also felt to be useful in sharing information about children’s
needs.
6.36 As we have seen, relatively simple changes in communication systems can bring
real results. By contacting schools directly to advertise training courses the SLT
service has increased take-up significantly.
Service Gaps
6.37 Although a rigorous Needs Assessment and Gap Analysis has not been possible
within the constraints of the ISLACS Project, our review of existing services,
combined with the surveys of stakeholders has raised a number of key issues.
These can be summarised as follows:
o Information - there is insufficient information available to stakeholders
generally about services for SLCN provided by Education and Health and
insufficient information to assist self help .
o Training: there are no agreed induction or training programmes regularly
delivered to staff and parents working with children with SLCN
o Early Intervention: Whilst there is a good range of specialist provision in
both Local Authorities, Outreach and Language Resources. These are
often over stretched and demand can outstrip supply . Further input lower
down the pyramid may alleviate this pressure and promote more inclusive
environments .
o Involvement: Pupil and family involvement in IEPs could be improved.
o Services: in the secondary phase, outside the very specialised resources,
services are patchy.
o Provisions for pupils whose learning skills are limited by other aspects of
their development and who also have a long term persistent language
disorder are not well developed.
49
o Communication: there are inadequate communication channels to ensure
that everyone involved parents , teachers , other professionals are
effectively sharing information.
o There are some services e.g. Hearing Impaired and Welsh language,
where pupil numbers are very small and SLT are very limited. Specific
gaps have been identified in these Services. Appendix.
50
7. Recommendations
7.1 During the course of this Project it has become apparent that there is broad
consensus on the values that should underpin speech, language and
communication work and on the range of services which should be provided. This
consensus can be summarised in the following key principles:
1. The development of speech and language is central both to personal
development and to educational achievement
2. Prevention and early intervention are crucial components of successful services
3. Services should provide a spectrum of provision from information and self help,
through training and support to group work and individual therapy/treatment
4. Children, Young People and their Families should be enabled to take an active
part in assessments, interventions and evaluation
5. Services should be based on evidence and best practice, should be outcomefocussed and should have mechanisms to receive and to listen to feedback
6. Services should be based on enhancing not just speech and language
development but a child’s overall sense of wellbeing and inclusion.
7.2 Taking these into account, the following recommendations are meant not as a
means to radically transform existing services, but as first steps towards greater
integration across agencies.
Overarching Recommendations for Further Integration
Recommendation 1. To create a single strategic forum to oversee joint planning of
speech, language and communications services across all agencies and to develop a
model for closer integration.
Recommendation 2. To build on areas of current good practice to promote joint
working and integrated provision at all levels.
Recommendation 3. To provide joint information for the public and for partner
organisations which sets out resources available for self-help, services available and
service standards.
Recommendation 4. To implement a core staff training programme at preschool age
and another for school age.
Recommendation 5. To agree a protocol for joint working which sets out arrangements
for sharing information and reports, arrangements for interagency involvement in
assessments, IEPs, reviews and therapy programmes.
Recommendation 6. To agree an inter-agency service standard concerning child and
family involvement in assessments, IEPs, service delivery and service planning.
Recommendation 7. To explore ways to overcome the delays caused when
professionals are unable to contact each other.
Recommendation 8. To consider joint funding and joint appointment of a “champion” to
drive forward integration of speech, language and communications services.
51
7.3 A detailed action plan could be developed to implement these recommendations.
Such an action plan would be project managed by the Strategic Joint-Planning
Forum and actioned by the “champion”.
7.4 The following actions are suggested as the basis for this Action Plan, although
they will need further consultation, discussion and amendment. And of course they
will need measurable targets and timescales.
Recommendation 1. Joint Planning
1.
To convene a strategic forum to oversee joint planning of speech, language
and communications services.
2.
Terms of reference for this forum would include needs assessment, overall
strategy, service benchmarking and promoting integration.
3.
Its membership would consist of heads of relevant services/authorities and it
would report to Children’s Partnerships in each Local Authority.
4.
This Strategic Forum to develop a detailed Action Plan arising from this report
and to monitor progress against that Action Plan.
5.
To revise the terms of reference for the Inter-County Speech and Language
Group so that it can provide a focus for operational work on integration.
6.
For the Strategic Forum to oversee feedback to stakeholders who participated
in the Project and consultation on the recommendations contained in this
report.
7.
To jointly compile a written protocol setting out commitments towards SLCN.
8.
To explore models for integration and agree a preferred model which
promotes prevention, inclusion and enhances the personal, social and
language development of children and young people.
9.
To consider SLC integration within the context of other moves to integration,
for example around Common Assessment and Children with Disabilities.
10. To consider the outcomes of other Pilot Projects undertaken through WAG
and relevant good practice recommendations arising from these projects.
Recommendation 2. Joint Working
11. To work towards establishing a single integrated speech and language
service which promotes early intervention and prevention by providing
information, consultation, training and face to face interventions for schools,
children and young people.
12. As a first step towards this, to develop a range of joint working mechanisms
including:
o The provision of joint information for the public and for schools and other
stakeholders setting out services available
o Development of integrated systems to support language development
o Explore the development of multi-agency panels to discuss referrals
o Establishing Integrated Care Pathways for the target groups
o An overarching model which links levels of intervention within pathways to
the stages of School Action, School Action Plus and Statementing
52
o A protocol for SLT involvement in IEPs and reviews.
13. To extend advisory teaching posts to cover all Key Stage education
provisions (currently at KS 1 and 2 only).
14. To extend specialist language services to the Youth Offending Services For
SLT staff to be members of Moderation Panels in both Local Authorities.
15. Consider development of multi-agency panels to consider SLCN referrals.
16. To revise current pathways to adopt the pyramid model of services where
intervention at the previous level has been completed. In particular this would
assume that for example, access to a Language Resource would normally
follow use of Language Outreach (except in unusual circumstances).
17. To consider the impact of impending changes to the Statutory Assessment
Process and how these changes might be used to stimulate new models of
integration across agencies.
18. To revise current pathways/processes so that access to Outreach can be
achieved at School Action Plus(S) level rather than requiring a statement.
19. To develop monitoring mechanisms (through the Inter-County Group) to
ensure equality of access for special interest groups including:
o
o
o
o
o
o
Welsh Language children
Excluded pupils
Looked After Children
Black and Minority Ethnic children
Travellers
Children whose first language is not English/Welsh.
20. To review the role of the Language Resources and in particular to explore
ways in which they can provide more outreach services and support to
children within mainstream school settings.
21. To review the structure of the SLT department with a view to enhancing
opportunities for integration in each Local Authority.
Recommendation 3. Joint Information
22. To provide a suite of information for stakeholders including:
o A directory of available services (across all agencies)
o A guide to training, tools and materials
o Simple guides for children and families setting out self-help tools for the
most common problems/issues
23. To agree with the Children’s (Family) Information Services what information
they should hold and what should be available on their website.
Recommendation 4. Joint Training
24. To explore the use of an agreed training programme to be used to support
staff in schools, nurseries, sure start etc. (e.g., Elklan, SLCF etc.)
25. To pilot the use of an agreed training course to be used by support staff in
schools, nurseries, Sure Start etc. (e.g. Elklan or SLCF)
26. To use an extended advisory teaching service to build on school’s existing
levels of understanding and competencies with regard to SLCN
53
27. To encourage schools to continue to audit their own language training needs,
linked to their school improvement plan
28. To explore ways to build greater understanding of each others’ roles across
professional groups. This could include team building work, best practice
seminars and training for managers.
29. To continue to provide information re speech language and communication
issues for discussion at SENCO forums and the wider Head Teacher forums..
30. To explore links to external bodies such as the various Head Teachers and
Governors Associations.
31. To ensure the Voluntary Sector is fully involved in pathways (as appropriate)
and fully supported to deliver its full potential.
32. To consider the training needs of escorts and other transport staff.
Recommendation 5. Information Sharing
33. To agree and implement an Information Sharing Protocol covering the sharing
of consultation outcomes, assessment information, IEPs, reports, and
reviews.
Recommendation 6. Involvement
34. To agree inter-agency good practice guidance on involving children and
families in assessments, reviews and IEPs.
35. To ensure that all services have mechanisms to receive and take account of
feedback from individual children and from families and other stakeholders
36. For the Inter-County Group to consider running limited parent surveys and/or
pupil focus groups to gather user views at regular intervals.
37. For feedback from children, young people and families to be considered by
the Inter-County Group at least annually.
Recommendation 7. Inter-agency Communication
38. To agree ways for professionals to contact each other, for example by using
emails, mobile phones and webinars to facilitate communication between
professionals who frequently work out of the office.
7.5 This leaves a number of areas where further work is still required, most notably
around aligning or pooling budgets and data management.
7.6 There was also a sense amongst the Project team that the development of robust
Outcome Measures would benefit services. SLT often use Outcome Measures in
the day-to-day practice and these could be used as the basis for shared outcomes.
7.7 Having said this, it is clear that there is a wealth of local good practice at grassroots level and a strong commitment to working together. This, more than anything
will form the basis for ongoing progress towards integration and continuous service
improvement.
54
7.8 Certainly there is commitment at senior level to achieving tangible improvement in
the experience of children with SLCN. So “early wins” should be possible. These
could include:
o
o
o
o
o
o
o
Establishing a Strategic Joint Planning Forum
Developing joint information for the public
Piloting an agreed joint training programme
SLT to join both Moderation Panels
Access to Outreach at SAPs level (this is already in development)
Developing an Information Sharing Protocol
Distributing e-mail addresses and mobile phone numbers between
professionals.
Acknowledgement
We would like to thank all those pupils, parents and our colleagues in schools,
health, education and other services who gave their time so generously in talking
with us, completing questionnaires and contributing information as part of the
project.
55
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DfEE (1997) ‘Excellence for all children’ Green Paper
DfES (2007) Statutory framework for he Early Years Foundation Stage
Dockrell, J. and Conti-Ramsden, G. (1996) ‘Children with speech and language
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Dunsmuir, R.,Clifford, V and Took, S (2006) Collaboration between educational
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Roulstone,S., Owen, R. and French, L. (2005) Speech and Language Therapy and the
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57
List of Available Appendices
Copies of background papers and appendices are available upon request from
sarah.morris@wrexham.gov.uk or Chris.Fergusson@flintshire.gov.uk
Documents relating to Section 1:
Original Bid to WAG
Key SALTAG Objectives
Target Group Glossary
Documents relating to Section 2:
School Pupils Numbers – Current and projected
Predicted Incidences
Documents relating to Section 3:
Local Guidance/Standards/Agreements/Protocol
Service Maps and Profiles (EP and SALT)
Current Pathways
Organisational Structures – SALT and Inclusion Service
Documents relating to Section 4:
Information to Stakeholders
Information to Parents, Pupils and Professionals (leaflets etc)
Annual Review Form
Pupil Participation - Do we meet your standards?
Information to Stakeholders (chart, presentation, leaflet, report)
Grids for semi structured interviews with pupils (setting up and conducting)
Flowchart re: semi structured interviews with pupils
Script for Teacher in Charge re: semi structured interviews with pupils
Letter to HT re: semi structured interviews with pupils
Letter of consent to parents re: semi structured interviews with pupils
Script for interviewer re: semi structured interviews with pupils
Thank you letter re: semi structured interviews with pupils
Certificate to pupils re: semi structured interviews with pupils
Feedback to Pupils leaflet
Evaluation of Methodology of Pupil Interviews
58
Glossary
Acronyms
ADHD – Attention Deficit Hyperactivity Disorder
ANCO – Additional Needs Co-ordinator
ASD – Autistic Spectrum Disorder
BME – Black and Minority Ethnic groups
BSL – British Sign Language
CAB – Citizens Advice Bureau
CLASS - Communication & Language Advice and Support Service (Flintshire)
CPD – Continuing Professional Development
CYPFP – Children & Young People’s Framework Partnership
CYPP – Children & Young People’s Plan
DfES – Department for Education and Skills
DoH – Department of Health
EP – Educational Psychologist
EPs – Educational Psychologists
EPS – Educational Psychology Service
IEP – Individual Education Plan
ISLACS – Integrated Speech, Language and Communication Service
KS – Key Stage
LA – Local Authority
LAC – Looked After Children
LEA – Local Education Authority
LHB – Local Health Board
MLD – Moderate Learning Difficulties
NEWT – North East Wales (NHS) Trust
NNEB – Nursery Nurse
PRU – Pupil Referral Unit
RCSLT – Royal College of Speech and Language Therapists
SALT – Speech and Language Therapy
SAP – School Action Plus
SEN – Special Educational Needs
SENCO – Special Educational Needs Co-ordinator
SLA – Service Level Agreement
SLCD – Speech, Language and Communication Difficulties
SLCN – Speech, Language and Communication Needs
SLT Services – Speech and Language Therapy Services
TA – Teaching Assistant
WAG – Welsh Assembly Government
59
Glossary of Terms Relating to the Target Group
Acquired Motor Speech Disorder
An acquired motor speech disorder is a general label that covers several distinct
disruptions to speech arising from illness or injury to the central or peripheral nervous
system. These include Dysarthia and Apraxia.
ADHD – Attention Deficit Hyperactivity Disorders
A range of disorders occurring in children. Symptoms may include poor concentration,
behavioural problems, hyperactivity and learning difficulties.
ASD – Autistic Spectrum Disorder
A lifelong, developmental disability that affects the ways a person is able to
communicate and relate to people around them. Autism and Asperger’s Syndrome are
names for different types of autistic spectrum disorders.
Cleft Lip / Palate
Caused when parts of the upper lip and/or gum and roof of the mouth (palate) do not
join together during pregnancy. It may be unilateral or bilateral.
Delayed Language Development
Usually used to describe a situation where the child has problems with speech or
language, but skills are developing along the normal developmental pathway.
Developmental Verbal Dyspraxia
Difficulty making articulatory speech sounds voluntarily. Struggling to get the target
sound. In some children producing single words may not be a problem but there is a
failure to produce them in an appropriate sentence pattern.
Disorder
Children with a speech and/or language communication disorder follow a pathway that
is different from the normal pattern or sequence of development.
Dysfluency
A disruption of the fluency and/or rate of speech caused by repetition, prolongation or
blocking of sounds, syllables and sometimes whole words. There may be associated
behaviours such as breathing irregularities, facial grimaces, involuntary bodily
movements etc.
Dysphagia
Difficulty in swallowing.
Dyspraxia
A disorder that affects the planning coordination of movement that can affect the
coordination of the speech organs and/or other actions – for example, eating, dressing
or writing.
Language Delay
A condition in which the child’s language level reflects that of a younger child.
60
Learning Difficulties
A general term used to describe a wide range of problems experienced by children who
find it significantly harder to learn than other children of the same age. The term can be
used to describe difficulties with learning, memory, concentration, behaviour, reading,
numbers or with speech and language.
MSI - Multi-Sensory Impairment
Children with multi-sensory impairment (MSI) have impairments of more than one
sense. Many children with MSI also experience other challenges resulting from medical
conditions or physical disabilities e.g. vision and hearing.
Progressive Disorders
A general term to describe disorders which are ongoing and deteriorate over time e.g.
dysarthria, dysphagia.
Selective Mutism
Also known as Elective Mutism. When children are able to talk comfortably in some
situations but are persistently silent in others. These children need multi disciplinary
involvement.
SLI - Specific Language Impairment
A term used to describe language difficulties with comprehension and/or no expression
where there are no other difficulties. Usually used where there is a significant
discrepancy in the child’s language from that of children of the same age or when
language development is disordered or unusual.
Voice
The sound made by the vibration of the vocal folds in the larynx (or voice box) in the
throat.
VPI – Velopharyngeal Incompetence
Failure of the soft palate to reach the back wall of the pharynx or throat.
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