Based on the current legislation, SPA guidelines, the best available evidence, and the aim of this service, a plan has been devised which seeks to improve school-readiness in at-risk children through the provision of an early intervention speech pathology service. This document outlines a service proposal, which will address key factors that impact service delivery, and ultimately will inform your decision as Director. Evidence Based Practice (EBP) As with all of my clients, this service will be guided by routinely incorporating the use of scientific principles in all resource development, planning, assessment, intervention, and outcome measurement. To support this, I critically evaluated the evidence from the literature, and incorporated my knowledge of research methods and statistics to ensure my planning is supported by the most recent and best available evidence. Trusted databases such as speechBITETM are always used. This service will consistently use evidence based resources for planning, which will help determine the efficacy and suitability of specific approaches going forward. As always, this process is paired with the needs, values and goals of the client, and my clinical expertise. It will also be ensured that all data is collected systematically, and meets with the centre’s current protocols and procedures for data collection and outcome measurement. Throughout this proposal, the evidence behind my decision making should prevail. Key Stakeholders To deliver this service, there are multiple stakeholders which have been considered and accounted for. Firstly, this service delivery varies depending on the age of a child. For children 0-3, my service will focus heavily on indirect strategies such as education of centre educators and parents. Considering the importance of speech, language, play, and social skills, these strategies will help nurture this and act as preventative measures for these at-risk children. Ultimately, promoting the development of children who will be best equipped for thriving in a school environment. As a part of my service for these children, fortnightly, there will be a educational presentation delivered face-to-face to the educators at the centre by myself. The duration will be 1 hour, and will be recorded so that any educators who cannot attend can still have access to the information. These sessions will focus on promoting the aforementioned skills, through providing applicable strategies they can bring readily adopt. To support parents of this age group, 2 hours a month will be dedicated to educating and supporting speech and language development in the home. This may include writing a newsletter, or planning an educational talk for parents. The second portion of my service will focus on children 4;0 years and older, as most of these children will be in their final year of preschool, and therefore are the highest priority for school readiness skills (Sheldrick and Perrin, 2013). Within this age group, children have started to form a solid foundation of skills necessary for school success; expressive language, receptive language, speech which can be understood by most adults, and functional social communication skills (Bowen, 1998). As a Speech Pathologist who predominantly works with these ages, I have a breadth of knowledge in this area of speech and language development. Therefore, when a child is not typically developing, my expertise in assessment allow this to be accurately identified, so that adequate intervention services can be planned. This aspect of my service will be split into 2 phases; phase 1, assessment and phase 2, intervention. This will allow for appropriate planning and distribution of the service in line with the budget. Another key consideration to my planning has been ensuring a family centred approach. As will be demonstrated throughout this proposal, involving the children’s families has been a key consideration throughout (Dunst & Espe-Sherwindt, 2016). Similarly, consideration of staff at the centre (eg. Director, educators’) has been key in planning, and has impacted service delivery models, budgeting and time allocation greatly. Through the Speech Pathology Australia (SPA) mentoring program, I will be accessing professional support 1 hour per week, which is available free of charge. This will be with an experienced SP who I can access professional support and learning through, to facilitate the development of my skills in this area. Furthermore it will provide an aspect of quality assurance, as my mentor will assist in evaluating my skills and plan for this service, whilst also encouraging self-assessment. Given the large proportion of children from culturally and linguistically diverse (CALD) backgrounds, 3 hours per week for the 6 months has been allocated for an interpreter so any CALD children and their families can be appropriately assessed and managed. This is based on the assumption the centre does not currently have an interpreter. This time will be planned accordingly depending on how many children are in need of this service and of what language. This is one of the many aspects of my service proposal which demonstrates my commitment to being a culturally responsive clinician, who values and respects the diverse backgrounds and cultures of the children and their families at the centre (Asnaani & Hoffman, 2013). My service also has been planned in line with the SPA Clinical Guidelines for ‘Working in a Culturally and Linguistically Diverse Society’ (SPA, 2016). Any extra time not spent on an interpreter will be reallocated for extra individual sessions. Examples of how this interpreter will be involved are: in the assessment process, conveying information to parent’s, translating written materials, etc. An allied health assistant (AHA) will also be involved in the delivery of services in phase 2 to ensure the service is delivered efficiently, and is maximising opportunities for pre-literacy, speech and language development (Lizarondo et al., 2010). The role of the AHA in this service will be addressed further in the proposal. Phase 1: Assessment The first phase of my proposed service plan will focus on formal and informal speech, language and pre-literacy assessment of all children (4;0 years and older). The purpose of this phase is to assess the children’s abilities in these areas in comparison to the evaluate whether their skills are comparable to typically developing children, and to guide intervention planning. Considering a large proportion of children at the centre are from culturally and linguistically diverse (CALD) backgrounds, there will be 2 models of assessment depending on the child’s language profile and background. This will ensure the assessment process is sensitive and appropriate for each individuals, and follows current best practice guidelines for working with these populations (Heilmann and Westerveld, 2013). The assessment process is detailed in Figure 1. The extent of assessment will vary from child to child, as some children will require all items on the listed process, however others may not, as sufficient information could be gathered earlier on. Figure 1: Phase 1 Assessment Process - Direct Contact (8 hours) Information gathering and assessment Indirect Contact (5.5hours) Analysis, scoring and interpretation of assessment data Progress Note and Report writing Planning and preparation of resources for direct contact hours Professional Activities (0.5hours): - Meeting to update and inform the Director of Centre on progress Lunch (1 hour) It is estimated that phase 1 will be completed within 1 month. At the end of this phase, there should be 2 groups of children who have been identified as ‘at-risk’ of not developing appropriate speech, language and pre-literacy skills required for school. Any children who are presenting with significant speech or language difficulties that could be as a result of a language, learning, or other disorder, will be referred to another speech pathologist for individualised assessment and intervention, in addition to participating in phase 2 of the program. This will ensure that my service provision is within the capacity of the current budget, while ensuring these children receive appropriate and necessary services. These children will also be included in phase 2 of the service plan. The structure of each week in phase 1, is detailed below. These hours will be split over 2 days. This structure allows sufficient time for appropriate assessment of the children, while leaving sufficient time for other aspects such as administration, resource development, note writing, collation of data and meetings. 1. 2. 3. 4. CALD Children Meeting with educator to flag specific children for delayed speech and language development Classroom observations of all children (with specific attention to flagged children) CALD Parent Questionnaire (The Alberta Language and Development Questionnaire (ALDeQ) If necessary, conduct a language sample analysis. Monolingual English Speaking Children 1. Meeting with educator to flag specific children for delayed speech and language development 2. Classroom observations of all children (with specific attention to flagged children ) 3. Parent Questionnaire (Children's Communication Checklist - Second Edition (CCC-2). 4. If necessary, administer: School Entry Alphabetic and Phonological Awareness Readiness Test (SEAPART). Phase 2: Intervention After phase 1, one week will be spent collating the collected data, analysing the assessment results, grouping children and planning elements of phase 2. This will consist of 5 months which will focus on providing an intervention service that is focussed on improving the children’s pre-literacy, speech and language skills. This service will be tailored specifically to areas that are challenging for the children as guided by the grouping of assessment results eg. 4 children all have low vocabulary therefore are grouped together. The structure of each week in phase 2, is detailed below. This plan was guided by the current evidence base, as well as the response to intervention (RTI) model. Daily Structure (2 days per week) Direct Contact (3.5 hours) - 15 minutes: discussion with educators and AHA regarding plan for hour session and how to best assist. - 15 minutes: meeting with AHA to discuss small group sessions for the morning. - 1 hour: Core whole class instruction working on foundational language and pre-literacy skills which all children (high risk and low risk) can benefit from AHA. - 1 hour: small targeted group sessions for medium- high risk children as identified in phase 1. Split into 4 groups. 2x 30 minute blocks. 1 group with SP and 1 group with AHA. - 1 hour: Two 30 minute individual sessions for 2 high risk children. Indirect Contract (1 hour) - 30 minutes: Correspondence with educators at the end of the day, emails to parents. - 30 minutes: Progress note writing. Weekly Structure (5.5 hours per week) Professional Activities - 1 hour: In-service for educators for educational session and plan for the fortnight (Alternating weeks eg. week 1: educators for 0-3year olds, week 2: educators for 4-5year old, etc.). - 30 minutes: Meeting to update and inform the Director of Centre on progress. - 1.5 hours: Interpreter. - 2.5 hours: Planning of sessions and resource development with AHA. Total=5.5 hours Monthly: 2 hours will be dedicated for planning and provision of a parent focussed educational presentation or planning of educational information to be sent home. This will be largely conducted by the AHA, with my supervision. Total= 9 hours The core whole class instruction will focus on enhancing foundational oral language and preliteracy skills in all children to promote school readiness. Small targeted sessions will consist of small groups (3-4 children) and will be tailored to assessment results to maximise this time. These sessions could focus on for example phonological awareness skills, book reading, print knowledge, story comprehension, or vocabulary. The individual sessions will focus on children who were identified in the assessment results at being high risk for delayed speech/and or language/and or literacy development. It was decided that 1 hour per week would be spent on providing an in-service for the educators at the centre. This will indirectly affect the child’s educational program through collaborating with the educators to promote specific skills relevant to school readiness. This could also include teaching stimulus to educators to use within the week to plan activities which can build upon the SP directed intervention (Suleman et al. 2014). Resource Management Professional Development Part of the budget has also been allocated for Professional Development, which will enrich the service provided and benefit not only myself and speech pathology planning, but will benefit the educators at the centre greatly. Firstly, I will attend the Learning Language and Loving It™ Certification Workshop conducted through The Hanen Centre. This will provide an effective framework that aims to empower educators to create the kinds of enriched language-learning environments that help children learn best. It has a focus on how I can collaborate with the educators on how they facilitate the language and emergent literacy development of young children (birth to 5 yrs) during everyday routines and activities. In addition to this, how to become more sensitive to the individual needs and abilities of children, responding in ways that will be most helpful to each child. It also will provide me with resources which can be used and shared with the educators in the centre during my sessions with them. Secondly, I will update my skills half way through the block by taking the ABC and Beyond™ Advanced Workshop for Speech-Language Pathologists and Early Childhood Education Consultants/Trainers. This will be a very important program as it will certify me to provide this workshop to all educators at the centre. It is a comprehensive and flexible approach to helping educators build the higher level literacy skills that prepare 3-5 year olds for success in school. It will be especially beneficial in outlining how I can empower the educators in promoting the six building blocks of emergent literacy during book reading and everyday conversations and activities. This content will translate across the planning and provision of not only my educator sessions but the planning of the whole class instruction, targeted group sessions and individualised sessions. Again, included in the workshop fee is also the full set of ABC and Beyond resources including guides, PowerPoint presentations, video clips, guidebook for educators, and resources for in the classroom. Workplace Resources The first main resource which will be utilised greatly at no cost is the access to the shared office space in the centre, with free use of office materials, a computer/printer and photocopier. The CCC-2, and the SEAPART were also budgeted to allow for a comprehensive assessment process of the children to allow for targeted intervention planning. The assessment comes with a 25 set of checklists and summary sheets. Considering this assessment will only be used for monolingual children and 70% of the children are from CALD backgrounds, this amount of forms should be sufficient. The ALDeQ is also available free of charge and available to download with no copyright violations. Any books that will be used in my service will be accessed at the centre (with permission), or at the local Toowoomba library. A lockable storage locker was also included in the budget to ensure client confidentiality and only those with permissions have access to clients assessment and intervention data, as well as resources. Lastly, a resource inventory will be developed to ensure all resources are managed appropriately, and can be tracked as to who is borrowing them, when they were loaned, and when they will be returned. This can then inform any problems with resources and allow solutions to be planned. Evaluation of Service This service will be evaluated through a variety of ways. Firstly, quality assurance protocols will be an ongoing activity within the centre, to objectively evaluate the service. It will aim to identify trends with the practice, efficiency of timetables, current problems, and solutions to those. Timetables will be regularly reviewed, to evaluate how the service is running, if time is managed appropriately, and if there are any changes to the service that need to be made to improve it. In phase 1, two review meetings will be conducted due to the length of this phase. Phase 2 will be reviewed monthly. In these review meetings, important aspects of time management will be discussed with the Director, which include: administrative tasks, report writing, meetings with other staff/parents/professionals/breaks, service delivery, preparation, and coordination of PD. A second outcome measure will be to use pre-, during and post- service satisfaction surveys for all staff at the centre. For parents, the ‘Focus on the Outcomes of Communication Under Six’ (FOCUS) will be given prior to assessment, and then at the end of the block to evaluate change in communicative participation (Eadie et al., 2006). This will allow direct measurement of staff and parent perspectives on the service, which can not only track progress in developing the service, but also help guide and plan the following weeks/ongoing treatment. Lastly, outcomes will be measured at the end of the block by re-administering specific assessments depending on each child and what was administered; an objective measurement of improvement. - Go back to lecture document Reshuffle stuff underneath.. Do we need RTI? Resource management tings This plan was guided by the current evidence base, as well as the response to intervention (RTI) model. The RTI model is a multi-tiered instructional approach to the early identification and support of children, which is gaining widespread acceptance for its use in early childhood settings (Buysse and Peisner-Feinberg, 2013). There is little research available on the efficacy of RTI for children prior to kindergarten. However, there is a strong evidence on its efficacy for school-aged children. Findings indicate the RTI is particularly effective when implemented in the early grades, and that it can yield positive learning outcomes, and reduce the need for special education services (Buysse and Peisner-Feinberg, 2013). 1. An awareness of relevant legislation, policies and professional standards and how they impact on your service and practice; 2. Skills in workload management; 3. Knowledge of finance management (i.e., budget) and how resources are acquired, appraised, and updated/developed; 5. An understanding of how to consult with key stakeholders for this particular caseload; and 5. An understanding of scientific process, particularly in relation to outcome measurement and evidence-based practice. foundational DOSE AND INTENSITY EVIDENCE . An allied health assistant (AHA) will also be involved in the delivery of services in phase 2 to ensure the service is delivered efficiently, and is maximising opportunities for pre-literacy, speech and language development (Lizarondo et al., 2010). Whole class instruction, By allocating time for whole class instruction, working together, an effective SLP-educator collaboration has the potential to support more students more effectively in the classroom. Small group sessions Individual Sessions Corresponance It was decided that 1 hour per week would be spent on providing an in-service for the educators at the centre. This will indirectly affect the child’s educational program throughout the week by providing modelling and coaching to relevant educators in the use of strategies to promote specific skills relevant to school readiness. This could also include teaching stimulus to educators to use within the week to plan activities which can build upon the SP directed lessons (Suleman et al. 2014). 1 hour meeting with staff on plans for week and to teach and scaffold education sessions 2 hours of whole class instruction to work on foundation language and literacy skills children not ‘high risk’ but will still benefit from school readiness skills) (kids who are struggling + kids identified by teacher then go on to do). Day 1: 2 x days 30 minutes to discuss with AHA+ staff plans for morning and how to best support in the 2 hour session 30 minutes to discuss with AHA plans for whole day 1 hour of whole class instruction to work on foundation language and literacy skills children not ‘high risk’ but will still benefit from school readiness skills) (kids who are struggling + kids identified by teacher then go on to do) 30 minutes out of classroom targetted group work for 2 groups (1 ran by AHA 1 ran by SP) 1 hour (2 x 30 minute sessions for 2 children) targeted work 3.5 5.5 hours - 1 hour at end of each day for note taking Phase 2: Intervention Evidence states that language intervention with preschool children has the potential to change the developmental course of their language difficulties, and improve long term outcomes Language intervention with preschool children has the potential to change the developmental course of their language difficulties and improve longterm outcomes. Assessment of language abilities in preschool children should involve an evaluation of both expressive and receptive skills and should include an evaluation of more than one dimension of language.