Partnership Working
Speech and Language Therapy
School Outreach Service
Lorraine Coulter
Speech and Language Therapist
Clinical Co-ordinator for Education
SETTING THE SCENE
• Bercow Government Report (2008)
‘Early identification and intervention are essential to avoid poor
social and economic outcomes in later life. The evidence that
early intervention brings benefits, and its absence incurs costs, is
there for all to see. The task is to act on that evidence
systematically, in delivering policy and allocating resources. ‘
(Bercow Report, 2008)
• 10 Year Strategy for Children and Young People, in N.I. (20062016)
‘Partnership working will be key…to improve the life chances of
all our children and young people.’
SETTING THE SCENE
N.I. Speech and Language Therapy Task Force Report (2008).
“Speech, Language and Communication difficulties affect more
children and young people in N.I. than any other single condition.”
• Speech, Language and Communication Therapy Action Plan (2011)
Key Themes:
-Early identification and intervention
-Collaborative working
-Capacity building .
SCHOOL OUTREACH
Service Redesign
Collaborative Working
Hard to Reach
Optimum Timing
Opinions
Life Chances
Outcomes
Unique
Transferable
Risks
Evaluation
Access
Cost Effectiveness
Health & Education
SERVICE REDESIGN
Drivers:
 Local needs
 Poor access
 Long waiting lists
SERVICE REDESIGN
2007 – Funding secured from Department of
Education to develop a school based service
• Move away from traditional medical model of
service delivery
• Based on Nursery Outreach and Speech and
Language Development Project model
• Service level agreements
• SLT integrated into the school curriculum
• Skill Mix: SLT Assistants involved in delivering
therapy
SERVICE REDESIGN
Parent
CHILD
Teacher
Speech and Language Therapist
CHILD AT THE CENTRE OF SERVICE DELIVERY
SERVICE REDESIGN
Signposting to
appropriate
services
(High need)
Targeted services
(medium need)
Universal services
(low need)
(Marie Gascoigne 2006)
COLLABORATIVE WORKING
• Funding: DE (2007-2010) , DSD (2012-2014)
• Partnership between Speech and Language Therapy
and local schools
• When teachers and therapy staff work together –
improved outcomes for children
• Training staff in identification and support for children
with speech and language difficulties
• Speech and Language Therapy integrated with child’s
learning environment
• Therapy targets linked to the curriculum
‘Every single education skill presupposes the use of
language’ (Dockrell etal, 1998)
COLLABORATIVE WORKING
Joint delivery
Joint monitoring
Joint assessment
Joint planningTherapy targets
Linked to the
curriculum
HARD TO REACH
• Uptake of services in areas of deprivation is lowchallenge for service providers (Harasty and
Reed, 1994)
• 50% fail to attend rates at the local clinic
• Prevalence: up to 50% pre school children
language delay (Law 1997),
• 42% of Preschool Children in S.E.T. area
(Coulter, 1997), 41% School Age Children
(Coulter,Halligan and Jordan,2009)
• Hard to reach – families or services??
OPTIMUM TIMING
“Children who do not receive timely
intervention before 5 years of age
are likely to have significant
impairments in all aspects of their
spoken and written language”
(RCSLT, 2007)
OPINIONS
• Community needs assessment – ‘easier access to Speech &
Language Therapy’
• Continuity from preschool to Primary school
Service users opinions:
• Teacher Questionnaires – pre & post training
• Parent questionnaires (end of year)
• Parent focus groups
LIFE CHANCES
• The language skills of children under three years
are most highly correlated with IQ and are the
single best predictor of school success (Rossetti,
1996)
• Many large scale studies of children with speech
and language delay at the pre-school stage
point to persisting problems in educational,
social and behavioural development often into
adolescence (Silva et al, 1987, Aramental, 1984,
King et al, 1982).
• Communication is the currency of life
OUTCOMES
Improved outcomes for;
i)
Children
52% discharged at end of P1
SLT embedded in classroom practice
Pre/ post assessment – improvement
ii) Community
Improved access to services (2 week waiting time)
Capacity building- resources and training
Health of community – early intervention & prevention
UNIQUE
• Not more of the same in a different place.
• We have broken the cycle of “traditional”
delivery, to make a difference.
• Skill mix :SLT and SLT Assistants
• Service level agreements: management and
supervisory structures
• Capacity Building: systematic approach to
training e.g. HANEN, ELKLAN
TRANSFERABLE
- Replication of model by other Services
e.g. Community Paediatrician
- Template developed
- Any locality
- Bilingual children e.g. Irish Medium
RISKS
Cost to the individual and the Nation:
- Education attainment/literacy
- Social/emotional development
- Mental Health: One third of children with
speech and language difficulties have mental
health problems often resulting in criminality
- Young offenders (Locked in and Locked
Out, RCSLT, 2009)
- NEET Population (Not in Education,
Employment and Training).
EVALUATION
-
External evaluation
Pre /post assessment of children
Parent questionnaires/focus groups
Education staff questionnaires
ACCESS
• Community call for ‘easier access to Speech and
Language Therapy’ (1997)
• Up to 50% fail to attend rates in local clinics
• Now 100% access to service
• Less disruptive for child
• Continuity from Nursery school
COST EFFECTIVENESS
- Resources have been optimised:
- Human: staffing, use of SLT Assistant, best use of
SLT time- Quantity increased; group and individual
intervention
- Environmental: familiar school environment, local,
accessible, use of school equipment
- Financial: 100% attendance, 52% discharged, early
intervention results in reduced ongoing difficulties and
need for services.
HEALTH & EDUCATION
- Culturally different organisations
- Real partnership working
- Transfer of skills: Health – Education
- Collaborative practice across health and
education services = improved outcomes for
children
- Cost effective (Law et al 2002, Lindsay & Dockrell
2002, Wright & Kersner 2004, Cirrin et al 2010).
FINALLY..
“Communication is the currency of life, you
need it to develop relationships, participate
in education and hold down a job.
One in ten children and young people
struggle with this invisible disability.
Without the right help, at the right time,
they will be left out and left behind.”
(ICAN 2007)