Kent: a strategic approach to securing quality and productivity in services for
speech, language and communication needs
The context
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Total population 1,411,000, including 348,200 children and young people aged 0-19
96 children’s centres
449 maintained primary, 90 maintained secondary and 29 special schools
Drivers for change
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A need for greater consistency in provision across a large county area
A need for greater consistency of provision for all age groups
The need for greater clarity for providers of children’s therapy services on how they should
prioritise limited resources to address the challenging modernisation agenda set out by
government
Aims of strategy
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A skilled children’s workforce that is able to provide effective first-line support for children’s
speech, language and communication needs
Cost-effective use of specialist services for children with the greatest needs
Effective, multi-agency provision across the age range
The journey
In 2000, Kent local authority and what were at the time five different NHS community children’s
services providers set up a communication and interaction steering group for speech, language and
communication needs (SLCN), to share good practice and develop multi-agency working. The group,
which meets three times a year, created joint policies for services for SLCN and autistic spectrum
disorder (ASD), and began work on a number of other areas, reflected in new subgroups.
Funding from the local authority’s Standards Fund and later its Area Based Grant was used to take
forward work strands identified by the steering group and sub-groups.
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Historically, the Kent area had no consistent standard of NHS commissioning for children’s therapy
services. Services wanted greater clarity on what their focus should be, given constrained resources
providing services across a very large area. In 2007, the senior commissioning manager for disabled
children in West, Eastern and Coastal Kent Primary Care Trusts (PCTs) initiated work to develop
cross-Kent standards. The SLCN steering group led the work on speech and language services, taking
as its ultimate focus the whole continuum of provision rather than just the NHS speech and language
therapy (SLT) resource, and specifying what should be provided at universal and targeted as well as
specialist levels.
There are now, in 2010, four rather than five NHS providers in Kent. The resources available to
deploy across the county are the SLT services, 13 advisory teachers employed by the local authority,
a number of mainstream school SLCN resourced provisions that are now moving into an outreach
role, and special schools. There are strong partnerships with the voluntary sector; ICAN have been a
key partner.
Strategically, SLCN is being given a high priority in the county, with plans for 12 Communication
Champions linked to the 12 council districts, as well as an overall Children’s Trust Communication
Champion.
The wider context
The work on SLCN provision sits within a wider context of work on SEN and disability. Kent’s elected
members have committed funding to develop multi-agency specialist hubs. These involve special
schools and will bring together services on a ‘one stop shop’ model, providing assessment,
intervention, review, training and the coordination of short breaks for families with disabled
children.
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The workforce development strategy
The steering group implemented a three-tier model of training, in conjunction with Canterbury
Christchurch University.
Training tier
Awareness
Training used
Language for Learning,
Worcestershire’s
package of six two and a
half hour sessions.
Core
Eight, one day sessions,
locally developed.
Postgraduate
Postgraduate certificate
that is part of a Masters
programme.
Target audience
Teachers plus teaching
assistants (TAs). TAs
are not accepted on
the course unless
partnered by a
teacher.
Teacher and TA pairs.
Teachers
Features
Training leads to an
action/development
plan which is
followed up after
three months.
Training covers
more theory than
Language for
Learning. Each
session has followup tasks which
when completed
lead to
accreditation.
Focuses on critical
thinking/evaluation
as well as theory
and practice.
A three-hour SENCO training package is also provided. All training is delivered jointly by SLTs and
specialist teachers. 52 people undertook a four day course to enable them to be accredited trainers
for the Language for Learning course.
There is a similar three-tier training model for ASD, with the government’s Inclusion Development
Programme forming the basis for the awareness level training.
The steering group keeps track of where individuals or whole schools have received training, and
build this into the workforce strategy. Over a three year period, 1160 people have received the
awareness level Language for Learning training – the majority from primary schools. 16 schools have
had all their staff trained together. The training is now appearing on statements of special
educational needs (SEN) as a strategy to support pupil progress.
Identification and first-line support
‘Speechlink’ and ‘Language Link’, two screening packages for schools, originated in Kent. The County
Council fund schools to use them. Speechlink is for children who have articulation problems and
helps schools decide who needs to be referred for therapy. Language Link is used with a whole class
(usually the Reception year group) and focuses on language comprehension. It takes in the order of
15 minutes per child. The class results are analysed by the provider company. Their report signposts
children with more serious difficulties who should be referred to the SLT service, suggests wholeclass strategies, and provides programmes for individual children. Re-tests at the end of the year
allow the school to evaluate the impact of the interventions.
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70% of Kent primary schools use Language Link and work is underway to develop versions for Key
Stage 2 and for secondary schools.
Early years
Kent has partnered with the charity ICAN to develop services in early years settings. In 2004, SLTs
and specialist teachers in one part of the county became increasingly concerned about the number
of children with severe SLCN requiring a place in a SLCN resource base, rather than attending their
local primary school. There was also a recognition that offering a child a set of 45-minute SLT
sessions, in isolation from the support that was being offered in the child’s nursery, was not going to
significantly improve the child’s skills. It was decided that a joint approach was needed, which
empowered parents to act as co-educators in the delivery of a therapy programme that could be
delivered in a nursery, Children’s Centre or home.
Local needs analysis showed that on average 10-12 children a year living in the area had severe SLCN
and could benefit from an intensive specialist approach in the early years. To meet their needs, a
multi-agency virtual team was established, consisting of a part time SLT (1.5 days a week); a full-time
Learning Support Assistant; a Children’s Centre Teacher (0.5 days a week); an Early Years Special
Educational Needs Coordinator (SENCO) (two days a week); and staff from a nursery based in a
Children’s Centre.
A referral pathway has been established which identifies the children who will benefit most from the
service – children with specific language impairment rather than speech difficulties alone, or
language delay. There is then a joint assessment by the SLT and Early Years SENCO. Targets are set
in partnership with the parents. The child’s home nursery place is kept open and the child is offered
a place for three mornings a week, over two terms, at a specific nursery linked to a Children’s
Centre, where intensive intervention is offered. Parents receive regular support from the virtual
team and a dedicated parents’ support group. Once the two terms are up, the child returns to
his/her home nursery and the virtual team continues to offer the child and parent targeted support.
This includes support in making the transition to the Reception class and follow-up support in the
primary school until the end of Reception.
The host Children’s Centre has developed a high level of expertise and become accredited at the
specialist level of I CAN‘s Early Talk framework. Other Children’s Centres are likely to seek similar
accreditation in future.
Offering to keep the home nursery placement open for two terms, whilst also funding specialist
nursery sessions, is an expensive option and may not be sustainable in the long term. So in another
area of the county a peripatetic approach has been trialled. In this case the virtual team offers a
joint specialist intervention in the child’s home and local nursery (one session in the child’s home
and one session in the nursery for 12 weeks). Outcomes have been good and the local authority and
PCTs are looking to roll out this model across the county, when resources permit.
Other early years developments include the use of ICAN’s ‘Early Talk’ programme of training and
accreditation of settings and services in targeted localities, Every Child a Talker in 20 settings, and
the locally developed ‘SPARKLE’ programme. SPARKLE is targeted at settings where there is a child
or children with significant special needs and disabilities and involves a multiagency team of SLT,
physiotherapist, occupational therapist, advisory teacher and specialist learning support assistant.
There is an initial observation of the child in the setting, joint identification of goals with setting staff,
and a cycle of intervention and then review over a period of about eight months. The aim is to
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develop the skills, knowledge and understanding of staff in the setting, so that staff are better able
to support not only the target child, but children in future intakes.
Secondary schools
Some areas of the county do not have a resourced provision for secondary aged pupils with SLCN,
leaving a potential gap in provision for children with persisting SLCN who have had intensive help in
their primary years. Data confirmed the gap, showing that pupils who had been identified with SLCN
as their primary need in primary years were ending up classified by their secondary schools as having
behavioural, emotional and social difficulties. The PCT therefore invested in a new service to
support these children. SLTs undertake transition work to prepare children for the Year 7 curriculum
and the vocabulary they will need, and provide the secondary schools with a menu of support at
universal, targeted and specialist levels.
Universal
Whole-school awareness
raising training
Teaching assistant training
Lesson observation and
feedback , providing generic
advice to class teachers
Targeted
Intervention groups –
Curriculum vocabulary for Y7,
Small-group Narrative Skills,
Lifeskills/interview skills for
Y10/11, Talkabout for
Teenagers (social and
friendship skills)
Basic screening to identify
pupils with SLCN
Specialist
Individual assessment
Individual language and
communication support with
teaching assistant present
Student-focused whole- class
participation plan
Working memory CogMed
programme
Transition student groups
Support for parents/carers
Quality and productivity: Communication and Assistive Technology
Joint funding from the NHS and Kent County Council has been used to set up a multiagency service
which assesses and supports disabled children and young people who need assistive technology –
voice output communication aids, devices that enable independent access to a computer for
educational and social purposes, environmental controls that for example operate TVs, music
systems and toys, or open doors. The service also provides training programmes for school staff,
SLTs and other professionals. Working in partnership with families and professionals who support
the child locally, three teams of SLTs, occupational therapists, therapy assistant practitioners,
teachers and clinical technologists provide full-day multi-professional assessments. On the basis of
these detailed assessments, communication aids and specialist computer equipment can be
provided to the child on a long-term loan basis. The team implement a cycle of (at minimum) threemonthly visits to review the suitability of the devices provided, monitor progress against targets and
set new ones. This ensures that ongoing training and support in using the technology is provided to
users and the adults who live and work with them, and that expensive equipment is used to full
effect or can be recycled and replaced with more suitable aids or software if it is not proving
appropriate.
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The service is provided in partnership between Kent County Council (education and children’s social
services) and the NHS. The case for funding from the local authority was made on the basis of
savings that would accrue as a result of educating children locally, rather than funding placements in
independent and non-maintained special schools. Economic analysis has shown that good local
services enabling just two children to remain in local provision will fund themselves; more children
retained will result in overall cost savings for commissioners.
An example of the benefits provided by the service is the case of one three-year old whose parents
were advised that he had learning difficulties and would need to attend a special school. The
assessment by the Communication and Assistive Technology Service team demonstrated that, at
three, this child could read. He went on to mainstream school and is now on the school’s register of
gifted and talented pupils.
Quality and productivity: verbal dyspraxia
Another example of effective use of evidence and cost-benefit analysis is the development of a
specialist service for children with verbal dyspraxia (a neurological speech sound disorder). Until
2009, these children received a traditional package of weekly 30 minute clinic-based therapy
sessions with a basic-grade SLT, in six-week blocks. Data indicated, however, that outcomes were
poor. SLT managers drew on research showing that children with verbal dyspraxia do best with
intensive support, and it was decided to trial a new way of working. Kent now has a service staffed
by highly specialist SLTs, who assess children whose difficulties have persisted after one long block of
at least 10 sessions of therapy in their local community clinic. The specialist SLTs see children in
their local school or nursery setting, providing twice weekly therapy alongside parents and an
identified member of the school staff, who are able to continue the therapy on a daily basis.
The impact has been evaluated using the innovative East Kent Outcomes System (EKOS), a tool
which allows aims and objectives to be set for episodes of therapy. This showed that therapy
delivered in the new form was much more successful. Cost benefits were analysed, demonstrating
for example that intervention for a child receiving the intensive service (28 previous clinic contacts
until he was five, then 38 subsequent contacts with the specialist service, until he was discharged
with age-appropriate speech at 5years 8 months) cost £1200, compared to £1350 for a child who
had help on the previous model between the ages of 2 and 9, with little progress and ongoing
therapy required.
Impact
The early years partnership work with ICAN has been evaluated. Evaluation has shown that, for the
model of children attending the specialist centre for two terms:
• 92% of the children supported were able to attend their local primary school and made good
progress. Historically, children with similar needs would have needed to access a costly specialist
language provision.
• 70% of children demonstrated a marked increase in their understanding of language.
• 80% of children showed an increase in their use of language.
• Only one child out of 12 needed a statement of SEN.
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• In some cases the child’s receptive and expressive language scores increased by such a large
extent that they would no longer be classified as having a speech and language disorder.
• Parental questionnaires returned evidenced a very high parental satisfaction rate for the service
as a whole, and the support offered concerning the transition to Reception class.
• All the children supported made progress above expectation. Improvement in their speech and
language skills had a positive impact on the progress they made across other areas of the Early Years
Foundation Stage Curriculum. The children showed greater self confidence and demonstrated
reduced levels of frustration when interacting with others.
• Home nurseries reported an increase in their knowledge base in supporting children with severe
speech, language and communication impairments.
The peripatetic service was also highly successful:
• 90% of the children supported were able to attend their local primary school.
• 33% did not need any further intervention after six months, and the others demonstrated
marked improvements in their use of language and understanding of language.
• The intensive intervention model led to an increase in parent’s confidence in meeting their child’s
SLCN.
Next steps
Next steps for Kent are to develop a truly integrated local authority/health commissioning
framework for SLCN.
The SLCN steering group has used consultancy from an experienced SLT manager from another area
to help them review existing provision and develop the strategy that will drive the planned
integrated local authority/health commissioning framework for SLCN. Parents were also brought
into the review process. So far, the review has identified a requirement for a more extensive needs
analysis, the development of measurable outcomes for services, and work on mapping the whole
system – not just SLT services.
It has also identified a number of priorities:
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More work on teacher training, including work with Canterbury Christchurch University on
how coverage of SLCN within initial teacher training might be improved,
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Increased involvement of School Improvement Partners,
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Rolling out Every Child a Talker across the county,
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Developing further services for secondary schools, and
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Developing work with the Youth Offending Service.
November 2010
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