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. (2006-2016)

‘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 needsPoor accessLong 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

CHILD

Parent

Teacher Speech and Language Therapist

CHILD AT THE CENTRE OF SERVICE DELIVERY

SERVICE REDESIGN

Universal services

(low need)

Signposting to appropriate

services

(High need)

Targeted services

(medium 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 assessment

Joint planning- Therapy targets

Linked to the curriculum

Joint delivery Joint monitoring

HARD TO REACH

• Uptake of services in areas of deprivation is low-challenge 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)