Promoting Speech and Language...

Promoting Speech and Language DevelopmentGuidance for Sure Start programmes

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Contents

Introduction 3

Adult-child interactions 8

Home languages 11

Promoting speech and language development 12

I. The home and community environment 14

II. Carers in childcare settings 29

III. Specialists 36

Outcomes 50

Appendices 54

A. Speech and language development 54

B. Organisations and resources 56

C. Helpful reading 58

Referenced Literature 59

Authors’ noteThis document reflects current Sure Start practice. A revised edition is planned for 2003/4, for which examples ofgood practice from Sure Start programmes are welcomed. Submissions can be made to the Sure Start Speech andLanguage Development Project c/o the Sure Start Unit.

Written for the Sure Start Unit by James Law and Frances Harris of City University, London, EC1V 0HB.

The Sure Start Unit would like to thank the programme staff and the Speech and Language therapists whocontributed to this guidance.

Appendices

Referenced

LiteratureO

utcomes

Promoting speech and

language development

Hom

e LanguagesA

dult-Child InteractionsIntroduction

List of Tables and Boxes

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Tables

1. Terms used in speech and language development

Boxes (Research notes)

1. Learning language and loving it: The Hanen programme for early childhood educators2. Playgroup speech and language therapy service3. Riverside nursery training package4. Croydon nursery package5. Shared book reading in childcare settings6. It takes two to talk Hanen parent training7. Training parents to help children’s language8. Parents with learning difficulties (1)9. Parents with learning difficulties (2)10. Parent training for children with behaviour problems11. Young mothers: home visiting12. WILSTAAR

Resource notes

A. Listening to children B. Talking to children C. Everyday talkD. Watching television and videosE. Reading with babiesF. Reading with toddlers and pre-school children G. Working with parents with learning difficulties

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Referenced

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Introduction

This guidance sets out a framework for promoting children’s language development within Sure Start.The ideas will be helpful both to those planning services and to those delivering services within SureStart communities.

This aim is expressed as a number of objectives, of which the third is relevant here:

The related Public Service Agreement (PSA) target reads:

Sure Start’s aim is :

To work with parent-to-be, parents and children to promote the physical, intellectual andsocial development of babies and young children – particularly those who aredisadvantaged – so that they can flourish at home and when they get to school, andthereby break the cycle of disadvantage for the current generation of young children.

Sure Start speech and language target (PSA target effective April 2001)

To achieve by 2004 for children aged 0-3 in the 500 Sure Start areas, a reduction of fivepercentage points in the number of children with speech and language problems requiringspecialist intervention by the age of 4.

Objective 3

IMPROVING CHILDREN’S ABILITY TO LEARN

Speech and language development

Children are communicating as soon as they are born. They are using looking, pointing, sound-makingand their play to engage in communication. In most cases children start to form words by the timethey are 12 months old. To communicate effectively, the child must be able to understand what issaid to them as well as learn how to speak. Speaking involves forming the correct sounds withinwords, putting words together into short phrases and sentences and then learning to tell stories. Theygradually learn to take control of their world through their language1.

Some children progress with their communication development even though they cannot easily use words. Such children make use of alternative communication systems. Examples of alternativesystems are sign languages, gestures, picture symbols and synthesised voice output mechanisms. This guidance primarily refers to children learning spoken language. However, the principles forpromoting communication development are essentially the same for all children, including those with special needs.

There are many skills needed for successful communication. The foundations of communicationdevelopment are laid in the very earliest of experiences, especially with regard to the baby’s lookingand listening skills. The context for this development is interaction. Communication skills can only bedeveloped with adequate stimulation and response from others. Babies need someone to respond totheir communication. Conversely, speech and language development is one of the key ways that thechild interacts with his or her environment.

The stages of spoken speech and language development are set out in Appendix A. Table 1 gives anexplanation of terms.

Table 1

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Terms used in speech and language development

Comprehension The ability to understand words and sentences. A comprehension difficulty means that a child cannot understand whatis said to him. Typically he cannot do as asked, or does only part ofwhat is asked. (This may need to be distinguished from the case wherethe child can understand but will not cooperate!)

Expressivelanguage

Speech sounds

Using words and sentences. An expressive language difficulty means that a child might point ormake noises instead of words; or that an older child uses only oneword at a time instead of sentences.

The accuracy of pronunciation. A speech sound difficulty means, for example, that a child says tarinstead of car.

Referenced

Literature

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Introduction

Speech and language therapy services

A proportion of children remain who are considered to need specialised speech and language therapyservices. Existing services are:

■ Looking for children who need specialist help with learning language;

■ Offering expert assessment and diagnosis;

■ Offering a range of treatment options and approaches (usually clinic based or within nursery / daycare settings).

Sure Start is not intended to replace existing therapy services. Rather, Sure Start programmes should‘add value’ to what is already available. Sure Start programmes could instead be described as:

■ Promoting speech and language development;

■ Reducing difficulties associated with poor communication skills;

■ Preventing persistent speech and language delays.

The interface between Sure Start programmes and their local speech and language therapy services isan important one. Each programme will develop their own links and procedures for liaising with theNHS services. To date different models of practice have arisen in response to local needs and priorities.

Sure Start and other government programmes

Sure Start should link not only with existing speech and language therapy services but also with othercommunity initiatives. Programmes such as Health Action Zones or regeneration funds are likely tohave similar areas of focus. Information and activities for parents will be better received if the variouscommunity programmes are well co-ordinated and offering distinct benefits.

Guidance themes

There are five key themes that are relevant to all of this guidance. These can be seen as setting thecontext for helping children’s communication skills.

■ The importance of adult-child interactions, especially parent-child interactions;

■ The relationship between communication skills and other aspects of a child’s generaldevelopment;

■ The potential for the local community environment to impact upon a child’s development;

■ The importance of collaborations between the many people involved with a child’s development;

■ The potential for a child’s (or parent’s) resilience to reduce the impact of potentially stressfulcircumstances, and the importance of enhancing that resilience.

The significance of the adult-child interaction is such that a section has been devoted to outlining keyelements of good practice when talking with babies and children.

In this framework, it is clear that it is not necessary (or even helpful) to focus entirely on language perse in order to help a child’s language skills to develop. Speech and language development initiativescannot easily be separated out from the overall framework of a Sure Start programme. A focus onparent skills, the home environment, the parental network of social contacts, community resourcesand even the child’s health will all be of relevance.

Essentially, promoting speech and language development in young children is not just about actionsfor individual children or even for individual families: it is about changing the way communities viewspeech and language development, and changing the social and community context within whichchildren develop.

Using this guidance

These guidelines are intended for use with all children within Sure Start programmes, whatever theirstage of communication development.

A range of activities to promote speech and language development are described, in three sections:

1. The home and community environment is described first. This section will be particularly relevantto outreach services, home visiting programmes and to community development workers.

2. The next section concerns carers in childcare settings. These comments will be helpful for thosewho organise day care or childcare activities, including crèche or playgroup leaders, day carecentre managers, nursery teachers and early years specialists.

3. The last section considers the role of specialists, such as speech and language therapists, healthvisitors, GPs, social workers, mental health nurses and so on. The focus is on training possibilities,group work with parents and access to expert advice.

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Resources

This guidance includes three types of resources:

Resource notes as a summary of good practice;

Short descriptions of current Sure Start initiatives;

Research summaries to illustrate evidence-based practice.

Outcomes

Sure Start programmes need to be able to measure outcomes in the short and medium term toshow progress towards the agreed targets.

A programme activity may have language as its main focus, or as a joint focus with other aims. Ineither case, an outcome with respect to language should be established. (The explicit nature of thePublic Service Agreement target for language means that each Sure Start programme has to considerlanguage outcomes.)

Demonstration of change over time requires the description of a baseline situation and a comparisonat a later date. The Sure Start Unit is issuing separate guidelines on how to set baselines for languagelevels within a Sure Start programme.

The section on outcomes gives examples of indicators of change for each of the programme activitiesdescribed in this guidance.

Introduction

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Box

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Adult-child interactions

The importance of the conversational interaction between an adult and a child is well recognised. Theinteraction refers to the style of talking by both the adult and the child, the adult’s way of listening tothe child, and the available opportunities for the child to speak and listen.

Interaction is also very relevant in the case of parents and children who do not use words tocommunicate. The same ideas of turn taking, listening and watching apply to alternativecommunication systems. Often the conversational exchange is slower, and new conversationalpartners may need time or training to get used to the system.

An awareness of positive adult-child interaction should be part of any effort to promote children’scommunication development. A key role of language specialists is enhancing the interaction skills ofparents and childcare workers.

Listening to babies and children

In order to talk with a child, it is necessary first to listen, and watch.

A child needs time and an opportunity to talk. When an adult listens, they give the child space tospeak. When an adult watches, they can see what a child might want to talk about, even if their wordsare not easy to understand. This means that the child’s attempts to communicate can make sense toan interested adult. Then, at last, the adult can talk with the child.

A child engaged in this way will learn new words and want to talk, because they know that theirattempts to talk will be heard and understood. A listening approach gives a child much more scopefor learning to talk than does an adult reliance on naming objects, or asking a child to name objects.

Resource Note A

Listening to children

Why?

■ See what your child wants to say

■ Give your child a need to talk

■ Give your child time to talk

How?

■ Watch what your child is doing

■ Match what they do with what theytry to say

■ Repeat what your child says or tries to say

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Referenced

LiteratureA

dult-child interactions

Talking to babies and children

Babies and young children learn to focus on adult speech very early on in their lives. It helps if adultsmake their communication easy for the child to listen to and to understand. Parents often do this.They adapt their own language levels to those of the child to help them to listen effectively. The focusis on giving the child a listening and speaking part in the conversation. This contrasts with an adultusing a high proportion of directive commands, which do not allow the child a turn to speak.

Of course, not all parents simplify their sentences in the same way. It is not clear that using simpleforms has the effect of teaching the child to use specific kinds of new sentences. However, it is truethat the more parents talk to their children the more the children speak themselves 2 3.

Resource Note B

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Talking to children (0 – 2 years)

■ Speak about the “here and now”

■ Use simple words

■ Use key words only

■ Use fewer word endings

■ Use sentences which are only 1 or 2 words longer than your child can use

■ Speak slowly and carefully

■ Repeat ideas

■ Use pictures or actions to show what a new word means

■ Use a new word several times in one conversation

■ Repeat back correctly a sentence which your child has said in a childish way

■ Add in ideas to your child’s sentence when you reply

■ Use sentences a little longer than your child can use

■ Give instructions clearly, in short parts

■ Speak clearly and not too fast

■ Repeat back correctly a word your child has said wrong

■ Enjoy rhymes and rhyming words

Talking to children (2 – 4 years)

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Risk Factors

There is evidence that some childhood circumstances reduce the quality of interactions between aparent or carer and a child 4 5. This means that the child is at risk of slow communication development.A focus on the interaction skills of these groups of parents and children is particularly relevant.

Risk factors include:

■ Families with low incomes, or no wage earner;

■ Families in poor quality housing;

■ Families in neighbourhoods with few facilities;

■ Children or parents with special needs (including disability, learning difficulties);

■ Parents with little knowledge of child development.

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ome Languages

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Home languages

In some Sure Start areas a considerable proportion of children and parents use English as anadditional language. For the child, there can be some confusion over words and sentences when theyare learning more than one language. These difficulties are usually short lived, and the child is typicallyable to learn as many languages as they need to, as long as they have enough exposure to thoselanguages. This means that bilingualism in itself does not place language development in any ‘risk’.

Of course, some children experience particular difficulty in learning language. This applies to bilingualas well as monolingual children. A bilingual child with a language learning difficulty will be likely tohave problems in all their languages, and will need specialist help.

The emphasis in Sure Start is on a child’s readiness to learn. The child’s home language(s) should beencouraged for the following reasons:

■ Natural interaction between child and parent in home language(s);

■ Link between home culture and home language(s);

■ No evidence that learning more than one language puts English ability ‘behind’;

■ Established communication skills in a home language, pre-school, form a foundation for learningEnglish readily on nursery or school entry.

This guidance can be used to promote language development in any language, not just English. Inparticular, the first section on the home environment allows for Sure Start workers and their bilingualcolleagues to promote language activities in the home setting. The later sections of this guidancefocus on childcare settings and training approaches. These are still relevant, although it is recognisedthat a bilingual co-worker, with relevant skills, is a necessary part of the team. Possible roles for abilingual co-worker are outlined below.

Bilingual co-workers (Sure Start Ocean Estate)

Main duties:

■ Interpreting for the speech and language therapist (SLT)

■ Working alongside the therapist to give advice to parents in the home and in workshops

■ Referring parents to other services as needed

■ Translating SLT leaflets and making audio tapes for Bangladeshi families

■ Giving advice to the SLT on cultural issues to be considered when developing resources

■ Home visiting to demonstrate activities for parent and child (alongside the SLT, orindependently if trained)

■ Taking charge of a toy-lending scheme called 'kheli-boli' (play-talk). One of the co-workers is taking extensive training (15 hours) at the Toy Libraries Association tosupport her in this role.

Promoting speech andlanguage development

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Overall themes

The themes of this guidance are:

■ Adult-child interactions

■ General child development

■ Collaborations

■ Community environment

■ Resilience

Adult-child interactions The quality of adult-child interactions within Sure Start programmes will be a key indicator of theprogramme’s potential effect. A fundamental part of helping children develop is to establishprogrammes that actively improve the quality of adult-child interactions, at all levels. There is morediscussion of interaction on pages 8–10 and pages 14–17.

General child developmentCommunication development is intimately connected to other aspects of a child’s generaldevelopment and health. Programme activities that seek to influence health and generaldevelopmental outcomes will also have a bearing on the child’s communication skills. For example, a child with a persistent cold may well have periodic ear infections affecting his hearing. A focus ongeneral health, such as to combat ear infections, is a valid part of helping speech and languagedevelopment.

Collaborations All those involved in working with children in their communities can be part of encouraging languagedevelopment. Everyone has skills and expertise to share. Community initiatives work best if all thoseinvolved, parents and carers, nursery staff and playgroup leaders, speech and language therapists andhealth visitors collaborate with one another in working towards the same goals. This is particularlyimportant in relation to achieving cultural relevance. A key representative from community culturalgroups should be involved not just with programme delivery, but at the stages of developingprogramme objectives and design. This allows recognition of the needs of that community, which maydiffer in perception from those of programme leaders 6.

Community environment Programme activities should be carried out in the child’s immediate community. Wherever possibleuse should be made of local facilities such as playgroups, clinics, community centres or churches.Consideration should also be given to delivering services in the child’s home and using methods withwhich the parents are familiar. The emphasis here is on non-clinical locations. Sure Start programmesalso have an opportunity to impact on the community structures themselves, to refocus priorities tothe benefit of children.

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Resilience The concept of resilience proposes that there are factors for any child (or parent, or family), which canreduce the impact of potentially stressful events or circumstances7. In practice this means that topromote the well being of a child is to look at factors that build resilience. This calls for a focus on thepositive aspects of the child’s circumstances rather than looking exclusively at their needs. Forexample, a young mother on a low income might gain self-esteem through a social support network,and show more effective coping strategies in her parenting as a result. The nature of the communitysupport may not have changed her income, but it has still had a positive impact on her situation.

Programme activities

It is helpful to look at three groups of people who can influence a child’s language development:

I. The home and community environment

II. Carers in childcare settings

III. Specialists

Each group is discussed in detail below.

In practice, many programme activities will be joint endeavours between parents and specialists, orparents and childcare providers, and so on. Programmes are likely to operate at a number of levelssimultaneously, working on the individual skills of the child, encouraging adaptive parenting skills, aswell as promoting a wider understanding in the community of early speech and languagedevelopment.

I. The home and communityenvironment

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Key people

Key people within the home and community environment are:

■ Parents and carers;

■ Extended family and social networks;

■ Librarians (toys/books);

■ Volunteers (playgroups/music groups).

These people have an everyday knowledge of the child. Even though they have little or no specialisttraining in language, they are a prime influence on the child’s speech and language development.

Activities

The following sections illustrate the scope for promoting language learning across the home andcommunity settings.

1. The home environment;

2. Information and resources;

3. Personal social networks;

4. Play and toy resources;

5. Music;

6. Storytelling;

7. Books;

8. Parent literacy.

The home environment

Routines

Language learning is an active, living experience. That experience begins in the home. Its deep rootsstretch back to the early days of babyhood. It thrives on the routines between a parent and their child:routines that are regular, familiar, intimate and predictable. Such routines are the rich soil in whichlanguage grows, one part on another, sounds into words, words into sentences, and sentences into stories.

It follows that any effort to promote children’s language learning must begin in the home. It mustreach back to babyhood, and into those everyday routines. It must allow the child to discover thepower of language and the fun of talking.

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The regular routines within the care giving of a baby or child are an excellent starting point. A child’s dayusually has a framework of routines: getting washed and dressed, feeding / meal times, nappy / toilettimes, hand washing, bathing, going to bed. Other events happen regularly, if not daily, such as going tothe shops or visiting a relative. Every routine has its own predictable pattern and words to describe it.The child can experience the same routine event, at predictable times, while hearing familiar words andsentences. He understands the routine, and so he learns the words. He can try out a new word, tomake requests or comments. The familiarity gives the child a way of learning language.

A key message for parents and carers is that their own talking during everyday routines is a great helpto their child. This kind of routine ‘chat’ is best when looking at the child and at the same physicalheight level.

Noise

Homes can be noisy places. Machines (washing machines, kettles, microwave ovens…) and gadgets(phones, radios, televisions and music systems…) all add to the background noise even beforepeople start to speak. Children find it hard to listen to language against a lot of background noise.Unlike adults, they cannot focus their listening just on the speech they want to hear. Instead they heareverything at once.

Cutting out background noise is a tremendous help to children’s language learning. In particular, times forsharing and talking need to be quiet times. For example, when it is meal time, play time or book time, achild can listen and share conversation much better with no radio, no television and no noisy toys.

Television can help children’s language. It can also be a great obstacle. A television left switched on forlong periods is a source of background noise, interfering with children’s listening and distracting theirattention. However, a television programme or video watched selectively can be a helpful joint talkingand listening time. The ‘art’ of watching television or videos is choosing programmes for the child’slanguage level and sharing the viewing with them.

Machines

A common feature of computers, personal stereo systems and hand-held software games and so onis that the user ‘communicates’ with a machine rather than a person. Someone wearing headphonescannot also have a conversation, for example. Children need adults to be available for conversationand play. Likewise, children’s own activities should encourage them primarily to communicate withpeople, much more than with machines.

Resource Note C

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Everyday talk

When?

■ Feeding /eating

■ Getting (un) dressed

■ Having a bath

■ Going for a walk

■ Going to the shops

■ Doing the laundry

■ Doing the washing up

Why?

■ Your child needs the routine

■ Your child needs the repetition

■ Your child can respond

How?

■ Say what things are called

■ Say what things are for

■ Say what you are doing

■ Say what will happen next

■ Listen to your child

■ Let them have a turn to talk

■ Look at your child when you are talking

■ Use actions as well as words

■ Use sound effect noises or words[Whee! Whoosh! Munch! Pop!]

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Watching television and videos

Look for programmes/videos with:

■ Easy to understand words

■ Music and songs

■ Story time

■ Activity time

■ Repetition of ideas

■ Set routines and patterns

Watch the television:

■ Switch on the TV when you are ready

■ Watch with your child

■ Say hello to the characters

■ Sound interested in what they are doing

■ Talk about what is going to happen


■ Switch the TV off when you have finished

After television:

■ Say what you liked

■ Sing a song from the TV

■ Act out what they did on TV

■ Use an activity idea or play idea from the TV

■ Read the book or magazine


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Resource Note D

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Information and resources

There is a range of general information that Sure Start programmes might want to share with familiesin their area. Topics of relevance include:

■ Baby and child development;

■ Helpful play ideas;

■ How to help your child’s language;

■ Community resources for parents;

■ Sure Start facilities and events.

The means of sharing this information can be equally varied. Some suggestions are:

■ Videos;

■ Cartoon material;

■ Magazine articles;

■ Local newspaper articles;

■ Word of mouth.

Innovative partnerships can be born between local enterprises and Sure Start initiatives. For example,the speech and language charity ICAN has collaborated with Tesco to run articles about speech andlanguage development in the Tesco Baby Club magazine. This is distributed free to parents of childrenunder two who have registered with the Baby Club.

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Goodie bag (Sure Start Billesley)

Includes book, toothbrush, toothpaste, Sure Start key ring, fridge magnet and informationon Sure Start facilities and events.

Cartoon material used to discuss children’s learning and development.

Child development cartoons (Sure Start South Fenland)

Personal social networks

Each family and its network has its own style and strategies for coping with the challenges ofparenting. A key concept is that of resilience, which acts to protect people from potential stressors(see page 13). The processes of resilience are as yet incompletely understood. The same stressfulevents on comparable families will vary in their impact, reflecting different ways in which people react,and different ways of using support systems.

The support system of the extended family is an important one. Broadly speaking, parents can usesupportive networks in three ways:

■ To get parenting information;

■ To get specific help (such as childcare or financial support);

■ To get emotional support.

All these combine to enhance parenting skills.

Some families have stronger links into their circle of relatives and friends than others. Parents withlearning difficulties can be particularly isolated, due to their lack of social skills to make and maintainfriendships. Parents of children with special needs may experience social limitations on account oftheir child’s disabilities. Some parents may be living at a distance from their wider family.

Grandparents and older siblings are key people within the family. A supportive relationship between a child and his or her siblings or grandparents has been shown to act as a protective factor againststressful life events. Another source of support for a family, increasing their resilience, is the use ofexternal support / social networks, such as church groups, youth groups, or educational systems.

The quality of the mother-grandmother relationship can have a bearing on the parenting of the child.In one study, the children of low-income young mothers who were also cared for by another adult (inmost cases, the grandmother) achieved better developmental scores at age 3 – 4. Where theseyoung mothers also lived with their parent(s), they were also more likely to complete their schoolingand to be employed 8.

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Play and toy resources

Play is a vital part of the language learning experience.

For babies, early turn-taking games form foundations for communication development. ‘Peep-o’games encourage eye contact and turn taking skills. Other sharing games are rolling a ball or toy toand fro; posting shapes or objects; physical actions such as jumping, clapping, hopping, taking toys orobjects out of a bag or box and so on.

Toddlers and pre-school children then move into a stage of ‘pretend play’. Examples would be settingout plates and cups for several toys to enjoy a tea party, or play-acting a train ride with chairs and animprovised steering wheel. When pretend play is shared between children and an adult there areopportunities for the child to develop concentration skills, listening for words and using new wordsand sentences.

Programme activities that promote play both inside the home and beyond are directly contributing tolanguage development. Schemes such as Playlink and Parents Early Education Partnership (PEEP) canencourage play. (For more details see the Sure Start publication A guide to evidence-based practice;details in Appendix C.)

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Toy library (Sure Start Nunsthorpe and Bradley Park)

Plan to develop leaflets to accompany toys on loan from the toy library. These will giveideas for talking about the toy when the child is playing with it.

Including discussion, video and quiz format to highlight the importance of early eye contactand games with a new baby.

Community parents are trained to give support to families. Visits at home cover topics suchas baby massage, playing with your child and talking to your child.

Antenatal and Postnatal groups (Sure Start Brighton and Hove Central Sea Front)

Community Parents (Sure Start West Everton and Breckfield)

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Music

Early songs encourage shared attention between adults and children. Children can learn to listen for the music starting and stopping; to copy clapping; to beat a rhythm; to take turns; to follow actionsand to learn the words of a song. Actions or gestures can be used readily with nursery rhymes set to music. Many children enjoy using the signs from the Makaton language programme, particularlywhen they are singing. (The Makaton language programme signs are based on British Sign Language, and are intended for use with the spoken word. They provide a visual expression of language to make communication easier.) For all children, musical activity develops listening, visual attention andmemory skills.

Some music tapes are commercially available, including videos of signed and sung nursery rhymes.Others have been developed by Sure Start programmes, tailored to a younger age group, or usinglocal children in the recording, or using other community languages.

Music activities can be encouraged in the home, or in community groups. They are suitable for bothbabies and young children.

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Music tape (Sure Start Bilston and Ettingshall)

Audiotape of children’s songs, produced locally, and distributed free.

Storytelling

Experienced storytellers might be librarians, actors, puppeteers or play leaders. When children listen toa story, they can develop their listening skills for concentration and for memory. They can also bedrawn into the story line with puppets, actions or real objects. Well-written stories often includefeatures of language that are known to help language learning, namely, repetition of key ideas, rhymeand rhythm. An expert storyteller may use regular routines for opening and closing a story, so thatchildren know what to expect and can be helped to pay attention.

An alternative use of storytelling is for parents as listeners. Here the focus is on the use of the voiceand the written word for enjoyment. The parents can listen to stories as part of a relaxation group.

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Storytelling sessions in nurseries (Sure Start Sudell and Central Darwen)

The Sure Start Reader Development Officer offers specialist storytelling sessions tonurseries, pre-schools, schools, and childminding and parent & toddler groups. Childrenand their parents are also invited on tours of the library.

A relaxation group for parents, held at the library. Parents listen to a specialist storyteller.

Parents-to-be are introduced to reading for relaxation by a specialist storyteller. Bookchoices include Pokemon and other current stories.

Play and learn library sessions for fathers and children encouraging the use of books and toys.

An evening session in a community venue to introduce fathers to the facilities of the library,including computer use.

Reading Lifelines (Sure Start Sudell and Central Darwen)

Antenatal group (Sure Start Sudell and Central Darwen)

Fathers groups (Sure Start Sudell and Central Darwen)

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Books

Sharing books with babies and children is known to prepare them for school 10 11. The fact of an adultsharing a book with a child means that the pair has a shared focus of attention. There is a sharedmotivation for conversation to take place, and something to talk about. Communication skills that aredeveloped in the child include listening ability, understanding of words and using new words andsentences.

There are two aspects to consider when encouraging the use of books in the home. The first is how thefamily can get hold of books through library services, second-hand schemes and so on. The other aspectis how the books are actually used.

From the point of view of communication development, the manner of reading a book is important. A ‘straight’ reading of the text in the book by the adult may mean that the child has little opportunity tocomment, or to show when they do not understand. By contrast, an ‘active’ reading, where both adultand child are commenting on the book together, provides more scope for the child’s language.

Research studies have looked at the impact of teaching parents and carers in childcare settings a readingmethod when sharing books with children. (Some of this work is summarised in the section on childcaresettings). The conclusions support an ‘active’ reading approach. Elements of this style are highlighted in theResource Notes E and F, on Reading with Babies and Reading with Toddlers and Pre-school Children.

Bookstart

Bookstart is one approach for encouraging greater access to and use of books. The scheme involves a local health visitor giving a pack to the parent at the time of the child’s 7-9 month developmentalcheck. The free pack includes two books, advice on how to share books and an invitation to join thelocal library. Children who received a Bookstart pack as a baby have now been followed up to age 7,

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at which age they are doing better on reading assessments than children who did not receive such apack. (For more discussion, see the Sure Start publication A guide to evidence-based practice: detailsare given in Appendix C.)

Bookstart and Sure Start

Many Sure Start programmes are combining their initiatives with Bookstart. In particular, someprogrammes are extending Bookstart principles to other age groups.

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Examples of Bookstart and Sure Start programmes

18-month pack given at the library or Sure Start Centre. Pack contains two books, abookmark, information leaflets and details about local services. Other elements of theprovision include one-to-one sessions, a parenting course and story-time sessions.(Sure Start Kendray and Bank End)

Interventions aimed at babies younger than 7-9 months and at 18 months in addition tothe core Bookstart intervention at 7-9 months. Multi-agency delivery through a variety ofaccess points including one-to-one sessions, outreach work and story-time sessions.Materials given to parents include a bag, books, bookmarks, leaflets and a toy.(Sure Start Osmaston and Allenton)

Providing an 18-month pack at the library or Sure Start Centre containing 2 books, information leaflets, a tape and a toy.(Sure Start Denaby Main)

2-year pack for children in Burngreave, Sheffield. A bag is provided which contains a book,leaflets, local service information and a jigsaw.(Sure Start Burngreave and Firvale)

Bag designed for three year olds, including a story book with audiotape, a notebook andchild safety scissors. The Sure Start Reader Development Officer gives the bags to aninvited group of parents and explains ways to use them. The parents are also asked if theyare interested in other Sure Start groups based at the library.

RightStart (Sure Start Sudell and Central Darwen)

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Libraries

Libraries are a key partner in Sure Start. The local library will offer support, space and resources whichcan support a child’s language development in a variety of ways.

Membership of public libraries is free and available to parents, children and carers. Libraries frequentlymaintain collections of videos, books and rhymes on tape, as well as books to share. This means thatthe library can be a rich resource base with different materials that can support the acquisition of a variety of speech and language skills.

Most libraries have specific weekly times when there are special activities for pre-school children.These times offer a chance for children to experience language through shared rhymes and story-telling as part of a group. They can also advise parents about the wide range of rhymes, stories andbooks available that they can share with their child.

Librarians are book experts. Their job is to make sure the right child finds the right book at the righttime. The local children’s librarian will help Sure Start parents and children with advice on good qualityreading material.

Libraries are not just concerned with what happens within the library setting. Library staff will beinterested and enthusiastic in supporting Sure Start across the community in promoting books,reading and language. Many Sure Start projects are involved in the appointment of early yearslibrarians to work in the community. The Library Association’s recent resource pack on Early Years12

looks in detail at the ways Sure Start and libraries can work together in their communities. Oneexample from the Library Association is that of Sure Start Edmonton.

Play Start (Sure Start Edmonton)

Focus

To encourage wider sharing of books and play

People involvedTwo new library staff members

Description

■ Bulk loans of books to under 5s groups(playgroups, nurseries, childminders, parent & toddler groups)

■ Toy lending to existing play sessions

■ Advice and training for parents on choosing and sharing books with under 4s

■ Additional under 4s story-times at Edmonton Green Library

■ Storytelling skills programme developed for parents and carers

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Reading with babies

Choose:

■ Board books, cloth books, lift the flap books, texture and feelie books, bath books,pushchair books, books with bits to fiddle with…

■ A quiet time and place (no background TV or noisy toys)

The pictures:

■ Look at the pictures together

■ Let your baby turn pages (any direction)

■ Listen to the sounds your baby makes

The book:

■ Point to a matching picture as you speak

■ Say one word or idea at a time

■ Listen to your baby

The book (again)

■ Use sounds and noises as well as words

■ Use actions for a picture as well as words


Eg. Pretend to drive a car, make a car noise, point to car picture, say car.

The book (yes, again)

■ Make your voice tuneful and varied

■ Use toys with the book (eg a toy horse with a horse picture)


The book (and again)

■ Play boo with the book near your face

■ Open and close the book, showing a new page as a surprise


✔

Resource Note E

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Resource Note F

Reading with toddlers and pre-school children

Choose:

■ Story books with pictures

■ A quiet time and place (no background TV or noisy toys)

The pictures:

■ Look at the pictures together

■ Let your child turn pages (any direction)

■ Name things in the pictures

■ Say what people are doing

■ Listen to what your child says about the pictures

The story:

■ Point to a matching picture as you read

■ Make relevant comments

■ Read a little of the story and then stop


The story (again)

■ Ask open-ended questions (not no/yes/point for answers)

■ Put feeling in your voice

■ Talk about what will happen next


The story (yes, again)

■ Talk about things your child has done which relate to the story

■ Use your own words to describe how things look and what they are used for

■ Add ideas of your own about people in the story


The story (and again)

■ Talk about why you like the story

■ Talk about feelings of the people in the story

■ Point to the printed words as you read


✔

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Parent literacy (Sure Start Osmaston and Allenton)

Focus To deliver flexible learning programmes to parents to improve their spokenand written language skills. All learning is accredited.

People Basic Skills Outreach Worker (adult education worker, part of the Sure Involved Start team)

Description ■ Home learning programmes to fit needs of parent. Outreach workervisits home for up to 12 weeks to cover topics such as budgeting,dealing with official correspondence, reading and spelling.

■ Ongoing programme of Basic Skills classes, with flexible attendancepossible.

■ Group work eg. Self-esteem classes

Results One mother noted that her child was using new vocabulary she had learnt.

Parent literacy

The spoken and written language skills of parents are of key importance to children. In some SureStart programmes there may be a high proportion of parents who have not achieved Level 1 adultliteracy skills. (Level 1 refers to the skills expected of an 11 year old 13.) This means parents wouldhave fewer skills for introducing their children to books and writing materials. These parents may alsohave more limited spoken language skills.

Liaison with existing Adult Education Services will be helpful. Sure Start programmes have thepotential to reach parents who might not take up existing services. One programme in Derby (SureStart Osmaston and Allenton) offers an initial reading assessment at home, with follow-up coursestailored to meet parents’ needs. The privacy and flexibility offered are distinctive.

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Carers in childcare settings

II. Carers in childcare settings

A substantial proportion of children within Sure Start areas, as elsewhere, will use some form ofchildcare. This provides an ideal opportunity to provide appropriate stimulus to children for all aspectsof their development, especially their speech and language.

Key people

The key people within a range of childcare settings are:

■ Playgroup leaders;

■ Childminders;

■ Key workers in day care centres;

■ Key workers in crèche facilities;

■ Nursery teachers / Nursery nurses.

They are skilled in child development issues, but may not have additional expertise in languagedevelopment. They can offer the child a familiar and routine setting.

Facilitating language development in childcare settings

A listening environment is fundamentalThe layout of the childcare facility, and its practice, should allow for a good listening environment. With regard to structural aspects, the use of sound barriers, walls or doors and quiet areas will beimportant. With regard to practice, the use of tape players, TV, voice, noisy activities and so on, will be relevant.

The skills of carers are vitalThe carers in childcare facilities are a primary resource for the children’s language development. Everyeffort should be made to enhance this resource through training and demonstration. In particular,adults need the skills to:

■ Listen to the child;

■ Repeat language appropriately for the child to hear;

■ Provide good examples (models) of words and sentences;

■ Provide opportunities for a child to speak, only prompting them as appropriate.

The routines and games of childcare facilities are part of encouraging language developmentThe daily structure is an opportunity to build in language elements, resulting in a whole-nurserycommunication strategy.

Stories are an essential part of good practiceChildren need to learn both how to listen to stories and how to make and tell stories. They can behelped by an explicit structure showing the parts of a story, such as:

■ Who;

■ When;

■ What;

■ What next;

■ Ending.

Parental involvement should be encouragedLinks between the childcare setting and the home create continuity of experience for the child.Further, parents can receive advice on helping their children’s communication development as part oftheir involvement with the childcare setting.

Activities

The following sections outline ways of working within childcare to promote children’s languagedevelopment:

1. Language development training for carers;

2. Collaborative working practices between speech and language therapists and carers;

3. Reading within childcare settings.

Language Development training for carers

Language development training for carers is a core part of enhancing the experience of pre-schoolchildren. Typically this training will come from a speech and language therapist or an early yearsspecialist. These workers might be available within the Sure Start programme, or available on aconsultancy basis from an existing service or Sure Start programme.

There are some training packages available commercially, and many more unpublished trainingmaterials, which have been devised by speech and language therapists. A therapist will often puttogether a training session based on the time available and the learning needs of the participants.Within this variety, the Hanen Early Childhood Educators course is one training approach.

Hanen Early Childhood Educators Course

The Hanen Programmes for early intervention include a training package known as LearningLanguage and Loving It – the Hanen programme for Early Childhood Educators. The skills gained bythe early years specialist are used within the childcare setting to the benefit of all the children. Peerinteraction, pretend play and emerging literacy are all encouraged.

There is a lack of research evidence to show the effect on children of training staff with thisprogramme. A recent study in Northern Ireland 14 looked at outcomes for staff and children whenusing the programme Learning Language and Loving it. The results are summarised in Box 1.

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Box 1

Learning language and loving it: The Hanen programme for early childhood educators

Focus Evaluation of the Learning language and loving it Hanen trainingprogramme for nursery staff

Study Study compared the staff and children in nurseries 1 and 2, with Description nursery 1 receiving training in the first part of the school year and

nursery 2 in the latter part. Staff training was held over 4-5 months.

Results For staff: Pre and post-training questionnaires and evaluation formsshowed:

■ Increased confidence in identifying children with communicationdifficulties

■ Increased skills for managing children with speech and languageproblems

■ Improved social interaction styles with children

For children: The children improved in their social interactions, asjudged by staff and speech and language therapist ratings. Severallanguage measures were also used before and after the training. Overthe short timescale of the study, the gains in language did not achievestatistical significance.

Collaborative working practices

There are many models of practice for joint working between childcare settings and speech andlanguage therapists. The approach has wide acceptance.

The following examples come from existing practice. The joint working between the playgroupsservice and the East Kent Community NHS Trust speech and language therapy service has beenpositively evaluated. See Box 2 for details 15.

A further example comes from speech and language therapy services in Riverside, West London. SeeBox 3. The training package has been published 16. Again there is a mix of training for carers and inputby the therapist. This training package has also been adapted by Sure Start Greenwich to providetraining for childminders and playgroup leaders.

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Training for nursery staff (Sure Start Nunsthorpe and Bradley Park)

Focus To give nursery staff and Sure Start workers information about normalspeech and language development;To give strategies for promoting speech and language in naturally occurringsituations.

People Speech and language therapist, Sure Start workers, nursery workersInvolved

Description ‘Learning Language and Loving it’- the Hanen programme for EarlyChildhood Educators. Staff trained in 2 three-hour sessions.

Results Increased awareness of a child’s language level;Increased awareness of stages of pretend play;Increased strategies for promoting language development;Increased confidence of workers;21 of 25 feedback forms rated the training as 5/5.

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Box 2

Box 3

Playgroup speech and language therapy service

Focus To help children within the playgroup setting who are slow at learninglanguage.To increase staff awareness of speech and language development

Study The speech and language therapist (SLT) works with a speech and Description language therapy assistant (SLTA) and a playgroup helper. They work

together over 8 – 10 months.

The SLT is responsible for assessing children and preparing languageprogrammes. The SLTA and playgroup helper carry out languageactivities devised by the SLT. The playgroup helper then worksindependently when confident to do so.

Results In a comparative study of groups of children, those playgroup childrengetting language help from the SLTA/playgroup helper made betterlanguage progress than those children who attended playgroup with nolanguage help, or those who had written language advice only.

Riverside nursery training package

Focus Joint working between speech and language therapist and nursery staff.The overall aim is to empower nursery staff and parents.

Study Speech and language therapist (SLT), nursery nurses/teachers (and Description optionally a child psychologist) work together within a nursery. A SLT

training package for nursery staff covers two days (10-12 hours). Topicsinclude speech and language development, identifying problems andpractical methods for facilitating language groups.

After the training, there are language groups within the nursery runjointly by the SLT and nursery staff. Parent workshops and resourcedisplays give further information about communication development.

SLT also attends nursery staff meetings to discuss language targets andlanguage curriculum in the nursery. Nursery staff also offered videofeedback on their interaction style with children.

Results 95% of staff rated SLT service as good or very good. Parent enquiriesto the SLT have increased, as has parent attendance at workshops.

An alternative way of working is to provide each early years centre with a level of training andcollaboration that matches their needs and resources. This has been done in Croydon (Surrey) 17.Details are in Box 4. The Local Education Authority, who were involved in its design, supports thismodel. The package is not yet available commercially.

Box 4

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Croydon nursery packages

Focus Training staff in pre-school settingsJoint working between speech and language therapist and pre-schoolstaff.Emphasis on integrated learning, not ‘fixing’ childrenStaff encouraged to problem-solve using their own skills

Study Speech and language therapist (SLT), nursery or early years centre staff, Description attached Special Educational Needs Co-ordinator, and (optionally) a

learning support assistant work together in a pre-school setting over theschool year.

Staff opt for the packages available according to their ability to committo the programme. Packages 1 to 5 are available, cumulatively, withpackage 4 being optional. The packages are:1. Assessment and Recommendations2. Environmental support3. Review and liaison4. Tailored training package5. Targeted interventionStaff help to identify children with slow language development, andassist in the liaison between parents and SLT. All assessments ofchildren and language help are given on site within the pre-schoolsetting.

Results Quicker processes for identifying and assessing children with poorcommunication skills;Staff considered the children’s communication skills within the nurseryhad improved;Whole class communication strategies in place;Children being discharged from the SLT service after their nursery year(in particular, previously language-delayed children).



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Reading within childcare settings

Childcare settings offer the opportunity for regular small group and individual reading times betweenadults and children. These have the additional role of acting as models for the home, with scope forbook lending. (Aspects of book use in the home are covered on pages 23-27.)

An active reading dialogue is more helpful to the child than a straight reading of the text. An activestyle is one that uses comments and open-ended questions about the story and pictures, pauses toallow for child commenting, and remarks which link the story to the child’s real experiences. The adultassumes the role of a listener, and prompts the child to give more complex descriptions of thepictures. For a research summary of such a scheme see Box 5 18. The evidence is that such an activereading leads more directly to an increase in a child’s vocabulary and sentence length.

Box 5

3

Shared book reading in day care settings

Focus Small group reading using an active reading method.

Study Parents and day care staff shared books with children, individually and Description in small groups, at home and in the day care setting. All the adults

were shown how to use an active reading method.

Different groups were compared. One group did not take part insharing books, while another only shared books in the day care setting.A third group shared books both at home and in the day care setting.

Adults read to their child(ren) for 10 minutes a day over 6 weeks.

Results 6 months later, the children who had shared books had made betterlanguage progress (in terms of vocabulary scores). There were bestresults where books were used in both the home and the day caresetting.

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Key people

The range of specialists whose skills influence child language development includes:

■ Speech and language therapists;

■ Occupational therapists;

■ Physiotherapists;

■ Music therapists;

■ Health visitors;

■ Practice nurses;

■ GPs;

■ Clinical psychologists;

■ Paediatricians;

■ Clinical medical officers;

■ Social workers;

■ Mental health nurses.

These specialists have expert knowledge of childcare and child development, but within standardservice delivery may only have occasional contact with children.

Activities

The sections below show different ways in which specialists can share their skills with parents.

1. Training for parents;

2. Work in the community;

3. Work in the home;

4. Clinical speech and language therapy.

Training for parents

There are a number of groups for parents that will draw on specialist skills. The focus here is on thosegroups where communication development and speech and language awareness will be a component.Features of such groups are the collaborative input by different professionals, engaging parents to helpchoose topics and run the groups and an emphasis on giving parents new skills and knowledge.

Such groups will obviously vary considerably in their content. They may focus on the generalmanagement of children’s development, which in turn impacts on language development and behaviour.The key features of effective groups are given below. In general the more focused the groups are and theclearer the parents are about their purpose, the more likely they are to be successful.

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Key features of parenting groups 19

■ Allowing parents to share experiences

■ Making everyone feel included in the group

■ Making sure everyone can access the programme

■ Educating parents so that they can make informed choices for themselves

■ Paying attention to parents’ perceptions and views about parenting

■ Strategic coherence from top to bottom

These notes consider four groups of parents:

A. General communication development groups;

B. Parents whose children have language difficulties;

C. Parents with learning difficulties;

D. Parents whose children have behaviour problems.

A. General communication development groups

A speech and language therapist is able to plan and run groups to help parents learn more aboutcommunication development in their child. Topics will usually cover:

■ What to expect at what age;

■ How to talk to your baby or child;

■ Helpful games and toys;

■ What to do if you are worried about your child’s speech or language.

Other specialists can be trained to take parents through this type of programme.

A preventative package has recently been developed by the Hanen organisation for use with parentswhose children may be at risk of speech and language problems. Community professionals under theguidance of a speech and language therapist can run the You Make The Difference programme. Atpresent training for this programme is still being organised in the UK. The latest information isavailable from Hanen UK/Ireland and the Hanen website (see Appendix B).

B. Parents whose children have language difficulties

Speech and language therapists offer two main approaches to training parents whose children havelanguage difficulties. The training can emphasise the parent-child interaction, or the language levels ofthe child. Effective training takes account of the child’s language needs, the skills of the parent, andthe existing interaction style between them.

Parent-child interactionThe parent-child interaction approach has become well known through the Hanen method. However,the Hanen programme is just one of a variety of methods for working on the parent-child interactionstyle. Often parent-child interaction approaches are used with children who have small vocabulariesand few word combinations.

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The Hanen programmes are recommended for children under six years old. (The research studieshave mainly used children aged 2 – 4 years.) Their principal aim is to improve parent-child interaction,so that the child’s communication can develop. Only an accredited speech and language therapist canrun the Hanen parent programmes.

There are two Hanen programmes for parents whose children have language problems:

■ Children with language delay (It takes two to talk);

■ Children with autism spectrum disorder (More than words).

There is also an adaptation of It takes two to talk known as Target Word which is intended for childrenwith severe expressive language delays. Research evidence for the Hanen programme It takes two totalk is summarised in Box 6 20.

Language levelsAn alternative type of parent training by speech and language therapists emphasises language levels.The focus is on enabling parents to consider specific language goals, giving them techniques to try ineveryday situations. It is appropriate for the older child or the child whose sentences are gaining incomplexity, where linguistic errors persist. Usually the goals for the child are to increase wordcombinations. An example appears in Box 721.

Box 6

It takes two to talk Hanen parent programme

Focus Parent training to improve parent-child interaction.

Study 2 speech and language therapists as trainers and parents met for Description group discussions. Over an 11-week programme, parents followed the

12 sessions from the It takes two to talk programme. There were also3 home visits and 8 parents’ evenings to teach parents additionalstrategies for helping children learn new words.

A comparison group of parents did not receive training. Children werean average age of 29 months.

Over the programme 10 new words were targeted for the child tolearn. Another 10 words, not taught, were ‘control’ words.

Results Significant differences between groups. Mothers in the trained grouphad improved their language modelling techniques and reduced thecomplexity of their language. Children in this group produced more ofthe target words and more word combinations. They showed anincrease in overall vocabulary greater than the comparison groupchildren.

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Box 7

Training parents to help children’s language

Focus Training parents to help their children’s language development.

Study Speech and language therapist and parents met for 11 group sessions Description over a 6-month period.

A comparison group of parents did not receive training. Children werean average age of 35 months.

Parents were given targets for their child, with demonstration ofactivities, small group practice, and structured teaching by the therapist.

Results On a variety of measures of child language, the children of motherswho had received training made the greater gains. The differencesbetween the groups were significant.

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Working with parents with learning difficulties

Materials Pictures, photos, line drawings

Methods Talk about one key topic only in one sessionExplain procedures in short stepsDemonstrate with the baby / childPractise the activity together

Language Use simple everyday wordsUse short sentencesReplace jargon with familiar wordsBe consistent with words used (eg. always talk about the ‘doctor’, not the ‘GP’)Support written ideas with explanationsRepeat information in other waysUse open-ended questions, not yes / no questionsCheck they have understood: can they show you?

People Include a parent advocate, if availableInvolve a specialist speech and language therapist, if available

✔

C. Parents with learning difficulties

There are about 250,000 parents with learning difficulties in the UK 22. They have the sameinformation and support needs as any other parent. However, the information that is available maynot be accessible to them. In addition, they are likely to have had less relevant experience of childrenbefore becoming parents.

This group of parents can have the following communication problems:

■ Poor attention when listening;

■ Poor memory for verbal information;

■ Limited understanding of abstract or complex ideas (including concepts of time and money);

■ Poor problem solving skills;

■ Poor sequencing and organisational skills;

■ Poor reading and writing.

Training schemes for parents with learning difficulties have been evaluated positively (see Boxes 8 23

and 9 24).

Resource Note G

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Box 8

Parents with learning difficulties (1)

Focus Interaction training for parents with learning difficulties.

Study Parent (mother) and a language specialist as trainer worked in the Description home with children aged 4-28 months.

Two comparison groups of mothers received either a trainingprogramme for attention control training plus health and safetyinformation, or no training programme at all.

The programme, over a year, gave interaction training aiming to

■ Increase mother’s praise and affection

■ Increase mother’s imitation of what the child said

■ Increase mother’s expansion of what the child said

Methods included verbal instruction, modelling and feedback on themother’s performance. [Other studies by the same author have lookedat use of video and picture material for self-training purposes.]

Results The trained mothers showed significantly higher parent-child interactionscores, with a higher rate of child vocalisations. Positive findings weremaintained over the 1-year follow-up period. The later trainedcomparison group replicated the findings.

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Family Ties Project (Sure Start Kerrier)

Focus To enable parents with learning difficulties, and so encourage familypreservation.

People Home-based services for parents with learning disabilities, who have involved children aged between 0 and 4 years.

6-10 families supported each year.

Description Topics include:

■ Diet and nutrition

■ Encouraging the development of language

■ Visual and motor skills

■ Child development

■ Health and safety

■ Assertiveness, anger and stress management

■ Accessing support and resources

Box 9

Parents with learning difficulties (2)

Focus Home-based teaching in parenting skills.

Study Parents were given 6 months skills training using a modified Portage Description approach, with video feedback. 3 groups of parents were compared:

two trained groups with and without learning disability, and one groupwithout training. Observational ratings were taken after the training, andat 6 and 18 months’ follow –up.

Results ■ Parents with mild learning disability were able to improve their skillsto stimulate their child.

■ Significant gains were made in the cognitive and language skills ofthe children whose parents received training, compared to childrenof untrained parents.

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D. Parents whose children have behaviour problems

Communication and behaviour problems are often found together. Sometimes helping behaviourproblems leads to improved communication skills, and vice versa. It is relevant, then, to considerbriefly work with parents whose children have behaviour difficulties.

A recent systematic review 25 of parent training programmes for improving behaviour problems (inchildren aged 3 – 10) highlighted the paucity of good quality studies with comparison (control)groups and valid results. The review made the following points:

■ Parent training groups can be effective in changing a child’s behaviour;

■ Group training is more effective than individual training;

■ Community-based work may be more acceptable to parents (and more cost effective) thanindividual clinic-based work;

■ Behavioural approaches are more effective (and more researched) than relationship(psychodynamic) approaches in changing a child’s behaviour.

However, the quality of studies limits conclusions about which parents benefit from which type oftraining support. One good quality study looked at the use of ‘family support’ groups, in which parentstook part in problem-solving discussion groups (see Box 1026).

Box 10

Parent training for child behaviour problems

Focus Parents whose children have behaviour problems.

Study Parents, clinicians and family support workers followed an 8-week Description programme. The children attended day care centres for low-income

families.

Comparison groups of parents did not receive skills training.

Parents took part in problem-solving discussion groups, facilitated byclinicians and family support workers. Some parents also becameinvolved in leading discussions.

Results Experimental group parents showed more gains in measures ofparental confidence. Children improved on measures of socialcompetence and behaviour problem ratings.

Kindergarten (school entry) teachers noted an increased involvementof experimental group parents in their child’s school.

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The Chatterbox Programme (Sure Start Barrow)

Focus Parent and toddler language group emphasizing the role of play inlanguage development.

People Parents and toddlers, Speech and language therapist, community Involved support worker. 6-8 families are invited to attend.

Description Chatterbox is a 6-week programme of 90 minute sessions.Parents are given an information folder to which ideas sheets are added asthe weeks go on. Each session has a topic or area of play as the focus e.g. listening to your child, messy play, music etc. introduced by the speech and language therapist.Relevant activities/ toys are available for free play. A Community Support Worker models good quality play with individualchildren and parents in a 'play leader' role. Opportunities for parents to ask questions.Parents are encouraged to try the new ideas at home.

Results Parents more confident, forming social groups. Children using more wordsand sentences (by observation.)

Parents’ “He's starting to put 2 words together now”Comments “I now know I am not the only one having problems understanding my

child's speech.”“Just being able to talk to someone every week about K was great.”

Work in the community

The emphasis here is on community access to specialists. Locations and structures can be chosen tobe familiar to families. Possible venues include playgroups, toddler groups and community centres.Visits to nursery settings by speech and language therapists can also allow for informal contacts or forassessment / therapy contacts with children.

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Art in the Park (Sure Start Aylesbury Plus)

Focus Bringing families together in a community facilityLanguage and play opportunities

People Speech and language therapist, musician, photographer, parentsInvolved

Description A summer course held outdoors in a local park7 children aged 2 and 3 years attended for 5 weeksActivities included

■ Video making

■ Photography

■ Songs

■ Creative play

Results A photographic record of children exploring their five senses.Families encouraged to use the park.

A further example comes from a Sure Start programme in inner London. The speech and languagetherapist teamed up with a musician and other volunteers to run a summer group outdoors in a local park.

Work in the home

Specialists who work in the home may devise their own programme of activities or follow publishedprogrammes. Locally devised programmes can make use of available specialists and be tailored tomeet local needs.

The key focus for home visiting is to encourage the language and play development of babies andyoung children. Some programmes have looked at the general development of the child, and themother’s skills, while others have studied language learning. A study of home visiting for youngmothers with pre-term babies is in Box 11 27.

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Pop-in sessions (Sure Start North Prospect)

Focus Improve parental access to child servicesInformal session making advice about child development availableSafe play activities for childrenProvide a meeting point for parentsGive information about services available

People Speech and language therapistInvolved Portage worker

Health visitorPre-school advisory teacher

Description The room is set up with both free play and structured activities. A snacktime highlights healthy eating practices, and a book corner encouragesreading. Parents are encouraged to suggest activities and toys for thesession. Records are kept of those attending, with new families registeredwith Sure Start.

Drop in access

Drop in (Sure Start Foxhill and Parsons Cross)

Focus Increase parental access to information and support

People Speech and language therapist (SLT), outreach servicesInvolved

Description Parents attending receive advice, based on an interview and playobservation of their child. Outreach workers may be briefed by the SLT forfollow-up purposes. Links can be made to statutory services if appropriate.Parents can return as they wish.

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One published package for use by speech and language therapists within the child’s home is the WardInfant Language Screening Test, Assessment and Remediation package (WILSTAAR). Babies arescreened at around 8 months of age, and those considered at risk of poor language development arefollowed up with more assessment. As indicated by the baby’s assessment, families are then offeredfurther advice within the home. The WILSTAAR studies are summarised in Box 12 28 29. (See also furtherdetails in the Sure Start publication A guide to evidence-based practice, as listed in Appendix C.)

The WILSTAAR approach has received attention because it is aimed at babies in the early stages oflanguage learning, and seeks to accelerate normal language learning patterns. Other therapists havetried to reproduce the results of the original studies. Some well-designed studies are still in process.The accuracy of the WILSTAAR screening test and the effects of the intervention on a variety ofpopulations have not been fully established. The views of parents taking part in WILSTAARprogrammes have not yet been reported; one study in progress is looking at this issue 30.

There have been no negative effects reported for babies, and there may be other benefits to usingthe home visiting approach, such as discussion of interaction and play styles, and parents accessing services.

Box 11

Young mothers: home visiting

Focus Home visiting for teenage parents with pre-term babies.

Study Trainer, with a female student and mother worked in the home with Description babies from birth to age 8 months.

Comparison groups included babies that were full term or pre-term,and also older and younger mothers. All the mothers were in low-income groups.

Home visits were 30 minutes each fortnight and then monthly after 4months. Aims were to

■ Facilitate the mother-child interaction

■ Educate mothers about developmental milestones and childrearing

■ Teach activities for stimulating motor and cognitive development.

Results With respect to the groups of young mothers with pre-term babies, thehome-visited group had better baby weight/length measures at 4months and better infant developmental scores, than the similar groupof mothers who had not been visited. Parental childrearing attitudesand expectations were also more realistic.

48

Box 12

WILSTAAR

Focus Accelerating language development through play routines.

Study Health visitor conducted brief screening questionnaire at time of 7-9 Description month developmental check.

As indicated by the screening questionnaire, a speech and languagetherapist visited parent and baby at home for more assessment. Afterthis babies considered at risk of slow language development weregiven the WILSTAAR programme at home.

Babies were aged 10-12 months at start of the study. A comparisongroup of parents and babies were not given the WILSTAAR programme.

The programme took an average of 4 months to complete. Home visitsencouraged the parent to develop the baby’s selective attention tovocal and verbal input. Additional play recommendations were givenaccording to the child’s profile.

Results At age 3 all but two of the home visited group children had languageskills within normal range.

30% of the comparison group children had been referred to speechand language therapy.

SpecialistsProm


ent

49

Clinical speech and language therapy

The main areas of clinical work look at difficulties with expressive language, comprehension andspeech sounds. (See page 4 for an explanation of these terms.) Therapy also considers the use oflanguage in social settings (appropriateness) and to meet needs (functional communication).Treatment may be on an individual or group basis, and be within a clinic or another location.

Treatment by speech and language therapists has been shown to help children with each of thesekinds of difficulties:31 32 33

■ Treatment for expressive language difficulties in pre-school children can produce significantpositive results.

This is true for treatments given by speech and language therapists, and parent-administeredtreatment 34 21, and for those families offered a parent training programme 20. That is, there are anumber of different approaches that have been shown to work.

■ Treatment for comprehension difficulties has also been found to have positive results, althoughthere are fewer studies in this area 31.

In general children with comprehension difficulties have more persistent and more far-reachingcommunication problems.

■ Treatment for (moderately severe) speech sound difficulties is effective when given by speechand language therapists.

Other approaches have tried guiding parents to help their child’s speech sound problems. Thishas been shown to be less effective than treatment given directly by a speech and languagetherapist 35 36. (The average age of children in these studies was 41-43 months.)

4

Outcomes

50

Sure Start programmes need to show their progress towards the overall objectives and targets. Suchoutcomes are essential to monitor practice and decide about the effectiveness of programmeactivities. Advice may be available within some programmes from local evaluators.

Outcomes can either be those that record the level of involvement of families and carers (processoutcomes) or those that relate to a specific change in the child’s abilities (individual outcomes).Some examples of both types of outcomes are given below. It is important that each project teamdecides how to set outcomes and how to monitor them. Some outcomes will be apparent morequickly than others. The time period should reflect the nature of the outcome chosen.

The home and community environment

Many of these schemes will focus on the family’s wider experiences and opportunities, not exclusively onthe child. As such, individual outcomes may be harder to measure than process outcomes. Potentialmeasures for individual outcomes are feedback sheets, short surveys and the take-up of schemes (viaactivity counts and so on).

I

Outcom

es

51

Outcomes

Examples of Individual outcomes

Families reporting more chat withtheir child at home;Families watching TV together,planned viewing

Parents report more awarenessof community facilities;Parents report more aware ofchild development/healthpromotion issues

Parents report more likely tomeet others;Parents report childcare is sharedwith others

Parents like the groups;Parents report on play activities at home

Parents report more aware ofvalue of music;Parents report children’s responseto music at home

Parents report more use ofspoken stories;Parents report children’s response

Parents report greater use ofbooks in the home;Children show greater interest inbooks

Parents achieve entry levelliteracy skills

Examples ofintervention

Homeenvironment

Informationand resources

Personal socialnetworks

Play and toyresources

Music

Storytelling

Books

Parent literacy

Examples of Process outcomes

Number of families given adviceon a specific topic (eg. about‘everyday talk’);Promotions in the community onspecific topics (eg. about the useof TV)

Number of families receiving aSure Start information/registrationpack;Number of methods for givingout Sure Start information intothe community

Number of initiatives targetingwider family and social circle;Number of social eventsorganised

Increased number of play and toy groups; Increased attendance at suchgroups

Increased number of communitymusic groups; Planned use of music in childcaresettings increases

Number of storytelling sessions

Increased library enrolment

Increased take-up of adult basicskills programmes

52

Outcomes

Examples of Individual outcomes

Level of understanding of carers; Observed change in carers’behaviour after courses;Examples of children whose skillshave changed followingimplementation

Improved identification ofchildren with communicationneeds;Improved carers’ awareness ofspeech and languagedevelopment;Examples of children whosecommunication skills haveimproved

Evidence of children showinggreater interest in books; Evidence of children learningmore words through books


Training forcarers inlanguagedevelopment

Collaborativeworkingpracticesbetween speechand languagetherapists andcarers

Reading withinchildcare settings


Number of courses offered/run; Proportion of carers who takethem up

Proportion of childcare settingswith a collaboration strategy; Proportion of carers shown to beaware of strategy

Increase in number of childcaresettings using books

Carers in childcare settings

The focus here is on childcare settings, and their impact on the child. Process outcomes look atresources, training and practices, while individual outcomes can record specific skills or experiences inthe children.

II

Outcom

es

53

Specialists

The specialist involvement in these types of programme activities means that there is scope for moretechnical measurement of language change. There are a number of specialised outcome measureswithin speech and language therapy which monitor progress towards aims 37 38 39 40. These may be ofvalue if used selectively in Sure Start programmes.

Outcomes

Examples ofIndividual outcomes

Parent report of change followinggroups; Measured change in parent-childinteraction indicators.

Feedback from parents aboutcommunity presence;Parents report greater access toservices and personnel

Feedback from parents aboutsupport offered;Parents report using the advicegiven;Observed measures of change inparent or child behaviour

Parent report of change in thechild; Measured change in child’slanguage skill


Training forparents

Work in thecommunity

Work in thehome

Clinical speechand languagetherapy


Number of courses offered;Attendance rates

Number of community basedprojects;Attendance rates

Number of families advisedwithin the home;Drop-out rates for home visitschemes

Percentage of sessions attended

III

Appendices A. Speech and languagedevelopment

54

An outline of what to expect of normal communication Normal development

Comprehension

By 9 months understands ‘no’,’bye’. By 1 year recognisesnames of some objects andresponds to simple requests eg.‘clap your hands’ with an action.

Almost always in advance ofexpressive language. Will handover familiar objects on request.Begins to understand verbs andsimple attributes.

Able to find two or threeobjects on request.

Able to understand conceptssuch as colour/size etc. Willunderstand most of what aparent is saying.

Can now understand abstractwords eg. ‘always’. Understandsand can reconstruct a storysequence from a book.

Speech sounds

0-1 years

Cooing after six weeks, babblingfrom six months, increasingfeeling of child experimentingwith sounds.

1-2 years

Initially uses strings of intonation(‘jargon’), which clearly includesspeech sounds. These graduallybecome assimilated intorecognisable words.

2-3 years

A good range of sounds,though there may be difficultieswith fricatives /f//sh//s/ etc.

3-4 years

Most speech sounds correct.May have difficulties with /ch/or /j/. Intelligibility may declinewhen excited.

4-5 years

Completely intelligible exceptfor occasional errors.

Expressive language

Gradually begins to use specificsounds in specific contexts eg.‘woof’ for all animals.

Words appear slowly at first butchild often has a substantialvocabulary by two years. Maybe beginning to combine wordsby this stage.

2 and 3 word utterances.Language used for a variety ofpurposes – possession/assertion/ refusal/attribution etc.

Talks increasingly fluently. Able torefer to past and future events.Marks tense with –ed etc. butthere may be some confusioneg. ‘I goed to the park’.

Grammatical errors may persistbut rarely affect the meaning.4-6 word sentences usedconsistently. Question forms eg.‘why?’ now common. Able toconstruct own stories.

General points to look out for ■ Family history of speech or language difficulties. ■ Any history of hearing difficulties.

IF IN DOUBT ASK A SPEECH AND LANGUAGE THERAPIST

Appendices

55

Speech and language development

development and some potential areas of concernPotential areas of concern

Comprehension

Little or no awareness of others.

No recognition of the words forsimple household objects.

Unable to find two items onrequest by 21/2 years.

Comprehension outsideeveryday context very limited.May still not be aware of thefunction of objects.

May be able to understandenough to cope with familiarroutines but cannot cope ifstructure changes. Child oftenisolated because cannot dealwith the verbal level of peers.

Speech sounds

No sounds.

Little variation in sounds used.No meaningful intonation.

Single sounds only eg /d/. Poorcontrol of facial muscles. Othersdo not understand much ofwhat is said.

Very limited repertoire ofsounds – much of what is saidis unintelligible. Normal non-fluency, common in youngerchildren, may persist.

Much of what is said is stillunintelligible. Pattern ofstammering may be emerging– especially if beginning to‘block’ on certainwords/sounds. Increasingawareness and frustration.

Expressive language

Little or no attempt tocommunicate.

No words by 18 months.

No word combinations reportedby 21/2 years. Very restrictedvocabulary.

Little feeling of interaction eitherbecause the child says very littleor because the child continuesto echo what is said. Restricteduse of verbs/attributes.

Child avoiding verbal demandseg. in nursery. Continues torespond in single words orusing very simple grammaticalstructures. Little idea of tense.Cannot retell a story.

■ Concerns about parent-child interaction ■ Associated difficulties with behaviour or attention

Very limited parental reaction to the child. Evidence of neuromuscular feeding difficulties. Little evidence of non-verbal communication from the child eg. Referential pointing

Very little intention to communicate on the part of the child

■ AFASICA UK charity representing children andyoung adults with communicationimpairments, working for their inclusion insociety and supporting their parents andcarers.50-52 Great Sutton StreetLONDON EC1V 0DJHelp line: 0845 3 55 55 77 (Monday toFriday: 1000 – 1600 local call rate)Tel: 020 7490 9410 (administration)Fax: 020 7251 [email protected] www.afasic.org.uk

■ Bookstart c/o The Book TrustThe Book Trust is an independenteducational charity bringing books andpeople together.The Book TrustBook House45 East HillLONDON SW18 2QZTel: 020 8516 2995www.booktrust.org.uk

■ Contact a FamilyA UK charity helping families whosechildren have disabilities or special needs.They operate a directory of specificconditions and rare disorders, and anetwork of parent support groups.209-211 City RoadLONDON EC1V 1JNTel: 020 7608 8700Fax: 020 7608 8701Minicom: 020 7608 [email protected] www.cafamily.org.uk

■ Croydon and Surrey Downs CommunityNHS TrustSpeech and language therapy serviceSanderstead Clinic40 Rectory ParkSandersteadSouth CroydonCR2 9JNTel: 020 8410 0472Fax: 020 8657 1057

■ East Kent Community NHS TrustMs Maggie Johnson Manager for Paediatric ServicesSpeech and Language Therapy DepartmentRoyal Sea Bathing HospitalCanterbury RdMargateKent CT9 5NSTel and Fax: 01843 [email protected]

■ Hanen UK/IrelandContact: Ms Anne McDadeSpeech and language therapistTel and Fax: 0141 946 5433www.hanen.org

■ ICANThe national educational charity forchildren with speech and languagedifficulties.4 Dyer’s BuildingsHolbornLONDON EC1N 2QPTel: 08700 [email protected] www.ican.org.uk

B. Organisations and resources

56

Organisations and resources

Appendices

57

■ The Library Association7 Ridgmount StreetLondon WC1E 7AETel: 020 7255 0500 Fax: 020 7255 [email protected] www.la-hq.org.uk

■ Makaton Vocabulary DevelopmentProject31 Firwood Drive, Camberley, Surrey GU15 3QDTel and Fax: 01276 61390 Tel and Fax: 01276 681368 (Training office)[email protected]://www.makaton.org

■ NCBNational Children’s BureauPublished resources include books andvideos for parents and professionalsEarly Childhood Unit8 Wakley StreetLONDON EC1V 7QETel: 020 7843 6000Fax: 020 7843 6307www.ncb.org.uk

■ ParentAbilityA national network of disabled people who are parents or who hope to becomeparents. Services include a contactsregister for parents and for professionals.Also a help line, newsletters and trainingfacilities. Part of the National ChildbirthTrust.Alexandra HouseOldham TerraceActonLONDON W3 6NHTel: 020 8992 8637

■ Riverside Community Health Care NHSTrustSpeech and language therapy serviceSouth Westminster Centre82 Vincent SquareLONDONSW1P 2PFTel: 020 8746 5770Fax: 020 8746 5777

■ Royal College of Speech and LanguageTherapists2 White Hart YardLONDON SE1 1NXTel: 020 7378 1200Fax: 020 7403 [email protected]

■ Special Parenting ServicesContact: Dr Sue McGaw, Head of Service;Barbara Trevor, Secretary Services for parents with learningdifficulties.Publications and resources available,including a booklet series entitled I want tobe a good parent written for this group ofparents. SPS also operates a contactsregister to help practitioners find localexpertise.5 Walsingham PlaceTRURO TR1 2RPTel: 01872 356040Fax: 01872 356059

■ Booth W, Booth T (1994) Parentingunder pressure Open University Press

This practical book looks at issues forparents with learning difficulties

■ Gregory W (1997) The InformabilityManual: Making information accessiblein the light of the DisabilityDiscrimination Act London: HMSO

This manual gives guidance on how topresent information clearly, particularly forpeople with learning difficulties

■ Harris M (1992) Language experienceand early language development: frominput to uptake Hove: LawrenceEarlbaum

This book is for those who have observedchildren regularly and wish to know moreabout the language learning process.

■ Hart B, Risley TR (1999) The socialworld of children learning to talkLondon: Paul Brookes

The authors conducted a detailed study ofchildren aged 9 months to 3 years. Theyobserved how the children began learninglanguage, and the responses made tothem by parents and carers. The book is anaccessible account of the study, whichgives insights into the social context ofchildren as they learn to talk.

■ Murray L, Andrews L (2000) The SocialBaby London: CP Publishing

This book has been written for parents andcontains some wonderful picturesillustrating babies interacting with adults. Itprovides practical information onunderstanding a baby’s needs. A centraltheme of this book is that carefully

watching a baby, and understanding thesignificance of the baby’s behaviourenables parents to provide the sensitivecare that babies need. It is an invaluableresource, and will be useful for all staffworking within Sure Start programmes.

■ Naremore RC, Hopper R (1997) Childrenlearning language: A practicalintroduction to communicationdevelopment London: Singular Press

This is an introduction for people who arenot familiar with speech and languagedevelopment. It will be useful to those whowork with children and families, to answercommon questions.

■ Shonkoff JP, Meisels SJ (2000)Handbook of early childhoodintervention (2nd edition) Cambridge:Cambridge University Press

This volume draws together many years ofresearch into early intervention. It includesoverviews of models of practice,summaries of research findings, anddirections for future research and practice.

■ Sure Start: A guide to evidence-basedpractice, 2nd edition (1999)DfES PublicationsPO Box 5050Sherwood ParkAnnesleyNottingham NG15 0DJTel: 0845 6022260Fax: 0845 [email protected] quote referenceSSEBP

C. Helpful reading

58

59

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2 Hart B, Risley TR (1995)Meaningful differences in the everydayexperiences of young American children London: Paul Brookes

3 Hart B, Risley TR (1999)The social world of children learning to talk London: Paul Brookes

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11 Wade B, Moore M (2000)A sure start with books Early Years 20 (2) 39-46

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