Derby: Cost-effective prevention and early intervention

The context

  • Total population 242,300, including 60,100 children and young people aged 0-19
  • 17 Children’s Centres
  • 76 maintained primary schools, 13 maintained secondary schools and 6 maintained special schools

Driver for change

Derby was one of several Children’s Trusts which received government funding for pilots to develop partnership work with children aged 0-7.

Aims of strategy

  • Improved early identification and support for children with speech, language and communication problems
  • An aim is that no child will enter schoolwith previously unidentified speech, language and communication problems.

The journey

Early Intervention

Pilot funding for partnership work, which began in October 2008,has been used to put in place a team of speech and language therapists (SLTs), speech and language practitioners (SLPs), a SLT assistant (SLTA) and Family Visitors, who work from Children’s Centres in one of Derby’s localities.

All 2 year olds are assessed on their language and development using the Child Profiling Tool from the Every Child a Talker programme – by Health Visiting team nursery nurses, Family Visitors or a SLTA. Where the screening shows language delay, families are provided with advice and resources and signposted to one of two routes:

  • parent/child groups where practitioners model interaction that promotes language development. These groups include Play and Talk and Chatterbox.
  • where families are reluctant to attend group sessions, home visits are provided by the SLP or Family Visitor, to carry out a 4-6 week programme with the family.

Mainstream services

A big emphasis is put on building capacity in the workforce, so that settings and school staff will be able to meet a wider range of need from their own resources. The Inclusion Consultants, Advisory Teachers and SLTs have used the government’s Inclusion Development Programme as the basis for jointly delivered training.

Use is made of The Communication Trust’s framework for speech, language and communication needs (SLCN) competencies to audit workforce skills. Staff in schools and settings use the framework to profile their competencies and identify their training needs; they are then signposted to appropriate courses.

Schools use the computer-based Speech Link and Language Link tools to screen children for language difficulties and identify which need to be referred to the SLT service. For children with less severe difficulties, the software provides suggested programmes and calculates average gains made by children before and after receiving help from a member of the school staff. SLTs provide advice and support to the school-based staff in implementing the programmes for these children.

For children with the more severe difficulties who are on the SLT caseload, the project also involves time from an SLP with a high level of expertise, who will visit a school weekly or fortnightly to provide the link between the SLT service and the school. The SLP helps school staff support the child’s programme. Evaluation has shown that where a SLP is embedded in the school team, children make more rapid progress towards achieving therapy goals.

The mainstream school SLT service is school rather than clinic-based, mainly funded by the PCT but with some funding from the local authority.

Schools have been provided with a staged Pathway to show the action they should take through everyday class teaching and assessment when initially concerned about a child, the small-group programmes they can use in school as a next step, and the expectations for what the school will provide (a teaching assistant carrying out daily practice between SLT visits) at the stage where an SLT is directly involved.

Because of the intensive investment in early years support, an aim of the Derby provision is that no child will enter schoolwith previously unidentified speech, language and communication problems. New referrals from schools will be scrutinised by a pilot ‘referral panel’ (inclusion consultants, SLT, Special Educational Needs Co-ordinator representative) that meets fortnightly. The panel will consider referrals and decide on appropriate action. In some cases, the decision will be that the school would benefit from help with whole-school systems and planning; here inclusion consultants will work with the school using resources from the national Inclusion Development Programme. In other cases an SLP will implement and coach the teaching assistant in a programme of speech and language communication support or an SLT will undertake an assessment. In some instances, no action will be required.

Links with behaviour

The Derby team are very aware of research evidence on the links between speech, language and communication difficulties, behavioural problems and potential involvement with the youth justice system. The Strategic Health Authority is funding the SLT service to work in the Youth Offending Team and an SLT service to screen the SLCN of the pupils and meet identified staff training needs is being developed with Pupil Referral Units. The Head of Social Development and Inclusion, Angela Cole, chairs a panel that considers all Primary age children and young people at risk of exclusion, and can make sure they are referred to SLTs where appropriate.

Impact

477 children have been screened to identify SLCN. 30% of these children has been identified as being at risk of speech, language and communication delay and have been given the necessary advice and signposted to further support.

There has been an increase in knowledge and skill in the 230 practitioners trained in supporting speech, language and communication development and a noted improvement in language, interaction and the learning environment.

84% of parents attending Play and Talk have demonstrated improved interaction and language. 94% of children attending Play and Talk sessions have demonstrated an improvement in their speech, language and communication skills.

Children attending schools with SLP input achieve their targets and are moved on more rapidly than in schools without a SLP. The knowledge and skills of school staff has increased.

Next steps

  • Extend screening of 2 year olds throughout DerbyCity as part of the Healthy Child Programme.
  • Continue provision of training funded by the local authority.
  • Share good practice between settings through ECAT and Communication Language and Literacy Development cluster groups.
  • Provide Play and Talk as an outreach service delivered by Family Visitors through Children’s Centres.
  • Extend the SLP role by offering the service to schools across DerbyCity.

July 2010