Ealing: Integrated, Cost-Effective Services for Children with Speech, Language and Communication

Ealing: integrated, cost-effective services for children with speech, language and communication needs

Context

• Population 312,100, including 72,400 children aged 0-19
• 28 Children’s Centres
• 65maintained primary, 13secondary and 6 special schools

Drivers for change

• Ealing was a Pathfinder Children’s Trust for children with disabilities, and focused early on integrated structures and services.
• With a rapidly growing child population and increasing levels of social deprivation, there was a need to find cost-effective ways of narrowing gaps and reducing health inequalities.
• The speech and language therapy service had long waiting lists.

The journey

Integrated structures and services

The Assistant Directors for Ealing Services For Children with Additional Needs (ESCAN)report to the Director of Children, Families and Social Care for Ealing Council and the NHS Director of Provider Service Ealing and Harrow Community Services. ESCAN is an integrated service which includes services for children with special educational needs.

The speech and language therapists (SLTs) sit within ESCAN. Their manager works in the same building as other ESCAN service managers andworks closely with Ealing’s School Improvement Services. 80% of funding for the SLT service comes from the Primary Care Trust and 20% from education. The strategy for children with speech, language and communication needs (SLCN) is driven by a strong partnership between the Principal Advisor for Inclusion (a member of the School Improvement Team) and the paediatric SLT manager.

A cost-effective continuumof provision

The strategy for SLCN has led to the development of a continuum of provision, at all ages. Provision is highly cost-effective, because of its focus on building capacity in the children’s workforce, and on early intervention so that specialist resources can be targeted at those with the greatest needs.

Universal / Targeted / Specialist
Early Years / SLTs and early years consultants provide training to all early years practitioners via the central CPD programme.
They provide more extensive CPD via the Every Child a Talker (ECaT) programme in 30 settings and an Early Years FoundationStage language programme in 24settings. / SLTsand ECaT consultants support practitioners in running language groups, providing training, modelling and advice. / SLTs based in Children’s Centres and community clinics provide direct support to children on their caseloads.
Four ICAN accredited nurseries provide full-time placements for up to 10 children each for 2-6 terms.
Primary / An SEN/Inclusion consultant and ECaT consultant provide the government’s Inclusion Development Programme (IDP) training for all primary schools.
ECaT consultants, together with a Communication Language and Literacy Consultant, provide universal CPD on speaking and listening to Key Stage 1 staff. / School-based learning support assistants are trained to run groups. / SLTs provide direct support to children on their caseloads.
AnSLT works within primary Pupil Referral Unit.
There is an additional resourced provision (ARP) for SLCN in a mainstream primary school.
Secondary / Advisory teachers and SLTs provide IDP training for all schools. / SLTs provide direct support to children on their caseloads.
There is SLT time for the Youth Offending Team.

Early Years provision

In 2000, Ealing was one of 26 local areas involved in government StandardsFund pilots to improve services for children with SLCN. The Inclusion Advisor and SLT manager developed SLT work with Foundation Stage classes in a group of primary schools. The pilot was very successful and was sustained after the pilot ended. When Standards Fund grant ended, the School Improvement Service funded a part-time teacher and two SLT posts to continue the collaborative model of working.

A second starting point was the presence of two specialist nurseries, funded by ICAN, the children’s communication charity. Further impetus was provided when ICAN in 2005 offered the opportunity to be involved in its new ‘Early Talk’ programme of professional development within, and accreditation of, early years settings.

A plan was developed to roll out existing early years provision to each of Ealing’s four ‘quadrants’ of settings and schools, so that each would have a specialist nursery and every setting would ultimately access Early Talk training. Currently at least one individual from every maintained early years provider or school has been trained, and 60% of maintained providers and schools have taken on the training as a whole staff group.

The ‘Every Child a Talker’ (ECaT) programme was added to the mix in 2009. One ECaT consultant is a SLT and the other has a teaching background. Their role has been to workintensively with 30 settings, supporting them in working towards ICAN’s ‘Early Talk’ accreditation. ECaT settings are linked to non-ECaT settings, helping them to implement the programme. The ECaT consultants have developed a self-evaluation tool for settings, with quality indicators of a communication-supportive environment. The National Strategies have rated the ECaT programme in Ealing as outstanding.

Service delivery by SLTs has undergone a fundamental change. Before 2009, the SLT early years service consisted of a number of different teams offering separate services. There was inconsistent delivery across the borough and long waiting lists for initial assessment and follow up therapy. Increasing members and complexity of referrals had meant that in some cases children could wait up to 30 weeks for an initial appointment.

The new model aims to deliver

• early identification and intervention
• shorter waiting times
• more equitable and accessible services
• stronger health promotion
• work at universal, targeted and specialist levels.

The diagram below shows the service model available in each quadrant.

SLTs spend a good proportion of their time-building capacity in the children’s workforce, so that the majority of needs can be met by front-line staff. They identify and join in with whatever local groups are available – so that, for example, they can build the skills of those running Saturday groups for Dads, or groups for teenage parents, or a range of other provisions shaped to local quadrant needs.

All families with children referred for SLTin the early years are invited to attend a drop-in ‘Play and Talk’ assessment sessions at a Children’s Centre. At these sessions, SLTs provide practical advice and signpost the family to

• A universal group available at a setting or library in their locality, such as “TALK TIME “ Groups run by CORAM staff at Children’s Centres.
• A targeted group at a local Children’s Centre or other setting, such as an attention and listening skills group, or a Parent Child interaction group where parents/carers are supported in using strategies to develop their child’s language, using video feedback.
• Specialist one-to-one sessions at the local community clinic.

Provision for school-aged children

Advisory teachers within the School Improvement team and SLTs haveworked together to ensure that the majority of schools have had training in SLCN using the national Inclusion Development Programme (IDP) materials. They have also developed web-based material to support the IDP.

Mainstream school referrals to the SLT service are assessed in school. The SLT will then offer a four-week block of therapy, modelling a programme for a learning support assistant (LSA) in the school, who then takes over. The SLT will become involved again only if there is evidence that the LSA has implemented the programme. In parallel, the LSAs are offered three days of training, spread across the year.

Vulnerable and harder to reach groups

Careful planning has ensured that programmes like ECaT support the needs of vulnerable and harder to reach groups. A member of the Traveller Education Service has been trained as an ECaT ‘Early Language Lead Practitioner’; and a teacher from the looked after children team attends ECaT network meetings and takes that learning into her work with foster carers.

SLTs work hard to reach families who do not readily engage with mainstream services. They ran a Saturday stall on speech, language and communication in a local park, for example, and are exploring evening and weekend work with families.

SLTs provide a service to the primary Pupil Referral Unit, and recently secured European funding for a programme which will evaluate the impact of placing a therapist within the Youth Offending Team.

Children and young people learning English as an Additional Language form over half of Ealing’s child population, so all serviceshave been designed to meet their needs. Assessment, for example, involves samples of a child’s home language utterances, collected from parents by Children’s Centre staff.

Impact

• In ECaT settings there was an average 2008-09 rise of four percentage points in children achieving a good level of development in the Communication, Language and Literacy scales of the Early Years Foundation Stage profile (EYFSP) at the age of five.
• The percentage of children with language delay in ECaT settings has fallen dramatically – from 42% to 23% after just two terms of the setting’s involvement in the programme. The percentage of children ahead of developmental norms has risen from 0% to 15% over this period.
• The gap between the percentage of children in vulnerable groups achieving a good level of development on the Language for Communication and Thinking scale of the EYSFP and their peers has narrowed across the whole Children’s Trust. Looked after children, Travellers, children who live in poverty and underachieving Black groups have all improved relative to their peers.

• Nearly eight of ten children attending the ICAN nursery provision are able to go on to mainstream schools, rather than Additional Resourced Provision (ARPs) or special schools, when they reach school age.

Challenges

The main challenge is ensuring sustainability, with a number of current funding streams coming to an end in 2011, and continued pressure on services because of rising pupil numbers and increasing complexity in children’s needs.

Next steps

• Working with ICAN on its 0-3 Early Talk pilot programme, focusing on reaching and supporting parents of the very youngest children.
• Securing sustainability for the ECaT programme, building a hub and spoke model in which Early Language Lead practitioners can be visited by other providers and lead local network meetings.
• Building on the work within ECaT to develop similar excellent practice in Key Stage 1 and 2, with a universal training offer and support for schools in developing their provision maps to include language interventions.
• Developing provision for secondary schools, including taking part in ICAN’s new Secondary Talk programme.
• Exploring the role of schools and school clusters as potential commissioners of SLCN services, purchasing additional SLT services over and above a basic entitlement - for example, buying into the ECaT programme as a strand of the authority’s traded School Improvement services offer.

November 2010