Schools As Commissioners of Speech and Language Therapy Services

Updated August 2011

Schools as commissioners of speech and language therapy services

This paper sets out why addressing speech, language and communication difficulties is vital to meet a range of schools’ priorities, and discusses models for commissioning speech and language therapy services. The Royal College of Speech and Language Therapists have produced quality standards, which provide guidelines to help schools to commission speech and language services which are safe and effective. Their document is available at: www.rcslt.org/speech_and_language_therapy/commissioning/schools_as_commissioners

This is one of a number of papers, prompted by discussions with commissioners in children’s and health services, which the Communication Champion hopes that commissioners may find helpful. The papers, and case studies from local areas, are available on the Champion’s website, at www.thecommunicationcouncil.org/commissioning and www.thecommunicationcouncil.org/case-studies.

The Communication Champion, for children and young people aged 0-19 in England, was appointed by Government in response to the 2008 Bercow Report on services for children and young people with speech, language and communication needs (SLCN). A key role for the Champion, who is independent of Government, is to assist commissioners and providers to develop services that improve outcomes for children with SLCN, including through spreading good practice.

The issue

Language and communication difficulties represent a substantial problem in the community. Nationally, one in six children have difficulty in learning to talk and understand, according to a 2009 You Gov poll of parents of children aged 1-7; amongst boys this figure is 22%. 7% of five year olds nationally – on average two or three in every classroom – have difficulty in speech and language.

In areas of high social deprivation the percentage of children with difficulties is considerably higher than this. More than half of children starting nursery school in socially deprived areas of England have delayed language - while their general cognitive abilities are in the average range for their age, their language skills are well behind.

Speech, language and communication is the most common type of special educational need in primary-aged children. Over a quarter of all mainstream-educated primary school children at School Action+ or with a Statement have speech, language and communication as their primary need, and this percentage is rising year on year.

Schools as commissioners

Headteachers consistently report that speech and language difficulties are an increasing problem in their intake, and that local speech and language therapy services are overwhelmed and unable to provide individual help for all the children referred. There is evidence, too, that an individual therapy response may not, for many children, be the most effective form of intervention.

In these circumstances, a growing number of schools across the country are, either singly or in clusters, beginning to find new ways of working with therapy services to improve their provision for their children. In many cases this involves the school or cluster commissioning additional support over and above a core offer provided by the NHS or the local authority.

This paper sets out the benefits to be achieved from such arrangements, and the factors that need to be considered when purchasing additional services.

The benefits

Attainment

Good speech and language skills predict school attainment.

·  Only a fifth of children with speech, language and communication needs reach the expected levels for their age in both English and maths (2009). Only 10% get five good GCSEs including English and maths (2009).

·  Vocabulary at age 5 is a very strong predictor of the qualifications achieved at school leaving age and beyond (Feinstein and Duckworth, 2006)

·  Early speech, language and communication difficulties are a very significant predictor of later literacy difficulties (Snowling et al, 2010).

·  At the age of six there is a gap of a few months between the reading age of children who had good oral language skills at 5, and those with poor oral language skills at 5. By the time they are 14, this gap has widened to five years’ difference in reading age (Hirsch, 1996) .

·  Research has shown that primary-aged children with poor reading comprehension made greater improvements when provided with an intervention to develop their oral language than they did when provided with an intervention directly targeting reading comprehension skills (Snowling et al, 2010).

·  A number of recent Ofsted reports note that a common feature of the most successful schools surveyed was the attention they gave to developing speaking and listening (Ofsted 2010, 2011)

As headteachers know, the barrier for many children in achieving Level 4+ in English at the end of Key Stage 2 is their lack of oral language to support reading comprehension and writing. There is also evidence that good oral language skills contribute significantly to attainment in maths.

Behaviour and wellbeing

Speech and language skills also predict behaviour and wellbeing. Good language skills act as a ‘protective factor’ which reduces the likelihood of poor school attendance, truancy, delinquency and substance misuse (Snow, 2000).

·  Two thirds of 7-14 year olds with serious behaviour problems have language impairment (Cohen et al, 1998).

·  Two thirds of young offenders have speech, language and communication difficulties, but in only 5% of cases were they identified before the offending began (Bryan, 2008).

·  Victims of bullying and those who are both bullies and victims are more likely to have had limited early language skills than other children (Gutman and Brown, 2008)

·  Without effective help a third of children with speech, language and communication difficulties need treatment for mental health problems (Clegg et al, 1999).

Employability

·  The changing jobs market means that communication skills, along with influencing skills, computing skills and literacy skills, have shown the greatest increase in employer-rated importance over the last 10 years (UK Commission for Employment and Skills, 2009.

·  47% of employers in England report difficulty in finding employees with an appropriate level of oral communication skills (UK Commission for Employment and Skills, 2009).

Narrowing the gap

A school strategy to promote improved speech, language and communication skills is vital in narrowing gaps between outcomes for disadvantaged children and their peers. Language skills are a critical factor in social disadvantage:

·  On average a toddler from a family on welfare will hear around 600 words per hour, with a ratio of two prohibitions (‘stop that’, ‘get down off there’) to one encouraging comment. A child from a professional family will hear over 2000 words per hour, with a ratio of six encouraging comments to one negative (Hart and Risley, 2003).

·  Low income children lag their middle income counterparts at school entry by nearly one year in vocabulary. The gap in language is very much larger than gaps inother cognitive skills (Waldfogel and Washbrook, 2010).

·  Vocabulary at age 5 has been found to be the best predictor (from a range of measures at age 5 and 10) of whether children who experienced social deprivation in childhood were able to ‘buck the trend’ and escape poverty in later adult life (Blanden, 2006).

Effective models

The most effective schools plan support for speech, language and communication at three ‘Waves’ – just as they do for literacy and maths – high-quality classroom teaching for all children (Wave 1), help for those who can catch up with their peers as a result of structured and time-limited small group interventions (Wave 2), and more intensive and individualised help from specialists for children with significant difficulties (Wave 3).

Wave 1 / Everyday practice in settings and classrooms that develops communication skills / All children
Wave 2 / Small group additional intervention / Just below age-related expectations
Wave 3 / Individual intervention with a trained and supported teaching assistant / Struggling
Intensive intervention on an individual basis with a trained language specialist / Lowest attaining

Schools, or clusters of schools, can purchase time from their local speech and language therapy service to enhance their provision at all three ‘Waves’.

In some local authorities, Education Improvement Partnerships (clusters of primary schools) buy in services. In others, the clusters opting for this type of service include one or more secondary schools, with their primary partners.

In other authorities, individual schools negotiate additional time from the therapy service, choosing to have up to one day a week of dedicated time.

In one local authority, the Schools Forum agreed to topslice the Dedicated Schools Grant to provide a universal, dedicated speech and language therapy service to all 54 mainstream primary schools in the authority. The service includes
·  Setting up and training support staff to run language stimulation and language for thinking groups from Reception up to Year 6 – initially involving joint delivery with the support staff, but later just the provision of ideas, plans and resources for support staff to continue running the groups independently
·  Working with class teachers to develop the listening and attention skills of the whole class.
·  Running workshops for education staff on specific areas of speech and language difficulties
·  Organising accredited training for support staff to develop their knowledge and skills to support children with speech, language and communication needs in the classroom.
·  Supporting schools to identify children with speech, language and communication difficulties by offering classroom observations, screening assessments, and teacher/teaching assistant drop in sessions.
·  Providing teaching staff with strategies for supporting children who are already on the therapists’ caseload, within the classroom setting
·  Working with parents to raise their awareness of speech and language difficulties, and how they can support their children’s speech and language development, by running coffee mornings, drop in sessions and training workshops
External evaluation undertaken by a nearby university has shown significant improvements on standardised test s of language skills for children taking part in language stimulation groups.
The evaluation also used before and after questionnaires from class teachers to assess attention and listening skills, understanding spoken instructions, use of sentences and vocabulary, and children’s social interaction skills with peers. Significant positive changes were found on all measures.

Factors to consider

Schools need to be aware that simply buying in time from a single speech and language therapist will not of itself mean that their children will be able to access a full range of services. Speech and language therapy services usually employ centrally a number of specialists who can support their colleagues with more complex cases, by providing training and advice or by doing direct work with the child. Examples are children with autism, or hearing impairment, or who stammer. Therapists also, like any other professional, need to be part of a system of professional supervision and support. The most effective arrangements are therefore those where schools have a service level agreement with a speech and language therapy service to provide this professional support and access to specialisms.

Options for schools as commissioners include:

·  Commissioning (buying in) extra speech and language therapy (SLT) time from the local SLT service via a Service Level Agreement that sets out what each party will provide

·  Collaborating with nearby schools to jointly commission extra SLT time from the local SLT service via a Service Level Agreement that sets out what each party will provide

·  Becoming part of NHS/local authority commissioning arrangements, providing part of the total funding and helping to shape a tripartite service specification for the SLT service.

Office of the Communication Champion

February 2011

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