Barking and Dagenham: an integrated, cost effective service for children with speech, language and communication needs

The context

  • Total population 164,572
  • 23%under 16
  • 41% of children live in poverty (England average 22%)
  • 18 Children’s Centres
  • 47 primary schools
  • 9 secondary schools
  • 1 special school

Drivers for change

  • Primary schools were reporting high numbers of children with speech, language and communication needs and asking for more speech and language therapy
  • Parents were complaining publicly about lack of speech and language therapy
  • The borough’s Health Scrutiny Panel commissioned a report on speech and language therapy provision
  • The borough was experiencing rising numbers of pupils at risk of exclusion
  • SEN resources had been increasinglydelegated to schools and there was a need to ensure that resources were being used to best effect

Aims of strategy

  • Early identification of children’s speech, language and communication needs, and appropriate intervention
  • Increased capacity of staff in settings and schools to meet needs
  • Reduction in numbers referred inappropriately for specialist speech and language therapy help

The journey

The Director of Children’s Services set up and chaired an ‘Empowered Voice’ steering group, with senior membership from across the local authority early years, school improvement and inclusion services and from public health. This high-level steering group built on a long-established and effective speech, language and communication needs strategy group, chaired by the Head of Inclusion, and made up of the Head of the Speech and Language therapy service, speech, language and communication needs advisory teachers, the voluntary sector (AFASIC), group managers of Early Yearsand Childcare and Inclusion, and primary and secondary headteacher representatives.

Early Years

An initial piece of work was a re-shaping of Early Years services. Building on four early Sure Start local programmes, a borough-wide strategy of training for early years staff was developed. Joint health and children’s services funding was identified for a new workforce of dedicated Play and Communication workers,based in each of the 18 Children’s Centres. These workers are trained to NVQ Level 3 and have received extensive additional training in speech, language and communication. They are managed by speech and language therapists in conjunction with Children’s Centre managers, and work directly with children and their parents.

All children are assessed on a speech, language and communication profile via parent interview; therapists then develop a care plan that might be attending the groups or workshops, or outreach support.

Play and Communication workers run weekly groups for parents and children - Baby Massage, Babbling Babes, Toddler Talk, Messy Play. These groups are tightly structured and are evaluated by parent self-rated growth in skills.The workers also deliver outreach, Portage Community Home Visiting and other tailored services.

Speech and language therapists run monthly drop-in advice sessions for parents, a four week Play and Language workshop for parents, and provide monthly supervision for Play and Communication workers. At these supervision meetings individual children’s carefully tracked progress is reviewed.

Every Child a Talker operates in 32 settings plus 23 linked settings. Lead practitioners receive intensive training in order to support staff development.

There is a consistent focus on early identification of children’s needs. 20 schools use computer-based screening for language comprehension level (Language Link) with all children, including those with EAL, at the start and end of the Reception year. The costs of screening are jointly met by the Primary Care Trust and the local authority. Depending on the child’s comprehension level, screening can lead to either referral to the speech and language therapy service or school based intervention supported by advisory teachers with training and resources.

Training and development for school staff

The local authority appointed two advisory teachers whose role was to empower schools to meet speech, language and communication needs (SLCN). Together with an educational psychologist and speech and language therapist they developed a speech and language handbook for each Key Stage, with accompanying whole-school training delivered by an advisory teacher and psychologist or speech and language therapist. All schools have now taken up this training.

This awareness level training is complemented by more advanced training.

Target audience / Content
Awareness level / Whole-school staff / How to maximise opportunities to develop speaking and listening, identification of need based on developmental milestones, intervention and tracking progress
Enhanced level / A teacher /teaching assistant pair per school / Accredited training on speech, language and communication plusplanning a piece of development work for the school, with two or three targets. The staff involved meet termly at network meetings to share progress in their development plans and receive further training on specific topics such as language and maths, or stammering
Enhanced level / Teachers and teaching assistants wanting to know how to help a specific child in their class , or develop their skills / Modular training programme offered centrally in the autumn term – 12 stand-alone sessions that can also be delivered in school, covering for example articulation, grammar, vocabulary, word finding, speech games, visual support strategies.
Specialist / A small number of school-based staff / This course is tutored by the advisory teachers and includes a research investigation.

There is a network of teachers who have undertaken action research on speaking and listening and opportunities for dialogue within their classrooms, supported by advisory teachers for English.Advisory teachers for science have supported schools in developing oracy across the curriculum, following work with the two speech, language and communication advisory teachers.

Provision for school-aged children

The speech and language therapy service is community-based and therapists are organised into three geographical areas.

From Key Stage 1 upwards each primary school has an allocated therapist and therapy assistant who work with the school for one term per year. The therapist and advisory teacher meet with SENCO and /or SLCN enhanced skill professional at the beginning of term to determine priorities. Advisory teachers pick up staff training issues arising from the meeting. The speech and language therapist and therapy assistant typically provide blocks of direct input with a child or group, modelling approaches to professionals in the school who continue these programmes at the end of the block and continue to support schools with provision management. In the next two terms the advisory teachersfollow up children to make sure their programmes continue as planned.

Local authority provision includes mainstream primary and secondary resource bases, which have dedicated SLT input throughout the year.

At secondary level, the speech and language therapy provision is run on the same basis as in primary schools with each school receiving input for one term per year. Eight schools are involved in the Enhancing Language and Communication in Secondary Schools (ELCISS) initiative, through which teaching assistants are trained to run six-week, 13-hour, small group language interventions targeting vocabulary and narrative language. ELCISS also provides whole-school staff training.

Current services for children and young people with speech, language and communication needs

Phase / Staffing
Early Years and Foundation Stage / Preventive work
1.0 FTE SLT employed by LA (who shares the Every Child a Talker consultant role with an Early Years advisory teacher)
20 Play and Communication workers (6 employed by NHS, 14 by LA)
2 FTE SLTs (employed by NHS)
Intervention work
2.4 FTE SLT Assistants(employed by NHS)
3.3 FTE SLTs(employed by NHS)
School-age (KS1 +) / 2 advisory teachers (employed by LA)
Primary Schools
2.0 FTE SLT Assistant Practitioners(employed by NHS)
4.3 FTE SLTs(employed by NHS)
Secondary Schools
0.4 FTE SLT Assistant Practitioners(employed by NHS)
1.6 FTE SLTs(employed by NHS)
Primary resourced SLCN provision for six pupils / Teaching staff
0.3 SLT Assistant Practitioner(employed by NHS)
0.2 SLT(employed by NHS)
Secondary resourced SLCN provision for 6-8 pupils / Teaching staff
0.2 FTE SLT(employed by NHS)
Other SLT provision (Clinical Lead SLT, Dysfluency, Deafness, Feeding difficulties and Portage) / 0.3 FTE SLT Assistant Practitioner(employed by NHS)
5.6 FTE SLTs(employed by NHS)

Impact

Foundation Stage Profile results show a rising number of children in Barking and Dagenham achieving an appropriate level on the Communication, Language and Literacy scale, and substantial improvements for the lowest achieving children.

The impact of Every Child a Talker training has been evaluated using direct observation (by Early Years consultants) of practitioners’ use of 14 key interaction skills. Before the training, practitioners used an average of six of these 14 key skills. After the training, the average had risen to 11. Individual child progress monitoring of the children involved has shown that the percentage of children at risk of delay in attention and listening has fallen from 22% in November 2009 to 17% in March 2010. In understanding of language, the percentage at risk of delay has fallen from 30 to 24%, and in speech sounds and talk from 37 to 26%. There have been substantial increases in the percentage of children ahead of age norms on all these scales, and also on a social skills scale.

The results of the six- week group ELCISS: intervention programme to develop secondary pupils’ ability to recount a narrative, delivered by a trained teaching assistant to Year 8 pupils with language impairment, are shown below.

Oral story telling measure scores

18 Year 7 pupils took part in another ELCISS group intervention, with end of Key Stage 2 English levels ranging from P8-4c. Three pupils had Statements of SEN, two were on School Action Plus and two on School Action. Their levels of progress in English by the end of Key Stage 3 are shown below;

Number of students
1 level of progress / 5
2 levels of progress / 11
3 levels of progress / 2

ELCISS also involves whole-school training. Over 70% of school staff said they would change their teaching practice as a result of the training received.

Critical success factors

  • High-level strategic support and a shared understanding that speech, language and communication skills are key to raising attainment and improving wellbeing
  • Committed and consistent leadership from the Head of Inclusion, Head of Early Years and Head of the Speech and Language Therapy service
  • Alignment of budget streams: local authority budgets, health budgets, SEN traininggrant, SEN regional hub funding,
  • Working systematically to develop shared health/education performance indicators for children’s language development in the early years
  • Strong evaluation–the EP service and advisory team published a paper evaluating the impact of training on early years staff skills, and City University are evaluating ELCISS
  • Partnerships - joint work with a neighbouring local authority (Redbridge), and with the third sector (AFASIC, I Can)
  • An effective staff development model in which experts work with teachers, then step back while teachers form networks to evaluate and improve their own practice. The local authority provides ongoing support to these networks.

What next/challenges

  • The long term aim is to have all workforce trained in speech, language and communication at a minimum of awareness level
  • Language across the curriculum – the challenge has been to get this on secondary schools’ agendas and secure CPD time
  • Developing and evaluating structured time-limited group interventions
  • Helping schools promote parental support for language development

May 2010

1