Partnership Working Speech and Language Therapy School Outreach Service Lorraine Coulter Speech and Language Therapist Clinical Co-ordinator for Education

SETTING THE SCENE Bercow Government Report (2008) ‘Early identification and intervention are essential to avoid poor social and economic outcomes in later life. The evidence that early intervention brings benefits, and its absence incurs costs, is there for all to see. The task is to act on that evidence systematically, in delivering policy and allocating resources. ‘ (Bercow Report, 2008) 10 Year Strategy for Children and Young People, in N.I. (2006-2016) ‘Partnership working will be key…to improve the life chances of all our children and young people.’

SETTING THE SCENE N.I. Speech and Language Therapy Task Force Report (2008). “Speech, Language and Communication difficulties affect more children and young people in N.I. than any other single condition.” Speech, Language and Communication Therapy Action Plan (2011) Key Themes: -Early identification and intervention -Collaborative working -Capacity building .

SCHOOL OUTREACH Service Redesign Collaborative Working Hard to Reach Optimum Timing Opinions Life Chances Outcomes Unique Transferable Risks Evaluation Access Cost Effectiveness Health & Education

SERVICE REDESIGN Drivers: Local needs Poor access Long waiting lists

SERVICE REDESIGN 2007 – Funding secured from Department of Education to develop a school based service Move away from traditional medical model of service delivery Based on Nursery Outreach and Speech and Language Development Project model Service level agreements SLT integrated into the school curriculum Skill Mix: SLT Assistants involved in delivering therapy

CHILD AT THE CENTRE OF SERVICE DELIVERY SERVICE REDESIGN Parent Teacher Speech and Language Therapist CHILD AT THE CENTRE OF SERVICE DELIVERY

Signposting to appropriate services SERVICE REDESIGN Signposting to appropriate services (High need) Targeted services (medium need) Universal services (low need) (Marie Gascoigne 2006)

COLLABORATIVE WORKING Funding: DE (2007-2010) , DSD (2012-2014) Partnership between Speech and Language Therapy and local schools When teachers and therapy staff work together – improved outcomes for children Training staff in identification and support for children with speech and language difficulties Speech and Language Therapy integrated with child’s learning environment Therapy targets linked to the curriculum ‘Every single education skill presupposes the use of language’ (Dockrell etal, 1998)

COLLABORATIVE WORKING

HARD TO REACH Uptake of services in areas of deprivation is low-challenge for service providers (Harasty and Reed, 1994) 50% fail to attend rates at the local clinic Prevalence: up to 50% pre school children language delay (Law 1997), 42% of Preschool Children in S.E.T. area (Coulter, 1997), 41% School Age Children (Coulter,Halligan and Jordan,2009) Hard to reach – families or services??

OPTIMUM TIMING “Children who do not receive timely intervention before 5 years of age are likely to have significant impairments in all aspects of their spoken and written language” (RCSLT, 2007)

OPINIONS Community needs assessment – ‘easier access to Speech & Language Therapy’ Continuity from preschool to Primary school Service users opinions: Teacher Questionnaires – pre & post training Parent questionnaires (end of year) Parent focus groups

LIFE CHANCES The language skills of children under three years are most highly correlated with IQ and are the single best predictor of school success (Rossetti, 1996) Many large scale studies of children with speech and language delay at the pre-school stage point to persisting problems in educational, social and behavioural development often into adolescence (Silva et al, 1987, Aramental, 1984, King et al, 1982). Communication is the currency of life

OUTCOMES Improved outcomes for; Children 52% discharged at end of P1 SLT embedded in classroom practice Pre/ post assessment – improvement ii) Community Improved access to services (2 week waiting time) Capacity building- resources and training Health of community – early intervention & prevention

UNIQUE Not more of the same in a different place. We have broken the cycle of “traditional” delivery, to make a difference. Skill mix :SLT and SLT Assistants Service level agreements: management and supervisory structures Capacity Building: systematic approach to training e.g. HANEN, ELKLAN

TRANSFERABLE - Replication of model by other Services e.g. Community Paediatrician - Template developed - Any locality - Bilingual children e.g. Irish Medium

RISKS Cost to the individual and the Nation: - Education attainment/literacy - Social/emotional development - Mental Health: One third of children with speech and language difficulties have mental health problems often resulting in criminality - Young offenders (Locked in and Locked Out, RCSLT, 2009) - NEET Population (Not in Education, Employment and Training).

EVALUATION - External evaluation - Pre /post assessment of children - Parent questionnaires/focus groups - Education staff questionnaires

ACCESS Community call for ‘easier access to Speech and Language Therapy’ (1997) Up to 50% fail to attend rates in local clinics Now 100% access to service Less disruptive for child Continuity from Nursery school

COST EFFECTIVENESS - Resources have been optimised: Human: staffing, use of SLT Assistant, best use of SLT time- Quantity increased; group and individual intervention Environmental: familiar school environment, local, accessible, use of school equipment - Financial: 100% attendance, 52% discharged, early intervention results in reduced ongoing difficulties and need for services.

HEALTH & EDUCATION - Culturally different organisations - Real partnership working - Transfer of skills: Health – Education - Collaborative practice across health and education services = improved outcomes for children - Cost effective (Law et al 2002, Lindsay & Dockrell 2002, Wright & Kersner 2004, Cirrin et al 2010).

FINALLY.. “Communication is the currency of life, you need it to develop relationships, participate in education and hold down a job. One in ten children and young people struggle with this invisible disability. Without the right help, at the right time, they will be left out and left behind.” (ICAN 2007)