1. Speech and Language Therapy Developing Speech, Language and Communication in ‘At Risk’ Children

2. Context  Speech, Language and Communication Needs [SLCN] are classed as the most common childhood disability  Incidence is significantly higher in particular groups of children, including:  Looked after and Accommodated Children  Children living in disadvantaged surroundings  Children living in poverty  Figures reach 50 – 60% in this population

3. Context Continued...  SOGS indentifying significant proportion of children in Airdrie not meeting SLC milestones at 27 months  Risk of poor attainment and social, emotional and behavioural difficulties  Impact on literacy and future employment  Existing systems mean children from vulnerable groups are more likely to be discharged from SLT due to non-attendance

4. Driver Diagram 85% of children at Richard Stewart Family Learning Centre will reach their speech, language and communication milestones by 2016 Parental motivation and engagement Increased parental awarness of SLC development Awareness of SLT service role and how to access advice/input Standardised processes for communication and collaboration with parents and EYWs Nursery knowledge of when/where appointments are Shared responsibility or planning and implementing intervention and meeting targets Consistent SLT presence in nursery High levels of parental and partner engagement for early intervention SLT involvement at initial discussion around any SLC concerns with parent Increased joint decision making with parents around treatment options and expectations Co-location of SLT interventions in nursery Increased staff knowledge and skills Involvement of staff in identifying training needs Implementation of new knowledge and skills into daily practice Consistent support and carryover of therapy plans

5. Parental Motivation and Engagement SLT attends enrolment days Drop-in clinics in nursery Joint sessions with parents & Key Workers Appts. in nursery vs. clinic Joint planning meetings with parents & Key Workers

6. Standardised processes for communication & collaboration Sharing appt. info. with nursery Consistent SLT presence in nursery Joint planning meetings to agree targets and roles Review pathway for missed appts.

7. High levels of engagement for early intervention SLT involvement at pre- referral stage Co-location of SLT services in nursery Enhanced joint decision making with parents (treatments, expectations, outcomes) Level 2 services to increase parental knowledge & skills

8. Increased staff knowledge and skills Engaging staff in identifying training needs Support to embed theory into practice Support carryover of specific therapy plans Responding to training needs

9. Who is involved?  Margaret McCluskey, Head of Richard Stewart Family Learning Centre Nursery and her team of Early Learning Practitioners  Karen Dixon, Speech and Language Therapy Team Leader (North), Children and Young People’s Services  Xenia Dennison, Speech and Language Therapist Advanced Practitioner  Naomi Priest, Specialist Speech and Language Therapist  Improvement Team, North Lanarkshire Council  The children and families attending the Richard Stewart Family Learning Centre

10. Higher attendance rates appear to be achieved as a result of a combination of factors: Co-location of SLT service in nursery Parental involvement in arranging appointments Reminders Collaboration with staff Review of DNA procedures Attendance Data

11. Early Learning Practitioners in the 2 – 3 Room were asked what areas of childhood SLC development they would most benefit from support with. It is predicted that a needs responsive training package will improve staff engagement and outcomes for children. (Training sessions TBA) Identifying Training Needs

12. Ongoing Training Hanen ‘ABC and Beyond’ – Building Emergent Literacy in Early Childhood Settings Blacksheep Press ‘Languageland’ – Language programme for 3 – 7 year olds

13. The Human Factor My name is Logan and I’m nearly 2 years old. When I started nursery my Key Worker noticed that I wasn’t talking very much and I wasn’t sure how to play with the toys in the nursery. She told my mummy that the Speech and Language Therapist would be in the nursery soon for a ‘Drop-In Clinic’ and it might be a good idea to go along. We went to see Xenia the next week and she listened and gave mummy some ideas for helping me. Mummy was still a little bit worried so Xenia came along to my PLP meeting with my Key Worker. The grown-ups all agreed that it would be a good idea if had an assessment so that they could find out more about how to help me. Mummy is taking me to see Naomi in nursery soon. This case is a good example of:  Collaboration with ELPs  Early identification  Parental engagement  Use of different levels of support

14. Next Steps Continue Testing...  Factors influencing attendance  ‘ABC and Beyond’ to be completed and embedded  Languageland to be completed and embedded  SLT pre-referral/Level 2 services for parents/carers  Benefit of responding to training needs identified by staff  Factors central to effectively co-locating  Impact on outcomes for children resulting from changes

15. Spreading Current Changes...  Redistribution of resources  Consideration to development of an Early Years Team  Review of departmental paperwork and processes New Change Ideas...  Targeted interventions for children and families e.g. Support groups, information sessions etc.  Co-location of additional specialist interventions  Increased collaboration with visiting services Next Steps Continued...

16. “So What?” Learning reveals...  Higher levels of family engagement  Reduced DNA rate  reduced empty clinic space  Increased departmental productivity  Increased access to evidence based language learning opportunities for children  Earlier identification of and support for childhood SLCN  Utilisation of learning from other Tests of Change and National programmes e.g. Bookbug, Solihull...  Improved SLC outcomes for children

17. Investment of Resources  What have you invested into this improvement work?  1 WTE Band 7 SLT  1 WTE Band 6 SLT  Capacity in funding for SLT staff to access relevant training  EYPs at Richard Stewart Family Learning Centre released for training, meetings etc.  Physical space within nursery for SLT use  What resources would you hope to reduce/stop in the future by implementing this change?  Redistribution of resources to be explored  Reduction in staff admin wastage related to DNA  Eventual increased SLT service capacity due to access to targeted SLCN supports in the nursery setting

18. For More Information Karen Dixon 01236 789 909 or Karen.Dixon@lanarkshire.scot.nhs.ukKaren.Dixon@lanarkshire.scot.nhs.uk Xenia Dennison 01236 772 280 or Xenia.Dennison@lanarkshire.scot.nhs.ukXenia.Dennison@lanarkshire.scot.nhs.uk @XeniaSLT Naomi Priest 01236 772 280 or Naomi.Priest@lanarkshire.scot.nhs.ukNaomi.Priest@lanarkshire.scot.nhs.uk @NaomiPriest