1. Referral and management of children with speech, language and communication needs: GPs and SLTs working together

2. What are SLCN?
A child with SLCN may:
Have speech that is not clear so that you have difficulty understanding them
Find it hard to link words into sentences to talk to you or answer your questions
Have a problem understanding what you say to them, or ask them to do
Have difficulties knowing how to talk and listen to others in a conversation

3. What is the impact of SLCN?
Being able to overcome these difficulties is crucial for:
developing positive relationships with parents and siblings, and for making friends
developing independence
for understanding and controlling emotions or feelings
participating in learning at school, including learning to read and write
Increasingly, GP’s are being asked to make referrals for these children. The aim of talking to you today is to ensure that children are referred early to the right services
The SLCN may be isolated difficulties but may occur in association with other developmental problems such as learning difficulties or Autism. So it is important to think about the range of referrals that might be needed. So I now want to talk about the speech and language referral pathway which has been designed to support GPs in making referrals

4. DELAYED OR DISORDERED LANGUAGE DEVELOPMENT
Does your child repeat sounds at the beginning of words, whole words or get stuck completely?
Does your child have any other difficulties with talking or understanding?
Speech and Language Therapy Referral Pathway
YES
YES
FLUENCY
Can your child say words clearly?
Do you recognise the words they are saying?
Although linking words together, speech is unclear? NO
SPEECH CLARITY
+ AUDIOLOGY
if no hearing test in the last 6 months
Does your child have any other difficulties with talking or understanding?
YES
Is your child:
Using any words to communicate?
Over 2 years old? Can they use more than one word at a time?
Over 3 years? Can they put more than two words together? NO
DELAYED OR DISORDERED LANGUAGE DEVELOPMENT
+ AUDIOLOGY
if no hearing test in the last 6 months
I now want to tell you a little more about the SLT service that you are referring to.
COMMUNICATION DIFFICULTIES IN THE CONTEXT OF OTHER DEVELOPMENTAL ISSUES
Can your child use words to get the things they need?
Do you think your child understands what you say to them?
Does your child show interest in playing or talking with you?
Does your child play like other children at the same age?
Did your child learn to sit and walk when you expected them to?
Can your child do the practical things you expect? NO NO
Consider referral to COMMUNITY PAEDIATRICIANS
+ AUDIOLOGY
if no hearing test in the last 6 months
Do you feel your child has other difficulties with communication, or other skills?
YES

5. Service vision Early Years Team aims
“Inspiring children, young people and families to overcome communication barriers and enjoy life”
Early Years Team aims

8. The Role of the SLT Our Role:
At universal level – to engage with colleagues in health and education to deliver clear and consistent messages to families in Tower Hamlets. To promote good practice in relation to identifying and managing SLCN
At targeted level – to work with colleagues in education to support them to provide group based or individual interventions for children
With Children
Average number of groups in a month = 116
With adults e.g. parents, school staff
Average number of training or coaching sessions per month = 127
At specialist level to assess, advise and offer intervention – based on the principle that care offered close to home is more effective there is a strong emphasis on training family members and school staff to facilitate children’s communication or to adapt the child’s environment to facilitate communication.
I want to move on to talk about two areas where we would like to our service and the GPs of TH to be agreeing on consistent messges.

9. Misinformation about stammering

10. What causes stammering. It isn't totally clear what causes stammering
What causes stammering? It isn't totally clear what causes stammering. We do know:
More men than women stammer (the ratio is 3:1)
20% greater chance if a close relative has a stammer.
Most experts think there is a genetic predisposition to stammer.
Children don't learn to stammer through imitation
A particular trauma does not cause a stammer.
Certain situations like tiredness, upset, excitement, feeling pressured and an unfamiliar environment can make a stammer worse but do not cause it.

11. Stammering is: A communication difficulty which:
Can involve repeating sounds, syllables or words,
prolonging (stretching) sounds, blocking or hesitating,
and avoiding or substituting words
May include excessive muscle tension in the face,
neck, back or stomach or unusual movements of the
head or limbs.
Children who stammer are normally fluent when
speaking in chorus, singing or whispering.
Children who stammer may speak even less fluently,
when they are feeling excited, ill, stressed, tired, or
upset (or any other heighten emotion).

12. Stammering affects:
5% of all children under the age of five will go through a phase of stammering
In Tower Hamlets that represents approximately 600 pre-school children
Without intervention during the pre-school years up to 25% of these children are at serious risk of developing persistent stammering into adulthood
This means that 120 children every year in Tower Hamlets are at risk.
In the under fives twice as many boys stammer as girls.
Stammering does not appear to be increasing or decreasing. Published research studies indicate that these figures are consistent worldwide and that stammering occurs across all cultures and in all social groups

13. Speech and Language Therapy is effective…
The British Stammering Association promotes and encourages the message that children showing early signs of stammering should be referred to a speech and language therapist (SLT) as early as
possible.
Speech and language therapy has proved to be most effective with under-5 aged children.
In many cases when the problem is caught early enough (before secondary issues of anxiety and self consciousness arise) the child is able to learn to speak fluently again with no evidence of recurrence.

14. Misinformation about Bilingualism
Speaking two languages can confuse your child and could have a negative effect on their language development.
Do not respond to your child if they are talking in a language other than the one you speak at home.
You should speak English even if it is not your first language because you live in Britain and your child will need to speak English when they get to school.

15. Current advice on Bilingualism
Speak your own language. Do not change your natural pattern of language use at home. Do not start speaking a language that you are not competent with even though you may be in an English speaking community.
At nursery or school, ask if your child can get any support in his /her home language. This will help your child’s English language skills to develop as well.
Share a simple list of commonly used words in your home language with nursery/ school, and friends.
Keep words and gestures consistent. If both parents speak different languages to the child, it is natural to switch between the two languages.
Encourage attempts from your child to communicate in any way or language – show them you are interested!
“Provide intervention in the individual’s mother tongue and support the family in their use of mother tongue when necessary or appropriate, i.e. when it is the individual's preferred or dominant language. Language choice should be discussed and agreed with families.” CQ3

16. SLCN Referrals Take home messages:
Always discuss referral with parents as soon as stammering is apparent as there is effective treatment available for young children.
Please positively promote the use of the language which parents speak most confidently and spread the message that bi-lingualism does not contribute to language delay.
Please use our referral pathway to help ensure that all appropriate referrals are made for children with SLCN.