1. Improving SLT for children with PSLI;
How to engage non-engaging families
14th December 2011
Prof Sue Roulstone - Principal Investigator
Dr Rebecca Coad - Research Programme Manager
Sam Harding - Senior Research Assistant 1

2. Summary Introduction to research programme
Programme aims
Primary Speech and Language Impairment
Background to research progrmme
Parent Involvement and Partnership
Overview of Phase 1
Selection of case study sites
Non engaging groups

3. Research team Applicants Staff team Advisory group Sue Roulstone
Norma Daykin
Jane Powell
Jon Pollock
Linda Lascelles
Jenny Moultrie
Yvonne Wren
Julie Marshall
Juliet Goldbart
Tim Peters
Alan Emond
Will Hollingworth
Jane Coad
Cres Fernandes
Rebecca Coad
Sam Harding
Lydia Morgan
Naomi Parker
Liz Lewis
Advisory group
Supportive Parents
Royal College of Speech & Language Therapists
Barnardos
NBT SLT clinical team
Bristol City Council Early Years Manager and commissioner
National Early Years Strategy
Parents from Parent Panel
UWE Early Years Education

4. Programme aims
to improve the quality of speech & language therapy services for preschool children with primary speech and language impairment
to develop an evidence-based approach to interventions in the pre-school years
to develop a model to support the appropriate targeting and stratification of interventions to suit the needs and context of the individual pre-school child and family
to improve the quality of speech & language therapy services for preschool children with primary speech and language impairment (PSLI), that is, where the speech and language impairment exists in apparent isolation from other disabilities. The focus of the programme is on the appropriate targeting and stratification of interventions to suit the needs and context of the individual pre-school child and family.
Our proposal aims to develop an evidence-based approach to interventions in the pre-school years. That is, it proposes to integrate systematic research evidence, consensus between clinical experts, and the perspectives of children and families.
The proposal follows a phased approach which will answer the following questions:
What are the current evidence, practice and user perspectives regarding SLT-led interventions for pre-school children with PSLI?
What model(s) of intervention can integrate current evidence, professional expertise and family perspectives in ways that allow the intervention to be individualised to children’s and families’ communicative, physical, social and cultural contexts?
What tools can be developed to ensure the appropriate stratification of interventions and the measurement of outcome?
How can we best engage preschool children in the process of developing appropriate interventions?
What conceptual frameworks can be developed to relate contextual factors and resource inputs to intervention mechanisms and outcomes for economic evaluation?

5. Preschool children with primary speech and language impairment (PSLI)
Identified (in the last 6 months) by SLT
Has a significant language impairment
May or may not have co-existing speech impairments
No indication of other neurological, sensory or developmental conditions
Aged 2yrs- 5 yrs 11mths
A preschool child who has (in the last 6 months) been identified by a speech and language therapist as a having a significant language impairment. The child may or may not have co-existing speech impairments.
There is no indication that the child possesses other neurological, sensory or developmental conditions including, hearing impairment, autism and learning difficulties that might account for the language impairment
In the Child Talk – What Works study the term ‘Preschool’ is defined as ‘the period of childhood from 2;0 until the legal age of school entry at 5:11’. To account for global variations this is considered to finish at age 5;11, which coincides with the average age of school entry across the world. Typical development within this period is associated with rapid language growth, development of phonological awareness, development of executive function and formation of friendships.
Comment on difficulty of diagnosis in the younger children and therefore the idea that we are focusing on children who are ‘at risk of PSLI’

6. Background Prevalence of PSLI is ~ 6%
A long term condition with negative outcomes
Increasing emphasis on the role of communication in securing and supporting a child’s development and wellbeing
The Foundation Years: preventing poor children becoming poor adults (Field, 2010
The Early Years: Foundations for life, health and learning (Tickell, 2011)
Prevalence of PSLI is ~ 6% ( so a significant group; higher prevalence than autism, cleft palate)
If children still have difficulties as they enter school (ie by the end of the period we are engaged with), then they are at risk of difficulties into their adult years and for associated negative outcomes such as poorer literacy, social exclusion (trouble with friendships, bullying), employment difficulties. Ie. An at risk group
Increasing emphasis on the role of communication in securing and supporting a child’s development and wellbeing – and there are a whole range of new national policy reports that have emphasised this including:
Frank Field , in his report on Poverty mentions the importance of language and communication virtually every time he talks about children’s development. The Field report lists language and communication as one of the proposed ‘life chances indicators’. These life chances indicators are recommended as the means by which government can measure incremental improvement for each new cohort of children
Dame Clare Tickell’s review of the Early Years Framework concluded that communication and language should be seen as essential foundations for children’s life learning and success

7. Evidence based SLT for preschool children with PSLI
Timeline
Activity
Aims
Oct Sept 2012
National survey
Case studies
Delphi Development of consensus/ evidence-based model
Development of assessment /diagnostic tools
Lit reviews
Evidence-based typology of interventions with an associated toolkit for individualisation of intervention and measurement of outcomes
Final dissemination and report writing
To develop an evidence based typology of SLT-led interventions for preschool children with PSLI
To investigate the feasibility of the typology and to develop a supporting measurement toolkit
Sept Aug 2013
Sept Dec 2013

8. NIHR Programme Grant for Applied Research (PGfAR)
Programme Aim
To develop an evidence based approach to intervention for children with or at risk of primary speech and language impairments, that integrates research evidence with practitioner consensus and the perspectives of families.
NIHR Programme Grant for Applied Research (PGfAR)
£1.2m for a three year programme of work
Capacity building for unit

9. Parent Involvement and Partnership (PIP)
Afasic, Barnardo’s and Supportive parents
Parent Involvement and Partnership Strategy
Parent research panel
Advisory group
Reviewers
Non engaging groups
Establish parent involvement for unit

10. Child Talk - What Works Phase 1
Aim
To develop an evidence based typology of Speech and Language Therapist led Interventions in England, incorporating the perspectives of families and children.
- End date 14th September 2012
- Selection of case study sites
- Focus groups, surveys and systematic reviews

11. Research questions
What do SLT practitioners perceive to be the critical components of intervention
What child and family /contextual factors cause SLT practitioners to modify interventions provided and targets set and in which way?
How do non-SLT professionals and families understand interventions and their effectiveness?
How do families and children experience different approaches to interventions?
What factors influence whether or not families would access and actively engage with interventions?
What economic health resources are utilised by the various components of interventions by SLT’s?

12. Research questions
What do SLT practitioners perceive to be the critical components of intervention
What child and family /contextual factors cause SLT practitioners to modify interventions provided and targets set and in which way?
SLTs who have worked with preschool children with PSLI
Focus groups to identify components of intervention
National Survey to SLTs
Systematic reviews to find level of evidence for effectiveness of components

13. Research questions
How do non-SLT professionals and families understand interventions and their effectiveness?
How do families and children experience different approaches to interventions?
Focus groups with early years practitioners
Focus groups with parents of preschool children with PSLI
Activity groups with preschool children
Gaining child’s perspective on intervention

14. Research questions
What factors influence whether or not families would access and actively engage with interventions?
Which communities do not currently engage with SLT services
What is their views on communication development
What economic health resources are utilised by the various components of interventions by SLT’s?
Documentary analysis

15. Selection of Case Study Sites
Intra-Site Factors
Data of Interest
Data Source
Ethnicity
Office of National Statistics requested Data CD - EE1: Estimated resident population by ethnic group and sex, mid-2009 (experimental statistics) – Ethnic Table 2009
Socio Economic Status
Office of National Statistics requested Data CD – Economic Deprivation Index 2008
Urban/Rural
Office of National Statistics requested Data CD – 2001 Density (number of people per hectare)
Transient Population
Table produced by Migration Statistics Unit Numbers to and from each LA in and
English as a second Language
Sfr pla
Early Years Foundation Stage

16. Selection Case Study Sites
Postcodes
Strategic Health Authorities
Unitary Authorities / Primary Care Trusts

17. Selection case study sites
South East Dorset
North Bristol
Central Manchester
Bassetlaw
Newcastle
North
Lincolnshire

18. Under Served / Non-engaging Groups
Ask local Speech & Language Therapists who these groups of people are in their area
Compare population demographics to patient demographics from service database
Check expert knowledge with service database and population data

19. Under Served / Non-engaging Groups
Components associated with identifying and recruiting

20. Acknowledgements
Thank you to the many people who have supported us over the two years in our journey towards the grant including
Members of our advisory group, particularly Supportive Parents, Afasic, Barnardos
Research design and R&D
SLTRU & SLT colleagues
Assessment Research Ltd