1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Re-designing a Speech & Language Therapy (SLT) service in a school for emotional, behavioural disorders Marie Fahy MSc. Leadership & Management Development
Abstract
This project takes a whole systems view of the challenges and opportunities for individuals working towards integration for children with speech, language and communication needs. The context involves collaboration across mental health and special education, to improve vocabulary outcomes for children attending a school for emotional, behavioural disorders. Collaboration is viewed from a multi layered perspective, incorporating service users, project facilitator, school staff, operational and strategic levels of collaboration.
Consultation with service users (children and parents) and the workforce led to the development of a whole school language approach, designed around the needs of children and their families. The facilitator used the HSE model (2008) as an effective framework to analyse the change process. The facilitator adopted an action research methodology, alternating cycles of reflection and action. Evaluation involved multiple stakeholders in health, special education sector and service users providing feedback to inform further planning. Evaluation of SMART aim and objectives ensured changes in the system. Quantitative and Qualitative outcomes evolved from the organisational development process, including new structures and systems to support children with communication impairment. Outcomes included improved communication within the school and acknowledgement of the need for service user involvement. The overall result was a more efficient, equitable, sustainable SLT service, making wise use of a scarce resource. This has implications at practice, research and policy levels.
Service users and the wider workforce can effect changes in systems to mitigate the negative trajectory of speech, language and communication effects on all aspects of children’s lives. The solution is making the inter-dependent journey together, adopting shared responsibility for communication impairment.

2. Introduction & Background Organisational Impact
Re-designing a Speech & Language Therapy (SLT) service in a school for emotional, behavioural disorders Marie Fahy MSc. Leadership & Management Development
Introduction & Background
Methodology
Evaluation
The purpose of this project is to re-design an SLT service in a special school setting according to service user needs
Traditionally, the expert model has been employed in SLT and mental health
This fails to address the unique experience each service user brings to the therapeutic milieu
Schools have an important role to play in supporting speech, language and communication skills at universal and targeted levels
Figure 1: Pyramid of need 1
Universal approaches – whole school language approaches, training wider workforce. Targeted- classroom groups for at risk children
Public health approach ensures all children can access communication support
Figure 2: HSE model
Jacob’s model 3 -collaboration, negotiation, consultation around context and policy of intervention
Qualitative & quantitative outcomes for multiple stakeholders
SMART objectives achieved by evaluating children’s vocabulary & consulting multiple stakeholders about new structures & systems
During lessons in class, some children brought up discussions in a positive way- Teacher
HSE model 2 (Figure 2) - change dynamic & continuous. Action research: cyclical process reflection & joint inquiry
Initiation- Force Field analysis, Stakeholder analysis, 7s model
Planning –Four focus groups including children, parent and school staff to inform whole school language approach, frequent communication of shared vision & values, managing resistance
Implementation- Parent workshop, service user panel, 35 children targeted vocabulary groups, teacher meetings, visual strategies-word maps
Mainstreaming- Balanced system 1 co-producing outcomes with service users
Organisational Impact
specialist
targeted
universal
Behavioural- School staff/SLT collaboration, common goals & communication about conflict
Structural-Parents access to school & SLT, weekly school meetings, classroom SLT groups
Cultural- Learning organisation based on shared vision, values & challenging mental models
Personal- vulnerable, courage, integrity, joint reflection
Conclusion
Integrated approach to improving outcomes for children with communication needs
Whole systems view of challenges & opportunities to interagency work
Trust, collaboration, dialogue, shared responsibility for better children’s outcomes
Distributed leadership, multiple perspectives to shape services
Aim & Objectives
Redesign SLT in a special school to create an efficient, equitable, sustainable service, using SMART objectives:
Measure five children’s language and communication skills
Evaluate the views of five children, their parents and teachers in focus groups
Implement changes to service delivery according to service user’s needs
Evaluate the effectiveness of service delivery changes by consulting multiple stakeholders
References
Gascoigne, M. T. ed. Better communication- shaping speech, language and communication services for children and young people. London: RCSLT; 2012
HSE. Improving our services: A user's guide to managing change in the Health Service Executive. Dublin: Health Service Executive; 2008
Jacob, C. The Evaluation of Educational Innovation. Evaluation 2000; 6(3):