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

2. 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. ( )
‘Partnership working will be key…to improve the life chances of all our children and young people.’

3. 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 .

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

5. SERVICE REDESIGN
Drivers:
Local needs
Poor access
Long waiting lists

6. 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

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

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

9. COLLABORATIVE WORKING
Funding: DE ( ) , DSD ( )
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)

10. COLLABORATIVE WORKING

11. 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??

12. 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)

13. 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

14. 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

15. 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

16. 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

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

18. 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).

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

20. 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

21. 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.

22. 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).

23. 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)