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Lorraine Coulter,Development And Evaluation
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Lorraine Coulter,Development And Evaluation


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  • 1. DEVELOPMENT AND EVALUATION OF A NURSERY BASED SERVICE FOR PRE SCHOOL CHILDREN Lorraine Coulter Speech and Language Therapist & Linda Hyde Speech and Language Therapist
  • 2. Aims of the Project
    • To improve identification and support for children with speech and language delay
    • To reduce the impact of speech and language delay on children’s overall development
    • To improve access to the speech and language therapy service
    • To develop a service in partnership with parents and Education
    • To increase nursery staff knowledge and skills in the area of speech and language development
  • 3. Background/Evidence
    • Speech and language delay-most common difficulty experienced by pre school children (Law et al, 2000)
    • Impacts on: communication skills, education, social skills, emotional development and life chances (Rosetti, 1996)
    • Up to 50% of children reared in poverty will experience early language delay (Locke, 2002)
    • Language delay persisting beyond 5-6 years of age more likely to impact on child’s literacy skills (Stothard et al, 1998)
    • Importance of providing service at optimum time in child’s development
  • 4. Background/Evidence
    • Outcomes for children improved when therapists and Education staff work together (Locke et al,2002)
    • Limitations of therapy detached from child’s learning environment (Elkin and Capiluoto, 1994)
    • Improved outcomes for children across a range of language measures when therapy provided in Nursery (Law et al 2002,)
    • Nursery based model more cost effective than clinic based (Law et al, 2006)
    • Community Needs Assessment-’easier access to speech and language therapy’ (Murphy, 1995)
    • Speech and Language Therapy Needs Assessment-high prevalence rate: 42% delay (Coulter, 1998)
    • Poor uptake of clinic based service
    • 30% failed to attend clinic appointments
    • 80% of Education staff have little/no training in identifying and supporting children with speech and language delay
  • 6. Reshaping
    • Research evidence
    • Local needs-high prevalence
    • Parent views
    • Poor access/uptake
    • Long waiting lists
    • Education staff training needs
    • Health/Education cultural differences
    • Funding/resources
    • Medical model
    • Consultation-parents, Education staff
    • Funding bids- Sure Start
    • Training needs assessment
    • Development of action plan
    • ICAN-service design
    • April 2002-Pilot in 9 nursery schools
    • Development of partnership-Health, Education, Sure Start and parents
  • 8. Multi-professional, partnership approach Health Education Sure Start Parents Speech and Language Therapists Health Visitors Community Paediatricians Nursery teachers Learning Support Assistants Curriculum Advice and Support Service Educational Psychologists Sure Start Co-ordinator Other Sure Start staff-Health Visitor, Social Worker Statutory, voluntary and community Views and perceptions Training
  • 10. Nursery Outreach Service
    • Speech and Language Therapist visits each nursery on a fortnightly basis
    • Jointly assesses, plans and carries out intervention in conjunction with nursery staff
    • Group and individual therapy
    • Therapy placed at the heart of child’s nursery environment, routines and activities
    • Key worker system established
    • Parental involvement
    • Training ongoing-group learning and in-class support
  • 11. Key Outcomes
    • Evaluation ongoing since April 2002
    • Range of quantitative and qualitative measures:
      • Pre/post assessment of children’s speech and language skills
      • Staff and parent questionnaires
      • Staff and parent focus groups
      • Pre/post evaluation of staff training
      • Narrative analysis of parents’ views
  • 12. Key Outcomes
    • Children:
    • 48% discharged following their Nursery year
    • 100% access to the service
    • Waiting times reduced to 2 weeks
  • 13. Key Outcomes
    • Children:
    • Comprehension of language:
    • Pre intervention 66% of children had delayed understanding of spoken language post intervention 34% (p=.000)
    • Phonology (sound system):
    • Pre intervention 40% of children presented with delayed and/or disordered speech sound system post intervention 17% (p=.000).
  • 14. Key Outcomes
    • Parents:
    • 100% rate the service as more/as beneficial as clinic based service
    • “ It meant she didn’t have to get out of school and miss her work to attend therapy.”
    • 100% report improvements in their child’s speech and language skills
    • “ My child has improved greatly and is receiving the help he requires.”
    • 100% want the service to be continued and extended to include Primary schools
  • 15. Narrative Analysis of Parents’ Views
    • Discourse narratives provide an understanding of the experiences related to health phenomena.
    • Narratives help to organise, interpret and give meaning to experience (Bruner, 1990)
    • Develops an understanding of personal reflection, what people know and to empower them to talk about their personal experiences what they mean to the individual and family involved (Cortazzi, 1993)
  • 16. 5 Key Themes
    • Perceived benefits of SLT in nursery
    • Parents concerns
    • Experiences of SLT in other settings
    • Impact of speech and language difficulties
    • Parents’ anxieties
  • 17. Key Outcomes
    • Nursery based service very beneficial
    • Natural learning environment important
    • Support from nursery staff was vital to success
    • Early identification and intervention were identified as significant factors of Service
    • Some parental ‘concerns’ were actually based on misperceptions e.g frequency of therapy. Leaflet adaptations/considerations required
  • 18. Key Outcomes
    • Parents anxieties did not diminish until the third term (even with mild speech and language difficulties) – parent information/training from the outset
    • Parents wanted the service continued into primary school
    • Findings applicable to SLT’s working in all settings and especially in schools
  • 19. Key Outcomes
    • Staff:
    • 100% of Nursery staff rate the service as very beneficial
    • 100% increased in confidence and knowledge and skills following training
    • 100% of staff report joint assessment and monitoring of progress
    • Staff highlight the progress made by children
    • ‘ A great improvement-children are more confident, fluent, greater comprehension. 9 out of 14 are discharged!! Amazing.’
  • 20. Key Outcomes 86% 85% Joint monitoring of progress 81% 65% Linking therapy goals to IEPs and curriculum 81% 45% Joint planning of therapy/class programmes 91% 75% Joint assessment 2005 2003 Type of activity
  • 21. The Way Forward
  • 22. The Way Forward
    • Outreach Service replicated and extended within mainstream Speech and Language Therapy Service
    • April 2002- 9 Nursery Schools
    • May 2006- 15 Nursery Schools
    • Mainstream Primary schools
    • Transfer to other services-Child Assessment Clinics
    • Service Level Agreements
    • Dissemination of model and process at NICCY Conference Feb 2006-DVD
  • 23. And Finally!!!
    • ‘ Change comes from small initiatives which work, initiatives which imitated become fashion. We cannot wait for visions from great people. We must light our own small fires in the darkness.’
    • (Charles Handy)
  • 24. QUESTIONS???