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Lorraine Coulter,Development And Evaluation
 

Lorraine Coulter,Development And Evaluation

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    Lorraine Coulter,Development And Evaluation Lorraine Coulter,Development And Evaluation Presentation Transcript

    • DEVELOPMENT AND EVALUATION OF A NURSERY BASED SERVICE FOR PRE SCHOOL CHILDREN Lorraine Coulter Speech and Language Therapist & Linda Hyde Speech and Language Therapist
    • 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
    • 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
    • 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)
    • LOCAL NEEDS/EVIDENCE
      • 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
    • Reshaping
      • DRIVING
      • Research evidence
      • Local needs-high prevalence
      • Parent views
      • Poor access/uptake
      • Long waiting lists
      • Education staff training needs
      • RESTRAINING
      • Health/Education cultural differences
      • Funding/resources
      • Medical model
    • RESHAPING PROCESS
      • 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
    • 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
    • MODEL OF SERVICE DELIVERY CHILD THERAPIST NURSERY STAFF PARENT
    • 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
    • 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
    • Key Outcomes
      • Children:
      • 48% discharged following their Nursery year
      • 100% access to the service
      • Waiting times reduced to 2 weeks
    • 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).
    • 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
    • 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)
    • 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
    • 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
    • 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
    • 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.’
    • 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
    • The Way Forward
    • 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
    • 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)
    • QUESTIONS???