Lorraine Coulter,Development And Evaluation


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Lorraine Coulter,Development And Evaluation

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