How are speech and language therapy services provided?

The aim of all speech and language therapy is to ensure that children and young people get the best chance to develop speech, language and communication to their full, natural potential. Another aim is to ensure the skills they already have are working well for them, whilst developing the new skills they need.

If a child or young person requires speech and language therapy, the therapist will recommend one or more of the following levels of therapy:

Universal level speech and language therapy

As the name suggests, this type of speech and language therapy is for all children.

The therapist works with parents, teachers and other relevant people to make sure the child or young person is constantly surrounded by people who know how to:

  • help their speech, language and communication develop
  • make sure the understanding and expressive  skills they currently have work as well as possible for them – at home, in the classroom, at Granny’s, Brownies… wherever
  • identify when a child may have SLCN and how to access speech and language therapy.

Typically at this level, the therapist will provide training or workshops for parents, teachers, classroom assistants etc., work as part of general parenting programmes and give out information and advice pamphlets on speech, language and communication development to inform and “skill up” the people who live or work with children and young people with SLCN.

Why is it a good thing?

Recent findings from an extensive survey of parents in England showed there is little common understanding of how speech, language and communication skills develop and the important milestones children should be reaching. Many people think it “just happens” naturally. Universal services help to plug this gap in awareness and knowledge so that families and others can help children develop better speech, language and communication skills.

Speech, language and communication skills develop and are used at every waking moment of a child’s life. This means that in every one of those waking moments there is an opportunity to help the child develop these skills. By adopting a universal model it means that the children receive help all the time rather than for only a small number of hours a week at face-to-face sessions with a therapist. Whatever the SLCN or whatever other speech and language therapy services are provided a child will progress faster if they are growing up in a supportive environment created through universal speech and language therapy services.

Universal services also improve speech, language and communication skills of ALL children – not just those with identified SLCNs.

Targeted level speech and language therapy

Targeted speech and language therapy is focused on those children where universal input is not enough. It is targeted at children and young people known to have a SLCN (or at risk of developing such needs) and/or where there is a risk of educational, emotional or other difficulties arising as result of their SLCN.

The difference is that the therapist’s input into the ‘communication environment’ – the home, school etc. is more focused, concentrated and carefully planned.

For children with known SLCN, targeted level support generally involves the speech and language therapist:

  • ‘skilling up’ parents, teachers, classroom assistants etc. to work at every opportunity to develop particular aspects of speech and language development (such as increasing vocabulary, asking questions or expressing feelings appropriately)
  • working with teachers and classroom assistants to adapt their language and teaching materials so that the child can understand and join in lessons on a day-to-day basis
  • monitoring speech, language and communication development through progress reports from teachers and others, then offering support and advice on how to overcome particular difficulties.

Children receiving targeted levels of therapy may stlll require direct input from a speech and language therapist if they are not showing progress.

Why is it a good thing?

Targeted provision is a way of providing enhanced speech, language and communication support for children and young people with SLCN in all parts of their life.

Children don’t need to wait to see the speech and language therapist directly before they start to receive support to stimulate their speech, language and communication development.

Targeted services make sure that while their speech, language and communication skills are developing they are able to take part in other learning.

Children at high risk of speech, language and communication delay or disorder are given an extra boost by staff skilled in supporting and accelerating speech, language and communication development.

Specialist level speech and language therapy

Specialist level speech and language therapy is the most direct form of service. It brings the most intensive speech and language therapy specialist knowledge and skills to bear on the child’s SLCN. It is provided to those children and young people with complex SLCN requiring complex programmes or to those who have not responded to universal and/or targeted provision.

It is commonly provided in episodes –  the child sees a speech and language therapist individually or in groups and then has periods of targeted work as detailed above where they do not see the therapist.

Not all children with complex SLCN will be able to develop speech, language and communication skills to a level where they can understand or speak like other children. For these children the aim of  speech and language therapy is to develop their understanding and expressive skills to their fullest potential and to enable them to use those skills as effectively as possible to communicate about as many different topics, in as many different places, with as many different people as possible.

This might mean developing the child’s use of Augmentative or Alternative Communication (AAC) systems such as sign language (Signalong or Makaton), symbols, photographs and objects or  ‘talking machines’.

Specialist speech and language therapy will typically involve:

  • detailed assessment
  • a child specific programme that integrates with their day-to-day school and home activities
  • ‘direct speech and language therapy’ and/or ‘indirect speech and language therapy’ via other people trained to deliver the programme e.g. parents, speech and language therapy assistants, nursing or  teaching staff. (Those providing ‘indirect therapy’ are directed and supervised by the speech and language therapist.) Just as nurses carry out care programmes designed by a doctor, under the doctor’s supervision, so speech and language assistants can deliver programmes designed by the speech and language therapist under their supervision. Speech and language therapy provided in this way is therefore not a ‘diluted’ service but a way of delivering routine speech and language therapy programme activities to individual children more often,  and spreading qualified speech and language therapy expertise to more children
  • training everyone delivering the programme and providing them with the necessary speech and language therapy materials they need to do the work
  • monitoring and adapting the programme based on progress and the observations of the therapist and others delivering the programme.

Why is it a good thing?

Parents, teachers and others often like specialist services because it is more ‘visible’ than other levels of speech and language therapy and it fits in with a medical model of addressing issues i.e. clinicians treat a problem and it gets better.

It is always important to remember that speech, language and communication skills do not develop during short sessions with a speech and language therapist but develop and are used every moment of a child’s day. Having a supportive communication environment and a well skilled ‘team’ of parents, teachers and others supporting them is equally as important.

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