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Understanding speech and language therapy

Speech, Language and Communication Needs (SLCN) are the most common difficulty faced by children. On average two children in every classroom (6%) will have difficulties. Here Kim Hartley, Scottish Officer for the Royal College of Speech and Language Therapists (RCSLT) explains how speech and language therapists work with children and young people with additional support needs.

How do I make a referral for speech and language therapy?

If you are worried about your child’s speech or language development or you are concerned that it is impacting on their behaviour, you can make a referral by calling your local Speech and Language Therapy Manager.  You can find their contact details by calling your local health board or asking your GP or health visitor or visit Enquire’s Find a service page.

You may need to wait for an appointment. A recent survey showed that speech and language therapy services will normally offer a first appointment within 9 weeks of referral. Children may wait between 5-20 weeks for actual therapy to begin.

What will happen then?

A speech and language therapist will normally carry out a face-to-face assessment of your child’s speech, language and communication development including talking to you, teachers and other key adults.

Shortly after the assessment, the therapist will produce a report of her findings and make recommendations on the best way forward. The report and recommendations will be shared with whoever referred the child, the parents, the child or young person and, with parental permission, any others involved with the child. Often the therapist will meet with key people to agree the way forward.

How are decisions about speech and language therapy made?

Decisions about the best way forward are based on the needs of the child and on published evidence of best practice i.e. quality research showing how best to help children develop speech, language and communication; professional ethics and codes of practice as well as national law, policy and guidelines.

The Royal College of Speech and Language Therapy published papers and clinical guidelines on what works for supporting children with SLCN, including those with particular conditions such as Autism. Parents can ask their local speech and language therapy service for copies or get in touch with RCSLT (info@rcslt.org /Tel: 020 7378 3012).

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 a. 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.

What can I do if I am unhappy with speech and language therapy services?

As the above description highlights, speech, language and communication development and speech and language therapy is a partnership between the therapist, the child, their parents, teachers and other key adults.  However, if you have any queries or concerns about the speech and language therapy your child is receiving you have the right, and are strongly encouraged, to raise these with the speech and language therapist or service.

Before doing this, you, along with teachers and others may want to consider asking yourself these questions:

  • Have I done what the speech and language therapist recommended and has there been no change?
  • If you haven’t followed the therapist’s recommendations, why not? Is it because you are not clear on what you are meant to be doing; you don’t know why you are doing it; you don’t have time; you don’t agree or don’t believe it will help?
  • Do I know what is reasonable to expect in terms of progress? Do I know what ‘success’ looks like?

Thinking about these questions will help you get the most useful answers when you speak to your speech and language therapist. The therapist should be able to explain the reasons behind his/her recommendations and respond to requests to help you follow recommendations, including demonstrating what you should be doing. You and others can also join in and observe sessions.

If, after talking to your speech and language therapist, you are not satisfied you could contact:

  1. The local speech and language therapy manager.
  2. The local Allied Health Professionals Manager  and start, if necessary, the local complaints procedure. Information on this is normally found on Health Board websites.
  3. Royal College of Speech and Language Therapists – RCSLT (info@rcslt.org/tel: 020 7378 3012)*
  4. The Health Professions Council (HPC) – see http://www.hpc-uk.org/or call 0845 300 6184
  5. Local MSPs and/or Councillors

*The Royal College of Speech and Language Therapists and Health Professionals Council will not normally respond to complaints unless the local complaints procedure has been exhausted.

What are the effect of cuts to speech and language therapy services?

Speech and language therapy services, like many other public services, are under severe strain due to public spending cuts which often lead to restrictions. The RCSLT, speech and language therapists and many others are all campaigning to protect current levels of service from further cuts. Support for this campaign is both encouraged and very welcome.

Anyone interested should contact the RCSLT Scotland Officer, Kim Hartley, kim.hartley@rcslt.org

 


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