DEVELOPMENT AND EVALUATION OF A NURSERY

BASED SERVICE FOR PRE SCHOOL CHILDREN

Lorraine CoulterSpeech 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 TherapistsHealth Visitors

Community Paediatricians

Nursery teachersLearning 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

1. Perceived benefits of SLT in nursery

2. Parents concerns3. Experiences of SLT in other

settings4. Impact of speech and language

difficulties5. 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 OutcomesStaff:• 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

Type of activity

2003 2005

Joint assessment 75% 91%

Joint planning of therapy/class programmes

45% 81%

Linking therapy goals to IEPs and curriculum

65% 81%

Joint monitoring of progress

85% 86%

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???