development and evaluation of a nursery based service for
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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???
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