Emily Hoskins – Early Years Speech and Language Therapist, Aneurin Bevan University Health Board.
Speech, language and communication needs (SLCN) are the most common type of additional learning needs with 4.8% of school children having SLCN. If unaddressed, this has lifelong impacts for education, wellbeing, mental health, youth offending and employment Speech, Language and Communication (SLC) needs: infographics | GOV.WALES. We know that the most important predictor of language abilities is the communication environment and this project has worked on bringing SLC to the fore in Gwent’s early years teams. Modest investment into training early years practitioners can have a huge impact on SLC outcomes and this has been the focus of the last 12 months of work.
Image taken from 41062 Talk With Me (gov.wales)
There is no specific training for SLC within Health Visitor pre-registration training and this led to the Health Visiting department in ABUHB creating an innovative role to have an in-house Speech and Language Therapist to deliver a training programme for their whole workforce. The training had been co-produced within Welsh Government for Health Visiting teams and ABUHB piloted integrating the rollout with Local Authority (LA) teams.
The second part of the project centres around developing a bespoke SLC contact for all children in Gwent to understand children’s SLC development, provide preventative public health SLC messages and offer targeted level support to address transient needs. The aim is simple, let’s see children early, improve their communication environment and reduce their risk of having SLCN!
Training rollout
Trained staff: 290
Overall increases in confidence from 6.19 à 8.60 across 6 domains…
Stakeholder engagement
Stakeholder engagement activities were completed to jointly design a bespoke SLC contact for Gwent….
- Staff survey: 28 responses, 11 Health Visiting, 17 LA
- Parental survey (QR codes given to parents/posted on social media): 32 responses
- Visited existing universal and targeted interventions to talk to parents, accessed 39 caregivers (33 Mums, 4 Dads, 1 Auntie, 1 Foster parent)
- Showed proforma to one LA area Health Visiting team (11 staff present and video available)
Themes identified
Parents want:
- To feel listened to
- Concerns taken seriously
- The session to not be rushed or feel like a checklist
- More time to discuss concerns
- Time to discuss SLC even if they didn’t have concerns
- Reassurance
- To hear what they’re doing well
Feedback was used to develop the proforma for a contact suitable for 18-21 month old children, using strengths-based feedback and natural play.
Outcome measures
In the contact, 2 outcome measures have been embedded
- Parent self-rating their confidence on a scale of 1-5 to interact in a way that helps their child learn to talk
- Observations of parents use of responsive communication strategies. Use of the Parental Responsiveness Rating Scale (PaRRiS). This is a 1-5 scale of how responsive a parent is in interactions (1 = very low 5 = very high)
Levickis, P. (2019) Parental Responsiveness Rating Scale (PaRRiS): Scoring Manual [unpublished manuscript]. Melbourne: The University of Melbourne, Melbourne Graduate School of Education, REEaCh Centre.
Pilots
2 LA areas have started pilots so far:
| Where | Who for | What age | Delivered by |
| Blaenau Gwent | Flying Start families | 21 months | LA Family Support Team |
| Torfaen | Flying Start families | 18 months | Health Visitor support workers |
Initial outcomes
14 contacts completed from November 2023-January 2024
| Start of contact | End of contact | |
| PaRRiS | 2.79 | 4.07 |
| Parent confidence | 3.00 | 4.43 |
Intended outcomes
- Making SLC ‘everybody’s business’: Increasing the knowledge and confidence around SLC for Gwent’s Early Years workforce to support us to consistently discuss and support SLC development in line with the evidence base
- Speeding up the time staff take to find appropriate resources to share with families for SLC (85.8% of trainees agree or strongly agree with this)
- Increasing parental responsiveness which in turn supports language development as they are the experts in their child and can make the difference. A focus on prevention via the universal contact point for dedicated attention on SLC
- Using behaviour change models to identify the right time for a referral to SLC support services where appropriate. The right support, from the right person, at the right time
- Monitoring DNA and engagement patterns to targeted and specialised SLC support services, aiming for reduction in referrals, increased attendance or both
Next steps
- Support 2 existing pilots and monitor feedback and outcomes
- Identify more areas of Gwent to begin pilots in 3 remaining LA areas
- Adopt across Gwent, monitor the impact and share nationally with other Health Visiting and SALT teams
- Bi-annual ‘mop up’ training to future-proof the skills within Gwent early years, with all new starters accessing SLC training
In time we hope to see longitudinal outcomes on referral patterns, engagement and in turn the longer-term impacts of unaddressed SLCN.
Learning
You always have an ally! Times of transition from one stage to the next can seem daunting but they happen and then the next stage is upon you. Relationships are so important to help drive things forward, and to have someone to support you in moments of doubt! Part of delivering a project is reflection and mental analysis and sometimes being sat thinking can be just as tiring as doing. Seeing other people become passionate about your area of specialism is exciting and finally, ‘if it isn’t there, don’t force it’.
