Research at the
University of the West of England (UWE) Bristol has reassessed
services for children with speech, language and communication
impairment, emphasising the perspectives of the children themselves
and their families. The findings have directly influenced major
policy reports, a National Year of Communication, and have improved
therapy practice.
Evidence from research
Language skills are crucial to children’s development, yet
impairments in these skills affect around 7% of children of
primary-school age. What are the best ways to help their language
development skills, and what are the priorities of their families
and of the affected children themselves? Research led by
Professor Sue Roulstone has provided evidence that helps answer
these questions.
Perspectives of children and parents
There was already a consensus that services for children were
likely to improve if their perspective is listened to. This is a
particular challenge in the case of children with speech, language
and communication impairment. Using non-verbal activities such as
drawing, taking photographs and compiling a scrapbook, the UWE
Bristol team created a supportive environment within which the
children could express themselves. This made their own thoughts on
their impairment explicit for the first time.
In 2007, the UK’s then Secretaries of State for Health and for
Children, Schools and Families asked John Bercow
MP (later the Speaker
of the House of Commons) to lead a review of the services provided
for children and young people with speech, language and
communication needs. This review commissioned Roulstone to
undertake independent research on the views of children and
parents.
Roulstone’s team found that parents saw communication as central
to their child’s development. They wanted well-signposted services,
access to specialist resources, and a timely diagnostic process in
which professionals worked in partnership with parents.
Finding the factors influencing development
How do parents’ activities with their children affect their
language development? In 2011, working with colleagues from the
Universities of
Bristol,
Newcastle and
Sheffield, the UWE Bristol
team analysed data from a large-population study (the Avon
Longitudinal Study of Parents and Children) with which they had
been involved. They found a significant link between the child’s
language abilities at age two and the parents’ activities with them
when they were younger. This ability level was in turn significantly linked to their performance in school entry
assessments, suggesting children who develop their language early
are at an important advantage.
The research also looked in 2012 at current practice in
programmes designed to support the development of children’s
communication. In collaboration with the Universities of
Warwick and Newcastle, Roulstone
and Dr Yvonne Wren from UWE Bristol found that only 5% of
these programmes were based on strong evidence; 56% had evidence
from at least one trial and 39% had only face validity or were
based solely on case studies.
Influencing public policy and guidance
The research had a direct influence on the report of the Bercow
Review, published in 2008. As well as acknowledging and quoting
from the research directly, the headings of four out of its five
key conclusions reflect the findings on parents’ priorities:
- Communication is crucial
- Early identification and intervention are essential
- A continuum of services, designed around the family, is
needed
- Joint working is critical
In response to the Bercow Review, the Government established a
‘Better Communication Action Plan’. As part of this, the UK
national Commissioning Support Programme published in 2011 a
guidance document for professionals such as those who commission
services for children with communication impairments. This
included, as a substantial appendix, the materials and guidance
tools developed by Roulstone and her team to help the children
express their perspectives. The document encouraged care
professionals to use these tools to involve the children in
planning their care.
The Government announced that 2011 would be a National Year of
Communication. This was recommended in the Bercow Report, which had
picked up Roulstone’s finding emphasising the central role of
communication in children’s lives. The National Year highlighted
the findings linking parents’ activities with their children in
their first two years with their subsequent language skills,
inviting Roulstone to present them to relevant professionals
including speech and language therapists.
Several other policy documents that recommend the development of
services to identify and help children with communication
impairments draw evidence from Roulstone’s research. Examples at
the UK national level include the Nutbrown Review (2012) and the
All-Party Parliamentary Group on Speech and Language Difficulties
(2013). Similarly, at the regional level in South Wales, the
Aneurin Bevan Health Board ‘Flying Start’ Speech, Language and
Communication Development Service drew on the research in drawing
up their ‘Strategy for the Prevention, Early Identification and
Intervention for Speech, Language and Communication Needs for
Children’.
Influencing practice
All this has had a direct bearing on practice on the ground.
Feedback confirms that speech and language therapists have
introduced children’s views into their auditing process as a result
of hearing about Roulstone’s research findings in this area.
The findings on the level of evidence that underpinned current
therapy programmes have stimulated moves towards better
evidence-based practice.
The Communication
Trust, a coalition of voluntary-sector organisations with
expertise in speech, language and communication, commissioned
Roulstone to help develop a database called ‘What Works’.
The database provides information to care commissioners,
managers and practitioners on the level of evidence underpinning
particular programmes and interventions, so that they can take this
into account in making their selections. The site was launched in
March 2013. By the end of July, there had already been over 5,000
individual registrants.
Relevant, rigorous research at UWE Bristol, via engagement
with policymakers and practitioners, is helping to bring about real
changes in the help that is offered to children with communication
difficulties.
This blog post is copied from UWE's website.
