Speech And Language Therapy Services Research Articles

Telerehabilitation Services for Communication Disorders during Covid-19 in a Tertiary Care Set-up: a Descriptive Report

Speech and language therapy (SLT) services were suspended for a major part in the year 2020 due to COVID- 19 spread. Reinstating SLT services via alternate medium of Telerehabilitation (TR) was imperative to provide continued care for various disorders along with providing a support base for the caretakers during these difficult times. This paper presents a descriptive report of SLT services provided via TR in a tertiary care hospital for months of January till October 2021.

Decoloniality and healthcare higher education: Critical conversations.

We explore the theoretical and methodological aspects of decolonising speech and language therapy (SLT) higher education in the United Kingdom. We begin by providing the background of the Rhodes Must Fall decolonisation movement and the engagement of South African SLTs in the decoloniality agenda. We then discuss the evolution of decoloniality in SLT, highlighting its focus on reimagining the relationships between participants, students, patients and the broader world. The primary objective of this discussion is to fill a gap in professional literature regarding decoloniality in SLT education. While there is limited research in professional journals, social media platforms have witnessed discussions on decolonisation in SLT. This discussion aims to critically examine issues such as institutional racism, lack of belonging, inequitable services and limited diversity that currently affect the SLT profession, not just in the United Kingdom but globally. The methods employed in this research involve the engagement of SLT academics in Critical conversations on decolonisation. These conversations draw on reflexivity and reflexive interpretation, allowing for a deeper understanding of the relationship between truth, reality, and the participants in SLT practice and education. The nature of these critical conversations is characterised by their chaotic, unscripted and fluid nature, which encourages the open discussion of sensitive topics related to race, gender, class and sexuality. We present our reflections as academics who participated in the critical conversations. We explore the discomfort experienced by an academic when engaging with decolonisation, acknowledging white privilege, and the need to address fear and an imposter syndrome. The second reflection focuses on the experiences of white academics in grappling with their complicity in a system that perpetuates racism and inequality. It highlights the need for self-reflection, acknowledging white privilege and working collaboratively with colleagues and students toward constructing a decolonised curriculum. Finally, we emphasise that while action is crucial, this should not undermine the potential of dialogue to change attitudes and pave the way for practical implementation. The paper concludes by emphasising the importance of combining dialogue with action and the need for a nuanced understanding of the complexities involved in decolonising SLT education. Overall, this paper provides a comprehensive overview of the background, objectives, methods and key reflections related to the decolonisation of SLT higher education in the United Kingdom. It highlights the challenges, discomfort and responsibilities faced by academics in addressing decoloniality and emphasizes the importance of ongoing critical conversations and collective action in effecting meaningful change. What is already known on this subject Prior to this paper, it was known that the decolonial turn in speech and language therapy (SLT) was a recent focus, building on a history of professional transformation in South Africa. However, there was limited literature on decoloniality in professional journals, with most discussions happening on social media platforms. This paper aims to contribute to the literature and provide a critical conversation on decolonising SLT education, via the United Kingdom. What this paper adds to existing knowledge This paper adds a critical conversation on decolonising SLT higher education. It explores theoretical and methodological aspects of decoloniality in the profession, addressing issues such as institutional racism, lack of sense of belonging, inequitable services and limited diversity. The paper highlights the discomfort experienced by academics in engaging with decolonisation and emphasizes the importance of reflection, collaboration and open dialogue for meaningful change. Notably we foreground deimperialisation (vs. decolonisation) as necessary for academics oriented in/with the Global North so that both processes enable each other. Deimperialisation is work that focuses the undoing of privilege exercised by academics in/with the Global North not only for localising their research and education agenda but checking their rite of passage into the lives of those in the Majority World. What are the potential or actual clinical implications of this work? The paper highlights the need for SLT practitioners and educators to critically examine their practices and curricula to ensure they are inclusive, decolonised and responsive to the diverse needs of communities. The discussions emphasise the importance of addressing institutional racism and promoting a sense of belonging for research participants, SLT students and patients. This paper offers insights and recommendations that can inform the development of more equitable and culturally responsive SLT services and education programmes.

The impact of the COVID-19 pandemic on speech and language therapy services in Ireland: A mixed-methods survey at two time points during the pandemic.

During the COVID-19 pandemic, Ireland implemented a series of stringent public health measures, including lockdowns and suspension of non-urgent clinical services. To investigate the impact of the COVID-19 pandemic on the demand for and delivery of speech and language therapy (SLT) services in Ireland in 2020. Two iterations of a cross-sectional, mixed-methods online survey were distributed to speech and language therapists (SLTs) and SLT students in Ireland in the spring and autumn of 2020 using a combination of purposive and snowball sampling. The spring survey yielded 407 responses (including 14 from SLT students), while 197 respondents took part in the autumn (13 students). Survey analysis focused on questions related to the impact of the COVID-19 pandemic on delivery and demand for SLT services (student responses were excluded from analysis owing to low response rate). The largest group in respect of experience were senior SLTs (58% in both surveys). The work settings most strongly represented were HSE primary care (34.4%) and disability services (26.5%) in the spring, and HSE primary care (39.1%), acute hospitals (22.8%) and disability services (20.8%) in the autumn. We used descriptive statistics, including distribution analysis, to analyse the quantitative data. Free text data were interrogated through a variant of a conventional qualitative content analysis. In the spring, cessation of face-to-face services featured prominently (reported by 65.6% versus 14.2% in the autumn), across SLTs' work settings, except acute hospitals. Lower demand was reported by 42.5% in the spring, while in the autumn, 48.7% indicated that demand was higher. SLTs experienced large-scale redeployment (spring: 45.9%, autumn: 38.4%), with HSE primary care SLTs redeployed most (spring: 71.7%; autumn: 62.3%). The need to suddenly pivot to telehealth was a significant challenge in terms of training, technology and logistics. New ways of working emerged and gradually, telehealth became more embedded. SLTs also had to adapt to working with evolving public health measures, such as space restrictions and personal protective equipment (PPE) requirements. Across the two survey iterations, SLTs reported tensions between demands and capacity: while referrals and demand initially decreased in the spring, this led to increased backlog and longer waiting lists, ongoing and increasing pressure on clinicians and services, and negatively impacted clients and families. The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists. What is already known on this subject The negative impact of the COVID-19 pandemic on SLT services has been examined in several countries. Ireland imposed more stringent pandemic-management measures than many other countries, and it was therefore warranted to investigate how SLT services in the country were affected. What this study adds to the existing knowledge Face-to-face SLT services effectively ceased in most non-urgent contexts in spring 2020. This coincided with large-scale redeployment of SLTs to non-SLT contexts. By autumn 2020, demand had increased again, but not all services had recommenced, and redeployment was still a factor. Although SLTs adapted to the ongoing changes imposed by the pandemic, they voiced concern about increasing backlogs and longer waiting lists, ongoing and increasing pressure on both SLTs and services, and negative impacts on clients and families. What are the actual and clinical implications of this work? The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists.

A retrospective study of patients presenting with speech and language therapy needs within multidisciplinary Long COVID services: A service evaluation describing and comparing two cohorts across two NHS Trusts.

Post-COVID Syndrome (also known as Long COVID) refers to the multi-system condition affecting individuals following COVID-19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. What is already known on this subject SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work? The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post-COVID voice, swallowing, communication and upper airway symptoms.

149 A PROFILE OF THE COMMUNICATION NEEDS OF NEW PATIENTS ATTENDING A MEMORY ASSESSMENT AND SUPPORT SERVICE

Abstract Background Communication is a key factor in maintaining quality of life and well-being. This is of core importance for people with dementia who experience changes to their communication abilities. The role of the Speech and Language Therapist working with people with dementia is well documented. Speech and Language Therapists support people with communication and swallowing disorders however in practice the focus is often on swallowing disorders with less emphasis on communication. The recommended allocation of Speech and Language Therapy (SLT) for a Memory and Support Service (MASS) is 0.5 Senior Speech and Language Therapist. A pilot SLT service was trialled in a MASS to identify the SLT service needs and the benefit of introducing SLT earlier for people with Dementia. Methods A retrospective caseload review was completed of ten patients seen by SLT as part of the MASS assessment. Communication profiles and SLT interventions were analysed. Results The majority of the ten patients reviewed self-reported communication and speech and language changes, such as word finding difficulties and difficulties understanding conversations. Patient's self-report often corresponded with formal assessment results. On formal assessment 30% of patients presented with slight cognitive-communicative changes and 30% of patients presented with slight-mild cognitive-communicative changes. 10% of patients presented with mild cognitive-communicative changes and 30% of patients presented with mild-moderate cognitive-communicative changes. SLT interventions included conversational strategies, language strategies, language tasks and conversation partner training. 50% of patients were referred to Primary Care SLT. Conclusion SLT interventions support patients’ cognitive-communication abilities in dementia. SLT within a MASS adds clinical value by supporting assessment and diagnosis of dementia and developing patients’ communication profiles to highlight communicative abilities. Furthermore, SLT input supports developing communication strategies for the patient and communication partner training. In summary these interventions support improved quality of life and well-being for the person with dementia and their family.

Impact of COVID-19 on digital practice in UK paediatric speech and language therapy and implications for the future: A national survey.

BackgroundThe COVID‐19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic‐induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed.AimsTo survey the impact of COVID‐19 remote working on UK paediatric SLTs’ digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM‐B) model.Methods & ProceduresAn online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open‐response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM‐B behaviour change model.Outcomes & ResultsA total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians’ perception of their frequency, convenience and confidence with digital practice during COVID‐19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service‐specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school‐based provisions.Conclusions & ImplicationsDuring COVID‐19, paediatric SLTs’ recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long‐term digital enhancement of SLT services.WHAT THIS PAPER ADDSWhat is already known on the subject The COVID‐19 pandemic led to an unprecedented interest in the use of technology across SLT practice. Studies are emerging nationally and internationally to identify the digital priorities of the SLT workforce, the areas of digital SLT provision that are thriving or lacking, and the evidence to guide clinical practice and service development. What this study adds to existing knowledge This is the first UK‐wide COVID‐19 survey solely focusing on the digital practice of paediatric SLTs. The findings provide critical insights into SLT perception of how practice has been impacted in the early stages of the COVID‐19 pandemic, including digital trends that are service, condition and demographic specific. Tools and channels required to support sustained beneficial change are also discussed. What are the potential or actual clinical implications of this work? This paper demonstrates the potential for digital solutions to enhance SLT practice, as long as implementation is guided by clinicians’ experiences and perspectives. The findings lay groundwork for service development work, such as the creation of training packages, updating of clinical guidelines and care pathways, and development of processes to ensure equitable allocation of evidence‐based resources.

Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project.

Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK, where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust’s community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4–5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.

The ASCEND study: protocol for a feasibility study to evaluate an early social communication intervention for young children with Down syndrome

BackgroundDown syndrome is the most common cause of learning disability, affecting approximately 1 in every 700 babies. Children with Down syndrome have particular difficulties with speech and language. This makes it challenging for them to participate fully in life, access healthcare services and educational opportunities. Improving the language skills of young children with Down syndrome is vital for their future social and emotional well-being and behaviour, and consequently contribution to society. As Down syndrome is detected before or at birth, we can provide support from early on. There are currently no standard interventions for improving the language skills of children with Down syndrome under the age of 36 months. Evidence suggests that early parent-based interventions may be effective in improving language outcomes. In partnership with parents and speech and language therapists, we have co-developed an intervention focusing on early social communication skills and our preliminary work shows that it can lead to better language in children with Down syndrome. Our aim is to carry out a feasibility study which will inform a future pilot/full trial to test whether the intervention is effective in improving language skills before children with Down syndrome start school.MethodsThis is a two-arm feasibility randomised controlled trial (RCT), with 1:1 randomisation stratified by trial site comparing the intervention (plus standard NHS speech and language therapy) with no intervention (standard NHS speech and language therapy only). We aim to recruit between 25 and 30 children with Down syndrome aged between 11 and 36 months. Sites are defined by the geographical boundaries of three National Health Service (NHS) Trusts. Recruitment is from NHS Speech and Language Therapist caseloads within the 3 Trusts, and self-referral. In the intervention arm, parents/guardians will receive brief training on the parent-based intervention and a manual to follow with their child for 10 weeks. The children’s language and early communication skills and family health outcomes will be assessed by a blinded assessor at baseline, post-intervention and 6 month follow-up. Questionnaire and semi-structured interviews will explore the acceptability of the intervention to parents and SLTs.DiscussionThe feasibility study’s outcomes will determine whether it would be viable to progress to a full-trial and whether adjustments need to made to the procedures, data collection methods, intervention delivery and the intensity of support needed. We want to assess whether our early intervention can be delivered and rolled out through NHS Speech and Language Therapy (SLT) Services. We anticipate that NHS SLT Services will need to make ongoing changes due to the COVID-19 pandemic, so it is likely that we will need to make adjustments for the definitive trial. We will also calculate descriptive statistics of the language outcome measure which we will use for any future sample size calculation.Trial registrationISRCTN13902755. Registered on 25 August 2020. http://www.isrctn.com/ISRCTN13902755

Speech and language therapy services for people with Down syndrome: The disparity between research and practice

AbstractThe need for speech and language therapy (SLT) for people with Down syndrome (DS) is well documented. However, there is a significant disparity between research and practice. This study addresses two of the three pillars of evidence‐based practice by 1) quantitatively profiling some key features of the 2019 public SLT service in Ireland, and referencing this against current best evidence; 2) asking parents, and adults with DS what supports they need in relation to an adequate SLT service. Adults with DS (n = 33) and parents of those with DS (n = 557), completed an anonymous survey online. The function of the survey was to collect information on: SLT service provision; levels of satisfaction with services; and SLT supports required. Based on parent responses, only 44% of participants (n = 253) were offered public SLT services in 2019. The mode waiting time was 1–2 years and the average number of sessions across the age groups was 5 per year. There was a strong association between age and number of sessions. Individual therapy was the most common model of service. A total of 40% of parents reported a 0 level of satisfaction. Seven key themes emerged from the qualitative support data. None of the participating adults received public SLT services in 2019. Our aspiration for evidence‐based SLT practice is far from being realized. The average number of sessions reported, does not in any way approximate the intervention intensity specified in evidence‐based interventions. Our limited service, at all ages, has detrimental implications for people with DS and our negligible adult service is in breach of human rights. Targeted, strategic investment is needed to allow practice to be aligned with best evidence; to support and treat people with DS effectively; to allow them to reach their maximum potential; and to exercise their right to communicate.

124 OUTCOME OF SPEECH AND LANGUAGE THERAPY CLINICAL DYSPHAGIA ASSESSMENT FOLLOWING AN INTERDISCIPLINARY SWALLOW SCREEN

Abstract Background A 7 question non-validated swallow screen (Any reported swallowing difficulties? Any coughing with food or fluids? Any choking? Does food get stuck when eating? Any recurrent chest infections? Any pain when swallowing? Any difficulty swallowing tablets?) is used by an integrated care team for older persons to prioritise referrals to the Speech and Language Therapy (SLT) service. This study identified the proportion of patients screened who appropriately required a clinical dysphagia assessment and intervention. Methods This was a retrospective study from September 2020 to June 2021. Patients were assessed by the Clinical Specialist SLT who determined if swallow impairment was present and whether intervention was required. Age, gender and clinical frailty score were documented. Patients who resided out of the catchment area or who had already received an SLT service were excluded. Results The average age was 80 years, range 67–103. The male to female ratio was 2:1 and the average clinical frailty score (CFS) was 5. N = 42(32%) screened positive. N = 29(69%) attended for SLT assessment. N = 27(93.1%) had a swallow impairment identified. N = 20 were discharged following a single intervention and 9 required further SLT intervention. Conclusion Presbyphagia is generally asymptomatic and results from age related anatomical and physiological changes, reduced functional reserve and sarcopenia. Older adults compensate for these difficulties and do not seek assistance. Presbyphagia may progress to dysphagia, resulting in adverse outcomes. The high rate of SLT confirmed swallow impairment and need for SLT intervention highlights a need to prospectively refine and validate this 7 question swallow screen.

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients.

Introduction: The UK's response to the COVID-19 pandemic presented multiple challenges to healthcare services including the suspension of non-urgent care. The impact on neurorehabilitation professions, including speech and language therapy (SLT), has been substantial.Objectives: To review the changes to SLT services triggered by the COVID-19 pandemic with respect to referral rates, service delivery and outcomes, as well as examining the contribution of SLTs to the neurorehabilitation of COVID-19 patients.Methods: Two surveys were distributed to Royal College of Speech and Language Therapists (RCSLT) members exploring experiences of service provision at 6 weeks and 22 weeks after the pandemic was declared in the UK. Responses to closed-ended questions, including questions regarding referral numbers were analyzed descriptively and compared at the two time-points. A database comprising routine clinical data from SLT services across the UK was used to compare information on patients receiving services prior to and during the pandemic. Data on COVID-19 patients was extracted, and findings are provided descriptively.Results: Referrals to SLT services during the acute COVID-19 period in the UK were substantially less than in the same period in 2019. A number of service changes were common including adopting more flexible approaches to provision (such as tele-therapy) and being unable to provide services to some patients. Database analysis suggests fewer patients have accessed SLT since the pandemic began, including a reduction in neurorehabilitation patients. For those who received SLT, the outcomes did not change. SLTs supported a range of needs of COVID-19 patients. Treatment outcomes for COVID-19 patients with dysphagia were positive.Discussion: The pandemic has affected neurorehabilitation and SLT services broadly: referral patterns are different, usual care has been disrupted and interventions have been modified affecting the impact on patient outcomes both positively and negatively. Some patients with COVID-19 require and benefit from SLT intervention.

Autistic adults' views of their communication skills and needs.

Autistic people require varying levels of support at different stages of their lives. Yet, the healthcare needs of autistic adults are largely unmet. Speech and language therapy (SLT) is one healthcare service that has an important role in supporting autistic people: both with initial diagnosis, and with the ongoing support needed to navigate different communicative challenges across the lifespan. Despite recommendations for such support, currently there is no clear SLT pathway for autistic adults, and a lack of established approaches to support autistic adults' speech, language and communication needs. To seek autistic adults' views on (1) their communication skills and support needs; (2) the type of support SLT could offer; and (3) how such support could be provided. A total of 18 autistic adults were interviewed in their preferred mode of communication (e.g., face to face, phone call, text messaging, e-mail), expressing their views on their communication skills and needs. Interview data were analysed using thematic analysis. Autistic adults presented complex views on communication, identifying the benefits of communication, while also emphasizing the significant negative impact that communication difficulties can have on their everyday lives. Identifying a range of internal (e.g., personal feelings) and external (e.g., the communication partner) factors, they highlighted the need for support at both individual levels (for specific life situations) and broader societal levels (to increase awareness and acceptance of communication difficulties). Considering the negative impact that communication difficulties can have for autistic adults, a need for support was emphasized. Despite recognition of this need within current legislation (in the UK) and positive steps toward providing support, more needs to be done. As experts in supporting individuals with communication difficulties, speech and language therapists could play a pivotal role in providing support at an individual level, as well as increasing awareness of communication differences more widely. What this paper adds What is already known on this subject There is a growing population of autistic adults with unmet support needs. A core characteristic of autism is difficulty with neurotypical social communication and interaction, which persists into adulthood and impacts across various life domains. What this paper adds to existing knowledge Autistic adults outlined the types of communication difficulties they experience, and how these can negatively impact on physical and mental health. Results highlight how these difficulties are not just rooted within the person themselves but can be influenced by external factors (e.g., the environment and the communication partner). What are the potential or actual clinical implications of this work? Some autistic adults may benefit from direct support from SLT services. However, increased awareness and respect for communication differences at a broader societal level is also needed. Speech and language therapists can play an important role in increasing this level of awareness, positively highlighting differences in communication and ways to support people with communication difficulties/differences.

Speech and language therapy for adolescents in youth justice: A series of empirical single‐case studies

Adolescents in contact with youth justice are a vulnerable and marginalized group at high risk of developmental language disorder (DLD) and other communication difficulties. Though preliminary studies have demonstrated the benefits of speech and language therapy (SLT) services in youth justice, limited research has empirically tested the efficacy of intervention in these settings. To evaluate the extent to which intensive, one-to-one language intervention improved the communication skills of incarcerated adolescents with below-average (> 1 SD below the mean) language and/or literacy skills. A series of four empirical single case studies was conducted, using multiple baseline intervention design. Individualized intervention programmes were administered, and progress on outcome measures (probes) was evaluated throughout the baseline, intervention and maintenance phases using Tau-U, a non-parametric distribution-free statistic. Additional measures were used as secondary outcomes of the intervention, including standardized language subtests, subjective rating tools by participants and their teachers collected pre- and post-intervention, and a brief structured participant interview, independently administered by youth justice staff. Medium-to-large effect sizes, the majority of which were statistically significant, were detected on the primary outcome measure across the four cases, indicating improvements in the targeted communication skills. Positive results were also evident in comparisons of pre- and post-measures on standardized language subtests, subjective self- and teacher ratings of communication, and the participants' impressions of the interventions. For those participants who could be followed up, gains in language skills were generally maintained at 1 month post-intervention. This study provides further evidence of the efficacy of one-to-one SLT intervention for adolescents in youth justice in order to address language and literacy difficulties. These findings inform future SLT service provision for adolescents in these settings, with clear policy and practice implications. Future research should investigate the wider benefits to individuals' engagement in youth justice intervention and recidivism, as well as assessing maintenance of gains over a longer period. What this paper adds What is already known on this subject The high rates of DLD in youth justice is well known, with difficulties spanning multiple areas of language and literacy. SLTs are increasingly working in community and custodial youth justice settings, and a few preliminary studies have demonstrated the effectiveness of such work. What this paper adds to existing knowledge This study extends the evidence base of the efficacy of SLT for language and literacy difficulties in youth justice, using a series of four empirical single case studies. It is also argued that SLT should be more actively considered in planning multidisciplinary interventions for young people in custody. What are the potential or actual clinical implications of this work? The results of this research support current moves to include SLT services in youth justice systems, and illustrate for clinicians currently working in this sector a way of structuring and measuring the impact of intervention services.

S4A-24 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I A LONGITUDINAL AUDIT OF EARLY LANGUAGE ASSESSMENT OF CHILDREN WITH CRANIOSYNOSTOSIS AND IMPLICATIONS FOR THE DEVELOPMENT OF MULTI-DISCIPLINARY CARE

Introduction: At Birmingham Children’s Hospital all children who present with single suture synostosis undergo speech and language assessment at 18 months, 3, 5, 7 and 10 years. Based on assessment findings and clinical judgement at these key ages, children are referred on to community speech and language therapy (SLT) services as required. An increase in referrals to the Birmingham Craniofacial Unit, and the subsequent increased demand on Speech and Language resources, highlighted the need to review the assessment care pathway, focusing on language assessment at 18 months, 3 years and 5 years of age. Methods: A retrospective, longitudinal audit of SLT notes of 87 children with single suture synostosis was carried out. Each child had undergone language assessment at 18 months, 3 years and 5 years of age. The outcomes for each child were categorised using a 3 point scale and were plotted and compared. Data on the nature of early intervention offered was also analysed. Results: The results showed that normal language assessment outcomes at 18 months are predictive of normal outcomes at 5 years in 84% of the cohort. The results also showed that 28% of children assessed at 18 months presented with language difficulties; all were given advice and/or referred onto the community SLT Service. By 5 years of age, 68% of the delayed children had improved to normal language levels. Conclusion: 15% percent of children with single suture synostosis in this audit had a language difficulties at 5 years of age. Detailed language assessment at 18 months by a trained SLT clinician has a predictive value for language outcomes at 5 years. It also allows for effective early intervention in the form of advice or referral to community SLT. Resource prioritisation and streamlining of care pathways for children with craniosynostosis were indicated and have now been implemented.

Speech and Language Therapy Services for Multilingual Children with Migration Background: A Cross-Sectional Survey in Germany

Speech, language, and communication needs are particularly common among multilingual and migrant children. More than every third child in Germany has a migrant background. In the city of Bremen, this figure is even higher, including refugee children. The availability of comprehensive data on the provision and uptake of speech and language therapy (SLT) services is still inadequate, especially for multilingual children. However, health-monitoring programs report that migrants differ in many health-related areas from the majority population, mainly in barriers in health care. This study examines the current provision of SLT services for multilingual children following a medical prescription for the specific case of suspected language disorder. Information was obtained from speech-language pathologists (SLPs) representing 28 practices in different districts across one of the moderately largest cities affected by sociospatial polarization. The SLT practices were clustered according to the proportion of minor migrants and minor welfare recipients in the district. The survey included the number and proportion of multilingual children on the SLT caseloads, as well as the age of children by time of referral, physician and SLP diagnoses, application and type of assessment materials, intervention goals, and sociodemographic data of practicing SLPs. Questionnaire responses were analyzed using descriptive statistics and an explanatory interpretive approach. Findings suggest that multilingual children experience later referral compared to monolingual German-speaking children, with approximately half of the multilingual children demonstrating a developmental language disorder (DLD). The SLP’s level of experience determines the accuracy of differential diagnosis between communication disorders and typical linguistic variations. Consequently, participation in continuing education focusing on service provision of the multilingual and multicultural clientele is essential. This study highlights the obstacles and the needs for increased multiprofessional awareness and an enhanced professional knowledge to provide effective and swift diagnosis earlier to allow multilingual children with a DLD to access relevant services on equal terms with native resident children.

‘We definitely need more SLTs’: The transgender community’s perception of the role of speech and language therapy in relation to their voice, language, and communication needs

According to Sydor (2013), it is critical to include all vulnerable, hard-to-reach groups in research in order to identify their specific needs. Transgender individuals can be considered as belonging to such groups. Speech, language, and non-verbal communication are often strongly related to gender. For transgender individuals experiencing mismatches between existing communication behaviours and their true gender, changes to these aspects of communication can help improve quality of life and mental health. Research has indicated that speech and language therapy (SLT) can successfully support the transgender (TG) community’s communication needs but, internationally, this intervention is under-utilised (Gelfer and Tice 2013; Hancock and Garabedian 2013). This qualitative study aimed to investigate the TG community’s understanding of the role of SLT in relation to their voice, language, and communication needs. It also explored how the TG community access the available care pathways and what factors are considered when making decisions relating to their participation in SLT. Two main themes, communication and SLT were identified. This study identified a continuing need to raise awareness of the breadth of the role of SLT within the TG community. As there is no defined referral pathway to SLT services, the research highlighted a need for the SLT profession to provide details of all trans-competent clinicians and to ensure that other members of the medical profession who interact with the trans community utilise this information to provide appropriate referrals.Keywords: transgender; communication needs; speech and language therapy; qualitative research; hard-to-reach; thematic analysis

A school-commissioned model of speech and language therapy

Many speech and language therapy (SLT) services have limited capacity for providing school-based input. Some offer commissioned SLT input, to enhance the service provided by the UK National Health Service (NHS), giving schools the option to increase the amount and scope of SLT intervention. This two-tiered model of service provision is relatively new and has not been researched. This study investigated the experiences of schools who had commissioned input from the local SLT service, in terms of (1) describing how this was utilized and (2) exploring perceptions of its value. Semi-structured interviews were carried out with special educational needs co-ordinators (SENCos) from 11 schools and were thematically analysed using Framework Analysis. SENCos reported many positive aspects of the commissioned model, including better communication with Speech and Language Therapists (SLTs) and improved outcomes for children. SENCos felt that the numbers of children with speech, language and communication needs (SLCN) had reduced following commissioned input. Very few disadvantages of the model were identified. SLTs delivered a range of activities, including training staff and providing direct input for children. SENCos would recommend the service, and perceived the cost to be moderate. These data suggest that SENCos place a high value on SLT in schools, and welcome the opportunity to purchase additional input.

Speech and language therapy service delivery: overcoming limited provision for children

ObjectivesTo test an alternative Speech and Language Therapy (SLT) service delivery model based on partnerships between a University and local schools and charities, and to report on the impact and feasibility of intervention based on long-term outcome measures and three case studies with individual analysis of Reliable Change. Study designThe following six-step model was tested: 1—establishing partnerships; 2—flagging children; 3—pre-treatment SLT assessment; 4—reporting and discussion with parents and teachers; 5—treatment; 6—post-treatment assessment. Case studies are presented. MethodsA partnership was established with one kindergarten in a pre-test and a total of 25 kindergartens during the second phase of the process. A group of 139 children were then flagged and assessed. The following long-term outcomes (18 months post-therapy) were investigated: phonetic-phonological standardised test percentiles and raw scores; receptive and expressive language percentiles and raw scores according to a standardised language test; percentage of syllables stuttered; duration of stuttering moments; academic achievement in norm-tests’ core areas (mathematics, Portuguese language and social studies). Case studies and a 95% credible interval analysis to assess Reliable Change are presented. ResultsSeventy five (54%) children needed SLT support. Fifty (67%) of those children returned to the clinic for long-term assessments and the analysis of all outcome measures showed significant improvements in their performance, 18 months post-therapy. Case Studies Reliable Change analysis revealed a statistically significant improvement, which also clearly shows the feasibility and the positive impact of the intervention. ConclusionsThis specialised and differentiated care network constitutes an alternative delivery system of SLT services that addresses the lack of support currently experienced by children and their families. The long-term outcome measures and the 95% credible interval analysis are reliable methods to determine the impact of interventions.

A weekly speech and language therapy service for head and neck radiotherapy patients during treatment: maximizing accessibility and efficiency.

Our hospital did not provide a weekly speech and language therapy (SLT) service for head and neck cancer patients during radiotherapy treatment. SLT is recommended in the international guidelines, but many centers do not offer this service. In the case of our hospital, SLT was not provided because there were no funds to cover the costs of additional staff. To create a new service model within a multidisciplinary setting to comply with the international SLT guidelines and without increasing staff. We aimed to measure the accessibility and efficiency of a new model of service delivery at our center both for patients and for the service. 79 patients were recruited for the study. We followed 1 group of patients (n = 29; observation group) throughout their treatment for 6 weeks to establish if there was a clinical need to offer SLT at the treatment center. A second group of patients (n = 50; intervention group) received a weekly SLT review at the treatment center throughout their radiotherapy. Data collected at the tertiary cancer center for 6 months included: age, gender, tumor site and size, treatment modality, swallowing outcomes, communication outcomes, patient satisfaction, multidisciplinary team feedback, and time efficiency. The observation group did not participate in the intervention group because the data was collected between 2 different groups of participants. However, all participants were referred to their local SLT service at the end of their treatment if that was clinically indicated, regardless of the group they had been in. The proportion of patients accessing SLT services during treatment and the time efficiency of the service were both improved with this model of delivery. The service's compliance with international guidelines was met. More patients continued with oral intake during their treatment at our center with the new service. Improvements were also reported in communication clarity and communication confidence in the same group. Offering head and neck cancer patients SLT at the same time and place as their radiotherapy treatment improves patient outcomes and increases SLT efficiencies. As this was not a treatment study, further clinical trials are required with regards to functional outcomes.

Non-attendance and utilization of a speech and language therapy service: a retrospective pilot study of school-aged referrals.

Non-attendance and inappropriate referrals affect the effective and efficient running of healthcare services. Non-engagement with speech and language therapy (SLT) services may lead to negative long-term consequences for children in need of SLT intervention. Currently there is a dearth of research on non-attendance and non-engagement with SLT services. To identify factors associated with (1) non-attendance and (2) parents' non-engagement with SLT services. Demographic data were collected from 140 case files of children (aged 5;0-17;11 years) discharged from a public community SLT service (November 2011-October 2013) with no intervention provided. Logistic regression analyses explored relationships between demographic data and (1) non-attendance and (2) non-engagement with the SLT service. There was an increased probability of non-attendance during winter (i.e. September-February inclusive; OR = 3.14; p = 0.028) relative to summer, and with each month a child waited for SLT assessment (OR = 1.19; p = 0.066). There was decreased probability of non-attendance with children referred for speech (OR = 0.08; p = 0.011) or language difficulties (OR = 0.15; p = 0.050) relative to dysfluency. The probability of non-engagement with the SLT service increased in each of the following conditions: with each month a child waited for assessment (OR = 1.27; p = 0.004); in urban (OR = 2.40; p = 0.066) relative to rural locations; during winter (OR = 2.65; p = 0.021) relative to summer; and with referrals made by occupational therapists, physiotherapists, psychologists and social workers (OR = 18.65; p = 0.016) relative to doctor referrals. Non-attendance is influenced by wait times, season and the reason for referral. Location (urban versus rural), referral source, wait times and season are factors related to non-engagement with SLT services. Targeted policies to improve efficiency and effectiveness of SLT services could be designed around these study findings.