Title: Evidence based intervention for pre-school children with primary speech and language impairment
Funder: Department of Health (England)

Abstract: The aim of this programme is to improve speech & language therapy (SLT) services for preschool children with primary speech & language impairments (PSLI). We aim to develop an evidence based approach to intervention that integrates research evidence with practitioner consensus and perspectives of families in a model that improves the targeting and stratification of interventions to meet the needs of the individual child and the characteristics of the family. Children with PSLI have difficulties developing their speech and language in the absence of other sensory, developmental, neurological conditions. There is a prevalence of approximately 6%, with evidence of long term difficulties with literacy and social relationships. Recent government initiatives emphasise the role of communication in a child’s health and well-being promoting early identification and intervention to reduce the long term impact on a child’s social, education and employment prospects. Children with PSLI are typically referred to SLT who are the lead profession providing support. Whilst there is evidence for the positive impact of intervention, current packages do not differentiate components that are critical to success with children with particular needs or to families in particular contexts. The programme builds on the team’s previous and current work that has evaluated intervention for PSLI and investigated children’s and families’ views. After a preliminary start-up phase, Phase II will establish a typology of SLT-led interventions for preschool children with PSLI using a national survey and case studies of SL T services in order to investigate the characteristics and components of these interventions; parents’ and children’s views of the impact of these services will also be explored. We will identify the level of research evidence available to support the effectiveness of any component identified. Phase III will investigate the feasibility, acceptability and generalisability of the typology through a series of consensus exercises using Delphi and other participatory exercises with families and with practitioners. We will also identify and/or develop methods of measuring the critical components in order to determine a child’s needs and the family context. This phase will develop a system of outcome measurement that is linked to the intervention typology. During phase IV, we expect to test the outcomes framework and measurement toolkit and establish a national data collection process. During this phase the team may also carry out studies to evaluate particular components of the intervention typology where necessary. We also plan to clarify how evaluation of SLT-led interventions for preschool children with PSLI can best be conducted, using this information to submit further evaluation proposals. The team’s expertise include clinical and methodological strengths together with a successful track record, both together and independently of grant completion. The programme is based in the Speech & Language Therapy Research Unit, which has a 20 year record of applied research and will draw on the research skills offered by North Bristol NHS Trust, and the three university partners. The programme has the potential to impact upon approximately 100,000 children under 4 years old who are referred each year to SLT. The explicit description of interventions and their evidence base alongside the measurement toolkit will enable rational stratification of services to meet the needs of children and their families. Within 3-5 years of the end of the programme, evaluations of these services will lead to progressive evidence based structuring of SLT services that is still sensitive to family contexts. The agenda for the programme has been influenced by previous consultations with families. Third sector organisations have been involved in the planning of the programme and will continue to provide support and direction through the steering group. We have also set aside funding for a participation worker to support the process of engagement particularly with vulnerable families. The main focus of this research is on a vulnerable group: preschool children with PSLI. Researchers will be checked for their criminal records and trained in procedures relating to the safeguarding of children. Further we will use procedures for obtaining consent and data collection which take account of difficulties in communication experienced by both children and their parents. Funding is proposed for: new posts to add capacity to the team (part-time project manager, fulltime postdoctoral researcher, 2 doctoral students, participation worker, statistician, technical support and systematic reviewer); team members so that they can play a significant part in leading the research, using their expertise to control relevant phases; for assessment and data collection equipment, for travel for field work, for engagement with stakeholders and for dissemination purposes.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH