Speech and language service integration in order to improve outcomes through early intervention

There is significant pressure on the Early Years sector across Doncaster following the COVID-19 pandemic, to support the delay in young children’s speech, language and communication. 

Settings have reported that since the pandemic they have observed that increasing numbers of children are developing differently socially. They are showing less confidence with interacting and taking turns. They are also finding it more difficult to form relationships with other adults and children due to them having fewer opportunities to develop their social and emotional skills.

A triangulated approach was taken to combat this, as we wanted to focus on the child, the parents and professionals. Initially, a two-step training package was created for professionals working with children aged nought to five. The first step is an introduction to the importance of language and communication on all aspects of development and emphasized the importance of communities communicating in a bid to embed a full culture change across Doncaster. The second step is specifically aimed at early years professionals who will be working directly with nought to fives s on their language and communication skills and involves discussion around the development of four keys areas of communication and how these can be promoted through targeted activities. This training is delivered in house by the speech and language therapist to keep running costs low, allowing the training to be offered to professionals for free.

Following the roll out of the training, it felt important to include support for parents and the home learning environment. Using the NHS Speech and Language Therapy pathway as a starting point, a targeted intervention pathway was created to provide child-centred language and communication intervention either within the child’s home, or small groups in the local family hubs. This intervention is carried out by Talking Together practitioners who have early years experience and is overseen by the speech and language therapist who holds clinical responsibility for all of the children under the pathway. Interventions are provided for children aged two to four years and focuses on early communication strategies. A group based intervention has been created for children who need to work on their attention and listening skills to enable them to access language interventions further down the line.

Universal support to continue embedding a communities communicating culture across Doncaster includes:

• a Facebook page and a website where information, tips and advice are shared
• a presence within family hubs to answer questions
• a speech, language and communication advice session held within the family hubs that parents can access without a prior referral. 

Between October 2022 and December 2023, 461 referrals were made in to the Talking Together service. Of these, 217 children were offered intervention and currently, 141 children have completed their Talking Together intervention. Children not offered intervention had either moved out of the area, parents had opted out of support or were signposted on to either universal or targeted services.

At the end of the intervention each child's vocabulary bank had grown by an average of 48 more words than their starting point before intervention with some children confidently using up to 112 new words. After the three month review this figure continued to rise with each child speaking an average of 67 more words than their starting point before intervention with some children confidently using up to 133 new words.

When asked for feedback parents shared:

Between November 2023, to the end of December 2023, 11 speech, language and communication advice sessions were carried out across four localities. Uptake of these sessions has been overwhelmingly positive with 89.39 per cent of offered spaces being booked (59 out of 66) and an attendance rate of 86.44 per cent (51 of 59). The age range of children seen at these sessions was between one year four months and four years four months. All families were given advice specific to how their child presented on the day and from the information provided.

Benefits of the advice sessions include:

• Allowing families to access advice sooner without sitting on a waiting list
• Referring children to services before they have had their 27 month development check meaning they are receiving support earlier
• Allowing families to access advice when other services may not be concerned so a referral may not have been made, including those parents who fall under the “worried well” category
• Children being referred on to the most appropriate pathway for their needs for example a child who had previously been referred to speech and language therapy but was better suited to targeted intervention and a child who had been accepted on to the outpatients speech and language therapy service but required support from the stammering specialist therapist.

All decisions made during the development of the pathway was with sustainability in mind. The biggest investment in this pathway has been the staffing. The strength of this model lies within the knowledge of the early years practitioners and the oversight of the speech and language therapist. The speech and language therapist post is currently funded by the LA and hosted by the clinical speech and language therapy team. We are continually working towards future planning and exploring options for continued funding opportunities beyond the current funding period. However, should this not continue there are possibilities for the approach to continue in a revised way.

A decision was made to hire consultants to develop an in-house training package that we had full ownership over so that we could retain the content indefinitely with no ongoing license requirements. As the training has been created specifically for Doncaster, and is delivered in house, the ongoing costs of this are minimal. Doncaster has always had a strong family hub presence and the Talking Together team are now embedded within the core family hub structure. 

• Start small and grow the offer over time. Don’t expect to see impact overnight. At the start of this journey we had the dedicated time of a speech and language therapist to help plan and design the referral pathway for two days per week for an 18 month period. Over time this role developed and became a full time position under the NHS but based within the Local Authority team. 
• Strong partnerships are key. For it to be successful you need buy in from all key services involved. A core group of professionals across health, early years, speech therapy and SEND came together often to ensure any decisions made worked across the whole system of support for families. 
• Maintain flexibility. Initially two licensed interventions (Growing Talk and Home Talk) were paid for however it quickly became clear that the current cohort of children did not fit in to the parameters within the licensing. The team have been very responsive to the changing needs of the children and have developed their pathways to ensure that intervention that is being provided takes into account the unique circumstances of each family and can help prepare the child to be in a position to access the licensed interventions in the future.
• Whenever something new is introduced, it can be difficult to ensure that the messages being given and received are clear, concise and respectful. In developing Talking Together, we wanted to ensure that the pathway was filling an established gap in services and was not treading on the toes of others’ work. Establishing clear goals and boundaries was important to ensure professional relationships could be quickly built and maintained.
• Secure an external critical friend to provide independent steer, guidance, and evaluation to ensure continuous growth and improvement. Our links with Sheffield Hallam University were instrumental in the success of the development of this pathway. 

Service Manager: 

[email protected]

Talking Together Speech and Language Therapist: [email protected]

Talking Together website

Talking Together Facebook page

2020 case study which laid the groundwork for Talking Together

Doncaster – Speech and Language Service Integration - National Centre for Family Hubs

Impact of intervention on Home Learning Environment – Child B’s story