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Supporting children with specific language impairment (SLI): What works?

This week we spoke to Ami Mathur, a speech and language therapist (SLT) and regional Makaton tutor whose service has received I CAN Accreditation at the specialist level for over 10 years. Here she tells us more about collaborating with the education service to provide the best support for children with speech, language and communication needs (SLCN).

Tell us a little about where you work.

I work as a highly specialist speech and language therapist at the I CAN accredited Speech and Language Nursery Provision at South Acton Children’s Centre (SACC) in Acton, situated in the culturally and linguistically vibrant London Borough of Ealing. We work in collaboration with the education service to enable up to 10 children with severe speech and/or language needs to have access to specialist, intensive teaching and therapy for the duration of their time at nursery.

What services do you offer for children and families?

Our service operates within a mainstream nursery, and is staffed by a highly specialist speech and language therapist, specialist teacher/education practitioner and nursery nurse. We support the communication and learning needs of children with significant SLCN via small group, paired or 1:1 intervention, and during free play for up to five mornings a week. We also support parents to become partners in the therapeutic process via coffee mornings, parent training sessions, individual education planning meetings and weekly home learning activities. For those children requiring ongoing support when they transition to Reception we have the option of requesting an education, health and care needs assessment for them.

What kind of needs are the children who attend likely to have?

The vast majority of our children present with severely delayed and/or disordered language needs. We also have children who present with severe speech sound delay and/or disorders such as dyspraxia and some who present with a mixture of both.

What would determine whether a child was eligible to gain a place at your I CAN accredited service?

In order to qualify for a place at one of Ealing’s three I CAN accredited provisions, the child’s speech and/or language difficulty must be the primary difficulty i.e. significant delay or disorder. There may be an element of hearing impairment, linked emotional, behavioural, learning or social interaction difficulties but none of these should be the primary difficulty. In addition, English may be (and often is) an additional language, and children will need to present with difficulties in their main language. Children don’t need an Education, Health and Care plan to access the service, but we often make requests for an assessment during their time with us so that they can be appropriately supported once they start Reception.

How does your service differ from a community clinic?

The most significant difference is that we have capacity to provide an intensive and integrated model of education and therapy to these children with significant needs. We build strong relationships with parents so that they become partners in meeting their child’s speech, language and educational needs. As speech and language therapy is integrated into the child’s time at nursery, attendance is also significantly improved as there is no longer the issue of having to take time out to attend clinic appointments. For some, offering therapy in their child’s educational environment reduces stress and anxiety for the child but also for the parent in terms of them feeling their child is different or that there is a problem.

What are the positive and negative aspects of working in collaboration with education providers?

There is no doubt that the pros of joint working far outweigh the cons. Working together with education providers is, in my opinion, vital to improving the lives of these vulnerable children. It is common knowledge that much of the curriculum relies on children having good speech and language skills. With this in mind, it makes complete sense to pool knowledge and skills with those professionals who share a common goal: to maximise every child’s opportunity to succeed in life. Improved information sharing amongst teams ensures that the care that children and families receive is efficient and co-ordinated.  This has been proven year on year by the overwhelmingly positive feedback we receive via satisfaction surveys from parents and carers.

Staff in the mainstream nursery setting also benefit from access to onsite specialists who model how to support the communication needs of all children accessing the nursery, and can also offer bespoke training to the staff team.

The cons to joint working are largely administrative. Differing IT systems and different ways of recording outcomes has meant that, at times, information has to be recorded in a number of ways to meet the requirements of each professional body.  In addition, differing policies and procedures have meant that slightly different protocols have to be adhered to.  On occasion, we may have a professional disagreement but open and honest communication usually helps us reach a compromise.

What do you see as the threats and opportunities facing your service as you move forward?

In the current economic climate, where budget cuts seem to be the norm, highly specialist and intensive provisions such as this do come under constant scrutiny. Although the long term economic saving is well documented, it is becoming increasingly difficult to justify such intensive therapy at such a high adult to child ratio, for such a small cohort of children, when waiting lists for other communication needs are incredibly long.

Finding the time to assess and make appropriate referrals to the I CAN speech and language nurseries is under threat as we are all constantly asked to do more in less time. However, there is enough commitment within Ealing’s speech and language therapy department and Ealing local authority to retain a universal, targeted and specialist level service model. We constantly evaluate our service to ensure we are offering the best possible support to our children and families and to ensure specialist services such as ours can survive.

You can find out more about I CAN Accreditation here.