The term speech, language and communication needs (SLCN) encompass a wide range of difficulties related to all aspects of communication in children and young people. These can include difficulties with fluency (stammering), forming sounds and words, formulating sentences, understanding what others say and using language socially (Gascoigne 2015). Children with eating and drinking difficulties can also be referred to speech and language therapists where there is a physiological problem with a child’s swallow. Much research has been devoted to looking at the at risk groups for children with SLCN. The main at risk groups are:
“We know that 50% of children in areas of social disadvantage start school with poor language, with language that isn’t adequate for the next stage of learning, for thinking, reasoning and communicating effectively with adults and peers. For example, children from low income families lag behind by nearly one year in vocabulary at school entry, with gaps in language much larger than gaps in other cognitive skills. These children are at a disadvantage from the start and without the right support don’t catch up with their peers. A recent CBI report highlighted that children who are failing to achieve adequate standards in primary education come disproportionately from disadvantaged backgrounds. These children’s needs are often transient and the right support can enable the children to make significant gains or ‘catch up’ with their peers.
There’s a significant group of children who have a rich communication experience, with lots of support from parents, though despite this will have more persistent needs. This group of children include those with a specific language impairment. 7% of all children have specific language impairment (SLI); it’s the most prevalent childhood disability, but a condition that is much misunderstood. These children also start school without the language they need in order to learn and are disadvantaged from the start. Children within this group have differing needs, dependent on the nature and severity of their difficulties. They need specialist support in order to learn and communicate to the very best of their ability.
In addition, at least 3% of all children have SLCN linked with other impairments, including those with hearing impairment, autistic spectrum disorders, specific learning difficulties, such as dyslexia and general learning needs. In fact, the majority of children with SEN have some degree of SLCN. They too need support in order to learn and to communicate to the very best of their ability. In total around 10% of children in the population will have persistent speech, language and communication needs.
So, the problem is the scale of the issue, both in quantity of children and the impact of SLCN; most children with SEN have SLCN, some children have specific language impairments and around half of the children in areas of social disadvantage can have SLCN. Language difficulties impact across all areas of development and on longer term prospects. Children need language to learn, socialise, to manage their behaviour and develop emotionally.” Taken from ‘A Generation Adrift’ published in January 2013 by The Communication Trust.
Much has been written about how commissioners need to begin the needs analysis process for children with SLCN by deciding and clearly stating the target population for which they are commissioning. Usually this will be for the full range of needs and therefore will be a broader group than those defined by the Special Educational Need (SEN) category of SLCN. ‘This would include all children and young people who have difficulties with their speech, language and communication, regardless of the reason’ (Gascoigne 2015).
We know that the majority of SLCN are identifiable from the second year of life and can persist through school and into adulthood. Some may become more apparent only as the school curriculum becomes more demanding, for example at secondary school. Data from Derby City early years Private, Voluntary and Independent sector settings (nurseries and playgroups), has highlighted high numbers of children with both transient and persistent SLCN. These figures reflect national prevalence data about the high levels of need across the country. At present, there is no centrally held record of SLCN need across health, education and social care organisations across the full spectrum of speech, language and communication needs in Derby. Some data does exist, for example the number of children receiving specialist tier intervention from the NHS Speech and Language Therapy Service, numbers of children receiving targeted language and communication support in children’s centres, and the number of children in receipt of 2 year old funded nursery places (held centrally by the Local Authority). Currently this activity-based information is not universally shared across the system between health, education and social care, and outcomes-based information i.e. the impact of support on the children, is not readily captured.
“In taking a broad view of speech, language and communication needs (including those children and young people who present with significant speech, language and communication delay, possibly linked with circumstance and experience rather than underlying long term need) it is clear that the wider workforce in universal services has to be a key part in the identification of and support of children with SLCN. Nationally it has been recommended that these services should work in conjunction with specialist advice from speech and language therapists and specialist advisory teachers. It is important for commissioners, practitioners in the wider workforce, and parents to understand the appropriately differing role for speech and language therapists at a universal, targeted and specialist level. It is also essential to understand the current capacity of the environment in which the child or young person is spending time (home, nursery or early years settings, school, youth service, Further Education college). The support required by the individual will vary and the role of the workforce will have to vary accordingly.” (Gascoigne 2015)
Speech, Language and Communication Needs in the under 5’s
Using the evidence detailed above, we can make some broad predictions about the numbers of children with SLCN in Derby. We know that according to the National Child and Maternal Health Intelligence Network (NCMHIN) in 2016 there were 17,900 children under 5 years of age living in the city and 65,000 children aged 0-19. We know that the Derby City Children and Young People’s Plan 2016 has identified that 32% of children under 18 live in the most socially deprived wards of the city. We know that at least 50% of children in socially deprived wards have SLCN. If we use this data we could predict that at least 16% (10,400) children under 18 in Derby have SLCN which have been contributed to by social deprivation. We can also estimate using the NCMHIN data, that 1% (650) children have the most severe SLCN, 7% (4550) have Specific Language Impairment (SLI) and 3% (1950) children have SLCN as part of a wider developmental condition.
A telephone survey conducted in Private, Voluntary and Independent early years settings (75 in total) across Derby in June 2016 revealed that an average 3.6% of children had a persistent SLCN, and 11.6% a transient SLCN. As would be expected, the highest number of children with transient needs was found in the most socially deprived wards of the City. Settings in Arboretum and Derwent identified the highest number of transient SLCN, at 149 (51%) and 68 (35%) respectively. This is consistent with the information that the settings from these wards provided last year. In addition, Sinfin and Mackworth also identified high numbers of children with transient SLCN, at 64 (24.5%) and 43 (23%) respectively. However within wards there continues to be a high level of variability which is likely to be due to accuracy of assessment data. Overall there continues to be a pattern of under-identification of children with transients SLCN across the City. Settings in Darley and Chaddesden identified the lowest number of transient SLCN, at 12 (3%) and less than five children respectively. Settings have had training in terms of raising staff ability to assess children and identify whether a child presents with immature speech and language development or whether their more persistent, or less typical needs would warrant a referral to NHS speech and language therapy services commissioned by the local authority.
More than 5% of children have persistent SLCN identified by settings in Sinfin, Boulton, Derwent, Spondon, and Arboretum. Settings in these wards are the strongest for identification of persistent SLCN (an average 6.8%). Fewer than 2% of children have been identified with persistent SLCN in settings in Alvaston, Chaddesden, Darley and Mackworth wards. No information is currently available about the number of children identified by other universal services such as health visitors or family visitors, though this is being pursued by the lead commissioners of those services. A Freedom of Information (FOI) request to the NHS Speech and Language Therapy service in 2015 found that 175 children under 5 years of age were receiving ongoing support with persistent and complex speech, language and communication needs.
Children identified with SLCN in primary schools in Derby
A number of Derby primary schools use an assessment and intervention tool called Language Link. This tool assesses children’s understanding of language in Reception Year (Foundation Stage 2). This intervention was introduced into schools by the Local Authority and the NHS Speech and Language Therapy Service approximately ten years ago. If a school has concerns about a child’s language development, they can assess them using Language Link. The tool shows whether the child is delayed, on track or needs referral to the SLT service. Children with delayed language receive targeted intervention from a Teaching Assistant (TA) in the school setting. City-wide data has been collected from Derby schools by Language Link since 2007. Below is a chart which shows Derby City results compared with England. Data from the last five years reflects a general trend of a higher than average number of children with language difficulties in Derby:
We can see that the data submitted by schools in the last academic year (2015/16) shows that Derby children appear to be performing better than their peers nationally. However this data should be interpreted with caution because: