Elspeth McCartney

Barriers to collaboration: an analysis of systemic barriers to collaboration between teachers and speech and language therapists.

A systems approach is used to examine the barriers to collaboration found in the working practices of speech and language therapists and teachers. Functional, structural and systems-environment barriers are found, but few process barriers, which may explain why good collaborative practice can be found in the field. The differences that serve as barriers are listed and discussed, with a view to fostering mutual understanding between teachers and speech and language therapists.

Cost analysis of direct versus indirect and individual versus group modes of manual‐based speech‐and‐language therapy for primary school‐age children with primary language impairment

BACKGROUND The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. AIMS To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a test of expressive and receptive language. METHODS & PROCEDURES The study design was a cost analysis integrated within a randomized controlled trial using a 2x2 factorial design (direct/indirect versus individual/group therapy) together with a control group that received usual levels of community-based speech-and-language therapy. Research interventions were delivered in school settings in Scotland, UK. Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF-III(UK)) of less than -1.25 standard deviation (SD) (receptive and/or expressive) and non-verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate/severe articulation/phonology/dysfluency problems or otherwise requiring individual work with a speech-and-language therapist. The intervention involved speech-and-language therapists and speech-and-language therapy assistants working with individual children or small groups of children. A therapy manual was constructed to assist the choice of procedures and activities for intervention. The cost analysis focused on the salary and travel costs associated with each mode of intervention. The cumulative distribution of total costs arising from the time of randomization to post-intervention assessment was estimated. Arithmetic mean costs were compared and reported with their 95% confidence intervals. OUTCOMES & RESULTS The results of the intention-to-treat analysis revealed that there were no significant post-intervention differences between direct and indirect modes of therapy, or between individual and group modes on any of the primary language outcome measures. The cost analysis identified indirect therapy, particularly indirect group therapy, as the least costly of the intervention modes with direct individual therapy as the most costly option. The programme cost of providing therapy in practice over 30 weeks for children could represent between 30% and 75% of the total gross revenue spend in primary school per pupil, depending on the choice of assistant led group therapy or therapist-led individual therapy. CONCLUSIONS & IMPLICATIONS This study suggests that speech-and-language therapy assistants can act as effective surrogates for speech-and-language therapists in delivering cost-effective services to children with primary language impairment. The resource gains from adopting a group-based approach may ensure that effective therapy is provided to more children in a more efficient way.

Becoming a manual occupation? The construction of a therapy manual for use with language impaired children in mainstream primary schools

BACKGROUND The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. AIMS The aim was to outline the decision-making processes that led to the construction of the research therapy manual, and to give a preliminary report on compliance with the manual. METHODS & PROCEDURES A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. OUTCOMES & RESULTS Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. CONCLUSIONS The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility.

Intervention for mixed receptive–expressive language impairment: a review

Studies indicate that language impairment that cannot be accounted for by factors such as below‐average non‐verbal ability, hearing impairment, behaviour or emotional problems, or neurological impairments affects some 6% of school‐age children. Language impairment with a receptive language component is more resistant to intervention than specific expressive or phonological delays, and carries a greater risk of comorbid behavioural difficulties as well as adverse outcomes for language development and academic progress. This paper considers underlying explanations that may account for receptive–expressive language impairment. It also reviews evidence for the effectiveness of intervention from theory and recent systematic reviews, trials, and speech and language therapy practice.

Social Capital Theory: A Cross-Cutting Analytic for Teacher/Therapist Work in Integrating Children's Services?.

Reviewing relevant policy, this article argues that the current ‘integration interlude’ is concerned with reformation of work relations to create new forms of ‘social capital’. The conceptual framework of social capital has been used by government policy-makers and academic researchers to examine different types, configurations and qualities of relationships, including professional relations, and how these may function as resources. Focusing on the co-work of teachers and speech and language therapists, this analysis introduces social capital as a means of understanding the impact of integrating children’s services on professional practitioner groups and across agencies. Social capital theory is compared to alternative theoretical perspectives such as systems and discourse theories and explored as an analytic offering a multi-level typology and conceptual framework for understanding the effects of policy and governance on interprofessional working and relationships. A previous application of social capital theory in a literature review is introduced and analysed, and instances of the additionality provided by a social capital analysis is offered. The article concludes that amongst the effects of current policy to redesign children’s services are the reconstruction of professionals’ knowledge/s and practices, so it is essential that such policy processes that have complex and far-reaching effects are transparent and coherent. It is also important that new social capital relations in children’s services are produced by groups representative of all involved, importantly including those practitioner groups charged in policy to work differently together in future integrated services.

How shall we be judged? Speech and language therapists in educational settings

Speech and language therapists are under ever-increasing pressure to demonstrate the value of their work, both in terms of cost to the pur chaser and benefit to the client. The work of these therapists in school settings differs significantly from their work in health-care settings, not least because of strong philosophical and organizational differences between health and education. This paper argues that the methods developed within the field of educational research are amongst the most productive in the investigation of effectiveness. It provides details of a multidimensional model which could be applied in educational settings.

Include us out? Speech and language therapists’ prioritization in mainstream schools

Speech and language therapy services face tensions when prioritizing in an increasingly inclusive educational system. The selection parameters available for prioritizing children are discussed, and they appear to have limits in a mainstream school context. However, prioritization must continue for resource reasons, and ways forward are discussed.

Development of a minimum protocol for assessment in the paediatric voice clinic. Part 2: Subjective measurement of symptoms of voice disorder

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. These include perceptual evaluation of voice, videostroboscopic imaging of vocal fold movement, acoustic analysis of specific voicing aspects, aerodynamic support for voicing, and a subjective rating of voice impact. No specific guidelines are available for children, but a similar range of parameters is needed to guide intervention and measure outcomes. The development of subjective voice measures for adults and their adaptations for the paediatric population are reviewed and compared to the research comparing these to evaluation of vocal function. The need for further refinement of child assessment measures, and a proposal of how these might be developed, is discussed.

Development of a minimum protocol for assessment in the paediatric voice clinic. Part 1: Evaluating vocal function

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. The current paper presents a discussion of four of the five parameters highlighted in the ELS protocol: perceptual evaluation of voice, videostroboscopic examination, evaluation of aerodynamic performance in voice, and acoustic analysis. Subjective rating of voice in children is explored in a companion paper. These parameters have been extensively evaluated in adults, and a review of the literature pertaining to the paediatric population is presented.

The Development of a Systems Analysis Approach to Small‐scale Educational Evaluation

Abstract The adaptation and application of a systems analysis model devised for educational evaluation is discussed in the context of educational evaluation of a small specialist centre and the benefits of the adaptation explained. The ways in which the adapted model was used to gain a realistic picture of the centre are outlined and the potential usefulness of the framework discussed.