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Headline
A descriptive framework of speech and language therapy practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures for preschool children with primary speech and language impairments.
Abstract
Background:
The Child Talk study aimed to develop an evidence-based framework to support the decision-making of speech and language therapists (SLTs) as they design and plan interventions appropriate to the needs of individual children with primary speech and language impairments and their families. The need for early identification and effective intervention for these children continues to be a government policy priority because of the link between children’s early speech and language skills and their broader well-being and outcomes in later life. The first phase of Child Talk sought to map and describe current SLT practice for these children; identify and summarise the existing research evidence relating to practice; and investigate the perspectives of parents, early years practitioners, preschool children and ‘underserved’ communities on speech and language therapy. The second phase of Child Talk focused on the development of a toolkit – assessment tools, outcome measures and a data set – to support future service and economic evaluations of the framework.
Methods:
Child Talk adopted a mixed-methods design. Quantitative methods included surveys and investigated the prevalence and patterns of intervention usage; qualitative data collection methods included focus groups, interviews and reflection to investigate participants’ perspectives and understandings of interventions. Data analysis methods included descriptive and inferential statistics, thematic and content analysis and framework analysis. Participants were recruited nationally through six NHS sites, professional bodies, parent groups and advertising. Participants included SLTs (n = 677), parents (n = 84), preschool children (n = 24), early years practitioners (n = 31) and ‘underserved’ communities (n = 52).
Key findings:
Speech and language therapy interventions were characterised in terms of nine themes, viewed as comprehensive and inclusive by practitioners. Relevant assessments, interventions and outcome domains were identified for the nine themes. Areas of tacit knowledge and underspecified processes contributed to variability in the detail of the framework. Systematic reviews identified 58 relevant and robust studies (from 55,271 papers retrieved from the initial literature search). The number of studies relevant to each theme varied from 1 to 33. Observational data on preschool children’s perspectives on speech and language therapy interventions revealed the dynamic nature of their interaction with different activities and people within therapy sessions. Parents’ experiences of speech and language therapy were generally positive although some reported that the rationale for therapy was not always clear. Parental perspectives in underserved communities suggested that, although parents were confident about how to support children’s language development, they were less informed about the nature of language impairments and the function of speech and language therapy. The availability of information regarding resources directed towards speech and language therapy services was poor. In particular, services lacked both a culture of collecting outcome data routinely and measures of professional input and costs associated with their activities.
Conclusion:
A descriptive framework of SLT practice has been developed to support the discussions between therapists and families when making decisions regarding the selection of interventions and outcome measures. Further research is needed to address gaps in the intervention framework and evaluate its effectiveness and cost-effectiveness in improving outcomes for preschool children with primary speech and language impairments.
Study registration:
This study is registered as PROSPERO CRD42013006369.
Funding:
The National Institute for Health Research Programme Grants for Applied Research programme.
Contents
- Plain English summary
- Scientific summary
- Chapter 1. Introduction and programme overview
- Child Talk phase 1
- Aim
- Objectives
- Chapter 2. The development of a typology of speech and language therapy practice
- Chapter 3. Identifying the evidence base for speech and language therapy practice
- Chapter 4. User perspectives on speech and language therapy
- Introduction
- Objectives
- Study 4.1: the perspectives of preschool children on speech and language therapist-led interventions
- Study 4.2: the perspectives of parents on speech and language therapy
- Study 4.3: the perspectives of communities who are underserved by speech and language therapy services
- Study 4.4: the perspectives of early years practitioners on speech and language therapy
- The typology and perspectives of parents and early years practitioners
- Discussion
- Child Talk phase 2
- Aim
- Objectives
- Chapter 5. Identifying a toolkit for assessment and outcome measurement
- Chapter 6. Economic evaluation of speech and language therapist-led intervention
- Chapter 7. Development of a website to host the intervention framework
- Chapter 8. Discussion and conclusions
- Chapter 9. Implications and research recommendations
- Acknowledgements
- References
- Appendix 1 Glossary of speech and language therapist-led activities
- Appendix 2 Glossary of speech and language therapist-led interventions
- Appendix 3 Glossary of speech and language therapist-led programmes
- Appendix 4 Glossary of speech and language therapist-led strategies
- Appendix 5 Glossary of study design
- Appendix 6 Glossary of general processes and terms
- Appendix 7 Child Talk parent panel
- Appendix 8 Example topic guide for the speech and language therapist focus groups
- Appendix 9 Topic guide for parent focus groups
- Appendix 10 Topic guide for early years practitioner focus groups
- Appendix 11 Topic guide for underserved focus groups
- Appendix 12 Example of ‘essential’, ‘advisory’ and ‘do not use’ activity at the Specific Interest Group events
- Appendix 13 Example of the assessment activity for typology themes at the Specific Interest Group events
- Appendix 14 Screenshot of the speech and language therapist assessment tool survey
- Appendix 15 Questions in the speech and language therapist intervention survey 1
- Appendix 16 Questions in the speech and language therapist intervention survey 2
- Appendix 17 Screenshot of the parent survey
- Appendix 18 Example search strategy for the systematic literature review
- Appendix 19 Subject headings used in the systematic literature review
- Appendix 20 The properties of papers in the systematic literature review
- Appendix 21 Assessment and outcome measures used in the systematic literature review
- Appendix 22 Characteristics of the children in the children’s groups
- Appendix 23 Structure of a typical children’s group session
- Appendix 24 Detailed content of activities in the children’s groups
- Appendix 25 First draft of the typology with illustrative quotes
- Appendix 26 Detailed background information on speech and language therapists participating in intervention survey 2
- Appendix 27 Detailed information regarding child and family factors reported by speech and language therapists in survey 2
- Appendix 28 Additional responses from speech and language therapists in intervention surveys 1 and 2
- Appendix 29 Full statistical analysis of data from intervention survey 2
- Appendix 30 Responses to the parent survey
- Appendix 31 Fictitious case study for the asylum seekers group
- Appendix 32 The Child Talk programme PhD project reports
- Appendix 33 Rationale behind speech and language therapists’ decisions to use assessment tools
- Appendix 34 List of outcome indicators underlying the outcome domains within each typology theme
- Appendix 35 Delphi consensus data for outcome domains with more than three outcome indicators
- Appendix 36 Free-text responses to the Delphi survey
- Appendix 37 The Child Talk programme research protocols: phase 1 and phase 2
- Appendix 38 Publications and engagement and dissemination activities
- Glossary
- List of abbreviations
Article history
The research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0109-10073. The contractual start date was in January 2011. The final report began editorial review in April 2014 and was accepted for publication in October 2014. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.
Declared competing interests of authors
Dr Yvonne Wren is the director of an independent speech and language therapy provider called ChildSpeech.
- NLM CatalogRelated NLM Catalog Entries
- Evidence-based intervention for preschool children with primary speech and langu...Evidence-based intervention for preschool children with primary speech and language impairments: Child Talk – an exploratory mixed-methods study
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