The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children

1. The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Authors:Annette Jackson Nikki Worthington Margarita Frederico Beverly Joffe

2. Acknowledgements Funders include: Baker Foundation, private donor, Berry Street and FaHCSIA Endorsed by DHS (Victoria) Research Coordinating Committee Ethics approval from La Trobe University, Berry Street and VACCA

3. The Small Talk Project • The aim of the project is to develop and trial a screening tool to identify hearing, speech and language difficulties in vulnerable children • Screening tool for non speech pathology professionals working with child protection client group • Tool aims to be culturally appropriate and can be used with children from Indigenous and non-Indigenous backgrounds • The target age range for children being screened falls between 4 and 7.11 years

4. Trauma – Abuse & NeglectHow it effects communication Research has shown that vulnerable children can exhibit a range of communication deficits including:- • Expressive language deficits • Difficulty articulating feelings and needs • Difficulty producing coherent narratives • Difficulty understanding the abstract • Difficulty with pragmatics • Hearing problems

5. Impact of Trauma on the Brain • Impacts on structures in the brain include: • Reduce number of neurons if we don’t use them (e.g. neglect) • Impact on how the brain is developed, beginning with brainstem • Reduce size of hippocampus • Reduce oxygen to “Broca’s area” - speaking about emotions • Impact on neurochemical reactions in the brain that respond to threat and danger include: • Cortisol and adrenaline (epinephrine) (fight, flight) • Endorphins (freeze) • Patterned repetitive activity leading to changes in how limbic system (e.g. amygdala) processes and responds to threat

6. Ways in which abuse and neglect can impact on language and communication • Not experiencing sufficient language opportunities, i.e. neglect (e.g. lack of interaction, lack of play, lack of other stimulation, left on own for long periods of time, actively discouraged to talk) • Exposed to trauma, such as abuse – unspeakable trauma, flight or freeze reactions, affect dysregulation, physical dysregulation, poor attention, only negative interactions. • Physical harms, such as head injuries, underdeveloped parts of the brain, poor hygiene, emotional causes of physical harm. • Impact on how child processes information – focused on threat and threatened by ‘new’. • Impact on how child perceives relationships & therefore their willingness to communicate.

7. The Small Talk Project Vulnerable children with undiagnosed speech, language and hearing problems may be disadvantaged in terms of: • Developing social skills, friendships and confidence • Learning and literacy • Being more difficult to identify as suffering abuse • Carers finding it difficult to communicate and understand children. • Underlying meanings for some of children’s behaviours • At increased risk of suffering abuse and trauma • Therapeutic outcomes

8. The Small Talk Project Vulnerable children are not readily referred for speech and language assessment because: • Some communication problems can be difficult to identify • The child’s behaviour can ‘get in the way’ of detecting language difficulties • Family are unable to recognise or acknowledge child’s communication difficulties • Case workers are focused on ensuring the child’s safety and providing a resolution to trauma and abuse ( and are likely to overlook communication per se)

9. Development of the screening tool 2005: Initial draft screening tool (developed by Professor Anne Ozanne School of Human Communication Sciences and piloted by Take Two). 1st Pilot findings of 100 children suggested. • A high, unmet need for speech, language and hearing assessments within this particular cohort of children • A possible re-development of the tool to reflect a more specific age range. 2007-2008 A proposal was put together and the Small Talk project was successful in attracting funding 2008: Dr Beverley Joffe, La Trobe University, took on role of modifying and re-developing the tool. 2009: Employed key staff, set up reference and working groups and began formal project.

10. Methodology • 2nd pilot of 10 children using draft tool and survey of workers in 2010 • Consultation with Royal Children’s Hospital and Austin CAMHS and Dr Bruce D Perry (ChildTrauma Academy) re tool and process • Currently in process of recruiting 150 children (with or without identified speech and language problems) where: • Workers/carers complete screening tool and background information • Child is assessed by speech pathologist or speech pathology students • Results of assessment and screening tools are then compared to see if screening tool is a valid and reliable predictor of which children would benefit from a more detailed specialist assessment.

11. The Small Talk Project “The immediate impact of this project will be the provision of a pre-assessment tool made available to direct service workers and carers to identify hearing, speech and language developmental difficulties quickly” (Jackson, 2007) • The importance of speech and language in a child’s overall wellbeing must not be underestimated. • For those children who have suffered abuse and trauma it is imperative that any issues that they may have communicating with others are identified early so that appropriate intervention can be provided. • The Small Talk Project aims to provide a reliable, valid tool that can be used quickly and easily by those professionals who work with vulnerable children

12. Partners involved with Small Talk • La Trobe University – School of Social Work – led by Assoc. Prof. Margarita Frederico and overall project leader • La Trobe University – School of Human Communication Sciences – led by Dr Beverly Joffe and Nikki Worthington • Berry Street – Led by Assoc. Prof. Annette Jackson, Carly Black, Margaret Kascamanidis and Naomi Ralph. • Northern Home Based Care – Led by Craig Cowie and Deb Collard • Victorian Aboriginal Child Care Agency - Led by Dr Peter Lewis and Julie Toohey