Mapping Educational Provision for Speech, Language, and Communication Support in Wales: A Study

1. Study to map the current educational provision of speech, language and communication support in Wales, for learners aged 0-25 Dr Duncan Holtom &Rhodri Bowen (People and Work) Commissioned by the Welsh Government

2. Structure of the presentation • Introductionto the study • Speech, language and communication needs • The current model for meeting SLCN • Evaluation of the model • Conclusions, challenges and options

3. Introduction Slides 4-5: the study aims and objectives Slide 6: the evidence base for the study

4. Project aim To “....bring together the various policy initiatives / developments across education, health, and social services to clarify and harmonise the approaches available for educational provision of speech, language and communication support, for the age range from 0 - 25, and identify effective interventions with options for implementation.”

5. Project objectives • To identify how speech, language and communication needs and desired outcomes are identified, assessed and addressed in education settings by local authorities (education and social services), NHS, and third sector or independent providers. This includes provision of generalised universal provision and support within schools and classrooms, as well as targeted support and intervention, in mainstream and special schools and units (including PRUs). • To identify and map existing policies and provision in place to address speech, language and communication support needs in all education settings including the identification of what services are currently offered from education, social services and the NHS, their relationship with evidence of effectiveness,  any resulting impact on outcomes and any perceived gaps or deficiencies in services. • To identify good practice arrangements and evaluations of effectiveness across the UK including individual or group approaches, and online resources that can contribute towards the development of ‘whole setting’ approaches to speech, language and communication support provision and generalised universal provision. • To identify and evaluate a range of options for evidence based effective and efficient arrangements in Wales to meet the needs of learners who require speech, language and communication support in education settings and provision for all learners, the likely impact on outcomes described in valid measures, and to make recommendations.

6. Evidence base • Fieldwork: Area based studies of practice in Wales: Cardiff, Carmarthenshire, Gwynedd, Merthyr Tydfil, Powys and Rhondda Cynon Taf. Studies included interviews with 73 stakeholders from local and central government, the voluntary sector, health, education and Flying Start services. • Desk based reviews of: • evidence and research in the UK and • policy and practice in Wales • Stakeholder workshop to discuss the findings (May 2016)

7. Speech language and communication needs • Slide 8: Why does communication matter? • Slide 9: What are SLCN? • Slides 10-13: SLCN and special educational needs (SEN) • Slide 14: How do SLCN relate to other needs • Slides 15-16: How many children and young people have SLCN? • Slide 17: What does this mean for a strategic approach to SLCN?

8. “Communication is crucial” for: • Being able to understand what’s happening and take part in lessons; • learning to read and write; • being able to think things through, and manage your feelings; and • being able to interact socially • SLCN change over time, and negative impacts (e.g. upon learning) can increase if needs are not met early. See e.g. Bercow , 2008 (http://dera.ioe.ac.uk/8405/) and The Communication Trust (n.d). https://www.thecommunicationtrust.org.uk/media/174/dontgetmewrong.pdf Oracy Reading Writing

9. Speech, language and communication needs (SLCN) / difficulties “Pupils with speech, language and communication needs cover the whole ability range. They have difficulty in understanding and/or making others understand information conveyed through spoken language.”* “Speech and language difficulties may show themselves in the following ways: • problems with the production of speech; • difficulty in finding words and joining them together in meaningful and expressive language; • problems in communicating through speech and other forms of language; • difficulties or delays in understanding or responding to the verbal cues of others; • difficulties with the acquisition and expression of thoughts and ideas; • difficulty in understanding and using appropriate social language; and • frustrations and anxieties arising from a failure to communicate, possibly leading to apparent behavioural difficulties and deteriorating social and peer relationships.”* * pp. 9-10, WG 2013, http://learning.gov.wales/docs/learningwales/publications/131128-guidance-for-ims-en.pdf

10. SLCN and special educational needs (SEN) • Where the child/young person’s degree of difficulty in, for example, finding words and joining them together warrants the provision of special educational provision, SLCN are classified as a special educational need (SEN). • Around 3% of children have SLCN recorded as their major SEN. • But, as we outline, many more children and young people have SLCN that are not severe enough to be considered a SEN. We use this broader definition of SLCN.

11. The proportion of pupils recorded as having SLCN as their “major” SEN is increasing Graph 1: Percentage of pupils with speech, language and communication difficulties as their major need (Source: PLASC) 25% increase over the last five years

12. But there are lots of regional variations... Graph 2: Percentage of pupils with speech, language and communication difficulties as their major need in case study Local Authority areas (Source: PLASC)

13. ....and lots of questions the SEN data can’t answer . E.g. • Is the data suggesting an increase in SLCN the result of increases in the numbers of children and young people with SLCN and/or the result of increased awareness and better identification of SLCN? • How much variation is there in how schools identify and record pupils’ SLCN for the Pupil Level Annual School Census (PLASC)? And does this explain differences in rates in different local authorities? • How many children have SLCN? (data on those with SLCN recorded as their SEN only covers a fraction of those with SLCN).

14. Which groups of children and young people are likely to have SLCN? SLCN cuts across labels and diagnoses, so many children and young people who have other SEN labels or diagnoses also have SLCN ASD= Autistic Spectrum Disorder SLI = Specific Language Impairment ADHD = Attention Deficit Hyperactivity Disorder Adapted from The Communication Trust (n.d.) https://www.thecommunicationtrust.org.uk/media/174/dontgetmewrong.pdf This diversity creates some complexity (e.g. children/young people with SLCN have widely differing needs) and contributes to confusion about definitions of SLCN.

15. How many children and young people in Wales are likely to have SLCN? • There are no definitive figures. Studies in the UK (England and Scotland), Australia and the USA indicate that: • Around 7% of children have SLCN as their main or primary difficulty (also referred to as specific language impairment (SLI))* • It is estimated that around a further 3% of children have SLCN as a result of another condition such as autism, hearing impairment or learning difficulties.** • In addition, some children have SLCN which are transient, provided the right support is put in place. These children, whose language skills develop more slowly than others, are often described as having a ‘language delay’.* • There is a strong social gradient, and in some disadvantaged areas, 50% of children may have SLCN. • Because many SLCN are transient the number of children with SLCN declines between Key Stages 1 and 2*** and young people with SLCN typically have persistent needs (e.g. a SLI or as result of another condition, like autism). * Law, et al, 2013, http://www.ncl.ac.uk/cflat/news/documents/Lawetal2013EarlyLanguageDelaysintheUK.pdf ** ICan, n.d. http://www.ican.org.uk/~/media/Ican2/What%20We%20Do/Primary/ACTT/ICAN_Commissioning%20Guidance.ashx *** Lindsey et al ,2010 https://www.gov.uk/government/publications/the-better-communication-research-programme-improving-provision-for-children-and-young-people-with-speech-language-and-communication-needs

16. In some disadvantaged areas, schools and early years services involved in this study reported that 50% of children entering a primary school may have SLCN • Some studies have identified that as many 50% of children in very disadvantaged areas may have SLCN, but other studies suggest lower rates. * • Needs are the product of both genetic and environmental factors. SLCN which are primarily the result of environmental factors should be transient, provided the right support is put in place. * *Adapted from ICan, n.d. http://www.ican.org.uk/~/media/Ican2/What%20We%20Do/Primary/ACTT/ICAN_Commissioning%20Guidance.ashx And Law, et al, 2013, http://www.ncl.ac.uk/cflat/news/documents/Lawetal2013EarlyLanguageDelaysintheUK.pdf.

17. Implications for a strategic approach to SLCN • SLCN are very important; • there needs to be greater clarity about what we mean by SLCN and how they relate to other needs; • given the diversity of needs, it is important to look beyond the ‘label’ (i.e. SLCN) to a child/young person’s individual needs; • there is a need to make better use of existing data, such as PLASC and develop data sources (e.g. for the early years, using e.g. SOGS* and the Foundation Phase Profile); and • better understand the data (e.g. trends). * The Schedule of Growing Skills

18. The current approach to meeting SLCN • Slides 19-20: What is the current model? • Slides 21-22: How did it develop in Wales? • Slides 23-26: What does it need to work? • Slide 27: How does it relate to education, health and ‘social’ policies? • Slide 28: What does this mean for a strategic approach to SLCN?

19. The approach: The continuum of model for meeting SLCN Most SLCN can be met by universal services (tier 1), but the severity and/or complexity of some children/young people’s SLCN means they also need more targeted or specialist services (tiers 2-4) to meet their needs. This model is consistent with the ‘graduated response’ for meeting SEN (in the SEN Code of Practice for Wales).

20. In the continuum model SLCN are (typically) met through a series of stages of action Health visitors and educational settings are involved in screening to help identify SLCN Interventions can be used as form of assessment: if a child identified as having a SLCN does not ‘respond’ to intervention (i.e. make progress in their SLC development), this can indicate the problem is not “delay,” and the child has a more complex and persistent SLCN and needs more targeted/specialist assessment (e.g. by a SLT) and/or intervention. This is known as “response to intervention”. Initiatives like “learning to talk”* aim to prevent SLCN associated with developmental delay * http://gov.wales/docs/dsjlg/publications/cyp/150904-flying-start-pack-parents-en.pdf

21. History: the situation before the Speech Language Service Pilots (2005-08) • Tensions between health, education and families (e.g. who pays, who does what?)*; • a focus upon specialist services/interventions to meet SLCN (rather than universal and targeted services); and • limited capacity (e.g. shortage of SLTs (especially Welsh speaking SLTs) and escalating demand for SLTs)**. • The impacts of this included: long waiting lists, inefficiencies, inconsistencies, negative experiences for families...** • In response, in 2005, the Speech Language Service Pilots were established *CRG, 2008 , http://gov.wales/statistics-and-research/evaluation-speech-language-service-pilots/?lang=en **NAFW, 2004; www.assembly.wales/N0000000000000000000000000026476.pdf

22. The Pilots’ key legacy has been making the model work better.

23. This model is not a ‘panacea’ This model, covering the stages of identification, assessment and intervention and a “continuum” of services from universal to specialist, requires: • capacity; • the right ‘tools’; and • partnerships

24. 1. Capacity and consistency at each level: enough people, knowing how to, and doing, the ‘right’ things. This requires: • skills and knowledge: so initial and post qualification training (e.g. ITET, professional learning for education staff) for each stage and type SLCN are important - • a sufficient workforce size and funding; and • clear roles and responsibilities (division of labour) e.g. limited capacity in universal services may increase pressure upon targeted and specialist services.

25. 2. Those involved need to use the right ‘tools’ e.g. ‘interventions’ need to be: • effective : the evidence base for interventions is emerging*, focused upon ‘medical’ rather than ‘social’ outcomes and there are related difficulties in identification and assessment (there is no single tool); • accessible: e.g. not all tools are available in Welsh; • appropriate: matching approach to need; and • implemented well: fidelity of intervention is important (and links to workforce capacity and support). * Law, et al, (2010), https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/219623/DFE-RR247-BCRP10.pdf

26. 3. Those involved need to work together (no single service/person can meet a child/young person’s SLCN) To engage with other services , parents and carers and the child/young person, services be need to be flexible and innovative Parents/carers have a key role as “agents of change”, but engaging families can be challenging. This can relate to families’ capacity and willingness to act and the way services seek to involve them.. Child/ young person

27. Many areas of policy have an interest in SLCN and a contribution to make to meeting SLCN. E.g. Additional/special educational needs Literacy and Numeracy Framework (LNF) Pupil data and use Pupil Deprivation Grant (PDG) Workforce development Early years/ childhood development/ Anti-poverty; Flying Start, Families First Communities First Policies for ‘vulnerable’ groups such as children/young people who are “looked after” or in the youth justice system Prudent health care. Working differently: working together . SALT Health Visitor services

28. Implications for a strategic approach to SLCN • A strategic approach needs to be ‘cross-sectoral’ (e.g. covering health, education and ‘social’ policies), and build on existing policies. • The continuum/stage model is well understood, widely supported by both research and practitioners and can address all SLCN (by providing a continuum of support). • A strategic approach requires capacity, the right tools and partnerships to work (the quality of the model cannot exceed the capacity of the workforce, the quality of the tools used or the quality of partnership working).

29. How well is the model working? • Slides 30-32: What is happening for different age groups, at each stage? • Slide 33: What measures should be used? • Slide 34: What does this mean for a strategic approach to SLCN?

30. The model for young children: age 0-3/5 (pre-school) * WG, 2014, http://gov.wales/docs/caecd/research/2014/140131-flying-start-synthesis-report-en.pdf; **Melhuish, 2004, https://www.nao.org.uk/wp-content/uploads/2004/02/268_literaturereview.pdf

31. For school age children/young people: age 3-5:16-19

32. The model for young people post-school: age 16 and19-25 * Taylor, et al, 2015, https://www.justice.gov.uk/youth-justice/effective-practice-library/speech,-language-and-communication-needs-of-young-people-in-the-yjs

33. Proposed outcome measures for differentsettings, age groups and types of SLCN * Compared to ‘expected’ rates, ages etc.

34. Implications for a strategic approach to SLCN • There is no national guidance which contributes to a post code lottery, but factors like differences in workforce capacity also contribute to inconsistencies across Wales. • There is a need to: (i) consolidate and review the work to establish the current model in primary schools, and then extend it to other ages/phases and settings (e.g. FE, PRUs, nurseries); (ii) develop universal and targeted services (especially for early language delays) and, to a lesser degree, specialist services (e.g. Welsh language provision); (iii) strengthen support and the transfer of knowledge about a child/young person’s SLCN as they make transitions between settings and services; and (iv) improve partnerships with, and support for, parents, which is often the weakest link.

35. Conclusions • Slide 36: What does this all mean for a strategic approach to SLCN? • Slide 37: What are the key challenges and options?

36. Conclusions: there is consensus.... • on the importance of speech, language and communication; • on the approach: a fairly simple model (e.g. stages & continuum of services; focus upon prevention, early identification and intervention; covering all types of SLCN (e.g. transient and more persistent and severe SLCN); & • on the progress made – but also the challenges (e.g. in making the model work and in engaging families). So, what’s needed..... • a cross-sectoral approach (education, health, ‘social’ policy), that engages families and builds on existing policies. • Wales doesn’t need a new model; it needs a strategic approach to make the current model work across all settings, across Wales.

37. Key challenges and optionsThere are multiple challenges, but no ‘silver bullet’