Communication Champion Jean Gross's (sometimes damning) report on SLT today

[working9while5]

is available here.

I think it says some important things. I won't say I agree with every last word, and regrettably some of the more spurious elements (such as sending texts to parents to remind them to talk to their children) have been capitalised on by the press today.

Important points for me were the following:

^Some of the management practices I have heard about in the NHS continue to shock me. Routinely, speech and language therapy managers are put under pressure to manage waiting times by counting brief advice given to a parent at the time of the first contact as ?treatment?. Routinely, they are asked to reduce ?DNA? (did not arrive) rates by discharging children if an appointment is
missed. Little is done to monitor equity in take-up of services, to find out - for example - whether access to services for socially disadvantaged children or children from minority ethnic groups is on par with access in other groups. Recent evidence from work with young offenders and young people
in special schools for those with behaviour difficulties is showing that while two thirds of these young people have SLCN, large numbers had not received help when they were younger because they fell into this ?DNA? group of children discharged because their families did not keep appointments.

37. A low priority is given to children?s community health services in some Primary Care Trusts. Given that the top-level accountabilities for performance in the NHS have had little to say about children, or about chronic rather than acute needs, this is hardly surprising. Children?s needs will always struggle to compete with those of people with acute illness, and with the growing numbers
    of older people in need of care.

38. I have met no one outside government who believe that commissioning by Clinical Commissioning Groups led by GPs will change this fundamental problem. All say it will make it worse. I have found that in London, for example, only 9% of referrals for speech and language therapy go though GPs. Most come from schools and health visitors. Most disabled children are
    dealt with by community paediatricians not GPs. Most referrals to CAMHs services do not go through GPs. Children requiring community health services are largely invisible to GPs, so it seems unlikely they will be a commissioning priority."^

I have only skimmed so far, as it makes for depressing reading regarding cuts and inadequacies in teaching/teacher knowledge. However, it might be something to wave about in anger?

PS there is quite a lot about how monitoring needs to be improved and there needs to be better research.

I wish I could say it will lead to change, but I fear not.

Some good stuff in there.
I dispute this though
'These cuts coincide with rising incidence of SLCN, with a 58% growth over
the last five years in numbers of school-age children with SLCN as their primary special need'

Where is the evidence? Non cited.I'd suggest it has more to do with poor teaching practice than issues within the child.
It feeds into the SN industry. The kid can't do it? He's got a problem. Nothing to do with us.

Also although lots of examples of what might be termed 'good practice' there is little data to support this assertion. A lot fo stuff looks and feels nice. Doesn't mean to say it is making a difference.

I haven't read the document yet, just a BBC report on it more generally. I have to say though that we have fought and fought for speech therapy for DD#1 since she started in reception in Sept 2009. She has had NO therapy from the local SALT service despite two assessments since then that state she should be a priority for therapy. Now they have decided to sign her off caseload because she has "only moderate needs" and they will only see children with severe needs. It is an utter disgrace. Even a formal complaint to the NHS acheived nothing. For us anything that might give some hope to changing a system that is failing children like DD is a good thing.

Moondog, I think it could equally said that there is no data to prove that it is poorer teaching resulting in these short-falls. There has been a recent audit in my service of students with severe and specific speech and language impairment that are a) statemented and b) have evidence to suggest they should be statemented (e.g. standardised assessment results, poor academic and social functioning, features of SLI). The number of statemented children who are receiving appropriate intervention are outnumbered 5:1 by those who are not, despite strong local data (across a range of measures, including standardised and non-standardised measures and including National Curriculum levels, reading scores and strong behavioural data e.g. frequency measures of behaviours etc) that appropriate interventions are enabling children to progress at above expected levels in comparison to their non-statemented peers.

Great teaching helps. It's true. However, I have to say that in the age range I work with, simply getting mainstream teachers to recognise that there are such things as speech and language difficulties and that they need to respond to these in their students is an uphill battle at times. This is recognised in this report, I feel, by the suggestion that all teachers really do need to be implementing the SENCoP and that this needs to be enforced.

Some of the best practice indicated includes as its first point use of data, and includes a focus on outcomes rather than activities, increased user involvement etc. There are figures quoted to support some initiatives and there is a call for more stringent audit etc.

There's also a lot of reality talked about the shortcuts taken to deny people a service yet paint it as one. I wouldn't really say that it dresses up poor practice as good, though there is a strong emphasis on joint commissioning of services as a major focus which isn't probably the panacea for all ills that some might hope it will be.

At present I am deeply concerned about the nature of cuts that are happening. My service is about to lose a manager and clinical lead before further "restructuring" of the rest of the team. I have noticed a worrying trend in neighbouring authorities to reduce specialisms and make speech therapists more "generic". No offence to some of my colleagues, but frankly when I left on mat leave and there was a therapist without SLI specialist knowledge in my setting, the educational staff said they found it virtually impossible to see progress as programmes were inefficiently updated or not at all as therapists flailed desperately to get to grips with working in that setting/with that age range/with that severity of SLI.

I do agree that there is sometimes too strong a focus on high-incidence but low severity SLCN but I suppose, like beautifulgirls, I do think that things are so terribly dire that anything that points in the direction that things need to change is important. Personally, I don't believe too much in arms-length consultancy working, and I feel that for children with the severest needs, there's little substitute for proper individual assessment and therapy with proper collaborative roll-out. I don't think it's really possible to meet the wide range of needs of children with significant needs using a half-termly model.

I don't deny the level of SLCN is high (although the phrase SLCN is so woolly as to mean little). I merely query where this rocketing of % has come from.

I don't beleive that s/lt as currently practiced in most places has much to offer, despite good will and commitment in many places.
I think it needs a radical rethink, but then again so does Education.
There is ample data to suggest teaching is in serious trouble.
I'd dig it out for you but my kids are calling me to say goodnight (they should be asleep) and I keep on promising myself I will spend less of my free time on work related issues (failing so far).

Oooh, whilst you are both on this thread, could I be really cheeky and ask you what you think of this school?

I know you can't comment on it further than the website blurb, or for it's suitability for ds but as website blurb goes does it look promising/potential/sensible?

PM me if you'd rather not post here, and please don't feel obliged to comment at all. You have both done so much to guide me already.

Hey, me too . I need to be studying!

I think it's really hard to make statements about what slt has to offer as it varies so widely. I see evidence on a daily basis of how teaching is in trouble, but again there is massive inconsistency. I've seen examples of very good and absolutely appalling teaching side by side. I also work with therapists that I rate highly and who I have seen bring about really positive changes (with lots of hard evidence to prove that they do) who are working alongside therapists who write reams of meaningless recommendations and seem themselves to have a poor grasp of the most basic of language development norms. I see people who enjoy having endless ranty meaningless meetings and those who would rather actually get on and do. It is so variable.

I also think a lot of the research in the UK wrt many health and educational needs of children is quite weak, too. There is a lot of apathy. So much needs to change.. but I don't believe there is any one answer, and I think some of what this report states is valuable information for parents and professionals to shout out about.

Starlight, I know two children who have gone there, one got it funded at tribunal. Both very happy although I haven't seen one for about a year.

Not many parents ask their GPs for SLT referrals, and routine check-ups have been pretty much abolished so no wonder so few GP referrals come through. Though it's probably true that adult health will always get more resources than child health, and acute care will win over chronic or preventative care. Plus as a largely female profession, SLT has always been undervalued. Add on disability issues, lack of big pressure groups etc and the general target-hitting, crisis-management, short-termism of health and social care... oh dear.

The latest proposal... would set up 300 different managed care insurance companies, with the massive increase in bureaucracy that entails, higher prices, and rising inequality.

Though it's probably useful to have GPs at the helm during rationing and the collapse of the NHS. Makes sure that any staff opposition can be diverted into infighting.

I've had a read as well. Some great recommendations eg. re AAC provision, 2 year checks, screening children with behaviour issues for SLCN. But it's not very reassuring. Given the council cuts, LEAs are likely to be in a even worse position than the NHS, so joint working may not really help at all resource wise. As a parent I must admit from my experience i have far more faith in the NHS than LEA to manage limited resources fairly (though once your child is school age you don't exactly have a choice anyway...). And I suspect schools will soon struggle to find extra money to "buy in" extra SALT....

I was also a bit that only the good authorities were named, the bad authorities were vaguely hinted at.

Moondog - good point re:evidence for % quoted in the report. I thought the report was very light on detail - e.g. how many children with SLCN have no other LD/ASD type DX for example. And special school provision didn't seem to be discussed much.

Working - as a parent I agree with you re:DNA rates, as it seems unfair to penalise young children for their parents non-compliance. Reminder phone calls or texts can help DNA rates in other areas of the NHS. My local area threatened to discharge if you didn't phone up beforehand to confirm attendance which after a lengthy wait to access appointments royally pissed me off, quite frankly.

I get a bit fed up with the government generating these 'reports' and then not giving anyone any incentive to carry out the recommendations but hailing them as good practice 'as if' it is current or impending practice.

I agree. I never liked the idea of a "Communication Champion" for this reason. The whole area needs an equivalent of the Rose report, something that brings about immediate and mandatory change. However, there's no political will for that.

I think the aim has been to try and make it a universal issue, but I don't agree with this approach. Have just been ranting on a fellow speech therapist's page about the pseudoscience quoted in some of the recent media articles - 1 in 20 parents do not see communication before 6 months as beneficial does not correlate with 1 in 20 parents failing to interact or communicate with their child at an level sufficient to ensure appropriate language development. If 58% of the child population has SLCN, it begins to look like rubbish assessment and something narrative. This really doesn't help the 1-2% with severe and persistent communication disability whose parents are faced with constant "oh but mine is JUST like that" misunderstandings and miscommunications.

I do believe SLT has a lot to offer, even sometimes in its current guise. There are areas I feel are almost universally substandard (SLD, ASD, AAC in many areas) but I've seen children with dyspraxia/stammering/cleft lip and palate/hearing impairment/language disorder make immense strides forward with regular specialist therapy from appropriately trained staff. However, trying to give a little to a lot and use SLT as some sort of ill-thought out tool for social mobility reduces the likelihood of appropriately specialist therapists being available to do hands-on nitty gritty work with students who actually need therapy and not "strategies/advice". Where SLT still offers something, it is where staff have experience gained through actually working with kids, assessing, monitoring, tracking changes. Sending out reams of photocopiables and believing every little press release yet not being able to access or critically evaluate serious research in your field is not professional nor value for money. Yet somehow, it's that that we are being moved towards as it is more "efficient" and "cost-effective" . Erm, no.

something narrative? Think I may have deleted a clause there. Something more of a middle-class narrative to better the ignorant working classes, I think I meant.

working, how far do you think the media is perpetuating the slcn due to crap parenting hysteria? a lot of mainstream media coverage during JG's stint did seem to be of the "shock horror 5 year old doesn't know own name" variety, but is this because JG was focussed on preventative work, or because this sort of story is all the media is interested in?

I think, sadly, a bit of both. This is the nature of the argument I was having with my colleague about it.. a great many SLTs are under the impression that because caseloads are heaving as a result of language deprivation that increasing knowledge about communication generally will impact on that and reduce caseload sizes so that we get back to working with the 5-6% who actually get some benefit from SLT and being able to afford due priority to the 1-2% with the most severe needs.

I think that's a very misguided and naive assumption. There has, as we all know, been oodles of media coverage of breastfeeding advice and there's not a lot of evidence it has increased breastfeeding rates. It makes for a lot of smug bunfighting, guilt and hysteria though. Arguably, bfing is an easier behaviour to encourage than the challenge of overcoming language deprivation caused by generations of poverty and disadvantage. I find it, to be honest, quite arrogant that SLTs really think that "the communication message" is the answer to serious social problems. It's a classic case of overstepping the mark, focusing on the woods and forgetting the trees.

'messages' don't do much at all except errode the self-esteem of those who are trying and seeking such 'messages'. 'Messages' are ignored by those that aren't.

Exactly how I feel about it. It particularly concerns me wrt to mothers who have had PND etc, because actually, some of the approaches to PND that have been proven to have an impact on mother-child interaction do all that is needed in terms of communication without further lambasting the poor woman for having a hormonal imbalance. Simple things like baby massage or watch, wait and wonder are going to have a far greater impact than telling people that they are risking their child's future by not talking x amount to them. I found those early months horrendous and I don't think I actually had PND, but I'd have been scathing of anyone trying to tell me that I needed to be reading Cat in the Hat to my child while he screamed blue bloody murder at me.

I find a lot of it quite nauseating as a parent, and am dubious about the quality of the evidence or how the subtleties of what is actually known about parent-child interaction are eroded. I frequently notice people who talk incessantly to their children but rarely respond to or notice when they are actually trying to tell them something, yet I don't see any apparent effects on their children's language or well-being or the bond between them. I would hazard a guess that what I'm seeing is a snapshot of a far more complicated picture, where a parent behaves in a particular way at playgroup or on the bus that really gives a very limited idea of the entirety of their lives. It makes me laugh when I hear people bleat on about how sad it is that parents don't talk to their children on the bus, as though it were some sort of spirit level for how the family communicates. It's pseudoscience based on a kernel of trurth. The type of relationship factors that make a significant difference to development are much more on the very severe end of the continuum e.g. a mother so profoundly depressed she can't look at or respond to her child at all, parents so wrapped up in complicated and messy lives that they can't manage to interact because it's all too much for them and spend their lives strapping their baby in a pushchair in front of the telly with a dummy in their moutgh because they are overwhelmed or busy fighting with their baby's partner etc on the phone.

It's wrong to make the NHS responsible for ensuring people's health, says the minister. I presume he thinks nudges might be cheaper and reducing the focus on individual treatments by qualified professionals would also fit with plans for a much slimmer health service.

But this innovative approach will probably have to wait .

Same as the bfing message being 'not bfing is BAD' without support at the practical and emotional level to make it even possible for some women.

There's a total lack of transparency. It makes me sick to see the Royal College of Speech and Language Therapists tweeting and retweeting spurious articles about texting etc yet reporting very little on the serious, swingeing cuts that are being justified clinically by managers with rubbish like the above.

LeonieDelt,I'd love to hear how they can possibly differentiate a "communication disorder that is expected with autism" from one which is not .

Mariamagdelena, I agree. It is about reducing face to face contact. There is a drive in my area to close language units because, despite the fact we have evidence ours are working, it's not "best practice" as that would be (apparently) to focus on "mainstream teaching strategies that would benefit everyone" vs intensive individualised therapy for specific speech and language deficits. All these kids need is, apparently, for teachers to "differentiate" their lessons. That's going to enable a 14 year old with age appropriate intelligence who can't follow a simple conversation and describes listening to language as making her throat constrict and her head rush all better .

Ah it makes sense now why my two expert witnesses have reported that ds has a SLI that is separate from his autism, coz until your post Leonie I thought they were quite mad.