SPEECH AND LANGUAGE THERAPY SERVICE ANNUAL REPORT1 April 2013 – March 2014

Jennifer LewinHead of Speech and Language Therapy services

Val ScraseHead of Children and Young People’s Services

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‘Chat with mePlay with meRead with meSing with meThis is how I’ll learn to talk’

IntroductionThis is the fourth annual report of the Wiltshire children’s speech and language therapy service and aims to provide a brief outline of the activity undertaken by the service during 2013-14. The report summarises the local and national priorities and the delivery of the service to support children with speech language and communication needs across Wiltshire.

Undetected and/or untreated speech language and communication problems can lead to low levels of literacy, poor educational attainment and difficulties finding employment. In turn, this can lead to a perpetuation of the poverty trap and a cycle of health problems, including mental health and health inequalities. 10% of children have a speech and language difficulty. 60-70% of youth offenders have speech, language and communication needs that have not been identified in their early years.

The Wiltshire Speech and Language Therapy Service is commissioned jointly by NHS Wiltshire Clinical Commissioning Group.(CCG) and Wiltshire Council to provide a training and collaborative model of support to children with speech language and communication needs in Wiltshire. This new service commenced in May 2010 following a procurement process undertaken jointly by NHS Wiltshire CCG and Wiltshire Council. The contract was awarded to Wiltshire Community Health Services which in June 2011 successfully merged with Great Western Hospitals NHS Foundation Trust (GWH NHS FT).

Our service provides qualified, experienced and specialist speech and language therapists able to assess, support and manage children and young people with speech and language and communication difficulties. Speech and Language Therapists work in partnership with children and young people, their families and with other professions to reduce the impact of these difficulties on children and young people’s well being, to allow them to participate fully in daily life and to enable them to reach their full potential. The speech and language therapists are supported by a skilled team of speech and language therapy assistants.

Our vision is to provide... A high quality service which is consistent across Wiltshire. A flexible and dynamic service which responds to the needs of children with speech

language and communication needs. A service that works in partnership with colleagues and other agencies. A service that has excellent leadership and staff with the highest clinical skills and

training.

National strategic driversThe Speech and Language Therapy Service (SLT) provides a model of service that has been developed following an intensive evaluation of national strategies and local health, educational, social and communication needs.

The national strategies stress the importance of early intervention and prevention, more choice and easier access to services, the reduction of inequalities, and the importance of supporting families. In addition there is a need for all statutory and voluntary services working with children and young people to work in partnership to ensure all these priorities are met.

In particular, the Bercow Report (DfE: 2008) made recommendations under five key themes:

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Communication is crucial; Early identification and intervention are essential; There is a need for a continuum of services designed around the family; Joint working is critical; There needs to be consistency and equity across service delivery.

We believe that our model of service delivery meets the recommendations of the Bercow Report.

In March 2012 the Wiltshire Children and Young People’s Plan was published by the Wiltshire Children’s and Young People’s Trust. This three-year plan outlines the vision and high level outcomes for children and young people in Wiltshire. This Plan has identified the following three high-level outcomes for children and young people living in Wiltshire:

Prevention and early intervention Raising aspirations and narrowing the gaps Promoting healthy life styles.

Wiltshire wide Paediatric Speech and Language Therapy ServiceThe training and collaborative service model is now well embedded across Wiltshire. We have:

A single point of entry into the service – all referrals and queries regarding the service are managed from Trowbridge Community Hospital.

A flexible and innovative service responsive to the needs of children and young people and families within Wiltshire.

Easy access to the service. A service provided to children and young people delivered in their early years and

school settings or their own home. A telephone advice line accessed by parents and professionals for advice,

signposting and acceptance of referrals. Triage by experienced therapists at the point of referral. A SLT website which provides current service information, an up to date database

on advice and activities, and signposting for children and young people and their families and other professionals and associated agencies to interventions and support.

Improved communication to early year’s settings, children’s centres and schools through allocation of a LINK SLT to a cluster of schools.

A well-established narrative therapy programme provided to schools developed to ensure succession planning of the programme within the school.

A Wiltshire wide service for children with fluency and swallowing difficulties. A comprehensive training package responsive to the needs of families, early year’s

settings and schools. Extensive knowledge and skills across all clinical areas e.g. AAC, dysphagia, autism

spectrum, cleft palate. Regional Makaton tutors. Skilled and knowledgeable SLT Assistants supported with robust supervision. Service designed and specifically targeted Video films for parents and carers.

Research indicates that in the UK the benefits of increased lifetime earnings generated by ensuring children with speech and language impairment received

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speech and language therapy nationally exceeds the cost of therapy by £741.8 million.

For every £1 invested in the SLT intervention generates £6.5 in lifetime earnings. Likewise speech and language therapy working with parents of children with autism

between the age of 2 to 4 years also indicates a cost benefit with later reduction in service use and productivity gains for the family as a consequence of improved communication and independence, and for every £1 invested there is a return of £1.5.

WorkforceUnderpinning all our work is our expert team of staff.

All our clinical staff are fully registered with the Health Professional Council (HPC) for speech and language therapists who determine the professional behaviours, regulatory standards and ethics expected of our therapists.

All our clinical staff are members of the Royal College of Speech and Language Therapists thus providing access to current evidence-based practice.

All our staff access clinical supervision and are managed within a robust clinical and professional leadership structure.

Our staff are fully supported by a systematic approach to training and continuing professional development which includes annual appraisal and a personal development plan. 100% of staff have had an annual appraisal and personal development plan in the last year.

Our services are fully registered and compliant with Care Quality Commission Standards (CQC) which set out the essential quality and safety standards in which we practice.

All our staff have enhanced DBS checks. We have an in depth knowledge of local communities and their health needs, and

plan services accordingly. We have developed and implemented evidence based and ‘best practice’ guidelines

for assessment and care pathways to support the new model of service. Our clinical services are supported by an infrastructure of professionals with

expertise in finance, human resources, estates management, clinical performance and risk management, information management and technology.

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The workforce teams are now fully established across Wiltshire as identified in the workforce service plans submitted to meet the agreed service model. These teams are led by a Professional Speech and Language Therapy Manager and Principals leading in the following areas:

1. Early years and Additional needs. This position operationally manages the south and west teams and is responsible for:

Team leader in additional complex communication needs and dysphagia. Team leader in Early Years. Team lead in Assisted Augmentative Communication (AAC) and Learning

Difficulties.

2. School age children and training. This position operationally manages the north and east teams and is responsible for:

Team leader in social communication and Specific Learning Impairment. Practice educator. Team lead for fluency and hearing impairment.

The Speech and Language Therapy team is skill mixed to ensure the most appropriate skills and competencies to meet the service requirements. The team consists of the following NHS Agenda for Change bandings:

Band 8 Principal SLTs – 2.2 whole time equivalent (wte)Band 7 Team Leaders – 5.79 wteBand 6 Senior SLTs – 9.96 wteBand 5 SLTs – 6.98 wteBand 4 – 0.95 wteBand 3 SLTAs – 4.85 wteBand 3 admin team – 3.46 wte33.19 wte fundedIn total 49 clinical staff and 7 admin staff.

Maternity leave2.00 wte Band 60.8 wte Band 3 A&C

Bespoke continuing professional development ensures a high quality professional team well supported through supervision and line management. The flexibility in training and staff enables targeted skills responsive to local needs.

To ensure that the workforce is of the highest calibre there is an ongoing training programme to replace skills of staff that have left and to further enhance the skills of the team. Training from Regional centres, Spires Cleft Palate Centre in Salisbury and the Regional Cochlear Implant service Southampton enables the SLTs to maintain high levels of competencies in these areas. Local interest groups provide feedback into the service of high level clinical developments

Two staff completed the national leadership training “Nurse First”. One staff member was successful in securing funding to complete MSc modules in

Cleft palate. A further team member, one of the speech and language therapy assistants was

awarded a prestigious Trust Star award, for outstanding performance. A speech and language therapist has achieved regional tutor status as Makaton

(signing) Tutor.

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The following table provides an overview of workforce performance for 2013-14 .

Staff Turnover April 2013-2014

4 leavers at 7.69%

Reasons for leaving

Leaving Reason WTE HeadcountRetirement Age 0 0Voluntary Resignation - Adult Dependant 0 0Voluntary Resignation - Child Dependant 0 0Voluntary resignation promotion 0.92 1Voluntary Resignation - Other/Not Known 1 1Voluntary Resignation - Relocation 1.3 2Total 3.22 4

Recruitment

8 Starters (6.4 WTE) all are now substantive posts.Sickness absence was at 1.59% There were no disciplinary cases.

Performance for 2013-2014Total referrals to the paediatric SLT service 2,257 (increase of 10% on 2012-13)

Numbers of new referrals triaged 2,257 = 100%

Total discharges from the paediatric SLT service 2,286

Total face-to-face contacts 45,196 (increase of 7% on 2012-13)

Total face-to-face contacts by location: Community

(schools / early years settings / children’s centres)68%

Health premises 32%

Total activity contacts 46,974 (increase of 11.2% on 2012-13)

For 2013-14 the child face to face activity took place 31% of the time in health premises, 2% at home, 67% in the community

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Referral Source – Pre-schoolThe majority of referrals are made by pre-school settings and then by Health Visitors.

6%

53%

3%

28%

0%0%

1%

5%

3%

SLT referral source - Pre school children

ConsultantEarly Years/NurseryGPHealth visitingOtherOther therapistSchoolSelf/familySLT beyond trust borders

Referral Source – Primary schoolWhen children attend schools the majority of referrals are made by the school and by consultant paediatricians. The latter are most likely to be referred with concerns regarding social communication.

26%

0%6%

0%0%

60%

3%3%

SLT referral source - Primary school children

ConsultantEarly Years/NurseryGPHealth visitingOtherOther therapistSchoolSelf/familySLT beyond trust borders

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Referral Source – Secondary schoolAt secondary school the majority of referrals are from paediatricians, again these young people may well be referred for concerns regarding social communication. Schools are the next most likely to refer in to the service.

52%

7%8%

27%

3% 3%

SLT referral source - Secondary school childrenConsultantEarly Years/NurseryGPHealth visitingOtherOther therapistSchoolSelf/familySLT beyond trust borders

Discharge Reason

73% of pre-school children were discharged from the service with their intervention complete with 11% failing to attend.

0% 0% 0%

73%

11%

9%7%

SLT discharge reason - Pre school childrenAssessmt & adviceDeathDischarge RequestedIntvtn Done&CompletePat did not attendTransfer Out of areaNo reason recorded

A higher percentage of school children are discharged with their intervention completed than pre-school and very few did not attend appointments.

0% 0%

88%

0%6%

5%

SLT discharge reason - Primary school children

Assessmt & adviceDeathDischarge RequestedIntvtn Done&CompletePat did not attendTransfer Out of areaNo reason recorded

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1%1%

87%

3%3%

5%

SLT discharge reason - Secondary school children

Assessmt & adviceDeathDischarge RequestedIntvtn Done&CompletePat did not attendTransfer Out of areaNo reason recorded

The total number of children discharged from the service was 2,289 with the main outcome being “intervention complete”.

Waiting List

The waiting list is closely monitored on a weekly basis by the Principal team ensuring that children do not breach the waiting times.

Completed Waiting list pathwaysUnder 8 weeks 8-12 weeks 13-17 weeks 18+ weeks Total

April 134 44 3 0 181May 124 28 6 0 158June 124 34 9 1 168July 140 31 4 0 175August 126 28 4 0 158September 150 34 2 0 186October 117 11 2 0 130November 99 16 0 0 115December 104 5 0 0 109January 207 23 2 0 232February 162 37 2 0 201March 144 31 0 0 1752013-2014 1631 322 34 1 1988

% 82% 16% 2% 0% 100%

82%

16%

2% 0%

SLT CYP waiting times - completed pathways 2013-14

Under 8 weeks8 to 12 weeks13 to 17 weeks18+ weeks

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he waiting list is monitored on a weekly basis. 82% seen in under 8 weeks, 16% seen in 8 to 12 weeks, 2% over 13 weeks, 98% seen before 13 weeks.

The largest part of the caseload are primary aged children with pre-school the next largest.

Pre school35%

Primary53%

Secondary11%

SLT Children & Young Peopleaverage caseload 2013-14

2013-14 Speech and Language Therapy Business plan

The business plan has been completed and can be found on www.getwiltshiretalking.org

It has been a very busy year for the department. Some of the projects we have worked on include developing a pathway for access to preschool groups across Wiltshire through the early years triage, ensuring that vulnerable children with speech language and communication needs in remote areas are supported. Reviewing the activity packs provided with some of the intervention strategies, ensuring that there is an equitable approach to managing services into complex needs resource bases,. The service has designed a Wiltshire wide tool for observing quality communication environments across early years and school-age settings; this is bespoke to Wiltshire and based on recognised national work. The service worked with Wiltshire Council to develop a robust process around statutory assessment that links into the single assessment framework. A continual piece of work is evaluating the learning that arises from the speech and language therapy service involvement in tribunals. A regular review of caseloads ensures that there is an equitable service across Wiltshire.

Dragon’s Den

Representatives of the Speech and Language Therapy Dept pitched for funding to the Dragon’s Den at GWH. They were successful in acquiring £22,000 for a joint bid for three projects.

1. Baby Chat in WiltshireThis project designed and distributed 20,000 leaflets and 2000 posters across Wiltshire. The posters encouraged parents and carers to talk to their babies and toddlers during daily routines. They were eye catching and carried simple messages, designed to remind parents of the importance of communication as the foundation for building relationships. There was a link through to the SLT website for further advice. Posters were deployed in Clinics, hospitals, libraries, Children’s’ Centres and in some Business premises!

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2. Towards talking Teenagers

Two therapists ran an Enhancing language and communication in secondary schools (ELCISS) programme in two Wiltshire schools. They worked intensively with 13 teenagers with known communication difficulties focusing on enhancing their vocabulary development and/or narrative skills. They were supported by teaching assistants from within the school in order to enable them extend the programme into the school in future. The initial findings indicate that the pupils improved in many aspects of their narrative and communication skills; this will impact on the pupil’s performance and achievement in schools.

Pupil’s comments: (I’m better at) “working with people”.“I always use my best talking in class now”.(Now I’ll) “be confident and listen more”.

SENCo comment: “The running of the programme allowed support staff time to develop positive relationships with pupils and increase their awareness of appropriate challenges for them.”

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3. Communication station

Ten teaching videos were produced on key aspects of developing communication skills in children. The videos are short, concise, modern and parent friendly. The key topics covered were:

1. Let’s Play - Supporting Early Interaction and Communication – top tips on how to encourage communication through play.

2. Helping Your Child Understand Language: One Information Carrying Word3. Helping Your Child Understand Language: Two Information Carrying Words4. Helping Your Child Understand Language: Three Information Carrying Words5. Let’s Get Moving with Action Words – shows ways to teach and encourage

children to use action words in everyday situations.6. Saying Simple Sentences –educates viewers about the key parts of a simple

sentences and demonstrates activities to try to encourage children to use simple sentences.

7. Exploring Speech Sounds – educates viewers on the different speech sounds in English and how we make them, hand signs for the sounds and shows ways to encourage sound making in everyday play.

8. Blending In – demonstrates activities to help children blend single sounds with vowels.

9. Visual Supports – demonstrates how to use choice boards, visual timetable and language jigs to support children.

10. It’s All Fun and Games – showing motivating games to motivate children in their speech and language activities

These videos can be accessed via a link and a QR code which can be included in an email, report, target sheet or given directly on a printed business card. The communication station enables parents and professionals easy access to specific areas that provides an explanation of how to help their child and models of ways to achieve this.

Working in partnership with a wide range of other professionals and agencies is key to a successful service model and to a communication rich environment within which children can develop their communication skills.

Wiltshire Council is a pathfinder council for implementaion of the new staturoy processes as outlined in the Children and Families Bill. The SLT service has worked with Wilshire Council

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towards the education, health and care plan, “Statutory My Plan” and local offer, ensuring collaborative practice with health and education .

The BLAST (Boosting Language, Auditory Skills and Talking), a programme rolled out by the Speech and Language Therapy service across all early Years settings in Wiltshire, targets children with delayed language and communication skills continues to be successful with a reduction of simple delayed speech and language cases referred in to the service.

The speech and language therapy service follows the Tribunal pathway it has developed to support parents, carers and professionals in meeting the needs of the child or young person with special educational needs. The central philosophy of this pathway is to ensure that there are skilled therapy staff with a depth and knowledge of their specialist areas, a competent and well trained team around the child, and a curriculum that has been adapted to meet the child or young person’s needs. Resolution through mediation is the most effective outcome. Each tribunal is reviewed to ensure that any learning is used to develop and enhance the service provision for all children.

Feedback from service usersWe encourage feedback from all users of the service including parents, and all compliments, comments and complaints are monitored through our governance meetings.

In 2013-14 we received one complaint regarding the service. This was concerning lack of communication regarding the review of targets. The concern was directly addressed to the satisfaction of the service user.

There were 91 written compliments concerning individual cases were received by the service with numerous verbal compliments. Examples received include:

Training

“Both tutors were amazing. Very willing to answer all questions and share knowledge and resources.”

“A really good course – knowledgeable tutors.”

“I just wanted to drop you a quick e-mail to say how fantastic the Makaton course was last week. It was one of the best courses I have attended in many years and I can't believe that I learned so much in one day. Everyone on the course felt the same and we are keen to sign up to the next phase.”

A parent commenting on the SWAPP 2 (Support in Wiltshire for Autism Parent Programme ) course said that the course had changed her life because she had realised that her son couldn't help his behaviour. She has implemented some of the strategies and her family are now significantly calmer and happier.

A Teaching Assistant who had worked for a number of years said “despite my experience I have changed the way I work with children with AS and I am very grateful.”

Children commenting about the narrative sessions “good”, “it’s cool” “fabulous”.

Narrative therapy

First screening on a child:“getting the biscuits.”

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“Then he got the stool.”“Then he got the biscuits.”“It was empty.”

Second screening after a few weeks intervention:

“One afternoon Jake wanted a snack and he saw where his mum had put the biscuits. Next he saw a stool and climbed to the top to reach the biscuits. Then he got it, then he climbed back down, but sadly the tin was empty.”

Parent “… the analysis you came through with was valuable and allowed us (and the school) to be aware of the specifics of As issues, and how to deal with them. ...he is on for grade A in product design( previously C) and Grade B/C in English and the improvement has been so marked is up at least two grades, and a class, and is now doing English language and literature.”

“ We cannot thank you enough for the work you did, as it has made a great difference to A’s work.”

Parent on therapy for their child’s stammer:

“Amazing, totally transformed my son’s speech in 6 weeks!!”

Parent:

“….. is so much more confident now and loves talking to others”

Parent asked whether they would recommend therapy to others:

“definitely”

Monitoring Quality of Service Delivery

To ensure that a quality service continues to be delivered and is meeting local needs a comprehensive annual audit programme is delivered which is agreed with partner agencies and commissioners. In 2013/14, the following audits were completed:-

Audits and surveysTwo clinical audits were undertaken:-

1. The phonology care pathwayThis audit was undertaken to re-evaluate the pathway in relation to clinical decisions and record-keeping. It was carried out to ensure there is a robust system with clear instructions for the management of children with speech sound delay or disorder.

Areas of good practice that were noted within the audit included:1. Speech and language therapists were making observations on the intelligibility and

stimulability of the child's speech sound system.2. The phonology care pathway had been widely shared with and implemented by new

staff.

Recommendations from the audit were:1. All therapists involved in the differential diagnosis of phonology delay and disorder will

show evidence in case notes of their rationale for their decision-making.

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2. All therapists will indicate in the case notes whether the phonemes (sounds) are able to be made by the child or young person.

3. All therapists will make an observation about the intelligibility of the child's speech preferably using the intelligibility in context scale.

4. There will be a re-audit in September 2014 to allow time to embed the standards.

2. Care pathway audit for children with cleft lip/palate (CLP) and/or velopharyngeal dysfunction

Children born in Wiltshire with cleft lip / palate have access to one of three specialist hubs; Spires, (Salisbury), Spires (Oxford Radcliffe), Frenchay (Bristol). Due to the specialist nature of the liaison and intervention required with the cleft population, a pathway was devised to ensure:

The child had access to an evidence based model of care The community therapist has clear guidelines to follow The community therapist has clear access to support.

This audit has been completed to ensure the newly developed pathway is facilitating appropriate care of the children with cleft lip / palate in Wiltshire.

The aim of the audit was to ensure that the current cleft lip / palate (CLP) / velopharyngeal dysfunction (VPD) pathway is fit for purpose and is being followed appropriately by Wiltshire Community Speech and Language Therapists.

In particular we wanted to understand whether The CLP pathway is being followed by all therapists; The pathway meets the needs of the service user in terms of:

o Early identification of undiagnosed structural abnormalitieso Provides appropriate and timely interventions in line with current guidelineso Working within the Team Around the Child to maximise outcomes;

That therapists have clear line of access to support and guidance relating to this disorder;

That the pathway is user friendly and meets service and service user needs.

Areas of good practice that were noted in the audit were: Therapists are following the CLP / VPD pathway and are accessing internal / external

support as required. In the majority of cases cleft hubs are taking an active lead in management and in all

cases community therapists are following their management advice. All children have had oral assessments; community therapists are completing oral

assessments before referring to regional hubs.

Recommendations for improvement were identified as:1. All children should have an oral assessment upon entry to the service. If an oral

assessment has not been completed this should be identified in clinical notes and an oral assessment should be attempted again at a future appointment. Completion of an oral assessment should be included in the CLP / VPD pathway as well as the triage pathway to prompt therapists to do so.

2. Therapists need to identify the hearing status of children before starting any period of intervention. This may be through liaison with regional hubs or local audiology services. Community therapists need to refer to audiology before referring to regional hubs.

3. Community therapists need to contact regional hubs for updates on interventions / surgeries / diagnosis if the hub has not provided this information within a reasonable time frame.

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Service user surveysA survey was carried out to identify parental views on Lidcombe therapy which is an intervention used to support children identified with a stammer. Prior to the re-commissioning of a Wiltshire wide speech and language therapy service, children and young people with a stammer were not able to access Lidcombe therapy on an equitable basis across Wiltshire. Over the past three years staff have been trained and there is an ongoing programme of Lidcombe training to ensure the speech and language therapy service across Wiltshire is able to provide this therapeutic intervention.

A survey was carried out to evaluate parental perception of Lidcombe therapy. The Lidcombe programme has strong evidence of its effectiveness and has therefore been selected as the intervention with the best clinically proven outcomes for young people with a stammer. The methodology resulted in a high response rate.

The key themes of the analysis indicated that parents:

1. Were happy with the Lidcombe therapy they have been receiving and highlighted positive impact it was having on their child's communication and confidence.

2. Were able to carry out the programme at home on a regular basis.3. Felt that Lidcombe therapy is effective in reducing their child’s dysfluency,4. Felt that the programme had a positive impact on their child’s confidence, friendship

and increased talking.5. Learnt more appropriate responses to their child stammer.

The programme has passed the NHS “Friends and family” test.

Recommendations were that Lidcombe therapy should continue to be offered within Wiltshire to those children who meet the criteria. The SLT service will continue to develop a programme to ensure that therapists are trained and supported in delivering Lidcombe therapy in an equitable manner across the County.

Analysis of outcomes of intervention using a dynamic evaluation at the review of a child or young adultThe Speech and Language (SLT) Department in Wiltshire is commissioned to provide a training and collaborative model of intervention for children with speech, language and communication needs (SLCN), working with the ‘Team Around the Child’ (TAC). These interventions are individual to each child, and recorded on the target sheets adapted from the East Kent Outcome measurements. The SLT Department updated the target sheets in September 2013, so both these and the previous version have been used in the audit which spans a six month time period.

The model delivered across Wiltshire is that each SLT is allocated to specific settings to develop professional relationships and collaborative practice.Each SLT will assess a new referral, set relevant targets to develop speech, language and communication, and monitor and review the child’s progress using the target sheet with setting staff and parents. Settings are required to return the completed form to request a review, or this may be completed collaboratively in settings. New targets can then be set as needed, or the child discharged if targets have been fully achieved.This model is supported by a range of formal bespoke training provided by SLT Department for settings, including “SLT Targets Explained, Module D, Derbyshire Language Scheme, Makaton signing, Using Makaton throughout the day”.

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A survey was undertaken to ascertain the success of Speech and Language Therapy intervention targets set. In particular we wanted to ascertain whether:

1. The targets set have been reviewed and the information is recorded on the target sheet.

2. the level of outcome of targets set for children3. To make broad recommendations for future target setting and review

Sample 5 Pre-school and school age children on the current caseload were selected at

random by 20 Speech and Language Therapist across Wiltshire A total of 100 children were audited.

Key Issues from this audit Approximately a third of target sheets are reviewed by SLTs. The service model

would recommend/support greater inter-agency working with greater responsibility taken by settings to initiate a review, given training available.

The majority of SLTs are setting three targets but results demonstrate greater success is achieved on only one target. There may be insufficient time to focus on three targets.

Areas of good practice noted from the survey were that: 86% of targets have been reviewed The target sheet system is being used in 99% of cases reviewed. Following request for review, 80% of requests for review occur within 3 months

Recommendations for improvement are: A maximum of one to two targets on a sheet is more likely to be successful than

3 or more After 3 months a new target can be offered from the original assessment where

appropriate. This will reduce response times for review, and allow time for re-assessment of children where this is required.

Greater percentages of target sheets need to be returned or reviewed by telephone by the appropriate settings. SLTs need to be reminding settings to comply with this.

Update care pathway to define a review wait time to be less than 3 months, and to promote telephone reviews to reduce waiting time.

Identification of suitable outcome measures to evaluate a child's views on their progressThe Commissioning Support Programme (2011) states “All children and young people can communicate, and children and young people with speech, language and communication needs (SLCN) are as able as other children to contribute to decisions about the services that affect their lives. But they need extra help in making their voices heard. Being involved in decisions that affect you is a basic human right which is enshrined in legislation including the disability Discrimination Act 1995 and 2005, and the United Nations Convention on the right of the Child”.

A previous service evaluation had explored the child’s view of their Speech and Language Therapy Assistant Intervention. This evaluation had recognised the usefulness of drawings as a successful alternative approach to listening to a child’s perspective. “The familiarity, freedom and non-threatening nature of a drawing can help children communicate what they think or how they feel” Holliday et al 2009.

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The audit undertaken this year used a combination of Solution Focused rating scales to gather children’s views of their own communication as well as drawings to try and find an alternative form of self expression.

The sample looked at a total of 52 children attending the Communication & Interaction Resource Bases at the time of the survey although two of these children were unable to complete the communication rating tool as they were functioning at too low a level/ had too complex SLCN and additional needs. A further four of the children undertook the survey but were unable to accurately complete all aspects of the communication rating tool therefore only 46 responses were analysed.

Areas of good practice identified included: Children with SLCN can be reflective about the different aspects of their

communication using alternative measurement tools other than speaking, although this does depend on age and level of understanding and complexity of need.

Children with SLCN can be solution focused about specific aspects of their SLCN and can make accurate judgments about their progress on specific targets that are meaningful to them.

Children with SLCN and the SLTs that work closely with them can collaborate to identify small steps and raise awareness as to how these support their specific targets that are meaningful and motivating to them.

SLTs (and the Team Around the Child) can incorporate child led targets into intervention which can lead to positive outcomes for motivation, engagement and allowing the child to work on what is important to them.

Recommendations for improvement were identified as:

1. Change SLT practice within the Communication and Interaction Resource Bases by continuing to refer to the communication ratings for each child (where applicable) to identify further targets and the small steps to work towards their goals for incorporation into their IEPs, including on-going self ratings for progress.

“Above all, if participation is to be effective in bringing about change it needs to be sustained and embedded as an integral part of relationships with users – not simply a one-off exercise” Commissioning Support Programme 2011.

2. Continue to explore and develop the best ways to elicit the views of children and young people who access the Speech and Language Therapy Service across a range of settings and incorporate these into target setting, identifying small steps to work towards their goals and include on-going self ratings for progress.

3. Explore the most successful ways to best elicit the views of parents and carers of children within the Communication & Interaction Resource Bases to inform communication target setting and intervention.

“Services and schools should systematically collect evidence of children’s and young people’s outcomes that include the perspectives of children, young people and their parents, and that provide evidence that changes in young people’s speech, language and communication are increasing their independence and inclusion” Lindsay, Dockrell, Law and Roulstone 2012.

The following are some of the measures used to evaluate the views of a child or young person with SLCN with specific reference to their own outcomes.

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The CYP is asked to draw themselves and this is then rated on six different features and rated as overall positive or negative.

Children and young people rate their progress using confidence and progress fans rate

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A Survey of the use of the Speech & Language Therapy Telephone Advice LineA log has been kept of all the calls made to the advice line since it was started in November 2008. It was decided to sample a year of phone calls made between 1 April 2012 and 31 March 2013.

The phone line is manned by a specialist speech and language therapist between 16.00 and 17.00 each day from Monday to Thursday. There is no answering machine; the line is activated each day at 16.00. The calls were initially logged in a book, but since 26/07/2012 data has been stored on an electronic spread sheet on the department’s central server.

Results: the table below shows TABLE (1) – The range of people accessing the telephone advice line and the reasons for calling.

Person calling

advice lineNumbers

callingDirect

referral taken

Discussion about

referring

Discussion about Re-

referral

Sign post different agency

Request for

advice

Inform-ation sent

Date of next

appoint-ment

Parent 129 44 7 19 82 35 12Health Visitor 11 1 1 6 2 1School Nurse 2 1 1

GP 1 1 1 1CAMHS 1 1OT 1 1School Staff 18 1 5 1 13 5Early Years Inclusion Officer

1 1

ASK 1 1 1SLT Out of County 5 2 1 1 1

Total 170 49 9 8 20 106 44 14

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TABLE (2) – The range of speech, language and communication needs that were discussed as well as associated difficulties such as feeding and dribbling

Language Speech Inter-action

Lisps / laterals

Fluency Voice Selective Mutism

Feeding Dribbling Second opinions

Total

27 36 4 8 19 2 4 2 3 2 107

Additional enquiries that were made to the service include: 1 Relative of adult who had had a stroke requesting support. Enquiry passed to adult

service.2 Adult who wanted to refer himself, enquiry passed to adult service.3 Enquiry about the quickest route to get referral processed, parent, GP or school.4 Request by student nurse to have some observational experience.5 Enquiry made by mother about the training that we offer and who can access it.6 Request by SLT from Scotland who had seen the resources on our website and

wanted permission to use some fluency resources for her clients.7 Enquiry about volunteering.8 Request to assess siblings with dyslexia

Total number of calls made to the advice line since it was opened in November 2008:

November 2008 – March 2009 (5 months) 50April 2009 – March 2010 101April 2010 – March 2011 156April 2011 – March 2012 200April 2012 – March 2013 170April 2013 – October 2013 (7 months) 100

Key issues from this audit were: Parents were the largest single group to access the advice line representing 86% of

all calls. When parents phone, they often say that another professional has suggested that they should call, for example, their health visitor.

Professionals working in schools were the second biggest group representing 10% of all calls.

A range of people access the advice line especially professionals working within health and education but they represent a very small number of individuals compared with parents. However, as mentioned above, other professionals do sign post parents to using the advice line.

It was interesting to see that professionals beyond Wiltshire’s borders were able to access the department using the advice line. They frequently said that they found the number from the SLT website. For example, speech and language therapy colleagues working for different NHS Trusts.

19 calls were signposted to different agencies and in particular for audiology assessments; some parents were advised to go to their GP for further medical assessments. For example, SLTs cannot take on voice cases unless the child has been examined by an Ear Nose and Throat Consultant.

Most people were seeking advice, especially the parents. The data also shows that a number of children were referred in to the service following the phone call. Some parents are given advice and it is suggested that if there is no change or progress over a period of time they should call the advice line again and referral to the service can be made then. The therapist answering the advice line makes a judgement based on the child’s age, what their current level of communication is and other information that the parent shares with them. Some parents and professionals use the advice line to check that referrals have been made and information has been received. They may also want to discuss a possible referral and how appropriate it

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is. Many parents and professionals are happy to receive emails with information and handouts that they can use. Parents are also signposted to the website for information.

There were some additional “one-off” enquiries that have been made to the advice line. These include calls from the relatives of adults who have acquired communication disorders and are seeking SLT. They are signposted to the adult service. A therapist from Scotland rang to ask permission to use some of the department’s handouts with her own clients.

A range of speech, language and communication needs that are discussed on the advice line. The majority of enquiries are about language development and speech problems. Some parents can be reassured when they are given the age norms for when children acquire specific sounds. Fluency can be a significant concern for some parents. The therapist has to try and establish by questioning if the problem is developmental or whether the child has a more significant problem that requires intervention. The speech and language therapy department has a wide range of handouts and resources that have been developed for anyone who contacts the advice line for assistance.

“No calls” are recorded and there were 43 days when there were no enquiries were made. Times when the line is not so busy are usually at holiday periods, for example, close to Christmas and New Year. There has been a steady increase in the number of calls made with a peak in the 2011/2012 period. This increase would be expected as more people know about the advice line. Professionals and parents who attend our commissioned training are always informed about our advice line and website and given fliers to take back to their work places.

The contact to the advice line from beyond the Wiltshire borders is testament to the marketing skills of the department.

Areas of good practice Parents are the biggest group accessing the advice line. The department is able to provide a significant amount of support and advice at this

first point of contact with the SLT service. Parents are able to refer their children to the service via the telephone advice line. The SLT service is effective in finding ways to market this universal service across

Wiltshire and beyond. For example, information on the advice line and website is included on all letters, reports, target sheets and emails that are sent out from the department.

Families are signposted to other agencies if appropriate. There are compliments associated with the advice line. For example,

Parent: “Thank you for your understanding and for your help today. I have received the attachments and look forward to using them.”

“Thank you very much. This information is really useful and it is good to see the things we are already doing and the additional things we can help … to do”

“Thank you for … resources”

Recommendations1. Therapists will inform all families, colleagues and settings about the website and

advice line.2. Fliers about the advice line and website will be included in all training packages to

alert people who attend our training courses. See below Appendix C.

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Training Programme 2013 – 2014

The Speech and Language Therapy service provided 48 courses during the year. Those attending the courses were Parents, Early Years Practitioners, Teaching staff including SENCOs, Head teachers, classroom teachers, Teaching Assistants, and staff from Children’s Centres, in total 484 attendees. Some of the courses have been delivered ‘under licence’ and are published training programmes. This includes the Derbyshire Language

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Scheme, the Makaton Beginners’ Workshop and Early Bird programme for Parents. Other courses have been written by the department to address the training needs of members of the ‘Team Around the Child’ across Wiltshire and are based on national research and standards.

In addition, 16 schools with 16 TAs and 160 pupils undertook the narrative therapy course.

The Dragons’ Den funding from GWH enabled the ELCISS (Enhancing language and communication in secondary schools.) pilot project to be undertaken in two secondary schools supporting 13 pupils and training 4 teaching assistants.

The training programme has been fully implemented across Wiltshire and has been highly successful and well evaluated working towards skilling the wider community to support children and young people with speech, language and communication difficulties.

Evaluation comments:“I am now more confident in what I have been doing.”“Strategies to use in class useful e.g. visual, pace of language”.“Liked hearing other people’s views and sharing ideas.”“Will look at the way a child is playing and what is behind the play now.”“It helped me relate back to the children I’m working with and I had the opportunity to share with others.”“Useful to look at behaviour from the child’s perspective.”

Development comments and future training considerations“Would like a longer course to understand in more depth.”“Asked for posters so could put on staff room wall”“Would have liked a handout on the different types of plans.” Asked for more visual resources so sent SENCo noise thermometer, ASD School toolkit, Black Sheep Press Practical Pragmatics and social stories handout with website for picture cue cards.”

Speech and Language Link setting model There are over 550 early years and school aged educational settings across Wiltshire. The challenge for the SLT department is to ensure that it meets the needs of all children with speech language and communication difficulties attending these settings by collaborating with the ‘team around the child’ and through delivering training. In order to be as effective as possible a ‘link setting’ model has been established. Each educational setting now has a link SLT who represents the service and sees all children in the setting regardless of their diagnosis or difficulties. Exceptions to this occur when therapists with additional postgraduate training are required to support children who have swallowing difficulties or problems with fluency.

This model of service delivery supports equity of caseload size across Wiltshire reduces time and cost of travelling prevents duplication, and ensures that each setting has a named professional with whom they are able to communicate directly.

This new model of service delivery commenced in September 2013 following a detailed caseload analysis of the speech and language therapy service across Wiltshire. The whole caseload was then reviewed again in February 2014 to ensure robustness in setting allocation.

This model enables a further layer of flexibility in the service to ensure it is responsive to the needs of children and young people with speech language and communication needs in

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Wiltshire. The SLT Department has a confident flexible workforce able to respond to different pressures and demands

Additionally commissioned activityIn addition to the core commissioned services other agencies have commissioned further training and support. This includes training in:

Talkboost, working with Wilshire Council to set up a programme aimed at narrowing the communication gap in 4-7 year olds.

Speech and Language Targets explained. Implementation of Makaton signing throughout the day. Autism training, with reference to communication.

The service also provided Quality communication environment observational audits for selected schools. Quality communication environment observational audits for Further Education

establishments. Specifically commissioned service bespoke to the school on a regular basis.

FinanceThe Children and Young People’s Speech and Language Therapy Services budget for 2013/2014 was made up of £1,228,329 pay and £93,830 non-pay.

The final outturn on pay was under-spend of £-23,397. There was an overspend on non-pay of £27,002.

The more significant non-pay overspends related to training expenses and materials £5,603 overspend; room hire £1,973 overspend; travel and subsistence £15,362 overspend; stationery £2,527 overspend; postage £4,889 overspend. Income was overachieved by £27,589. Cost improvement plans were not taken into account in the budgets this year but were held centrally by the Women and Children's Directorate.

Business plan 2014-15A business plan for the Speech and Language Therapy Service has been agreed for 2014-15 based on strategic priorities and local health and communication needs. The priority areas identified include:

On-going evaluation of service user experience, Audit programme aimed at monitoring quality and performance. Continued programmes to support partnership working. Effective management of resources including staffing. A comprehensive multiagency training programme. Continuing to develop easily accessible resources. Updating speech and language procedures. Developing the use of technology via video links to support target reviews, therapy

intervention and clinical supervision with an added advantage of targeting financial resources.

Working with the adult speech and language therapy team and Wiltshire Council colleagues to develop a 0 to 25 years service.

The complete business plan for 2014-15 can be found on www.getwiltshiretalking.org

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ConclusionThe paediatric speech and language therapy service across Wiltshire has completed four full years. The service is now well embedded as a training collaborative model. This ensures that all those supporting children and young people with speech, language and communication needs have access to training and to speech and language therapists and assistants. There continues to be an increase in referrals into the service of increasing complexity and the team has been very busy throughout the year managing this increase and supporting services into over 340 early years’ settings and 240 schools as well as district specialist centres, clinics and children's homes.

Training provided by the service continues to be acknowledged to be of a high standard and enables those trained to actively support children with speech language and communication needs in Wiltshire. Audits carried out by the service ensure that current practice is based on current research and evidence-based practice.

The success of the video clips enabling parents and professionals to access modelling of interventions where ever and whenever they wish has been another great success.

References

Matrix evidence, an economic evaluation of speech and language therapy. Marsh Bertranou, Suominen, Venkatachalam December 2010.

The Better Communication Research Programme (BCRP) December 2012 DfE

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