Early Intervention Helps Children Communicate in Kent

Children who start primary school unable to communicate effectively are at a serious disadvantage. Bewildered by what is going on around them, and ignored or pushed aside by their fluent peers, they struggle to make sense of school and may never catch up. All too often, although they may be of normal or high ability, they find themselves in a specialist unit, with a statement of special educational needs.

Early intervention to help these children with their specific language problems can transform their prospects. In Kent, the NHS and the county council have joined forces to develop a service that shows how timely, intensive therapy can help most of these children make a smooth transition to their local primary school. It has been validated by C4EO as an example of good local practice.

The service, developed under the umbrella of communication charity I CAN’s Early Talk programme, evolved as the result of concern among speech therapists and specialist teachers in the town of Ashford.

“We were becoming more and more worried about the number of children with severe speech and language difficulties who needed to attend a specialist unit rather than their local primary school,” says Helen Waymouth, head of paediatric speech and language therapy at the East Kent University Hospitals Foundation Trust.

“We also recognised that offering children with these specific difficulties 45-minute speech and language therapy sessions in isolation from the support they were getting at their nursery was not going to help them much. So we decided that a joint approach was needed, engaging parents as co-educators in a therapy programme that could be delivered in a nursery or children’s centre, or at home.”

The Ashford service, called Ashford Better Communicators, is targeted at two to five year olds with severe communication problems but who are otherwise developing normally. Speech and language therapists and specialist teachers assess the child’s needs and provide 12 weeks of tailored therapy at a nursery based in a children’s centre. This is followed by more support when they return to their home nursery and further help with the transition to primary school.

Since the scheme started in 2005, more than 40 children have passed through the Ashford service. In that time, six out of seven have moved on to their local primary school and some have required no further help with communication. Last year, (2008-9), 80 per cent of children showed an increase in use of language and only one in 12 needed a statement of special educational needs.

Working with I CAN is particularly helpful as the charity is used to cross-sector working, say the staff involved in the service. It has provided training for the speech and language therapists (health service) and specialist teachers (education) who are working together on communication skills in early years settings. The charity also set rigorous criteria on staffing and practice that had to be met before the Ashford centre could be accredited as an I CAN Early Talk Specialist Centre in 2006.

“It kept us focused – rather like preparing for Ofsted, but in a more positive way,” says Helen Waymouth.

Meanwhile, a peripatetic version of the early intervention model has been tried out in the deprived east Kent district of Thanet and has also proved very successful. This scheme, which involved giving intensive therapy to pre-school children in their home and nursery, was piloted in 2008-9. Of the nine children with severe communication difficulties involved in the pilot, seven made clear progress with speech and vocabulary and three needed no further intervention.

Now the Thanet peripatetic scheme is being extended from April 1 across more of the coastal towns and Canterbury.

And the cost of this intensive intervention? Much less than the cost of not intervening, according to Martin Cunnington, an NHS senior commissioning manager for disabled children, who jointly commissions the programme with Kent County Council.

Before the ABC service was established in Ashford, four out of the 12 pre-school children found to have severe language difficulties would have needed a specialist unit place, at an annual cost of £22,000, and the same number would have needed a statutory assessment of special educational needs, costing £15,000 each, giving a total in one year of £82.000. In 2007, the total annual cost of the ABC service was reckoned to be £46,300.

"Through intervening early, the ABC service and the Thanet pilot have been able to show a reduction in demand for specialist services and statutory assessments, enabling the NHS and the county council to use their finite resources more efficiently," says Mr Cunnington. "But we also know that the cost to the nation of failing to intervene early to help a child with communication difficulties is considerable - and can amount to more than £150,000 by the time the child is 16."

He stresses the need to identify dedicated resources for the scheme and to have contingency funds in place to cover staff sickness and vacancies. And he says a strategic level commitment to mainstream an effective service once it has gone beyond the pilot phase is vital. That means a commitment to dedicated staffing from all agencies and, perhaps, a pooled or aligned budget.

 Kent wants to mainstream the multi-agency approach to helping pre-school - and older - children with their communication needs. It aims to launch a multi-agency commissioning framework for speech and language therapy throughout the county.

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