Integrating Speech and Language Therapy and Education- case study

Integrating Speech and Language Therapy and Education – case study

Recently, I was asked to work with a group of schools on a project to integrate speech and language therapy support into the school setting. This blog post is the first of two, summarising the work I did with the schools, which was needs led and bespoke for each school. I have attached the resources we used, which you can download and re-use.

Prior to starting the project, I thought about some of the possible challenges I might encounter. For example: 

  • Recent financial cuts mean there is an even bigger need for developing speech and language expertise within schools and embedding skills in the curriculum and daily routine.
  • We know that 10% of school aged children have long term speech, language and communication needs, 7% have specific language impairment and 1% have severe and complex speech, language and communication needs (The Communication Trust, 2014). However, only 3% of the school population is identified as having speech, language and communication needs.
  • Research tells us that 50% of children starting school in areas of deprivation enter reception with language difficulties. The schools that offered me the chance to work with them are in a very deprived part of the country.
  • Language underpins everything we do. Research shows that if children start school with language difficulties, and do not get the right support, they don’t catch up and the problems spread wider, e.g. to self-esteem, confidence, behaviour and engagement.
  • One size does not fit all. It takes time to find what works for each school and what the support could look like, but it must be right for them.

I asked each school what they wanted and what would be the best use of my time in their opinion. Each school asked for something different, which made this project very interesting.

  1. Training

Integrating speech and language therapy and educationI did a training session for all of the schools on speech, language and communication; the communication chain, possible breakdowns and their impact; supporting the invisible part of the chain – attention and listening and understanding language. It was a very interactive, practical session, with an absence of technical terms and jargon. I wanted language to be transparent and accessible, and I wanted to show the relevance of speech and language therapy to learning, social interactions and psychological wellbeing.

One of the schools asked for a training session for a group of their Teaching Assistants who were providing speech and language therapy support. We looked at:

  • Supporting attention and listening skills, in the classroom, why this is important and how you can do it.
  • Integrating speech and language therapy and educationUsing different types of visual support, how to increase and reduce support depending on the level of the child and visuals to support metacognition (see attached visuals and task planners)
  • Activities to use in the classroom to support attention and listening skills (see this earlier blog post)

They were keen to learn about supporting speech sound difficulties, so we started on cued articulation – part two is to follow! (see sounds for literacy website)

Download resources referred to in this section

Download ‘I know/ I don’t know’ visual

Download ‘Do I Understand‘ map

Download ‘Prompt to work out if you need help or not

Download ‘Steps To Independent Learning’

Download ‘Task Planner 1

Download ‘Task Planner 2

Download Task Planner 3

  1. Including parents in speech and language therapy support

One of the schools I worked with has a high proportion of parents who do not engage with the school, which impacts on helping the child. It is an area of deprivation and they want to work with parents more than they are currently able to. I attended parent drop ins, not held on the school premises, to give advice on speech, language and communication difficulties. The PTA helped me to talk to carers, which made it easier, but it was hard. There was a strong culture of mistrust.

Nursery practitioners in this school highlighted a group of children they had concerns about. We were able to observe and spend time with the children and unpick their difficulties together, which was extremely helpful as staff could see what I was describing to them. Practitioners described the children that they were most worried about as having speech difficulties as they found them hard to understand. Most did have some speech sound difficulties, but this was not the whole story. Three had attention difficulties and communication difficulties, e.g. they mumbled, smeared words into one another, did not direct language to others, and these contributed to difficulties understanding what they were saying. We worked with these children doing short, structured attention and listening activities and developing early social understanding and interaction skills (see attached programme). Parents came to sessions, which was great.

  1. Creating a language enriched environment

Integrating speech and language therapy and educationOne of the schools was concerned about the low language levels that children entering nursery and reception have and they wanted to adapt the environment to support this. We looked at ways of doing this and together we planned the following:

Using table top activities to develop understanding and use of vocabulary. We discussed verbs and nouns that staff could model in activities and play, testing understanding and then testing use of the words in context (see attached sheet to list words you are working on and record outcomes). For example, words to model on the craft table:

Integrating speech and language therapy and education1. Sticky 2. Shiny 3. To glue 4 to dry. Practitioners model the target words in context, i.e. when they are doing the craft activity with the child. Then, test understanding by asking, for example, “Show me something sticky” “Which one is shiny?” (offer a choice of two things) “Show me a picture that is dry” etc. Test at the end of the activity and the next couple of days. Then test to see if the child can use the word, e.g. leave a pause for the child to fill, “I’ve got glue on my fingers! Yuk! It’s really ______” pause and see if they say “Sticky” If they don’t, increase the prompt, e.g. “Oh what is that word! Look it is on my fingers! It’s ….?” If the child can’t name it, see if they can with a clue, e.g. “It begins with sti….” If they can’t go back to modelling it and testing understanding and try testing use again. We thought of word lists for the dinosaur table, the home corner, the doll’s house – all of the table top activities (see attached word lists)

Download the resources referred to in this section

Download ‘Testing of understanding of vocabulary in Early Years setting

Download ‘Verbs dinosaurs

Download ‘Nouns dinosaurs

  1. Identifying strategies to support speech, language and communication skills

We discussed strategies staff can use to enable children and support their speech, language and communication skills in all of the schools I worked in. For example:

  • Positioning: being at the child’s level so that they can see your face easily
  • Keeping language simple and giving time to process information
  • Reducing questions
  • Following the child’s lead rather than directing them
  • Using visual support, e.g. Makaton signing, symbols

We discussed choosing skills for practitioners to develop and using video as a reflective tool. I can’t say that staffed were overjoyed with this idea!

We also talked about giving reasons to communicate for children who have social communication and interaction difficulties. Toys, drinks and snacks are often accessible in nursery settings and the child can help themselves. Whilst this might help some children to become more independent, it can hinder others as it does not help them to develop social understanding or communication skills.

In the next post, I am going to talk about work supporting social communication in this project.

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