The accelerated roll-out of NELI (Nuffield Early Language Intervention) in response to disruption caused by Covid-19 has highlighted the role of targeted interventions for supporting pupils with SLCN / weak oral language skills.  Of course, NELI is not the only school-based language intervention available and other programmes such as Talking Partners (Primary and Secondary), Language Link, Narrative Programmes, and Talk Boost have been running for some time.

Rightly, a lot of effort has been spent on evaluating such programmes and trying to ensure they work.  However, in recent years, as I have seen such programmes come and go in schools, I have increasingly wondered whether we need to be asking the question, ‘is it sustainable?’ as well as, ‘does it work?’

In my experience, interventions often start with a fanfare and a lot of enthusiasm.  But a year or two down the line, many of the resources may have gone missing, the intervention might be running but perhaps only once a week, or maybe the trained staff members have moved to new roles or new schools.  A head teacher once told me he reckoned any group intervention in a school had a shelf life of up to three years – regardless of whether it works or not.  Sadly, I have seen this come true time and time again – despite strong data demonstrating the impact of an intervention, it stops being delivered.  Something else takes priority, a staff member leaves, there is no longer time for it.

Yet undoubtedly the need that was there when the intervention was first introduced will still be present – there will still be children with SLCN and impoverished language development, children who would benefit from the interventions.

This led me to think about how school-based interventions could be designed in the future – not just for speech and language but for literacy, mental health, physical fitness.  What if it were possible to identify factors that support an intervention being sustainable?  What if they could be built into the design and delivery of the intervention.  What if that shelf-life could be increased from three to five or six years, or more?

These questions led me to Anna Moore, research officer with the Anna Freud Centre.  Anna is currently working on her PhD with the Evidence Based Practice Unit at UCL looking at exactly this question in relation to school-based mental health inventions.  Her blog post relating to this is below:

https://www.ucl.ac.uk/evidence-based-practice-unit/news/2020/dec/sustainability-school-based-mental-health-interventions-why-it-important

Anna and I agree that the barriers to sustainability of mental health interventions are likely to be very similar to the challenges of sustainability of Speech and Language interventions.  And of course the relationship is in some way even closer than that given the higher incidence of mental health difficulties in children and teenagers with SLCN.

So in the first week of July 2021 we are planning to hold an online discussion about this.  Anna will explain her work, but also we want to hear from therapists working in schools about their experiences of published interventions like Talk Boost, Talking Partners, Language Link, Narrative, NELI.  We’re hoping to find out how successful these are in terms of outcomes but also sustainability.  What have been the challenges to sustainability? If an intervention has been maintained for a number of years, why is that? What are the ingredients that help to make an intervention sustainable?

If you would like to participate in this discussion, please email me at office@springboardspeech.org.uk.  We would like to hear a range of therapists’ insights into this important question, and if you know of Teaching Assistants, Teachers or SENDCos who would also like to contribute we would love to hear from them too.

Many thanks,

Chris

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A quick guide to ‘active listening’ or ‘comprehension monitoring’

A child who has typically developing language will usually – even when quite young – tell you when you have said something they didn’t understand or they will ask what an unfamiliar word means.

Children with language needs do this rarely if at all.  The reason is that they don’t have the same obvious distinction between understanding and not understanding that other children do. They are used to only understanding SOME of what is being said. Most of us can relate to being in a different country and not knowing much of the language – we hang on to key words in sentences and use the clues around us to try and work out what is being said. Children with difficulty understanding language may be experiencing something similar in class, and not have the skills or awareness to ask for clarification.

The positive news is that this is definitely a skill that can be taught and improved. A couple of key points:

• A whole-class / school approach is important. Encourage ‘comprehension monitoring’ as a positive learning skill.

• Explicitly discussing with students (as a whole class or in small groups) the variety of reasons why we might not understand is important. Asking the speaker to “say it again” won’t always solve the problem and so working out WHAT has not understood helps the student seek the RIGHT clarification. For example:
• weren’t paying attention = “Please can you say it again”
• it was too much to remember = “Can you tell me one thing at a time”
• unfamiliar words = “What does X mean?” “I don’t know that word yet”
• didn’t make sense e.g. ‘get the red books’ when there are no red books there = “there aren’t any red books”
• non-literal language was used e.g. ‘we’ve got to pull our fingers out now’ = “That doesn’t make sense to me” “I don’t know what you mean”

Two excellent resources are:

“Active Listening for Active Learning” (ISBN: 9781898873617) which contains much more information on this area, including screening tools, whole class resources and group session plans.

“Helping Children Hang on to Your Every Word” (ISBN-13: 978-1898873532) – an easy to read book looking at the range of aspects involved in children being able to focus fully in class.

We can help schools implement this approach and provide further training in this area.

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When a child has speech sound difficulties which make it hard to understand them it can be really frustrating for the child and those who look after them.

For some children, therapy can bring about a big improvement in clarity fairly quickly but for others it will take longer.

Here are some things you can do to help in the meantime:

(1) Information is key! Knowing in advance the things a child is likely to talk about (the names of their family members, pets, friends, favourite TV programmes, toys, cartoon characters, places they go regularly) can make a huge difference. If you are a parent, you could make a list for your child’s teacher or key worker or even better make a small photo book with your child to take in and share.

(2) Encourage the child to use pointing, gestures, taking you to the thing they are talking about, mime, find a picture, to back up their speech (all those things you do when on holiday in a country where you don’t speak the language!).  If you do these things when you talk, the child is more likely to do the same when they talk.

Some children will also be helped by learning some simple sign language (e.g. Makaton) to support them while they are working on their speech.

(3) Find out about any patterns in the child’s speech as this can really help you work out what they might be saying e.g. a child that comes to mind has an unusual pattern where ‘m’ ‘p’ and ‘b’ are replaced with ‘g’.  Once you know this when they say, “guy gall” you can try putting m/p/b in instead and work out they are saying “my ball”!

(4) Even when a child isn’t able to copy the correct version when you say it to them, it is still helpful for them to HEAR how a word should sound. Therefore try and repeat words back to them in a relaxed and natural way, so they can listen to how it should sound.

So, if a child said, “Can I borrow the didderd?” I might say, “Can you borrow the scissors? Yes of course…here they are…scissors.”

(5) Other children can sometimes help you out. They often tune in better than adults and can tell you what is being said. This is a double-edged sword though as you have to make sure that those children don’t jump in every time!

(6) Narrowing down the topic can help so asking yes / no questions can be helpful e.g. “Is this something that happened at the weekend / home / at break?” “Is it something you saw on TV?”

(7) Having to repeat yourself lots of time is annoying! Therefore try and tell the child everything that you DID understand e.g. “Oh so you went somewhere with Daddy at the weekend and then……” This means they don’t have to say the whole thing again just the bit you didn’t understand.

(8) Share the responsibility for the difficulty understanding “My ears don’t seem to be understanding very well today” and try and end with a plan if you have not been able to work out what they were trying to say:

• Shall we see if (grown up) can help us out when they pick you up?
• Shall I keep thinking about what you were saying and see if I work it out? (this really can help)
• Shall we see if X (friend or sibling) can help us out?

Should I pretend to understand when I haven’t?

Being honest most of us have had to do it at times. However, children seem to spot it a mile off and some get very cross and will wait until you repeat back what they say so they can be sure you have really understood! Whenever you can try some of the suggestions above first.

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Here’s a quick sense of what usually happens from the point of view of everyone involved.

Child
There will always be a ‘warm up’ time at the beginning which varies according to age but is something like looking at a favourite book / toy, drawing a picture, or playing together (without any pressure from the therapist to speak or make sounds).

The main part will be saying lots of words – through play, naming objects, naming pictures in a book (often a specially chosen assessment book so all the sounds are covered). We will then ask the child to try and make all of the individual sounds and maybe try out some sound combinations to see how able they are to change their speech at that time.

There may be some listening games too, such as seeing if they can hear the difference between similar sounding words ‘chop’ versus ‘shop’ ‘sky’ versus ‘sigh’ etc.

We will usually have a quick look in their mouth to check everything is working as it should be. We tend to pretend to be a doctor or try and guess what they had for breakfast!

In our experience most children enjoy their assessment – they get lots of attention, encouragement, and there’s usually a game or two involved somewhere!

Parent
We aim to get most of the background information we need (e.g. if your child has any hearing issues, which sounds / words you notice as being difficult to say) before the session so we can get straight on with the assessment when we meet. It can be frustrating for children if we have to talk about this for a long time when we meet.

It is common for children to feel a bit on the spot (especially if they are younger) at the start of the assessment. We are very used to this and plan assessment sessions with enough ‘warm up’ time. We may also ask you to lead some of the play / looking at books with your child while we hold back and transcribe what is said.

Therapist
We collect lots of examples of how your child says words. We then analyse them to work out what is happening; whether there is a difficulty, what kind of difficulty it is, and what needs to be done to help.

Sometimes it is an issue with a particular sound, such as an unusual way of saying ‘s’. Sometimes it is far more complex with many sounds and words affected meaning the child’s speech is very hard to understand. We therefore have a lot more analysis to do in these cases. It’s like solving a complicated jigsaw puzzle and we enjoy it!

We then get onto the best bit – therapy and the pleasure of seeing children’s speech improve.

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We were given a set of Sandra Boynton books from American relatives when our first child was born and we quickly fell in love with them. They are well crafted rhyming books with fun / silly elements and are packed full of things to talk about.

One of my favourites is ‘The Going to Bed book’.  It’s the story of a group of animals living on a boat who go through their bedtime routine (including an exercise session on the deck!).

It is packed full of potential to use as a base for speech and language activites:

(1) Vocabulary – animal names, different forms of exercise, things you need at bedtime.
(2) Sequencing – brushing teeth or having a bath routine (some useful pictures on Twinkl’s website for this).
(3) Retelling the story (narrative skills) – act it out as you go along – the story lends itself well to this.
(4) Play skills – act out the story with props (as in the photo).
(5) Rhyme – go through and spot the rhyming words together.
(6) Early literacy skills/phonological awareness – work out which animals have 1/2/3 syllables when you clap out their names
(7) Descriptive language- take turns to describe your favourite pyjamas or your duvet cover.
(8) Practise a concept such as ‘after’ e.g. ‘What did they do after they brushed their teeth?’ ‘What do you do after you brush your teeth?’ Then look for ways to talk about ‘after’ in the rest of the day e.g. when retelling the day together.

Phew! One little book but loads of language opportunities. Enjoy! 

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