Speech and Language Therapy

Things to know about Speech and Language Therapy

Around 700 Speech and Language Therapists (SLTs) work for babies, toddlers, children and young people with speech, language and communication needs (SLCN) and / or eating, drinking and swallowing difficulties.

Speech and language impairments are the most common difficulties faced by children and the most common developmental delay. On average two or three children in every classroom will have some difficulties.

Anyone can make a referral to an SLT if they are concerned about any aspect of their child’s speech, language or communication – or they are wondering if it could be contributing to behavioural or emotional difficulties. Call your local health board or ask at any health care location for contact details.

If you require an appointment with an independent SLT, their services are listed by the Association of SLTs in Independent Practice (ASLTiP) see www.helpwithtalking.com/.

A recent survey of services showed that SLT services should offer a first appointment within 9-12 weeks of referral, where required, children wait 5-20 weeks for SLT intervention.

SLT assessment will normally involve a face to face assessment of the child’s speech, language and communication (SLC) development and interviews with parents, teachers and / or other significant adults.

The SLT will produce a report of her findings and make recommendations on the best way forward shortly after assessment. The report and recommendations are shared with whomever referred the child, parents, the child or young person and, with consent, any others involved. SLTs will meet with those concerned to work out a support plan.

The SLT’s decisions about the best way forward is informed by best practice and underpins the best way to help children develop SLC.

Legislation, policy and guidelines (e.g. Additional Support for Learning Act and Codes of Practice, Getting it Right for Every Child, Curriculum for Excellence etc.) are at the heart of planning support for children and their families.

Universal level SLT

What is it?
As the name suggests this sort of SLT is for all children.

The aim of universal SLT is to ensure that every child and young person (with or without SLCN) gets the best chance to develop SLC to their full natural potential.

The SLT works with parents, teachers and any relevant others to ensure that, as much as possible, the child or young person is constantly surrounded by people who know how to;

  • help their SLC develop
  • make sure the understanding and expressive language skills they have at any particular time work as well as possible for them – at home, in the classroom, at grannies, Brownies…wherever
  • identify when a child may have SLCN and how to access SLT if they are concerned.

Typically, at this level of service the SLT will provide training or workshops for parents, teachers, classroom assistants etc.; and work as part of general parenting programmes such as Triple P.

Why is it a good thing?
People tend to believe SLC development “just happens”. There is very little information and guidance available for parents to correct this misconception. SLC delay can therefore be due to a perfectly understandable gap in parents and other’s knowledge of how to support and encourage SLC development.

SLC develops and is used every waking moment of a child’s day. Every waking moment then is an opportunity to help a child develop SLC and have successful communication experiences. Improving the 24/7 support for SLC development and success through universal SLT input. It significantly increases the amount of informed SLC “input” a child with SLCN receives – far more than if “input” is restricted to one or two face to face SLT sessions a week.

Targeted level SLT:

What is it?
As the name suggests this sort of SLT has a narrower focus than universal. It is “targeted” at children and young people who are known to have a SLCN and where there is a risk of educational, emotional or other problems arising as result of their SLCN. That is children for whom “universal” level service isn’t enough. It also “targets” children and young people who are at high risk of developing SLCN as a result of, for example, their home circumstances.

The aim of SLT at this level is, as before, to ensure that these children and young people get the best chance to develop SLC to their full natural potential – and that the SLC skills they already possess already work as well as they can for them – while they are developing new skills.

The difference is the SLT input to the “communication environment” at home, school etc. is more focused, concentrated and carefully programmed.

Targeted level provision may be the main mode of SLT for children with SLCN depending on the capacity of those around the child to provide SLC support and how well the child’s SLC develops with this type of SLT.

For children with known SLCN, targeted level SLT generally involves the SLT

  • “Skilling up” parents, teachers, classroom assistants etc. to work on a 24/7 basis on particular aspects of SLC development such as vocabulary or asking questions or expressing feelings appropriately
  • Working with teachers and classroom assistant to adapt their language and the materials used for other children so that the children with SLCN can still understand and join in lessons on a day to day basis
  • Tracking SLC development through reports on progress from the teachers and others and offering support and advice on what to expect when, how to overcome particular difficulties etc
  • The option as always remains to for individual children to receive direct input where they are not showing progress with targeted levels of support

Why is it a good thing?
Children don’t need to wait to see the SLT directly before they receive enhanced SLC support to stimulate their SLC development.

Targeted provision is a way of providing 24 / 7 enhanced SLC support for children and young people with SLCN.

While a child is developing SLC skills they are still able to access broader learning opportunities. Their SLC difficulties don’t need to hold them back in every aspect of learning.

Children at high risk of SLC delay or disorder due to their life circumstances are given an extra boost by “extra skilled up” staff. 

Specialist level SLT:

What is it?
Specialist level SLT is the most direct form of service. As the name suggests it brings the most intensive SLT specialist knowledge and skills to bear on the child’s SLCN. It is provided for those children and young people with complex SLCN which require complex SLC development programmes or those with intractable SLCN which are not responding to universal and / or targeted provision.

It is commonly provided in episodes with targeted work in between the periods when the SLT sees children directly either individually and / or in a small group.

The aim of SLT at this level is, as before, to ensure that these children and young people get the best chance to develop SLC to their full natural potential – and that the SLC skills they already possess already work as well as they can for them – while they are developing new skills.

Not all children with complex SLC disability will be able to develop SLC skills to a level where they can understand or speak like other children. For these children the aim of SLT is to develop their understanding and expressive skills to the child’s fullest innate potential and to enable them to use those skills as effectively to communicate about as many topics in as many different places with as many different people as possible. That is – to optimise the usefulness of their full communication potential. This might mean developing the child’s use of Augmentative or Alternative Communication (AAC) systems such as sign language (Signalong or Makaton), symbols, photographs, and objects or “talking machines”.

Specialist level SLT will typically involve;

  • Detailed assessment
  • A child specific SLC programme which ideally integrates with the day to day school and home activities
  • Direct SLT and / or “indirect” SLT via other people trained to deliver the programme, for example parents, SLT assistants, nursing, teaching colleagues. Those providing “indirect therapy” are directed and supervised by the SLT. Just as nurses carry out care programmes designed by a doctors, under the doctor’s supervision – so SLT assistants may deliver SLT programmes designed by the SLT under the SLT’s supervision. The qualified SLT always carries ultimate responsibility for the quality of SLT. SLT provision by an SLT assistant therefore is not a “diluted” SLT service but a way of delivering “routine” SLT programme activities more often to individual children – and spreading qualified SLT expertise to more children
  • Training everyone delivering the programme and providing them with the necessary SLT tools or materials they need to do the work
  • Monitoring and alteration of the SLC development programme based on SLT observations and those of others delivering the programme

Why is it a good thing?
Parents, teachers and others like specialist SLT possibly because it is more “visible” than other levels of SLT and it fits in with the medical model of health care. That is – the clinician does something to the patient and they get better – no one else needs to get involved. As explained above however SLC doesn’t develop during sessions with an SLT – SLC develops and is used every waking moment of a child’s day so every waking moment is an ideal opportunity to help a child develop SLC and have successful SLC experiences. Not to use these opportunities is a waste.

Specialist level provision is focused on tackling those SLCN which require complex SLC development programmes and which need more than universal and / or targeted provision.