Stoke Speaks Out: supporting speech, language and communication
A city-wide, multi-agency strategy in Stoke on Trent to tackle the high incidence of speech and language delay identified in children in the early years.
Background
Early language is recognised as a key child wellbeing indicator which impacts on social, emotional and learning outcomes. Speech and language skills are essential for children’s development and readiness for school. They help a child achieve their potential which in turn enables higher educational attainment, better employment and improved life chances in the future. Conversely, difficulties with early language development can negatively affect the life chances of a child and such effects can continue on into future generations.
Difficulties in early language development can lead to:
- educational disadvantage resulting in reduced school readiness and poor academic achievement.
- emotional and behavioural difficulties such as increased risk of ADHD and anxiety disorders in adolescence
- risky behaviours, for example more than 70% of young people in the youth offenders system have a communication disability
- issues with criminal justice: 50% of the UK prison population have language difficulties, compared to 17% of the general population
- economic disadvantage, shown by 12% average lower earnings among those with inadequate literacy skills, who are also twice as likely to be unemployed at age 34
- a threefold increased risk of mental health problems in adulthood
What was involved
In 2004 a local prevalence study in Stoke on Trent indicated that as many as 64% of 3-year olds in Stoke-on-Trent presented with significantly delayed language on entry to nursery. This led to a collaborative, multi-agency strategy being developed called Stoke Speaks Out. Its vision is to ensure speech, language and communication are supported at every contact point, from antenatal information through to early identification and first line targeted interventions, to enable every child to have the best start in life.
Stoke Speaks Out has been a whole city approach since 2004. Its aim is to make communication ‘everybody’s business’ and ensure that the city has united, clear, evidence-based messages, early identification and clear targeted programmes in place to support children’s early language development.
What worked well
The strategy has enabled all services to sign up to shared joint messages around early speech, language and communication and shared ways of working. A multi-agency training framework has been developed, resulting in improved confidence of practitioners and parents and shared key messages around speech, language and communication as part of public health campaigning. Training has so far been delivered to over 8,000 practitioners.
Stoke Speaks Out has resources to support practitioners such as the ‘staged pathway’ to give pre-referral guidance, and a screening tool for all children aged 2 to 5 years to assist early identification and allow targeted interventions to support those children identified by the screen. This is being used by every nursery and school in the city. All practitioners have been trained, both to administer the tool and in early intervention packages.
A further School Readiness Programme over 3 years (2015 to 2018) embedded systematic good practice across all private nurseries and maintained schools in the city.
Evaluation indicates that the shared clear public health messages in the city around speech, language and communication messages are reaching parents in all communities. The programme has improved the quality of referrals to core service speech and language therapy. Over 30 settings have achieved the ‘Stoke Speaks Out communication friendly award’.
All early years settings and schools in the city have been trained to use the Early Communication Screen and they routinely screen their children aged 2 to 5 years. They have also been trained in early intervention packages for those children identified as needing support. Stoke Speaks Out has had a marked impact: from October 2017 to July 2018 the percentage of children in high need of early language development reduced from 29.8% to 11.6%, while the percentage of those who were on track or ahead on early language development improved from 38.6% to 57.2%.
Return on Investment (RoI) calculations in 2016 indicated that in the short term, £1.19 worth of value was created for every £1 invested while in the long term the programme showed a return of £4.26 for every £1 invested.
What could be improved
It can be challenging to improve speech and language skills in a systematic way, as this is not a quick fix and it may take a whole generation to create change. Furthermore, for sustainability, the focus needs to be on embedding and sharing practice with a very wide workforce.
Funding is inconsistent and changes of funders’ priorities mean that outcome measures, milestones and focus have to be flexible. This makes it essential to have an active overarching strategy which is able to adapt to current funding priorities.
Next steps
The city-wide multi-agency strategy is continuing and developing. Since 2018 Stoke Speaks Out is undertaking an Opportunity Areas Programme funded project to work with targeted schools to enhance early years practice.
Further information
Janet Cooper, Early Language and Communication Strategy Lead, Children, Adult and Family Services, City of Stoke-on-Trent