Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention.

BACKGROUND: A manualized language therapy developed via a randomized controlled trial had proved efficacious in the short-term in developing expressive language for mainstream primary school children with persistent language impairment. This therapy had been delivered to a predetermined schedule by speech and language therapists or speech and language therapy assistants to children individually or in groups. However, this model of service delivery is no longer the most common model in UK schools, where indirect consultancy approaches with intervention delivered by school staff are often used. AIMS: A cohort study was undertaken to investigate whether the therapy was equally efficacious when delivered to comparable children by school staff, rather than speech and language therapists or speech and language therapy assistants. METHODS & PROCEDURES: Children in the cohort study were selected using the same criteria as in the randomized controlled trial, and the same manualized therapy was used, but delivered by mainstream school staff using a consultancy model common in the UK. Outcomes were compared with those of randomized controlled trial participants. OUTCOMES & RESULTS: The gains in expressive language measured in the randomized controlled trial were not replicated in the cohort study. Less language-learning activity was recorded than had been planned, and less than was delivered in the randomized controlled trial. Implications for 'consultancy' speech and language therapist service delivery models in mainstream schools are outlined. CONCLUSIONS & IMPLICATIONS: At present, the more efficacious therapy is that delivered by speech and language therapists or speech and language therapy assistants to children individually or in groups. This may be related to more faithful adherence to the interventions schedule, and to a probably greater amount of language-learning activity undertaken. Intervention delivered via school-based 'consultancy' approaches in schools will require to be carefully monitored by schools and SLT services.

'Thinking for two': a case study of speech and language therapists working through assistants.

BACKGROUND: Many speech and language therapists (SLTs) in the UK work with speech and language therapy assistants, and the numbers of SLT assistants is expected to grow. There has been very little empirical investigation of how SLTs feel about this situation or the effect on working practices of working indirectly. AIMS: To investigate SLTs' opinions on working with SLT assistants in a small-scale research case study. METHODS AND PROCEDURES: The study design was a case study of five SLTs delivering intervention within a research intervention project. Prepared questionnaire and formal interview techniques were used to elicit opinions on working through assistants, and a content analysis was performed. OUTCOMES AND RESULTS: Although respondents could see value in working through assistants, they stressed the time required to do so and the difficulties of adapting and updating therapy plans when working indirectly. CONCLUSIONS: The study suggests a variety of factors that have to be carefully managed if SLTs are to work competently through assistants.

Becoming a manual occupation? The construction of a therapy manual for use with language impaired children in mainstream primary schools.

BACKGROUND: The construction of therapy protocols for a large-scale randomized controlled trial comparing speech and language therapists and assistants, and group and individual therapy approaches for children aged 6-11 in mainstream schools is outlined. AIMS: The aim was to outline the decision-making processes that led to the construction of the research therapy manual, and to give a preliminary report on compliance with the manual. METHODS & PROCEDURES: A search of the research and professional literature and of published therapy materials was conducted to locate usable examples of effective language therapy for primary school children. Results were collated into a manual of therapy principles and activities to structure research intervention. The use of the manual with children (n=30) receiving individual or group direct therapy from a speech and language therapist in the first phase of intervention was audited. OUTCOMES & RESULTS: Very few high-level research studies were found, but the professional literature gave added information. Therapies for comprehension monitoring, vocabulary development, later grammar and narrative were adapted for the research intervention, and procedures compiled into a manual to guide research speech and language therapists and assistants. The audit of direct therapy suggested that the manual was useable, providing a suitable range of activities and materials for therapy intervention. Its use helped to record the therapy offered to research children, and formed a sound basis for discussion amongst speech and language therapists and between speech and language therapist/assistant pairs. CONCLUSIONS: The construction and use of a therapy manual allowed the provision of replicable therapy within the research project whilst maintaining flexibility.