A randomised controlled trial of the effectiveness of parent-based models of language intervention for 2- to 3-year-old children with speech, language and communication needs (SLCN) in areas of social disadvantage.

BACKGROUND: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. AIMS: To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. METHODS AND PROCEDURES: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. OUTCOMES AND RESULTS: One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found. CONCLUSIONS AND IMPLICATIONS: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes.

Children with speech, language and communication needs: their perceptions of their quality of life.

BACKGROUND: This study is part of a programme of research aiming to develop a quantitative measure of quality of life for children with communication needs. It builds on the preliminary findings of Markham and Dean ( 2006 ), which described some of the perception's parents and carers of children with speech language and communication needs had regarding children's experience of quality of life. However, this earlier study did not observe and evaluate the perceptions of children themselves and consequently left a vital gap in the evidence. The study reported here seeks to address this by describing the quality of life experiences reported by children and young people themselves. AIMS: The study aimed to provide a qualitative, child-centred, description of the quality of life experiences of children and young people with speech language and communication needs. METHODS & PROCEDURES: The study used a qualitative methodology to provide a credible and thick description of the quality of life experiences of children and young people with speech language and communication needs. Children and young people participating in the study were selected to represent a range of speech and language pathologies, according to their capacity to comprehend and participate within the data-collection activities. A modified focus group technique was used as a method of data collection and data were analysed according to the principles of Grounded Theory and Framework analysis. OUTCOMES & RESULTS: Seven focus group interviews were conducted with a range of children and young people in full-time education and in receipt of speech and language therapy. The data showed a number of key themes regarding children's quality of life experiences. These themes ranged from the participant's perceptions of what improves their daily lives to the difficulties they experience and consequently the negative impacts perceived on their quality of life. CONCLUSIONS & IMPLICATIONS: This study illuminates the quality of life experiences of children with speech language and communication needs. The findings are of direct benefit to clinicians, researchers, and policy-makers alike as they broaden the understanding of children's speech and language difficulties. Despite the potential bias inherent in qualitative research with children, the findings provide support for the development of a quality of life scale for children with speech language and communication needs. Such an outcome measure would enable clinicians and researchers to quantify children's quality of life, thereby broadening the range of clinical outcomes available.

Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay.

BACKGROUND: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness. AIMS: To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis. METHODS & PROCEDURES: Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group (n=10) received standard individual general care. The comparison group (n=12) received PBI. OUTCOMES & RESULTS: After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care. CONCLUSIONS: Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach.