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Children and young people’s speech, language and communication needs- an introduction for health audiences

This short briefing has been produced on behalf of The Communication Council to be shared with key health audiences with responsibility for strategic planning, commissioning and delivery of services relating to speech, language and communication across England. It is intended as an introduction to the issue and it is hoped it will provide a starting point for further discussion, improvements and changes. The team at The Communication Trust are happy to discuss anything in the briefing and to work with colleagues across the health, education and social care sectors to address the issues raised in it. If you would like to get in touch please email [email protected]

Key points

(full document attached at bottom of page)

What is the impact of SLCN (Speech Language and Communication Needs) for the health and life outcomes of children and young people?

The impacts of SLCN on children and young people can be significant and wide-ranging, particularly if their needs go unidentified or unsupported.

Some statistics:

• Self-perceived quality of life is worse for pupils with SLCN than their peers, in particular difficulties with social acceptance and being bullied, moods and emotions.
• Limited language skills are a significant risk factor for mental health difficulties^.
• The attainment at GCSE of pupils with SLCN is significantly lower than their peers. Around 13% of pupils with SLCN gain 5 A*-C grades at GCSE. Nationally, 59% of all pupils and 69% of pupils who don’t have any SEN achieve this level.
• The attainment gap at GCSE is high, at 46% and widening.
• At least 60% of young offenders have SLCN.
• 88% of long term unemployed men have SLCN.

The Annual Report of the Chief Medical Officer 2012 included some excellent examples of the potentially avoidable long term issues that unmet SLCN can have on children and young people. The report listed poor speech and language development as an adverse child health outcome associated with risk factors which

“play a fundamental role in determining the life chances for that child”.

The report highlights the role early identification needs to play in order to improve the life chances of children as they progress into adulthood, and contextualises the issue well with examples from the impacts SLCN can have. It is important to note that “acting early does not mean just acting in early life”, but as early as needs occur, at any point in the life course- the earlier needs are identified the earlier they can be acted on. It is a widely recognised public health message that prevention and early support are preferable to later intervention and treatment.

What can be done to improve outcomes for children and young people from the health perspective?

“We need to stop thinking of spend on healthcare for children and young people and instead think of investing in the health of children and young people as a route to improving the economic health of our nation.” - The Annual Report of the Chief Medical Officer (CMO) 2012[11]

Areas in particular where health colleagues can make a real impact for the outcomes of children and young people with SLCN include:

• Spreading the word about the importance, prevalence and impact of SLCN to colleagues across the health sector, this will be especially important for new health bodies including CCG’s and Health and Wellbeing boards in particular.
• Understanding the importance of early and effective identification of SLCN in socio-economic groups where there are often issues relating to appropriate identification. This includes children and young people living in areas of social deprivation and also some ethnic groups. Ensuring appropriate equality monitoring and cultural competence are part of planning and providing services for SLCN will be important for practitioners and those with responsibility for strategic planning, as with any health provision focussed on minority groups.
• Recognising the importance of speech and language therapists (SLTs) in providing prevention and promotion services in local areas to aid early support and identification of SLCN, helping to stop needs going unmet.
• Being able to offer timely, specialist SLT assessments and interventions, to those children and young people identified as having SLCN.
• Supporting and investing in the crucial role SLTs play in ‘bridging the gap’ between health and education and working collaboratively with colleagues in settings in both sectors to do so.
• Prioritising SLCN as an area for both initial training and CPD for professionals working directly with children and young people such as GP’s, school nurses and health visitors, particularly considering the current government commitment to expand and transform the health visiting service to ensure that children have the best start in life. It must also be an area of understanding for those responsible for commissioning services locally and nationally.
• Recognising the essential importance of specialist SLT services in helping to achieve the above by increasing the knowledge, skills and confidence of the wider workforce.
• Getting positive outcomes for children and young people with SLCN by ensuring it’s an issue that is recognised and included within the Joint Strategic Needs Assessment (JSNA) process.
• Prioritising clarity about the specialist and local commissioning services for AAC support and making sure the provision available through both of these routes is sufficient to meet identified need. It will also be essential for long term sustainability that data interrogation and local approaches are used to ensure potential areas of unidentified need for such services are picked up and improved.
• CCGs need to be supported to understand local health needs in relation to SLCN and the savings and impact planning for and commissioning SLCN services to meet the local health population needs can have in the longer term. A good example of this would be that they could buy in a higher level of evidenced early years intervention for language and communication, including SLT services, for deprived areas where evidence has shown there is likely to be a high incidence of language delay in school entry age children. This pro-active effort would work to ensure more children were supported to ‘catch up’ early, saving on more costly assessments and interventions for those children later in their development.