Children with Speech, Language and Communication Needs

Transcription

1 Children with Speech, Language and Communication Needs Health Needs Assessment December 2013 Author: Andrea Clement - Public Health Specialty Registrar Supervisor: Dr Mashbileg Maidrag - Public Health Consultant Date for Review: December

2 Contents Executive Summary...3 Introduction What is the issue and why is it important for Suffolk? Which population is this needs assessment about? What is the focus of this needs assessment? Expected numbers, distribution and pattern by person, place and time Existing services Service Use Stakeholder experience Evidence of Effectiveness Information gaps Conclusions Recommendations Glossary References Appendix A. Services for Children with Speech, Language and Communication Needs 70 Appendix B: Summary of reports produced by the Social Research Unit and Scottish Collaboration for Public Health Research and Policy on early interventions

3 Executive Summary This needs assessment has been undertaken in order to establish whether the current Speech, Language and Communication service provision is sufficiently meeting the needs of children and young people in Suffolk. Speech, language and communication can have a significant impact on a child s health, social and educational development. The definition of what constitutes a speech and language problem has been subject to some debate and is often used differently. Estimates of the prevalence of children with speech and language impairments vary according to the type of data collected. The national prevalence of speech, language or communication needs is estimated to be around 10% of all children (Law, 2000), 6% of which are children with specific and primary speech and language impairments. If this prevalence rate is applied to the Suffolk child population, there may be up to 16,000 children aged between 0-18 (inclusive) with primary or secondary speech, language and communication needs. Services within Suffolk for children with speech, language and communication needs are provided at a universal, targeted and specialist level. The key findings are as follows: National prevalence figures suggest that there may be around 600 children within Suffolk with a speech, communication or language need who may not be accessing appropriate services. This may be due to them being unknown to the services or not able to access a service. There is concern around access to Speech and Language Therapy (SLT) services within Suffolk with long waiting times for therapy following an initial assessment. This may be due to a lack of resources and an increased number of children with increasingly complex needs. There appears to be a lack of clarity around referral pathways and procedures between providers of children s services although work is currently underway in the SLT service to improve this. There is insufficient data regarding ethnicity, postcode and condition for referrals to Suffolk SLT services, and no data could be accessed for the Language Units and Hearing Units. There is inconsistency in way in which service users and their parents/carers are engaged in services. 3

4 The following recommendations for action are made: 1. Consider improving joint commissioning between Suffolk County Council and NHS Commissioners and develop an integrated approach by identifying whole pathways and processes with clear guidance on where and how each service links up, and the roles and responsibilities of each stakeholder. 2. Building upon the work already underway within the SLT service, consider how referral criteria and referral pathways could be developed and clarified and how these processes can be disseminated to the wider workforce. 3. Review the current data collection systems and develop a common information system where appropriate and method of information sharing amongst clinical commissioning groups (CCGs), provider services and Children and Young People s Services at Suffolk County Council. 4. The survey undertaken among professionals providing children and young people s universal services highlighted a possible need for further training in identifying children with speech, language and communication needs (SLCN), referral processes and providing advice to parents about SLCN. Further investigation is required to ascertain the extent of this need and whether this is a common theme in other settings/groups of early years professionals. 5. Consider whether there is a need to expand existing early intervention programmes for children and their parents to aid in preventing speech and language issues. 6. Consider undertaking a review of the process for allocating statements and the provision of speech and language therapy for children with statements in relation to the additional funding currently provided by Suffolk County Council. (It is understood that this will be undertaken as part of the current reforms being lead by Suffolk County Council). 4

5 Introduction This needs assessment was requested by commissioners in Suffolk and was undertaken between October 2012 and December It includes description and data relevant to Suffolk (including Waveney), although further assessment of Waveney services would be beneficial due to a focus on Suffolk in this report. Due to the workload and working pattern of the author, this needs assessment took place over a longer period of time than originally anticipated. It should therefore be noted that work is already underway on many of the recommendations presented in this report. 1. What is the issue and why is it important for Suffolk? 1.1 This needs assessment will assess whether the current provision is sufficiently meeting the needs of children and young people in Suffolk. Nationallevel evidence has suggested that speech and language services can have high variability and a lack of equity, with a greater need for joint working, early identification of children with speech, language and communication needs (SLCN) and improved communication. Additionally, concerns have been raised by local commissioners around access to services and therapy. 1.2 Evidence suggests that speech and language difficulties can have a significant impact on a child s health, social and educational needs (Lindsay et al, 2000). 1.3 Some speech and language needs are evident from birth, others only become apparent in later life such as at secondary school (Bercow, 2008). Speech, language and communication needs may include the following:- Disordered speech and/or language (as a result of specific medical condition or origin unknown) Delayed speech and/or language (as a result of specific medical condition or origin unknown) Hearing impairment Stammering Voice difficulties Socio-communication difficulties (associated with children with autism). 1.4 For the purposes of this report, speech, language and communication needs (SLCN) will be used to collectively describe speech, language and communication difficulties, disabilities and impairments. SLCN can be classified into three groups (Jordan, 2010): 5

6 Primary needs: these are SLCN in the absence of any identified neurodevelopmental or social cause. Secondary needs: these are SLCN which are present in association with another need, i.e. a cognitive, sensory or physical impairment. Transient needs: these are SLCN which are linked to limited experience, for example some children from socio-economically disadvantaged populations can have speech and language skills that are limited when compared to other children of the same age. 1.5 Those who struggle to communicate are at a high risk of poor outcomes in terms of education achievement, behaviour, vulnerability, mental health, employability and criminality (CSP, 2011). It is therefore essential that appropriate services are available and accessible to those who require it from an early age. Health Outcomes 1.6 Children with SLCN require healthcare appropriate to their level of need. This includes speech and language therapy, use of appropriate aids and technologies and interventions for associated health needs such as learning disabilities. 1.7 Aside from health needs directly associated with SLCN it is reported that children who had poor vocabulary at age five are one and a half times more likely to have mental health problems at age 34 than children who did not (Office of the Communication Champion, 2010): Poor communication is a risk factor for mental health (Snowling et al, 2010). 40% of 7 to 14 year olds referred to child psychiatric services had a language impairment that had never been suspected (Cohen et al, 1998). Without effective help a third of children with speech, language and communication difficulties need treatment for mental health problems in adult life (Clegg et al, 1999). 1.8 Contrary to the above, Arkkila et al (2011) reported in a questionnaire based study of children with and without SLCN that the only significant differences between children with specific language disorder and controls was in the area of speech and sleep patterns. 40% of children with specific language disorder felt they had problems at school with speech. Social Outcomes Social Relationships and Development 1.9 SLCN can have a significant impact on a child s social development outcomes. It has been found that children with SLCN are more likely to 6

7 experience emotional and behavioural problems. Because of their need, these children are more likely to find peer interaction and forming friendships difficult compared with their peers (I CAN, ). This puts children with SLCN at a higher risk of being bullied. In older children, social difficulties can result in lower self-esteem particularly in relation to academic achievement, social acceptance and behavioural competence (I CAN, 2006). I CAN also reports that people with poor basic skills are less likely to marry or co-habit. If they do marry, it is at a young age and they have more children at an earlier age than average A study by Glogowska et al (2006) followed up children at ages 7-10 that had been identified at a pre-school age of having SLCN. The results of the study showed that 27% continued to struggle with a variety of speech and language tasks and by this age demonstrated literacy difficulties as well. This study suggested, from reports by teachers and parents, that the children s ability to form social relationships with others was also poorer than that of their agematched peers. Behavioural and Emotional Development 1.11 I CAN (2006) also reports that undetected communication difficulties are evident in children with a history of behavioural, emotional and social difficulties. The incidence of SLCN in this group is estimated to be around %. As they grow older these children are more likely to have poorer emotional health, and in adulthood there is a greater likelihood of mental health problems Another questionnaire based study by Lindsay et al (2000) concluded that children with SLCN were more likely to have associated behavioural and emotional difficulties. They had poorer behaviour than children without SLCN. Children with SLCN may be considered likely to have more negative self perceptions due to the effects of failure at school and associated negative feedback; and secondly the stigmatising effects of being singled out and labelled. Criminal Activity 1.13 ICAN (2006) reports that there is a high correlation between children with special educational needs and youth crime. Around 35% of offenders have speaking or listening skills at a basic level and there is evidence that education and training can help reduce recidivism. 1 Children s Communication Charity 7

8 Employment 1.14 ICAN (2006) reports a relationship between SLCN and unsatisfactory employment histories such as breaks in employment, redundancy, unemployment and interpersonal difficulties at work. Educational Outcomes 1.15 SLCN can have a significant impact on a child s educational attainment. It is reported that this group of children are likely to have lower levels of attainment than other children (ICAN, 2006). Early Years 1.16 There is increasing evidence of the links between children s early language and their success in school (DoEb, ICAN, 2006). The early communication environment in the child s first two years of life is important in preparing children for school. Data from ALSPAC (the Avon Longitudinal Study of Parents and Children) found the following key findings (DofEb): There is a strong association between a child s social background and their readiness for school Language development at the age of 2 years predicts children s performance on entry to primary school The children s communication environment influences language development. The communication environment is a more dominant predictor of early language than social background The child s language and their communication environment influence the child s performance at school entry in addition to their social background Evidence has shown that children with early persistent language disorders are around 5 times more likely to have academic difficulties than their peers. Without the right help 50-90% of children with persistent SLCN go on to have reading difficulties. Fewer children with SLCN go on to higher education (ICAN, 2006). Attainment 1.18 The language and educational attainment scores of the children in special and mainstream schools were generally not significantly different from one another, but parents rated the latter group as having more behaviour difficulties (Lindsay et al, 2000). 8

9 1.19 The graph below shows the percentage of young people at School Action Plus or with statements aged 19 years in 2010/11 in England achieved at least five GCSEs or equivalent at grades A* to C (level 2) by age 19 in 2011 and 16 in 2008 by primary type of special educational need. It shows that the percentage of children with SLCN who achieved level 2 by age 19 was less than 60%, compared to children with hearing and visual impairments (around 70%). Only 40% of children with multi-sensory impairments achieved level 2 by age 19. Graph 1. GCSE attainment of children with educational needs in England Taken from Department of Education: Children with Special Educational Needs 2012: An Analysis 2012 Exclusion from School 1.20 Children with educational needs are more likely to be excluded from school than children without educational needs (Department of Education, 2012). The graph below shows the percentage of fixed period exclusions by reason for exclusion for pupils at School Action Plus or with statements of special educational needs in 2010/11 in England by primary type of need. Larger proportions of children within the speech, language or sensory impairments groups are excluded for physical assault against adults or other pupils than in other groups of educational need. 9

10 Graph 2. Reasons for exclusion from school of pupils with special educational needs in England Taken from Department of Education: Children with Special Educational Needs 2012: An Analysis 2012 Attendance at School 1.21 According to the Department of Education (2012), pupils with special educational needs were less likely to be absent from school due to medical appointments and family holidays. However, they were more likely to be absent due to exclusions and traveller absence than children without special educational needs. The graph below shows the percentage of sessions missed, by reason for absence, for pupils at School Action Plus or with statements in 2010/11 by primary type of special educational need. It shows that more absence in children with communication and sensory needs is often due to illness although a notable amount is also due to medical and dental appointments or unauthorised circumstances 10

11 Graph 3. Difference in absence reasons between different educational needs in England Taken from Department of Education: Children with Special Educational Needs 2012: An Analysis It is important therefore, that services take a multi-agency approach and work closely together to ensure that all three aspects (health, social and educational) of a child s needs are being met sufficiently In 2008, the Bercow report was published following an investigation and review into the systems for providing support to children with SLCN. The report highlighted large amounts of variation in the provision of services and that needs were not being met sufficiently. The report called for changes in the way that speech, language and communication services were delivered The Bercow report (2008) stated that there are inconsistent practices for identifying and referring children with speech, language and communication needs. It put forward five key themes for recommendations for Children and Young People with Speech, Language and Communication Needs. These were: - Communication is crucial - Early identification and intervention are essential - A continuum of services designed around the family is needed - Joint working is critical - The current system is characterised by high variability and a lack of equity. 11

12 1.25 The Royal College of Speech and Language Therapists (2006) state that models of care should be evidence based rather than informed by resource restrictions. Communicating Quality 3, sets out Service Standard 54 which is that at a local level, there should be a clear care pathway for each speech and language therapy care group that reflects and anticipates the needs of referred individuals, many of whom have enduring, complex and multiple health and social needs The Graham Allen review (2011) states that early intervention to promote social and emotional development can significantly improve mental and physical health, educational attainment and employment opportunities. It outlines the importance of early intervention in safeguarding children. Early interventions should be provided to the 0-5 age group in readiness for school, 5-11 in readiness for secondary school and from in readiness for life and programmes should be implemented across all stages of child development. The report identifies examples of good practice such as the Nurse Family Partnership The State of Children in Suffolk (2013) report highlighted key areas for development across 6 topic headings, namely socio-economic profile, families, education and learning, health and wellbeing and safety of children. Many of the recommendations are pertinent to SLCN, for example: Addressing deprivation and poverty including hidden pockets in rural areas with recognition that it is the root cause of poor outcomes for many children and families. Increased access and uptake of universal and targeted early years and childcare services, particularly for vulnerable groups Ensuring sufficient services are available in order to meet health needs of those vulnerable groups of children e.g. looked after children to support their engagement in education Targeted support for those children with conduct disorders and autism, learning disabilities, attention deficit hyperactivity disorder and special educational needs. Improved communication and joint working between all agencies working with and for children 12

13 Definitions 1.28 For the purpose of this needs assessment the following definition will be used: Speech, Language and Communication Need for the purposes of this needs assessment this can refer to any condition listed in section 1.3 (above) or any child with an unspecified/diagnosed difficulty with speech, language and communication. Many children with a SLCN are classified as having a special educational need. Also, many children with SLCN may have additional special needs. Children with Special Educational needs may be categorized as follows: School Action the individual child s school is able to meet the child s need with in house resources and staff. School Action Plus the individual child s school is able to meet the child s need with inhouse resources but has support and input from outside agencies Statement of Special Educational Needs the child s needs are severe / complex enough to require additional funding and support to supplement that which they receive at their school. 2. Which population is this needs assessment about? 2.1 This needs assessment related to the children and young people with SLCN who were resident in Suffolk (including Waveney) up until the 31 March Young people aged 19 are included in this report if still in full time education. 2.2 The outcomes from this report should be used in conjunction with the children with learning disabilities needs assessment when commissioning services given that some children with be in both groups. 3. What is the focus of this needs assessment? 3.1 This assessment will focus primarily on needs of children and young people with SLCN and assessing whether the current service provision is meeting their needs. The current service provision will be assessed against the Bercow report recommendations provided in

14 3.2 The objectives of this exercise are: 1. To highlight risk factors associated with speech and language impairments among children and young people. 2. To provide epidemiological data on children and young people with speech and language impairments in Suffolk to measure the burden of the problem in this group. 3. To map current services provided in Suffolk for children and young people with communication difficulties. 4. To conduct an analysis of current service utilisation to assess inequity in service provision. 5. To assess the current capacity for service provision in terms of staff, skill mix, etc 6. To compare service provision in Suffolk with evidence based best practice guidelines. 7. To make recommendations in light of the findings to relevant partners in Suffolk. The following approaches have been used in this exercise 1. Epidemiological assessment. (i) Risk factors associated with speech and language impairments among children were identified through a literature review. (ii) The prevalence of speech and language impairments among children in Suffolk was determined by analysis of national school census data (iii) Mapping of current services - the levels of service received between different populations were compared (iv) School census data from 2011 was analysed to determine the distribution of children with speech and language impairments in Suffolk by type of school. 2. Corporate assessment (i) Stakeholder views were obtained through a questionnaire and face to face or telephone interviews. (ii) Expressed and felt needs of service users were obtained through reviewing recent local consultation reports and individual service user surveys where available. 3. Comparative assessment (i) Literature was reviewed to identify the most appropriate and cost effective interventions at primary prevention level. 14

15 4. Expected numbers, distribution and pattern by person, place and time Estimated Prevalence Office of National Statistics (ONS) population estimates for Suffolk suggest there were 160,088 children aged between 0 and 18. A breakdown by gender and five-year age bands is provided in Table 1. Table 1: Population estimate for children and young people in Suffolk) aged 0-19), in 2012 (including Waveney). Age 0-4 Age 5-9 Age Age Male 21,897 20,840 20,958 18,553 Female 20,841 19,902 19,859 17,238 Total 42,738 40,742 40,817 35,791 Age15-16 Male: 9,308 Female: 8,616 Overall: 17, The Suffolk schools census (2012) indicates there are 77,995 children between the ages of 3-18 in schools and pre-schools. This includes Waveney. This figure does not include pre-school children, children in independent schools or academies, and children not in school for other reasons. 4.3 Estimates of the prevalence of children with SLCN vary according to the type of data collected. Some large scale studies use the definition of SLCN very broadly which can skew results (Broomfield & Dodd, 2004). The definition of what constitutes SLCN has been subject to some debate and is often used differently which can result in some discrepancies in the figures. It is therefore not possible to provide one definitive figure of prevalence. However, it is possible to estimate the prevalence from national and local data. 4.4 Research suggests that approximately 6% of children aged 0-16 years have primary SLCN (Law, Peacey et al, 2000). It also suggests that, including children with secondary SLCN (which means those who have SLCN resulting from or co-occurring with other underlying needs), this may rise to 10% (Law, Peacey et al, 2000). These figures have been used by the Department of Education (2008) and I CAN (2006) to predict the number of children in England with SLCN. Table 2 shows the point prevalence if this rate was applied to the Suffolk Population. It is unclear whether these prevalence rates can be applied to older age groups, with Law et al (2000) undertaking study on children aged 0-15

16 16 only. The estimate for the 18 and under age group should therefore be interpreted with some caution. Table 2 Estimate of Point Prevalence of SLCN in Suffolk (including Waveney) using national estimates. Type of Need Age Population Estimated Number of children with SLCN Long term persistent SLCN (primary and secondary) 10% 11 and under 98, and under 142,222 14, and under 160,088 16,008 Specific Primary SLCN (6%) 11 and under 98, and under 142, and under 160, There is some discrepancy between the data sources regarding the number of children with speech and language difficulties in Suffolk. According to the Department of Education (2013), there are 1672 children (aged 2-19 and attending either state funded primary, secondary, or special schools or academies and technology colleges) with a statement of educational need or at school action plus for SLCN as a primary need. No figures were given for children categorised into the school action group or for children attending privately funded schools. 4.6 However, according to the Suffolk schools census, 1.9% of all school children have a speech, language and communication need, which equates to 1482 children across the county. Of these children, 858 (or 1.1% of total school population) are categorised as school action plus and only 624 (or 0.8% of total school population) are categorised as having a statement of educational need. It is possible that different category definitions were used for the two data sets as the overall numbers are broadly similar. These figures are both significantly lower than the estimates calculated using the national prevalence rates (see section 4.4) however many children will have been identified and had their difficulties resolved in pre-school years. Other children may not be deemed to require a statement and some may go unidentified. 16

17 4.7 According to the Department of Education (2013), a further 194 children in Suffolk schools have a statement of special educational needs for a hearing impairment including primary, secondary and special schools. 4.8 Smaller numbers of children in Suffolk schools have either a visual impairment or multi-sensory impairments. 129 children across the three types of school, have a visual impairment whereas 11 children have a multi-sensory impairment. 4.9 There is some discrepancy between the national prevalence rates applied to a Suffolk population and Suffolk schools data. This may be explained by the exclusion of pre-school children from school based data and also the exclusion of children attending private schools, being home-schooled or not attending school at all. Additionally, the Department of Education data includes children who have a statement or school action plus only. Many children are known to the system but do not have a statement and are therefore not included in SEN data. Therefore, for the purposes of this needs assessment, national prevalence rates of 6% (children whose primary needs is SLCN) and 10% (overall number of children with a SLCN need) will be applied to the Suffolk population for the purposes of comparison with service referral and activity rates. In other words, it will be assumed that there are 14,222 children aged 16 and under with a speech and language need in Suffolk, of which 8533 have specific primary needs. However Department of Education and Schools Census data will be used to describe at risk groups in children of school age in Section It should be noted however that overall, Suffolk is a relatively affluent county in relation to other areas in the country, for example the proportion of children aged 0-16 experiencing poverty in Suffolk is 15.2% compared to a national average of 20.6%, and there are lower proportions of children claiming free school meals compared to nationally (State of Children in Suffolk report, 2013). As some speech and language difficulties are associated with socio-economic factors this may mean the national rate overestimates the rate in Suffolk. However it should also be noted that there are pockets of deprivation in Suffolk, for example in Ipswich and Waveney where rates of SLCN are expected to be higher than the national average SLCN are some of the largest types of primary need amongst students on school action plus and with statements in England. Graph 4 shows the percentage of pupils with each primary type of special educational need amongst those who were at School Action Plus and with statements in 2011/12(The corresponding report for 2012/13 has yet to be published). It also shows that there is likely to be some children with co-morbidities as children whose primary need is not speech, language or communication may however have needs in this area, for example, children with autistic spectrum disorder (ASD), physical disabilities or learning disabilities (LD). 17

18 Graph 4. Comparison between the proportion of pupils with different needs in England Taken from Department of Education: Children with Special Educational Needs 2012: An Analysis 2012 Incidence 4.12 Broomfield and Dodd (2004) used Middlesbrough PCT (considered as a deprived area) as a case study subject. The study suggested that, based on the Middlesbrough data gathered, the estimated national incidence rate of referrals who attend for assessment and who have speech and language disability is 85,000 90,000 children per year (14.6% of births). The incidence rate is therefore 14.6 per 100 births per year. According to ONS (2012) data there were 8316 live births in Suffolk in 2012, therefore it might be expected that 1214 of these may have or develop some form of SLCN. However not all may require intervention (see section 8.2). The incidence rate would be likely to increase over time with an increased number of children with complex needs surviving birth (see section 4.39 for time trends). Estimated Mortality 4.13 Although no direct data is available regarding the mortality rate in children with SLCN, it is likely that these children will, as they become adults, have a higher mortality rate than children without SLCN due the association of SLCN 18

19 with, for example, lower socio-economic status and higher levels of criminality (ICAN, 2006). Risk Factors 4.14 There is a reasonably strong evidence base for a multitude of risk factors for childhood and adolescent speech, language and communication difficulties. These can be categorised as modifiable and non-modifiable. Non modifiable risk factors Age 4.15 As seen in table 3 below, according to the Suffolk Schools Census (2012), the biggest proportion of children with SLCN in school were in the 5-11 age group (2.2% of all children). It should be noted that this does not include pre-school children. Table 3. Age of children with speech, language and communication identified as an educational need in Suffolk Age (years) School Action Plus Statement All SLCN (% of all children in age group) All children (1.7) (2.2) (1.5) (0.9) 7959 Source: Suffolk County Council Schools Census and EMS (2012) 4.16 The smallest group of children with SLCN was in the age group. This may be due to a number of reasons such as speech and language difficulties being resolved with successful treatment and therapy but perhaps more so due to this being a figure of children in school and education is not compulsory beyond the age of 16, hence some young adults may not be included in this figure This age distribution pattern correlates with national data, although it can also been seen from national data that a large proportion of children are also in the under 5 age groups. The numbers of children with SLCN in England by age can be seen in Table 4 (Department of Education, 2012). The 2013 data is not yet available. 19

20 Table 4. Number of children in England with SLCN by age, Age School Action Plus Statement Number Percentage Number Percentage 2 and under , , , , , , , , , , , , , , , , , , , , , , , , , Gender 4.18 According to the Department of Education, in England, in 2013 the percentage of boys with SEN was higher than girls with SEN in both primary and secondary schools. Only data from 2012 has been published relating to type of SEN In England, in state funded primary, secondary and special schools, there were 96,905 children with speech, language and communication needs on the School Action Plus programme of which 67,960 were boys and 28,945 were girls. There were a further 28,735 children with a statement of educational needs for speech, language and communication of which 20,965 were boys and 7770 were girls. The higher prevalence of speech, language and communication needs in boys compared to in girls is consistently reported by studies (Department of Education, 2012((c)), although no reasons are given for this difference. Ethnicity 4.20 Table 5 shows that, in England, for children in the School Action Plus category and for children with statements, children from the Chinese ethnic group had the largest proportion of children (46.4% and 21.8% respectively). 20

21 Table 5. Ethnicity of children with speech, language and communication needs as a SEN Statement and with School Action Plus in England in state funded primary, secondary and special schools (Department of Education, 2012) School Action Plus Statement Ethnic Group Number % Number % White 55, , White British 51, , Irish Traveller of Irish Heritage Gypsy/Roma Any other white background 3, Mixed 3, White and Black Caribbean 1, White and Black African White and Asian Any other mixed background 1, Asian 8, , Indian 1, Pakistani 3, Bangladeshi 1, Any other Asian Background 1, Black 6, , Black Caribbean 1, Black African 4, , Any other Black background Chinese Any other ethnic group 1, Classified 76, , Unclassified Minority Ethnic Pupils 25, , All pupils 76, , Asian ethnic groups also have a relatively higher proportion of children with speech and language impairments, than Black, Mixed or White ethnic groups. The proportion of children with statements from ethnic groups is lower than the proportion of children on School Action plus from ethnic groups, although the pattern of distribution is similar National level data for England is also available for children with hearing impairments, visual impairments and multi-sensory impairments. This data shows a relatively high proportion of children with hearing and multi-sensory impairments in the Asian ethnic groups although the difference between groups is fairly small. This is similar to children with SLCN. No ethnicity data is available for Suffolk children with speech, language and communication needs although it 21

22 is known that 15.3% of the school population is from a minority ethnic background and 4.3% of school pupils have a first language other than English. In comparison with some other areas of England, the number of people with a primary language other than English is not high (State of Children in Suffolk, 2013) Evidence suggests that Chinese, Black African, Black Carribean, Black Other and Bangladeshi pupils were all substantially more likely to have identified SLCN than White British children (Department of Education, 2012, E). These disproportionalities reduce when factors such as social disadvantage are taken into account In Suffolk, 12.8% of all children in state funded primary and secondary schools are non white british ethnicity compared to the England national average of 26.3% (Department of Education, 2012). Modifiable Risk Factors Socio-Economic Status 4.24 There is some evidence that children from lower socio-demographic background tend to have poorer language skills when they start school (Department of Education, 2012b). Approximately 50% of children and young people in socioeconomically disadvantaged populations have speech and language skills that are significantly lower than those of other children of the same age ((ICAN 2006 & Department of Education 2012 E) 4.25 In Suffolk schools, 11.6% of primary, 9.7% of secondary and 27.7% of special school pupils are eligible for free school meals (SCYP, 2012). According to the Department of Education (2012) data, the number of children with speech, language and communication needs on School Action Plus who are receiving free school meals is 30.5% whilst the corresponding number of children with a statement is 29.3%. Therefore, a relatively high proportion of children with SLCN in Suffolk are likely to be receiving free school meals although no data is available to support this. Information regarding the socio-economic status of children with SLCN in Suffolk would be useful to inform commissioners as to areas or specific schools in which there is likely to be greater need, and therefore where services could be targeted or where there are opportunities to adapt service provision or delivery to meet the needs of these areas. 22

23 Table 6. Number of children in England, with School Action Plus or statements receiving free school meals (Department of Education, 2012) Need Number of pupils known to be eligible for and claiming free school meals SLCN - School Action 29, Plus SLCN - Statement 8, Hearing Impairment 1, School Action Plus Hearing Impairment 1, Statement Visual Impairment 1, School Action Plus Visual Impairment Statement Multi-Sensory Impairment School Action Plus Multi-Sensory Impairment Statement % of pupils known to be eligible for and claiming free school meals 4.26 For children with other communication impairments, the proportions are lower but mirror a similar pattern Whilst free schools meals should not be used in isolation as a measure of socio-economic status and/or deprivation, there is not currently any information or data linking prevalence to socio-economic status or deprivation indices Some socio-demographic factors such as the mothers being between 20 and 24 years of age, large numbers of children in the family (>4), a reconstructed family, hearing impairment and gender are recognized as independent determinants of poor linguistic skills. Black et al, (2008) found no significant correlation between lexical development and socio-economic status. It did find however that there are several factors which may affect the relationship. The researchers suggested that the home environment may be a better predictor than social class when identifying children with lower levels of vocabulary. The tests showed that word frequency may be a confounding variable as the effects of word frequency on errors made in the test were significant. Family History 4.29 Family history appears to have an impact on the susceptibility of children of having a speech, language or communication impairment. It was shown in a study 23

24 by Lewis et al (2007) that risk of speech sound disorders increases with the number of 1 st degree relatives with the disorder (e.g. if parent has a speech sound disorder the higher the risk of their child developing a speech and sound disorder). This study controlled for family size and familial relationship. The odds of speech and sound disorder doubled with another affected family member. The odds of language impairment increased four times with another affected family member. Fox et al (2002) backs up the relevance of close family history of speech and language impairments but suggests that children do not necessarily show the same language disorder as their affected family member. Fox suggests that there is a genetic link. Birth Weight 4.30 A low birth weight has also been identified as a risk factor for children in developing speech and language impairments (Yliherva, 2010). Low birth weight children have more difficulties in many aspects of speech, learning and motor abilities when compared to other children (as reported by parents and teachers). It has also been suggested that pre-term babies are more at risk of articulatory disorders, and stuttering was found to occur more frequently in pre-term babies than full term babies. Looked After Children 4.31 The graph below shows the percentage of pupils with each type of special educational need who are listed as looked after children. The corresponding report for 2012 has yet to be published. It shows that there is a small proportion of looked after children with SLCN in comparison to children with behavior, emotional and social difficulties. Approximately 6% of pupils at school action plus and 7% of children with statements relating to SLCN are looked after children. This is slightly less than in the general population however should still be noted when making commissioning decisions. 24

25 Graph 5. Percentage of children looked after for at least a year at 31 March 2011 with each primary type of special educational need in 2011 in England. Taken from Department of Education: Children with Special Educational Needs 2012: An Analysis 2012 Other Risk Factors 4.32 Other risks were identified by Weindrich et al (1998) who linked speech and language impairments with low education level of the parent(s), psychiatric disorder of the parent(s), early parenthood, incomplete family, lack of social integration and severe chronic difficulties Weindrich also suggests that boys appear to be more vulnerable to language problems than girls and this is backed up by the data from the Department of Education analysed earlier in this report. Weindrich states that this pattern is true mainly for articulation disorders but that these gender differences are almost only evident up to age Fox et al (2002) undertook a questionnaire based study which along with family history mentioned above, also put forward evidence to suggest that pre and peri-natal problems, general ear, nose and throat (ENT) problems and use of a bottle as a pacifier could be considered as risk factors. The questionnaire results showed that there was a significant difference in the numbers of children with speech disorders whose parents reported problems during pregnancy or child birth 25

26 and parents whose child did not have a speech disorder. ENT problems did not have a significant independent effect Other findings around risk factors were that the aetiological significance of auditory impairments for speech disorders was likely to be low and that speech disordered children were more likely to use a dummy or pacifier, however only bottle use showed a significant difference Howell et al (2006) found that the prevalence of stuttering was higher in bilingual children than non bilingual children and these children had a lower chance of recovery. The study found that if a language other than English was used at home, delaying the age at which English was learnt reduced the risk of the child developing a stutter, however it was also shown that a stutter did not impact on the child s school performance Snowling et al (2006) found that there was no correlation between having a history of speech-language delay and the rate of adolescent psychiatric disorder. However the psychological outcomes could be impacted on by the persistence and severity of the initial delay and the outcome was not so good for children whose disorder continued into school aged years. The study found that different language profiles can also be associated with ADHD and social difficulties and this correlates with the ethnicity data presented previously Snowling et al (2006) found that children from severely deprived backgrounds were most likely to have language difficulties. Early language delay, delay in general development and behaviour concern were each reported by parents of approximately one-third of the children referred. Behaviour was an issue for 43% of children with receptive language disability, but the same was true for only 21% of children with speech disability. Few referrals in the study were received for children from bilingual backgrounds, perhaps, as suggested by the researchers, due to lack of clarity on referral guidelines and thresholds. The majority of the referred population is younger than 6 years of age, and the predominance of boys across all diagnoses is clear. There was a decreasing incidence of referral with increasing age found in this study. This corresponds with the data from the Department of Education (2012). It would be useful to ascertain whether the findings from the PCT used in this study were evident in other geographical areas. Where are the people with the issue locally? 4.39 It was not possible to obtain data relating to the localities in which children with speech, language and communication needs currently reside. However, due to the evidence of an association between socio-economic status and prevalence, it could be hypothesized that prevalence mirrors the deprivation indices of these areas. It is known that within Suffolk, Ipswich and Waveney are wards of specific 26

27 deprivation (State of Children in Suffolk, 2013) and therefore it is likely that there are higher numbers of children with SLCN in these areas According to the Department of Education (2012), most children with SLCN within Suffolk are currently within primary schools. However it should be noted that many children, particularly within special schools, have SLCN requiring intervention but do not have SLCN listed as their primary need, and so would not be included in the below data. The Department of Education data (2012) shows that more than 1225 children with statements or at School action plus are currently in primary schools with the remaining 304 children in secondary schools. Table 7. Type of School for children with speech, language and communication needs in Suffolk (including Waveney). Educational establishment Not Currently Placed Academy Elective Home Educated Alternative Education Out County Independent School Out County Maintained School Out County Non Maintained School County Maintained School Other Placement Pupil Referral Unit Special School Children on School Action Plus (numbers/ % distribution in category) 0 0% 3 0.3% 0 0% 0 0% 0 0% 0 0% 0 0% % 0 0% 0 0% 0 0% Children with a SLCN statement (numbers/ % distribution in category) 5 0.8% % 5 0.8% 1 0.2% 7 1.1% 2 0.3% 2 0.3% % 1 0.2% 3 0.5% % All SLCN (numbers/ % distribution in category) 5 0.3% % 5 0.3% 1 0.1% 7 0.5% 2 0.1% 2 0.1% % 1 0.1% 3 0.2% % All educational establishments % % % Source: Suffolk Schools Census,

28 4.41 Table 7, above, shows the figures from the Suffolk schools census and this broadly correlates with the pattern shown in the Department of Education data. Is it what is expected from regional and national comparisons? What are the trends? 4.42 ONS population projection estimates suggest that by 2016 there will be a 2.3% rise in the number of 0-18 year olds. Within Suffolk, this equates to up to an additional 3600 children and young people (excluding Waveney), 360 of whom are likely to have SLCN based on the national prevalence estimate of 10%. The numbers of children with speech and language difficulties may potentially also increase due to further developments in medical methods which may be likely to result in higher numbers of children with complex needs surviving birth. Therefore there is likely to be a greater demand for services over time. There were no studies predicting future changes in prevalence however The recent and forthcoming changes in healthcare commissioning and provision may have some impact on the way in which speech, language and communication services are commissioned or delivered. County Councils and the NHS are increasingly being required to work coherently and provide a joined up service. The formation of clinical commissioning groups may also impact on services by changing the way in which services are commissioned (see section 5 for detailed information). How does our picture of services and burden compare nationally, regionally and with counties of similar characteristics? 4.44 Nationally, of school age children, the highest proportion of children with speech, language and communication needs are found in primary schools, with speech, language and communication needs most common in boys. The Suffolk picture is similar to that of a national one The proportion of children with speech and language impairments is comparable with both neighbouring counties and Suffolk s former comparator Primary Care Trusts (PCTs) (Gloucestershire, Wiltshire and Somerset), as can be seen from tables 8 and 9 below. Table 8 shows the proportion of children in primary schools with speech, language and communication needs by county. It shows that in the East of England, Suffolk has third highest proportion of children in Primary schools with SLCN and is comparable to other counties in terms of hearing, visual and multisensory impairments. When compared to comparator PCTs, Suffolk has a lower proportion of children with SLCN than Gloucestershire and Somerset but is slightly higher than Wiltshire. The proportion of children with hearing, visual or multi-sensory impairments is similar across all counties with the exception of a particularly high proportion of children with hearing impairments in Gloucestershire 28