Stoke Speaks Out’s Early Communication Screen won the Outstanding Achievement Award at this year’s Shine a Light Awards. Sal McKeown explains why.
Stoke Speaks Out, a community strategy commissioned by Stoke-on-Trent City Council, started in 2004 to bring together teachers, speech and language therapists and parents to tackle low levels of speech and language in under-5s in Stoke-on-Trent, a city in central England once famous for its pottery industry.
They developed an Early Communication Screen (ECS) in 2016 that won two categories at the Shine a Light Awards in March 2018: SLCN (Speech, Language and Communication Needs) Innovation of the Year as well as the Outstanding Achievement Award. They followed this in April by winning the Contributions to Public Health category of the Advancing Healthcare Awards 2018.
Awards such as these have helped them to build a following and already childminders and practitioners outside the Stoke area are showing an increasing interest in the ECS, adding to more than 1,800 regional practitioners who have been trained to use it.
Unlike some other products which have been developed by companies or research bodies, this screener is rooted in practice and developed by people with keen sense of what was needed.
Janet Cooper, Clinical Lead Speech/Language Therapist, led a team of speech and language therapists from Staffordshire and Stoke-on-Trent Partnership NHS Trust. They could see that there was a need for widespread screening in schools and nurseries but it had to be easy to administer and to fit into the school day.
Speech and language therapist Sarah Jimenez-Novoa explains:
The communication screen is so innovative because it makes use of resources that schools and nurseries already have, so there is no cost. It’s quick and easy and can be repeated more often than a standardised assessment so we recommend it is used termly. The tool looks at the child’s ability to use words, to use phrases to understand concepts, to understand instructions.
It takes just 5-10 minutes per child and so far, more than 7,000 children have been screened.
‘It is a very simple system which uses a red, amber, green system,’ Cooper adds.
Red identifies more serious cases requiring trained support, amber the children who need some support in their settings and green is for the children whose language and communication are progressing satisfactorily. Once the data has been collated it can help services under stress to identify the most pressing needs and prioritise provision.
The screener in use
The screener has allowed staff in Stoke’s nurseries to measure the effectiveness of what they do. Cooper and her team have trained all the nurseries and schools in the city and been into the settings to observe staff using the resource. Now all the data is sent to the local authority, which can extract information on special educational needs (SEN), gender and ethnicity so it can target support much more accurately. It can also gather Pupil Premium data, which is a subset of information in the UK identifying children from economically deprived households.
Stoke is currently in the final year of a three-year project focusing on school readiness and when staff across the nurseries used the screener for a formative assessment they were horrified to discover that 64 per cent of children aged three to five had speech and language delay. This was much higher than expected but in part can be explained by the fact that Stoke is the 16th most deprived area in the UK and the second most deprived in the West Midlands. There is a close link between social deprivation and speech and language delay.
‘It is a multi-layered issue,’ explains Cooper.
If parents are in low paid jobs, struggling to meet the rent, energy and food bills or they are often working long shifts or unsocial hours then chatting to a baby or playing with children becomes a luxury. There is also rarely the money for trips out in the city or further afield so their horizons are narrower and they struggle to give their children access to high quality toys and books or the opportunities that money can buy.
While we all like to believe that standards of living and standards of education improve over the years, Cooper is sceptical. In 2018, there are many of the same problems that were prevalent in 2002 but in some cases there are new difficulties. The make-up of Stoke’s population has changed. There are many new arrivals and a wider range of ethnicities with 101 languages spoken in the city these days but some groups are very isolated with no one close by who speaks their language or comes from their country of origin. Also people expect a much higher standard of living, so parents are under pressure to work longer hours to buy their children the clothes and technology that other children have.
View from the ground
Lucy Phillips, nursery worker Kingsland Nursery, Bucknell, describes her own experience of using the ESC.
Kingsland Nursery in Stoke has 82 three- to four-year-olds. Last autumn we screened 43 children who were aged between 24 and 30 months. It is important to give them time to settle in, and we don’t want to assess them before they are two because children develop at different rates but by 24 months we can begin to see if there is a problem.
It really opened our eyes: 23 per cent were in the red area — mostly on receptive language — so they were not understanding as much as we sometimes had assumed. We planned interventions with a key worker who would use Time to Talk in small groups, three sessions a week over six weeks, focusing on topics such as clothes, food, toys and animals. This would include singing, practical games and models of language.
We also run a Play and Stay session for parents once a month on topics such as early maths learning or Easter. Here we model language and behaviour and we always have a very good turnout. Part of the time they observe us and then have a go themselves so they can carry on at home.
It has worked very well for the children. Noah was assessed in September and was clearly in the red group. We registered our concerns with a speech and language specialist but by February he had responded so well to interventions that he had moved up to the amber group and was discharged at his first speech and language appointment.
Why did the ECS win?
Stoke has developed a multi-agency training programme to ensure communication is ‘everybody’s business’, building on current provision such as toddler groups, ante-natal classes etc. to enhance their practice; created quality resources with reliable key messages for parents, carers and practitioners; and, above all, created a ‘buzz’ around early communication.
The team has gathered an enormous range of evidence over a long period. The Shine a Light judges noted that practitioner feedback was overwhelmingly positive and users were reporting that it was quicker and easier to identify language delays and that staff were increasingly skilled and confident in choosing appropriate interventions for young children.
Jonathan Douglas, Director of the National Literacy Trust, described the Stoke Speaks Out ECS as, ‘an excellent approach to screening very young and Early Years Foundation Stage children… [which]can be rolled out across any setting with the correct training.’
Fellow judge Wendy Lee, Director of Lingo Speech and Language Therapy and Consultancy, praised the authority for screening on such a large scale saying, ‘No other service has done this at population level’.
In 2016, a total of 4,396 children were assessed: 1,323 in private, voluntary and independent (PVI) settings and 3,073 in schools. The results were:
- 27 per cent red (1,189) — high need for intervention.
- 38 per cent amber (1,673) — in need of targeted support.
- 35 per cent green (1,534) — within normal range or above.
- All three areas of the City showed similar results across the levels of need with central having the most children in the ‘red’ (high need) category
- In all areas the red results were higher in the private, voluntary and independent (PVI) settings than in the schools, and school nursery scores had more red results than reception class indicating progression with age.
- Many of the red scores are linked to settings and schools with high levels of children with English as an additional language (EAL) — 52 per cent of the children in the red category were reported as children with EAL
- Boys were at increased risk of being in the red category compared to girls. This matches Early Years Foundation Stage (EYFS)
- Children with SEN and Children in Care were at increased risk of being in the red category than other children.
International research projects
Low income and poverty dynamics: implications for child outcomes — Warren D Canberra, ACT: Dept. of Social Services, November 2017.
Many studies have shown a strong negative association between poverty and children’s developmental outcomes, but it isn’t clear whether it is low income itself — or the complex set of circumstances that lead to poverty — that is responsible.
Tackling the Poverty-Related Gap in Early Childhood Learning in Northern Ireland — Save the Children, December 2017.
Evidence from across the UK and internationally shows a strong link between low income and cognitive outcomes in early childhood.
The links between children and young people’s speech, language and communication needs and social disadvantage — The Communication Council, July 2015.
An overview of the relationship between speech, language and communication needs and social disadvantage, and its impact on the education, health and wellbeing of children and young people.
Risks associated with communication delays in infants from underserved South African communities — Van der Linde J, Swanepoel D, Glascoe FP, Louw EM, Hugo JFM, Vinck B in Afr J Prm Health Care Fam Med. 2015;7(1), Art. #841, 7 pages.
In developing countries such as South Africa the prevalence of communication delays will probably be higher, due to more biological and psychosocial risks such as poverty, violence, nutritional deficiencies, HIV infection and substance abuse.