Organisation submitting example
• Nottinghamshire Sure Start Children’s Centres
Local authority/local area:
The context and rationale
The Home Talk service in Nottinghamshire Sure Start Children’s Centres is a parent-implemented intervention for children with delayed language development. The aims of the service are to improve two-year-olds’ language skills by increasing parent/carer knowledge, skills and confidence in supporting language development through everyday interactions and activities at home, and to provide early identification of children with complex speech, language and communication needs.
Delayed language development occurs in 10% to 20% of children at two years of age (Zubrick et al., 2007). Around a quarter of these children will have continuing language difficulties at school age which have a significant impact on their social, emotional and cognitive development and their achievement at school (Clegg et al., 2005). The rate of language difficulties is also known to be substantially higher in areas of high social disadvantage; in some areas, up to 40% of primary-school children have delayed language development (Law et al., 2011).
Parent-implemented speech and language therapy (SLT) for two-year-olds with delayed language development has been shown to be effective, but there is no evidence to show whether intervention that is not directly delivered by SLT can improve outcomes (Roberts & Kaiser, 2011).
The Home Talk service in Nottinghamshire Sure Start Children’s Centres is a parent-implemented intervention for children with delayed language development. The service is offered to 2-year-old children who do not meet the local SLT service criteria for intervention, but who nevertheless have delayed language skills. The Home Talk service is delivered in family homes by a Sure Start children’s worker who has enhanced skills and training in facilitating language development, and guidance and advice from a children’s centre SLT. Their training includes a reduced (Hanen-approved) version of the Hanen ‘Learning Language and Loving It’ training course (Girolametto et al., 1996).
The aims of the service are to improve 2-year-olds’ language skills by increasing parent/carer knowledge, skills and confidence in supporting language development through everyday interactions and activities at home, and to provide early identification of children with complex speech, language and communication needs.
Children are identified for referral to the Home Talk service by the local health visiting team, who have completed training with the Sure Start Children’s Centre SLT service to enable them to screen children’s language development as part of the universal 2-year developmental check. The health visitor service is commissioned to complete this check between two and two and a half years of age, as close to children’s second birthday as possible. Children with expressive language delay (expressive vocabulary of between 10 and 30 words) are referred to the service.
The aims of the service are divided into four key areas, which are informed by the current evidence about what works, namely -
• promoting the key role of responsive parent-child conversation in developing language skills (Zimmerman, 2009)
• providing an optimal language-learning environment at home, for example by reducing the use of television and dummies (Roulstone et al., 2011)
• focusing on language-rich activities to promote language development, such as book-sharing (Farrant & Zubrick, 2011)
• coaching parents/carers in the use of interaction strategies known to facilitate language development (Girolametto et al., 1996).
The service consists of six home visits of around an hour. Each visit has a routine and structure with songs and rhymes to start and end the visit, and a language-rich activity forming the core of the session, such as book-sharing or making a photo book together, a playdoh-making activity or a trip out for a listening walk. Although guidance about session structure is given, the activities are adapted based on children’s interests, so the exact content of visits is not fixed.
Parents are actively involved in the session by the worker, and the importance of the parent’s role in developing language (e.g. through everyday routines and play activities) is stressed and promoted throughout the visits. Toys and resources related to the session may be left with the family between visits to help them continue using a particular game or activity throughout the week.
Families agree a small number of targets to focus on during Home Talk. Again, these targets stress the key role of the parent in supporting their child’s communication skills, and relate to the other key messages about language-rich activities, and the home communication environment. Typical targets are that the parent and child will have 30 minutes of face-to-face play time every day with no background noise, will sing a nursery rhyme every day, or will share a bedtime story every day. Some families also target specific adult interaction strategies; for example, a parent target may be to interpret their child’s nonverbal messages by putting them into words, or ‘saying what they would if they could’.
After they take part in Home Talk, families are supported to access universal play and learning opportunities at their local children’s centre, and referred to appropriate services as needed (e.g. SLT; two-year-olds nursery entitlement scheme; behaviour management parent courses).
Evidence and evaluation - making a difference to children, young people and families
In 2011, an internal evaluation of the Home Talk service was conducted, with 16 families from six different children’s centres taking part. All these families were from areas of high social disadvantage. The children’s average age was 24.4 months at the time of referral to the service, and their mean reported expressive vocabulary size at the time of referral was 17.5 words (range 1–50).
Three evaluation visits were made separately from Home Talk intervention visits. These were before and after the family participated in the intervention, and then four months after the second visit as a final follow-up.
At each visit, three standardised questionnaires were completed to evaluate outcomes (children’s language and communication skills, and parenting stress). These were –
• an expressive vocabulary checklist (Language Development Survey; Rescorla, 1989)
• a parent questionnaire to measure children’s pragmatics skills i.e. their skills in using gestures and words to communicate for different reasons (Language Use Inventory; O’Neill, 2009)
• a parenting stress questionnaire (Parenting Stress Index – Short Form; Abidin, 1995).
Summary of results
The evaluation showed that
• 75% (12 of 16) of children’s language skills developed at an accelerated rate and had caught up with age expectations by 3 years of age.
• 31% (5 of 16) of children had ongoing speech, language and communication needs; these needs were identified early, and families were helped to access specialist services, such as SLT.
• five parents/carers who reported high levels of parenting stress before taking part in the intervention then reported average levels of parenting stress at the end of the evaluation, at which point their children’s language skills had developed to be within the typical range.
• All parents/carers who had high levels of parenting stress were helped to access other appropriate child and family services.
• Parents/carers reported that they changed their everyday activities and routine with their child, meaning the home communication environment – a key influence on children’s language development – was improved.
• families who were experiencing high levels of social disadvantage were reached and supported by the service.
Full details of the references in the text are available on request from the C4EO team at the NFER.
Helping others to replicate your practice
The Home Talk service fits within the following C4EO Golden Threads:
• Together with children, parents and families, as it focuses strongly on the crucial role of parents and aims to develop parent’s confidence and skills in supporting children’s language development.
• Learning Together, as it involves different professionals working together, especially health visitor teams, Sure Start children’s workers and speech and language therapists.
• Prove It, as it is based on existing evidence about what works, and aims to contribute to the evidence base through rigorous evaluation.
Tips for others
We believe there are several crucial elements of the service that help it to work effectively. The service is:
home-based so the family can see how the ideas and activities can apply to what they usually do at home, and the service is easy to access;
parent-focused so the parent/carer participates actively in the sessions and uses the ideas and activities throughout his/her daily routine, and does not view the service as something the worker does during the weekly visits;
delivered by highly skilled staff with skills and training and regular mentorship by a SLT in facilitating language development, knowledge of local services, and the ability to build a warm, respectful relationship with families;
multi-disciplinary so the staff delivering the service have the right advice, training and support from a speech and language therapist when needed;
embedded with other services so families can access related services easily when they need them - such as family support services, targeted children’s centre groups for children who need extra help with language, or speech and language therapy.
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