Carden Primary School, on the edge of Brighton, was built after the war to be either a school or an isolation hospital, but today hosts an innovatory nursery which is all about integration.

The first in a new national network of early years centres for children with severe speech and language impairment was opened there quietly a year ago by the charity I CAN, in conjunction with the local health and education authorities. It is already showing that working with such children on a day-to-day basis, offering integrated education and therapy in an ordinary school environment, gives the the kind of flying start that no amount of segregated speech therapy can come near.

“Twenty out of 21 children we had last year are in mainstream schools, four of them with statements, which is much better than you would normally expect for a group of children like this,” says teacher Eva Marsh. “It’s been absolutely brilliant,” says Natalie Marchant, whose son Jack attended the nursery last year, and has now moved on to his local primary school. “Before he started he was only saying three or four words and he was so frustrated, but even after three months we could see a difference. His speech and behaviour improved, and now he’s 100 per cent. We never thought a year ago he’d ever do this well.”

Natalie also appreciated the close contact the nursery kept with parents. “Jack used to go by taxi so I didn’t see the teachers every day, but they always sent reports home and I used to go up every couple of months and talk to them.”

Speech and language problems come in a variety of packages, but all can lead to a loss of confidence, problems with reading and writing, difficulties in socialising, and burgeoning behaviour difficulties - things guaranteed to handicap children’s school life before they even get there unless they are tackled early.

At the Brighton nursery a teacher and therapist work with 10 children in the morning, and 10 in the afternoon, withdrawing them once or twice a day from the main nursery for small group work, or for one-to-one sessions. Blue cards are handed out to tell children when it is time to go for their special lessons in the two bright and cheerful rooms across the corridor, while a general “signing environment” in the main nursery, using symbols and hand gestures, also helps develop communication skills. In the I CAN nursery they might practise sounds, blow bubbles, and play sound recognition games, but everything is tailored to individual needs and is closely monitored.

“My job here is unique in my profession,” says full-time speech and language therapist Emily Powell-Smith, who works in partnership with Eva Marsh. “If a child comes to a clinic it’s a very alien environment, and you also have to try to get through everything in 40 minutes, but here I can gain their confidence, I can really get to know them. I can see the whole of their personalities, and watch how the different aspects of them affect how they speak and play.”

Speech and language difficulties are complex, and can often be masked by children using learned phrases, or by spending their time on activities such as bike-riding, which do not involve talking, so specialist expertise also feeds back into the general nursery. “There’s a benefit across the board. The methods put a lot of emphasis on listening and concentration skills, for example, which we’ve had to think about,” says early years co-ordinator Lorna Cadwallader. “It’s been a learning curve for us all but I think we’ve all welcomed it.”

Carden School, which alreay had an on-site speech and language unit, and is the base for Brighton and Hove’s new Speech and Language Support Service, was an obvious home for this trial unit, but I CAN’s planned pound;2.5m network of centres is now spreading its wings. A second centre opened in Liverpool this September, a third will open in Kingston in March, and a further 17 are planned by 2003. To do this, the charity needs to raise pound;2m in voluntary donations, although a third of the money has already come in since the appeal was launched last year.

I CAN also plans to evaluate the best methods of early intervention, and establish a nationally registered accrediting framework for provision in this area, and has funding from the Department of Health, and the Department for Education and Employment for these initiatives.

“It’s a programme that’s unique in scale, approach and reach,” says Alex Hall, the charity’s early years development manager, emphasising that it will aim to offer a model of good pre-school practice and spread ripples far wider than the immediate centres.

At the heart of the plan has been persuading education and health authorities to work together - a notoriously difficult task, particularly in an area such ase speech therapy, where there is confusion about where the responsibility for provision actually lies, although, says Alex Hall, “it has got easier in the past six months because of Government encouragement and greater flexibility with funding arrangements. And a spin-off has been that when you get people together they then start looking at children of school age as well”.

To get a centre up and running for two years, I CAN offers a pump-priming pound;155,000, but in return demands that local health trusts and education authorities commit to maintaining it for at least three more years.

It also knows that provision must vary with circumstances, and that no single model will suit all needs. “In Wales, for example, because of the rural nature of much of the area, there has always been a greater emphasis on outreach, and we have to take account of that.”

What does not vary is the huge need for this kind of provision. An estimated one in 100 pre-school children has speech and language difficulties, and while for some this can be simply a delay in developing skills, for many others it is a severe problem. In Brighton this year 40 severely impaired children competed for the nursery’s 20 places, and I CAN expects similar pressures on other centres. But because speech and language are often be seen as problems with behaviour or ability, the scale of the need tends to be hidden from the public gaze.

I CAN, the national educational charity for children with speech and language difficulties, 4 Dyer’s Buildings, Holborn, London EC1N 2QP. Tel: 0870 0104066. E-mail: ican@ican.btinternet.com

SPEECH AND LANGUAGE IMPAIRMENT

Speech and language impairment is an umbrella term covering difficulties associated with developing communication and language. Problems traditionally affect three times as many boys as girls, and can occur in children from any socio-economic background. Causes may include hearing loss, lack of stimulation in early life, genetic predisposition and neurological damage, but often the underlying cause is never known. An estimated 1.2 million children have some form of impairment, which might include difficulties with:l understanding language and conceptsl expressing language and vocabularyl producing speech sounds and organising sounds into wordsl attention, concentration and listening skillsl social and emotional development associated with limited communication skillsl pragmatic skills and social communication.