Too much television, a lack of bedtime stories and family meals, not enough nursery rhymes - many theories are regularly voiced about why an increasing number of children are showing signs of delayed speech and language.
For schools, this has an impact on children learning to read and write. The basics - phonological awareness, a developed knowledge of rhyming and of onset and rhyme, need to be well established in order to lay solid foundations for literacy.
Many problems are picked up before the children start school or in the early years of school, and they are referred for speech and language therapy. But some have less obvious delays and manage to learn to read and write adequately; it is later on that problems occur with their literacy and communication.
How do you stop these children falling through the net? Provide speech and language therapy for all children? Yes, say primary schools in Clackmannanshire, where many elements of a two-year language project have been integrated into everyday practice.
The Clackmannanshire Language Intervention Project (CLIP) began in August 2009, as part of the wider Health and Wellbeing in Schools Project funded by the Scottish government to address the health and well-being needs of children and young people by increasing healthcare in schools. Four areas took part - NHS Ayrshire and Arran, NHS Forth Valley, NHS Grampian and NHS Lothian. In Forth Valley, work concentrated on Clackmannanshire, with CLIP as one of the projects.
Today the P1 children at Park Primary in Alloa are on week five of a six-week programme, Language through Listening. This develops the pre-linguistic skills needed for expressive language. It focuses on turn-taking, on listening and on complimenting each other.
Working with one group, teacher Christine Stewart passes round prompt cards, which they talk about together. The children wiggle their fingers and stamp their feet to demonstrate what is on the card. They take turns to talk about the cards and listen to each other before moving on to the next one.
Wendy Harrison, the inclusion teacher who headed the project alongside speech and language therapist Hazel McKellar, says: "The adult models behaviour and by the end we expect the children to compliment each other on how they have got on. Initially, they say that they are good at everything, but by the end they are more accurate, picking up on what their classmates have been good at."
Collaboration is central to the project and to Elklan, the speech and language training package they used. Mrs Harrison and Mrs McKellar both attended the two-day training on Elklan at the Royal College of Speech and Language Therapists in London. Elklan encourages speech therapists and teachers to work together to deliver training. It was an approach which both took to very easily.
"I think we are quite lucky," says Mrs Harrison. "We had worked together before. Much of my role is about working with speech and language therapists, and we have a close relationship."
"I'm the same," agrees Ms McKellar. "My last post was at a Sure Start centre in England, working with teachers. Both of us were appointed because we had the experience, but at the same time we were fresh to it. We didn't waste much time and looked into resources."
They got started fairly quickly, says Mrs Harrison: "Probably because we had worked together before. We had one common language. One of the aims of the training is to have a common language."
The first thing they had to do was to train infant teachers in three schools - Deerpark, Park and Banchory primaries. This was done in one full-day session and three twilight sessions. After each session, they were given tasks on which they would receive feedback at the next session, as well as more learning.
"Normally most training is done either by a speech and language therapist or a teacher," says Mrs Harrison. "The CLIP project was about having both.
"We could have done it separately, but for best practice you should have both. Staff could see that it was practical. We looked at how literacy and communication develops, and a bit of theory. So we would say, if they were having difficulty at this level, here is what you can do, and on to the next level."
The aim of the training was to gain a broader understanding of how speech and language develops for each child. So they told teachers what it was like for a typical child.
"If teachers know how a typical child develops, they will know when things are wrong. A lot of it was recalling information on child development they knew already, but bringing it to the fore," says Mrs Harrison. "It was about revisiting."
Seven resources were chosen for schools to pick from (see panel) - resources that Mrs McKellar and Mrs Harrison knew worked, either because they had used them or because there was sufficient evidence that they worked.
Along with the teachers, they visited the schools regularly to take the sessions. While children soon began looking forward to their visits, for teachers there was an added bonus.
"It was a luxury for us to sit and observe the children," says Mrs Stewart. "We could watch how they were responding - as a teacher, you can't do that - you are too busy focusing on the lesson. You see things that you don't notice in the hurly-burly of a lesson."
As well as allowing children to take story sacks home, Park Primary arranged for the P7 buddies to partner up with the little ones and get involved.
"We had a workshop for the buddies where we talked them through the bags," says Mrs Harrison. "They practised while they were there and it worked really well. They were very good at saying `remember to look at me' and `have you shared?'. It was a double whammy - the wee ones had extra time and the Primary 7s learned new skills."
Teachers would sometimes use the work done in the sessions as a basis for other class work. Sometimes, if they were covering the "who" narrative, the teacher would pick up on the characters and focus on that in writing.
"We have rule prompts - one person talking at a time - and we got anecdotal evidence very quickly from the teachers that listening and attention improved," says Mrs Harrison.
"These are skills that will take them through life - good communications skills, empathy, turn-taking, eye contact, listening."
For the vast majority of children, the discrepancy between chronological age and performance age decreased, proving the project to be a success. Many of these children would not have been referred to speech therapy until much later on, if at all, so early intervention worked.
"Some children appear to pick up phonics easily, but their syllable awareness and rhyme identification and generation is not developed, so this increases the risk of later problems with literacy skills," says Mrs McKellar.
"The kids who didn't improve - we fed the information back to the nursing team and we put our heads together about why this could be."
Headteacher Adrienne Aitken says: "I feel we benefited in a number of ways from the increasing understanding and skills level of teachers - not just from the formal course but from working alongside Hazel and Wendy and the practical aspect.
"The children were motivated. They had fun and were eager to take part in learning. The approach CLIP took helped sustain this. It helped teachers systematically address areas they had been struggling with for a long time."
The school has re-evaluated the work it does since taking part in CLIP, where CLIP showed it a different approach. "Although it is a time-framed project, we are still using elements. Sustainability is very important," she says.
The project has now ended, but Mrs McKellar and Mrs Harrison have a keen interest in seeing the work carries on.
"When we discovered that there was to be no more funding, we decided which elements to continue," says Mrs McKellar. "We decided on training."
They will be training at the February inset days. Earlier on in the project they evaluated the training they did for teachers and it came out so well that they were able to open it up to all schools in Clackmannanshire, so every primary has now been trained.
"For us, the key message is the collaborative nature. It is not an isolated job. Also, we were not looking at speech and languages difficulties - we were getting past that," says Mrs McKellar.
"These are skills they need to be healthy, to achieve. Maybe in the long term, we can stop them falling through the net."
Healthy approach to well-being
The Health and Wellbeing in Schools Project ran in communities with a high number of vulnerable children and young people, taking on the philosophies of Getting it Right for Every Child and Curriculum for Excellence. The aim was to redesign services using existing skills and knowledge, while developing new roles.
The NHS Forth Valley project had four main strands: substance misuse; healthy eating; sexual health; and communication, with each working interdependently.
The programmes used by the CLIP team were:
- Time to Talk;
- Language through Listening;
- Nursery Narrative;
- Reception Narrative;
- Social Use of Language;
- Circle Time;
Gap of ages cut to the minimum
One of the project's aims was for the discrepancy between chronological age and performance age scores to decrease in at least 75 per cent of a sample of children.
An initial screening programme for phonological awareness in two of the schools found more than half of the children showed delayed skills.
A group of children who took part in "Time to Talk" were tested before and after for phonological awareness. Of the 14 who initially performed poorly for their age, 12 were available for testing at the end. All 12 had a decrease in the discrepancy between chronological age and performance age, with seven performing at or above their chronological age.
Photo: Pupils at Park Primary in Clackmannanshire are focusing on the pre-linguistic skills needed to develop expressive language. Credit: Alan Peebles
Original headline: Language scheme aims to give speech a chance