Language gains for children with persisting developmental language disorders through use of an intervention programme and support model for teachers.
Submitting InstitutionUniversity of Strathclyde
Unit of AssessmentEducation
Summary Impact TypeSocietal
Research Subject Area(s)
Education: Curriculum and Pedagogy, Specialist Studies In Education
Summary of the impact
Strathclyde researchers developed, via a randomised controlled trial, a
replicable effective language intervention programme (SLIP) for
primary-school children with persisting developmental language disorders.
This was followed by a cohort study investigating SLIP's
implementation in schools, and an evaluation study providing information
for speech and language therapists and teachers on implementing SLIP
in the classroom: the Language Support Model (LSM). The Royal
College of Speech and Language Therapists included the research outcomes
in commissioned economic evaluations and in their Resource Manual for
commissioning and planning Speech and Language Therapy Services. Also,
many speech and language therapy and education groups have requested
presentations and training on SLIP and LSM. The impact of
the research has been upon speech and language therapy education
internationally; on therapists and teachers using SLIP and the LSM;
on service commissioners; and on improved language intervention for
Approximately 6% of school entrants (around 2-3 per primary class) show
specific developmental oral language impairments. Where these have
persisted to school entry they predict poor social, mathematical,
literacy, communication and quality-of-life outcomes. Policy and good
practice mean children are educated in their local mainstream schools,
with their language-learning supported via collaboration between speech
and language therapists (SLTs), who work for the NHS, and teachers.
Non-professionally qualified assistants are often involved in delivering
language-learning activities. Little was known about the efficacy of such
language interventions, and no full-scale trial had been undertaken.
The research team was commissioned by the NHS Research & Development,
National Co-ordinating Centre for Health Technology Assessment (NCCHTA)
following competitive tender to investigate the efficacy of intervention
delivered by SLTs or speech and language therapy assistants to children
individually or in groups, in comparison with a control group of children
receiving their current SLT language interventions, with a one-year follow
up. A full-scale randomised controlled trial (Study 1, 2002-2007)
developed a language intervention based on a systematic review of existing
evidence-based interventions, leading to writing and auditing a manual of
language-learning activities, The Language Therapy Manual. An
economic evaluation compared costs of research delivery modes. The Strathclyde
Language Intervention Programme (SLIP) was then trialled in a cohort
study (Study 2, 2003-2004), funded by the Chief Scientist Office
Priorities and Needs Programme (CSO PNP), with language-learning
activities delivered by school staff. The implementation and outcomes of Study
2 were less successful so an evaluation study (Study 3,
2004-2005, also CSO PNP) was undertaken, which involved discussing SLIP
with SLTs and teachers from four Education Authorities, refining SLIP
for teacher use, and consideration of further co-working between SLTs and
teachers. This is one of the few studies reporting the views of classroom
teachers and practising SLTs. Study 3 produced the Language
Support Model for Teachers (LSM) outlining language-teaching
principles for primary school staff cross-referred to activities from the
Language Therapy Manual, and adding an implementation and
monitoring schedule for delivering language intervention in schools within
the SLIP protocol. Participants evaluated positively the
frameworks offered by the LSM, in particular the clear
language-learning principles, and the implementation and monitoring
schedule to be shared with school management. Key insights from Study
1 were that SLIP was equally efficacious when used by SLTs
or speech and language therapy assistants with children individually or in
groups, and for each mode child progress exceeded that of the control
group. Moderate effect sizes (gains) were shown for expressive language.
All research delivery modes were acceptable to teachers, parents and
families, and functional gains were identified. There were cost benefits
for delivery through assistants. The Language Therapy Manual
provided language-learning activities for individual and group delivery
via SLTs or assistants, and the intervention was replicable. The gains
shown during research intervention did not continue to accelerate during
the study's one-year follow-up period, where limited intervention took
place from NHS services. Study 1 thus impacted upon SLT practice
by providing an efficacious intervention that could be used across current
service-delivery modes for children in need of specialised intervention,
and gave indications of the amount of intervention required. In Study
2 some school staff found it difficult to undertake the amount of
language-learning activity required by SLIP, and Study 1's
efficacious results were not replicated. The impact of Study 2's
non-significant results was to reinforce the need for enhanced levels of
intervention, and the indication that the widely-used SLT practice model
of delivery through school staff was not unproblematic, and that teachers'
understandings and the amount of intervention to be delivered required
careful consideration. Study 3 addressed these issues, developing
the Language Support Model for Teachers (LSM). The LSM
supported language-learning activities delivered by school staff by
providing `how-to' information, and a joint SLT-school monitoring
Key researchers at Strathclyde
Elspeth McCartney, Lecturer, then Senior Lecturer in Dept. Speech and
Language Therapy 1987 to present; James Boyle, Reader, then Professor,
School of Psychological Sciences and Health from 1993 to present. Susan
Ellis Lecturer then Reader School of Education from 1989 to present
Study 1: Professor Anne O'Hare, Reproductive and Developmental Medicine,
University of Edinburgh contributed to the CONSORT diagram and to
discussion of the findings; Dr John Forbes (Reader in Health Economics)
University of Edinburgh conducted the economic evaluation. Neither
contributed to the development of SLIP.
References to the research
Outputs from Study 1.
1. McCartney, E., Boyle, J. et al. (2004). Becoming a manual occupation?
The construction of a therapy manual for use with language impaired
children in mainstream primary schools. International Journal of
Language and Communication Disorders, 39, 135-148.
Notes on quality: Published in a peer-reviewed international
2. McCartney, E., Boyle, J. et al. (2005). `Thinking for Two': a case
study of speech and language therapists working through assistants. International
Journal of Language and Communication Disorders, 40, 2,
Notes on quality: Published in a peer-reviewed international
3. Boyle, J., McCartney, E., Forbes, J. & O'Hare, A. (2007). A
randomised controlled trial and economic evaluation of direct versus
indirect and individual versus group modes of speech and language therapy
for children with primary language impairment. Health Technology
Assessment, 11, 25, 1-158.
Notes on quality: Publication in the NCCHTA research series Health
Technology Assessment is reserved for reports of work commissioned
for the HTA Programme of a sufficiently high scientific quality as
assessed by the referees and editors. Access statistics were available for
the first year of publication, and between July 2007 and July 2008 the
publication had 18,658 views or downloads.
Studies 1 and 2.
4. McCartney, E., Ellis, S. & Boyle, J. (2009). The mainstream
primary school as a language-learning environment for children with
language impairment: implications of recent research. Journal of
Research in Special Education, Themed Invitation Issue `Social and
Environmental Influences on Childhood Speech, Language and Communication
Difficulties', 9, 2, 80-90.
Notes on quality: This is the peer-reviewed version of an invited
contribution by the first author to the Third Journal of Research in
Special Education (JORSEN) Invitation Seminar `Social and Environmental
Influences on Childhood Speech, Language and Communication Difficulties',
Manchester Metropolitan University, 3rd July 2008.
Study 2 and 3.
5. McCartney, E., Boyle, J., Ellis, S., Bannatyne, S., & Turnbull, M.
language therapy for children with persistent language impairment in
mainstream primary schools: outcomes from a cohort intervention. International
Journal of Language and Communication Disorders, 46, 1,
Notes: Included in REF 2, UoA 25 Education. Published in a
peer-reviewed international journal. This paper remains on the journal's
list of most accessed papers. It won the journal's article prize for 2011.
6. McCartney, E., Boyle, J., Ellis, S., Turnbull, M. & Kerr, J.
(2010). Developing a language support model for mainstream primary school
teachers. Child Language, Teaching and Therapy, 26, 3, 359-374.
Notes: Included in REF 2, UoA 25 Education. Published in a
peer-reviewed journal. This paper remains on the journal's list of most
Other evidence for research quality: The three studies were funded
by UK Government (NHS, Chief Scientist Office) with research grants
totalling over £813k.
Details of the impact
Process from research to impact
The intervention protocol and the Language Therapy Manual were
disseminated as the Strathclyde Language Intervention Programme (SLIP),
supplemented later by the Language Support Model for Teachers (LSM);
SLIP and LSM were placed online in the institution's
repository, Strathprints [Sources A & B]. Published reports of the
studies were disseminated in journals read by relevant professionals. Health
Technology Assessment is widely read by medical professionals; the International
Journal of Language and Communication Disorders is the journal of
the UK SLT professional body the RCSLT; the Journal of Research in
Special Education is the research journal of the National
Association of Special Educational Needs (NASEN), and Child Language,
Teaching and Therapy is read by teachers and therapists working with
language-impaired children. Professionals reading the papers could access
the Language Therapy Manual and the LSM from Strathprints,
for direct use. Thirty-two presentations (17 invited) were made to
professional conferences, teacher and SLT study days, and seminars across
the UK, in Europe and in New Zealand.
Types of impact
Impact on UK policy and practice: The positive results of Study
1 were cited in the Bercow Review, 2008 [Source C p. 24), a
cross-party review of services in England for children with speech,
language and communication needs (SLCN), chaired by MP John Bercow. In
response to this review, the UK Government commissioned a Better
Communication Research Project (BCRP), to develop policy and
practice in English schools. BCRP evaluated international
evidence-based interventions and listed them on a `What Works' website
[Source D]; SLIP appears with a `moderate' level of evidence of
efficacy, which is the highest level listed for language impairment
interventions. SLIP is recommended for use in schools, impacting
upon professionals' choice of interventions. In 2009 The Royal College of
Speech and Language Therapists (RCSLT) cited Study 1 as their
evidence for intervention for children with language impairment in their `Resource
Manual for Commissioning and Planning Services for SLCN' [Source E],
which lists efficacious therapies appropriate for NHS delivery.
Impact on cost-efficient public services: In 2010, RCSLT
commissioned an economic evaluation of therapies from international
consultants Matrix Evidence, which also analysed language outcomes from Study
1 as the evidence related to language impairment. Since language
benefits exceeded costs (benefit:cost ratio 6.43), Matrix Evidence
concluded the intervention represented an efficient use of public
resources [Source F p. 47]. In 2013, RCSLT commissioned new consultants
(RTK Ltd and Concentra) to update the Matrix model regarding population,
prevalence and cost statistics, and to develop an on-line cost-benefit
analysis tool for local NHS services' use [Source G], which also uses Study
1 as the evidence for language gains. The RCSLT also presents this
information to other professions, such as the Royal College of General
Practitioners, as evidence of the value of therapy. The outcomes of Studies
1 and 2 have informed the amount of intervention understood to be
needed by children with language impairment, and correspondingly, have
impacted on those planning and developing SLT services; on decisions about
the amount of therapy and delivery mode; on workforce planning in relation
to the use of assistants, and on the provision and purchase of efficacious
interventions, particularly within current service commissioning regimes
in UK NHS and education services.
Improved practice and language gains for children: SLIP
provides an evidence-based intervention that can impact positively upon
the expressive language skills of children with language impairment. The
randomised controlled trial design, the rigorous analysis of effects, and
the replicable therapy mean it can safely be used by SLTs directly or via
supervised assistants, with the LSM, to achieve language gains for
children in schools.
Influence on SLT education internationally
Email correspondence, course documents, professional forums, and
invitations to present and publish indicate that SLIP and the
underpinning research is taught in SLT qualifying courses in the UK, South
Africa, USA, Australia, New Zealand, Ireland and in other European
countries, and has influenced the international SLT professional knowledge
base. SLIP and the LSM have also impacted upon the design
of an Australian trial of language intervention for pre-school children
Reach and significance
The strong research support for SLIP, its accessible information
on implementation and materials, and the fact that SLIP,
supplemented by the LSM, fits easily into primary school contexts
all mean that it has reached the international community of SLT
clinicians, educators, teachers and other practitioners whose professional
roles commit them to evidence-based practice, and who require
evidence-based interventions that can be used safely and effectively.
Through this community, SLIP has reached many children with
developmental oral language impairments, their schools and families.
Publications from The Royal College of Speech and Language Therapists that
draw upon the Strathclyde research have influenced service commissioners
and providers across the UK and beyond who seek cost-effective
interventions, bringing effective changes to intervention practices for
children with language impairment.
Sources to corroborate the impact
A. Strathclyde Language Intervention Programme (SLIP) http://strathprints.strath.ac.uk/32807
B. Language Support Model for Teachers http://strathprints.strath.ac.uk/32808),
C. Bercow Review 2008
D. The `What Works' database. http://www.thecommunicationtrust.org.uk/whatworks
E. RCSLT Resource Manual for Commissioning and Planning Services for
SLCN: Specific Language Impairment. 2009.
F. An economic evaluation of speech and language therapy. Final Report.
Matrix Evidence, December 2010. http://givingvoiceuk.org/wp-content/uploads/2012/06/matrix_report.pdf
G. RCSLT (2013) Cost benefit analysis models for SLTs.
H. Wake et al. (2012) http://www.biomedcentral.com/1471-2431/12/96