The application and impact of a public health intervention supported by a speech and language therapist in the early years foundation stage

Abstract

PhD ThesisIntroduction Prevalence estimates indicate up to 50% of children in areas of social deprivation have speech, language and communication needs (SLCN). Three-tiered service delivery models are widely recommended to support early communication, however there are few studies examining the effectiveness of entire multi-tiered systems of support (MTSS). This thesis presents a longitudinal evaluation of a locally developed MTSS, with two overarching aims: 1) evaluating the impact of inclusion in this MTSS on vocabulary growth, and 2) exploring how children with differing SLCN move through the MTSS. Method Data about SLC skills, EYFS attainment and social deprivation were collected for 409 participants attending a cluster of school-based nurseries over two years. Participants were within the control cohort (n=165), the experimental cohort (n=128), or the controlexperimental cohort (n=116). Staff received training and support to implement the MTSS. Data were analysed to explore distinct patterns through the MTSS. Longitudinal multi-level modelling was used to explore vocabulary growth and the impact of the MTSS. Results Participants followed three distinct pathways: universal tier only, specialist tier only, or multiple tiers over time. At nursery entry, 100% of participants were below age related expectations for communication (EYFS) and the mean standard score for receptive vocabulary (BPVS) was M = 84.9 (SD = 12.2) (n=181). Participants accessing the MTSS gained 2.42 (p<0.05) additional standard score points per term completed in the MTSS. Those entering nursery with the lowest vocabulary scores, made the most rapid progress (intercept –slope covariance -0.70). Discussion These results indicate that MTSS within schools can have a positive impact on children’s vocabulary development. Children entering nursery with the most significant needs can be supported to begin to close the gap and it is crucial that the universal tier of support is more than simply ‘business as usual’