The child, the process & the expertise: Identification of priority children from preschool referrals to speech and language therapy

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This study concerns the decisions and expertise of speech and language therapists (sits) working with preschool children, in particular, the selection and prioritisation of newly referred youngsters for therapy. The literature review covers three aspects: the difficulties of identifying communication disorders in preschool children; the nature of speech & language therapy knowledge; the nature of the selection and prioritisation task. These three aspects provide the theoretical foundations of the study and gave rise to the selection of a multimethod and predominantly qualitative methodology. Using a series of knowledge elicitation tasks, the selection and prioritisation decision was explored. A small group of expert slts participated in semistructured interviews, case history analyses, focus group discussions and card sorting exercises. The results are summarised under three headings: the child, the process and the expertise. The study identifies areas considered significant in the discrimination of priority children. In particular, the co-consideration of the child's communication skills and the supporting communicative context emerged as the key categories. Features within these categories associated with priority and nonpriority children were identified. The process emerged as one whereby sits collected and evaluated baseline descriptions of the child and context. As these findings accumulated, they were judged as to their diagnostic and prognostic significance, as evidence of progress and as potential causes for sit concern. Substantial consensus was demonstrated between sits suggesting that the knowledge elicited emanated from a body of knowledge rather than being idiosyncratic. Even where variation occurred, patterns were evident, reflecting the possible existence of theories-of-action related to differing working contexts. The results are presented as theories-of-action which underpin slts decisions. As such they will be of support to junior sits in their understanding of the selection and prioritisation task and to more experienced slts in making their own decisions explicit.REMEDI; Department of Health Research Training Awar

Improvements in forecasting intense rainfall: results from the FRANC (forecasting rainfall exploiting new data assimilation techniques and novel observations of convection) project

The FRANC project (Forecasting Rainfall exploiting new data Assimilation techniques and Novel observations of Convection) has researched improvements in numerical weather prediction of convective rainfall via the reduction of initial condition uncertainty. This article provides an overview of the project’s achievements. We highlight new radar techniques: correcting for attenuation of the radar return; correction for beams that are over 90% blocked by trees or towers close to the radar; and direct assimilation of radar reflectivity and refractivity. We discuss the treatment of uncertainty in data assimilation: new methods for estimation of observation uncertainties with novel applications to Doppler radar winds, Atmospheric Motion Vectors, and satellite radiances; a new algorithm for implementation of spatially-correlated observation error statistics in operational data assimilation; and innovative treatment of moist processes in the background error covariance model. We present results indicating a link between the spatial predictability of convection and convective regimes, with potential to allow improved forecast interpretation. The research was carried out as a partnership between University researchers and the Met Office (UK). We discuss the benefits of this approach and the impact of our research, which has helped to improve operational forecasts for convective rainfall event

The contribution of early language development to children's emotional and behavioural functioning at 6 years: An analysis of data from the Children in Focus sample from the ALSPAC birth cohort

© 2014 Association for Child and Adolescent Mental Health. Background: An association between children's early language development and their emotional and behavioural functioning is reported in the literature. The nature of the association remains unclear and it has not been established if such an association is found in a population-based cohort in addition to clinical populations.Methods: This study examines the reported association between language development and emotional and behavioural functioning in a population-based cohort. Data from 1,314 children in the Children in Focus (CiF) sample from the Avon Longitudinal Study of Parents and Children (ALSPAC) were analysed. Regression models identified the extent to which early language ability at 2 years of age and later language ability at 4 years of age is associated with emotional and behavioural functioning at 6 years while accounting for biological and social risk and adjusting for age and performance intelligence (PIQ).Results: A series of univariable and multivariable analyses identified a strong influence of biological risk, social risk and early and later language ability to emotional and behavioural functioning. Interestingly, social risk dropped out of the multivariate analyses when age and PIQ were controlled for. Early expressive vocabulary at 2 years and receptive language at 4 years made a strong contribution to emotional and behavioural functioning at 6 years in addition to biological risk. The final model accounted for 11.6% of the variance in emotional and behavioural functioning at 6 years.Conclusions: The study identified that early language ability at 2 years, specifically expressive vocabulary and later receptive language at 4 years both made a moderate, but important contribution to emotional and behavioural functioning at 6 years of age. Although children's language development is important in understanding children's emotional and behavioural functioning, the study shows that it is one of many developmental factors involved

Integrating external evidence of intervention effectiveness with both practice and the parent perspective : development of ‘What Works’ for speech, language, and communication needs

Aim The aim of the study was to develop an ecologically valid synthesis of the evidence underpinning interventions for children with speech, language, and communication needs (SLCN), integrating a range of different data sources. Method Three sources of information were integrated: the Cochrane Review of interventions for children with primary speech and language delays/disorder; current practice from an online survey of 534 speech and language therapists and other professionals working with children with SLCN; and parent reports of preferred outcomes. Evidence was ranked as strong, moderate, or indicative. Results Of the 58 interventions identified, three (5%) were found to have a strong level of evidence, 32 (56%) had moderate evidence, and 23 (39%) had indicative evidence. Five were universal interventions, the remainder targeted and universal. The integrated findings were then turned into an online interactive database, which is moderated and updated at regular intervals. Interpretation There are a number of interventions that have a moderate or strong level of evidence underpinning them but they tend not to be those used by practitioners who often favour well-established familiar programmes even if they have only indicative evidence. There is a degree of complementarity between professional and parent views about outcomes, albeit with different emphases

Outcomes from a community speech and language therapy service treatment waiting list: The natural history of 527 children with identified speech and language needs

Abstract BackgroundUnderstanding the natural history of developmental speech and language impairments can support the selection of children whose difficulties are persistent rather than transitory. It can also provide information against which the effectiveness of intervention can be evaluated. However, natural history data is difficult to collect ethically. Furthermore, as soon as an impairment is identified, the behaviour of those around changes, thus creating some level of intervention. Longitudinal cohort studies, where intervention is minimal, or the control arm of randomised trials have provided the best evidence. However, occasional opportunities arise where service waiting lists can provide data about the progress of children who have not received intervention. This natural history study arose within an ethnically diverse, community paediatric speech and language therapy service in the UK where levels of social disadvantage are high.Aims:To identify (i) characteristics of the children who attended initial assessment and were selected for treatment (ii) differences between children who did and did not attend reassessment (iii) factors associated with outcomes.Methods and ProceduresA cohort of 545 children were referred and assessed as in need of therapy. Due to resource constraints, intervention was not available for an average of 12 months. Children were invited to attend for a reassessment of need. Initial and follow-up assessments were conducted by experienced clinicians using service guidelines and the Therapy Outcomes Measures Impairment Scale (TOM-I). Descriptive and multivariate regression analyses examined child outcomes for changes in communication impairment, demographic factors, and length of wait. Outcomes & ResultsAt initial assessment, 55% of children presented with severe and profound communication impairments. Children offered appointments at clinics in areas of high social disadvantage were less likely to attend reassessment. By reassessment, 54% of children showed spontaneous improvement (mean TOM-I rating change 0.58). However, 83% were still judged to require therapy. Approximately 20% of children changed their diagnostic category. Age and impairment severity at initial assessment were the best predictors of continuing requirement for input. Conclusions and Implications:Although children do make spontaneous progress post-assessment and without intervention, it is likely that the majority will continue to be assigned case status by a Speech and Language Therapist. However, when evaluating the effectiveness of interventions, clinicians need to factor in the progress that a proportion of the caseload will make spontaneously. Services should be mindful that a lengthy wait may disproportionately impact children who already face health and educational inequalities

The gut feelings of medical culture

This is the first book to consider digestive health in the nineteenth century from the combined angles of politics, literature, art, ethnography, psychiatry, emotional health, intellectual processes, morality, and spirituality. The chapters address the meanings and significance of digestive health in modern France, Northern America, Germanic Europe, Italy, colonial Australia and Britain. By revealing the particular nineteenth-century focus on digestive function and its influence on both emotion and cognition, the volume makes a new contribution not only to the history of literature, science and medicine, but also to current debates about the relationship between the gut and the brain. Here we help to show how medical breakthroughs are often historically preceded by intuitive models imagined throughout cultural production of different kinds

Identifying and Supporting Children’s Early Language Needs

Acknowledgements: We would like to thank the practitioners in our five sites for their contribution to this project. Perhaps it goes without saying that it would not have been possible without their input but we would like to thank them especially for their enthusiasm about the project and for contributing to the different elements of the project. Similarly, we would like to thank the parents who gave so readily their time to contribute to the project. It was clear that they valued the service and wanted to improve it for other parents. We are especially grateful to our PPI groups who helped steer the project, as did the Expert Advisory Group hosted by Public Health England and the Department for Education. And, finally, we would like to thank Nikki Hawley, administrator at Newcastle University, for help in data entry and support for the project.Publisher PD