Contents

Acknowledgements ...... 2 1. Derby Integrated Early Years Speech, Language and Communication Strategic Model ...... 3 1.1 Introduction ...... 3 1.2 National Policy Context ...... 5 1.3 Local Context ...... 12 1.4 Early Intervention Foundation Maturity Matrix ...... 14 2. Needs Analysis ...... 16 2.1 Special Educational Needs (SEND) ...... 20 2.2 Provision for children ...... 21 3. Parent Views ...... 26 4. Wider Stakeholder Views ...... 29 5. Speech, Language and Communication Logic Model ...... 33 6. Integrated Model of Working ...... 35 6.1 Integration ...... 35 6.2 Assessing need ...... 57 6.3 Co-ordination of local service delivery/organisational structures ...... 58 6.4 Places ...... 59 6.5 Purpose of the Derby Speech, Language and Communication Pathway ...... 80 6.6 City-wide Public Health messaging ...... 80 6.7 The Wider Workforce...... 81 7. Organisational Structures ...... 81 7.1 Professional respect and relationships ...... 81 7.2 Place based model ...... 82 7.3 Information sharing ...... 82 7.4 Risks and issues ...... 84 8. Integrated Commissioning ...... 85 9. Integrated Governance ...... 87 9.1 Accountability ...... 87 9.2 Parent and child engagement ...... 88 9.3 Clinical Governance ...... 88 9.4 Workforce ...... 89 10. Implementation ...... 89 11. Five Year Delivery Plan ...... 90

1

Acknowledgements

The Author wishes to thank Derby City Council analysts in the Policy and Insight Team and the wide cross section of operational, strategic and parent stakeholders who have provided guidance, local knowledge, intelligence and passionate views about children’s speech, language and communication in Derby.

2

1. Derby Integrated Early Years Speech, Language and Communication Strategic Model

1.1 Introduction This document describes the proposed model for the integration of health, early years education and childcare settings, early help, public health, voluntary sector, family support and primary care for children’s speech, language and communication, 0-5 years in Derby. Over a period of 5 years, from 2020 to 2025, the model aims to ensure that ‘All children are ready to start school with good speech and language skills which support learning, mental health and later employment prospects and life chances’.

The strategy was developed in partnership with a group of stakeholders including parents, strategic leaders and operational practitioners from midwifery, health visiting, Family Nurse Partnership, early years education settings, health and local authority commissioners, family information service, NHS Speech and Language Therapy service, children’s centres and early help, the Virtual School for children who are looked after (LAC), primary schools, early years improvement and SEND teams and officers, library and educational psychology services.

The original scope of the model described was brought together by the Department for Education funded Early Outcomes Fund programme. The project was designed to improve early language outcomes for 0-5 year olds through high quality services by increasing the leadership focus at Local Authority level on the key issues of early language and to focus on resource evaluation and partnership working amongst a local area to encourage innovation around the wider system. The Derby programme was developed in conjunction with two partner Local Authorities – Nottingham and Leicester cities, Better Communication CIC (a not for profit organisation specialising in supporting the implementation of change in the commissioning and provision of services for children and young people with speech, language and communication needs – SLCN) and the School Development Support Agency (SDSA), a regional not for profit organisation supporting schools to work collaboratively, building professional partnerships related to school improvement. The three city programme of work was designed so that each local authority could learn from one other and provide the following outputs;

• A needs analysis for each city, looking at population and qualitative data from key stakeholder semi-structured interviews. • A review of the literature, looking at evidence-based assessment tools, interventions and methods for the age group. • A pathway of support for parents and professionals which included an outcomes framework to describe universal, targeted and specialist advice and tools available. • Development of a strategy and model of support to describe the way forward. • A methodology to address integrated commissioning that incorporates models of strengths- based partnership working across sectors and improves wider outcomes across the system such as children’s educational attainment, parent and child mental health and children’s later social mobility and employment.

3

The project was co-ordinated by a steering group in Derby City Council whose membership comprised of a Senior Early Years School Improvement Officer, Senior Programme Manager for the Early Outcomes Fund programme, Principle Public Health Manager and the Head of Service for Early Help.

The strategic model describes how speech and language support can be delivered in an integrated way by a wide group, involving local services and education settings to maximise help for parents and children. To support the development of the strategy, a pathway of support was also co- produced with the same group of stakeholders. The strategic model aims to support parents and children in two ways;

1. Prevention – enabling and supporting parents to build strong attachments with their children and provide opportunities for early language skills to flourish at home, helping them to confidently seek advice and know when and where to find what they need. 2. Identification and intervention – supporting local services and early years education settings to spot problems early, knowing how to identify need and provide support which avoids speech and language needs becoming entrenched and needing intervention from specialist services, preparing children for statutory school.

This document feeds into the Derby City Council Health and Wellbeing Strategy, the contributions of the Public Health nursing team and the delivery of the Healthy Child Programme, drivers from the Joined Up Care Derbyshire 5 Years Strategy Delivery Plan and strategic responses to SEND. It sits alongside findings from additional speech and language reports produced in the initial scoping phases of the Derby Opportunity Area which later became TALK Derby and also the Special Educational Needs and Disabilities Insight Pack 2019/20 produced by Derby City Council Public Health Department.1

In 2020, children’s early speech and language development became a Public Health priority in Derby alongside other key areas of need such as childhood obesity and mental health, enabling further opportunities for deeper integrated service models with the 0-19 Healthy Child Programme and NHS Speech and Language Therapy service specifications.

As a footnote, the needs analysis which under-pinned this document was collated before the COVID- 19 crisis. Stakeholder perceptions of the system and data regarding predicted and actual need should be read with caution. Indications are that the potential effects of the crisis could widen the disadvantage gap between children living in the highest social quintiles compared to the lowest which may suggest that children in poverty may experience greater need. The Children’s Commissioner Report in May 20202 ‘Lockdown Babies: Children born during the Coronavirus Crisis’ reported that at the time of writing 76,000 would have been born during lockdown. The report highlighted the limitations of support available to families including inability to make face to face contact with Health Visitors due to re-deployment and infection control concerns and maintenance of birth registers. Concerns were also raised about how vulnerable families would be identified and supported, particularly those living in poverty.

1 Special Educational Needs and Disabilities Insight Pack 2019/20 Produced by Derby City Public Health Department, Knowledge, Intelligence and Strategy Planning 2 https://www.childrenscommissioner.gov.uk/publication/lockdown-babies/

4

1.2 National Policy Context Many national documents have been produced in the last five years which make a case for the growing numbers of children with speech, language and communication needs in the early years and beyond. This document will refer solely to the research and policy responses which are relevant to early years.

Close links have been made between children living in deprivation and speech, language difficulties. In the report ‘Talking About a Generation’ produced by The Communication Trust3 children with speech, language and communication needs (SLCN) are reported as ‘missing’ and that there is known mismatch between prevalence levels of children with SLCN and those that are actually identified across the early years system regardless of whether children are seen within the health, education settings or the wider early years system.

Many professionals report ‘norm-shifting’ when working within disadvantaged communities where because so many children’s language skills are not where they should be, the professional starts to lose sight of what would be expected at that age and stage.

We also know that under-identification of SLCN as a Special Educational Need (SEN) continues past early years and changes as children become older. Those who are identified as having SLCN in their early years are often re-categorised as having Moderate Learning Difficulties (MLD) or specific learning difficulty in secondary school and their need is moved to a lower level by Key Stage 3.

Nationally SLCN is the most common SEN for children who do not have an Education Health Care Plan. The most prevalent SEN for children who do have an EHCP is Autism Spectrum Disorder.

‘50% of children starting school in the most disadvantaged areas will have speech, language and communication needs that should be recognised by schools and will benefit from targeted support in addition to good universal provision.

Some of these children will go on to be identified with more significant and long-lasting SLCN. That’s half of every reception class in the most disadvantaged areas.

7.6% of children in the early primary years will have a developmental language disorder, not linked to factors such as general learning difficulties, cerebral palsy or hearing impairment. That is two children in every class of thirty.

Analysis of the SEND data tells us that only 2.6% of children are identified by the SEND System (School Support as well as for an Education, Health and Care Plan) as having SLCN as a primary need.

In a review of thirty speech and language therapy caseloads, the average percentage of children known to speech and language therapy is just under 4% of their local population, of which approximately half are school age. Whatever the measure, research tells us that these children and young people are in our Early Years and school systems, and yet they are not being identified.’

Gascoigne and Gross – Talking About a Generation (2017)

3 https://www.thecommunicationtrust.org.uk/media/540327/tct_talkingaboutageneration_report_online.pdf

5

We know that social disadvantage has a strong impact, not just on children’s speech and language development but also on their social mobility and life chances because of its close links to mental health needs in childhood and educational under-performance. As children with SLCN move into adulthood with poor vocabulary skills, they are twice as likely to be un-employed when they reach adulthood and 60% of young offenders having low language skills.

By 5 years of age, children who have experienced poverty throughout their early years are far more likely to have SLCN and this picture is more noticeable as the level of disadvantage which the child has been exposed to increases. The Talking About a Generation report described a large-scale UK cohort study at a population level which showed that at the age of three, children in the lowest income group have language skills on average 17 months behind children in the highest income group. The gap in language is very much larger than gaps in other cognitive skills, and larger than in other developed countries. Additionally, children from disadvantaged backgrounds who do well in vocabulary tests at age three are more likely to fall behind by the age of five than their wealthier classmates. The report goes on to say that children in Local Authorities with the highest levels of disadvantage consistently do less well in all the 17 early learning goals of the Early Years Foundation Stage Profile, but the most significantly affected areas are Understanding, Speaking and Reading. The cohort study described the disadvantage relationship with a widening of this gap as deprivation levels increase when children are assessed at age five using the Good Level of Development (GLD) measure at the end of their Reception year in school, an indicative score used to measure school readiness.

In terms of Special Educational Needs, SLCN is the most reported SEND category in primary schools with 28% of all children and young people reported by schools in their PLASC survey to have additional needs.

There is good evidence from evaluations of language interventions that we have tools available to us that can be used in early years education settings which can accelerate children’s language skills and are particularly effective when parents also deliver the intervention materials at home.

A study in Scotland4 that looked at child vocabulary development from birth found that language is most influenced by factors in the home environment as opposed to pre-school education which indicates that if we are to look to narrow the disadvantage gap, solutions need to be found which can help parents to develop children’s language and communication skills at home as well as providing communication rich early years education environments.

Higher prevalence rates of SLCN have been reported in children who are in care. ‘No Wrong Door’ in North Yorkshire, a service for young people who are within or on the edge of care comprising of a Clinical Psychologist, a Speech and Language Therapist, community foster carers and supported living places found that 62% of the children seen by the service had SLCN, but only two had previously been seen by a Speech and Language Therapist.

4 Bradshaw, P, King, T, Knudsen, L, Law, J, and Sharpe, C (2016). Language Development and Enjoyment of Reading. Impacts of Early Parent-Child Activities in Two Growing Up In Scotland Cohorts

6

The Bercow 10 Years On Review (2018)5 report published by the Royal College of Speech and Language Therapists and the charity ICAN carried out a review of the Speech Language and Communication (SLC) landscape nationally. The report aimed to follow up the progress made from the original Bercow Review commissioned by the Government in 2008. In the 2018 review, parents continued to report that they felt that there continued to be a lack of awareness about speech, language and communication needs nationally and in their local communities coupled with insufficient information available to them about how to support their child’s speech and language development at home. The review also suggested that in terms of national and local policy, children’s views should be more actively sought about how services are delivered and designed around them. More recent research looking at child perspectives about how they preferred their speech and language needs to be supported in school in Ireland6 revealed that when children’s views have been sought, the children said that they wanted greater autonomy and inclusion and asked to have a greater influence and opportunities to support their ability to make choices in their places of learning. They would like to be given more time to talk, especially when learning something new and talked about how this helps them to learn. The children reported that they felt that ‘difference’ and diversity was a good thing and wanted this to become the norm and universally accepted rather than children being seen as a homogenous group. They also placed great emphasis on the importance of their ability to talk like everyone else because this gave them social status and capital.

The Bercow 10 Review also raised the importance of the need for integration of services in order for all children’s needs to be supported effectively across the children’s sector. Significant weaknesses were found in local areas around strategic planning, joint commissioning and leadership with regards to meeting children’s SLC needs. The Early Intervention Foundation has subsequently developed a Maturity Matrix for Speech, Language and Communication7 as part of the Government Social Mobility Action Plan8. The tool is a self-assessment tool used by a local area to measure how well it is creating a local system to help children with speech, language and communication needs to thrive. It is a core tool used by two other initiatives which derive from the Social Mobility Action Plan – the Local Government Association (LGA) Early Years Speech and Language Peer Challenge process9 where local government leaders and experts work together with key partners to help councils with their improvement and learning. The programme provides a practitioner perspective and acts as a critical friend to challenge and support innovation and uses the Maturity Matrix self-evaluation as the focus. The second initiative is the Early Outcomes Fund programme.

Much has been written in the literature about the wider determinants which indicate a child may experience social and developmental difficulties. The Early Intervention Foundation (EIF)10 reports a range of parental and child factors which increase likelihood;

• Parental education and occupation • Low income/poverty • Area of residence

5 https://www.bercow10yearson.com/wp-content/uploads/2018/03/337644-ICAN-Bercow-Report-WEB.pdf 6 Gallagher, A, (2019). Establishing premises for best collaborative practice when supporting children with a developmental language disorder in school. Doctoral thesis. https://ulir.ul.ie/handle/10344/8475 7 https://www.eif.org.uk/resource/eif-maturity-matrix-speech-language-communication-early-years 8 https://foundationyears.org.uk/wp-content/uploads/2019/07/DfE-Social-Mobility-Programe-slides.pdf 9 https://www.local.gov.uk/early-years-social-mobility-peer-challenge-programme 10 https://www.youtube.com/watch?v=ujJqUNOwWT4&feature=youtu.be EIF webinar understanding the evidence on early language

7

• Maternal age • Parental health, disability, ethnicity, gender, identity and sexuality, alongside socially stratified vulnerabilities and genetic factors • Child birth order • Premature birth • Use of toxic substances in the womb • Parental nutrition and smoking in pregnancy and postnatally • Adverse Childhood Experiences • Parental attachment and attunement with the baby/young child • Use of services • Child development opportunities and safety /quality of parenting.

In the Early Intervention Foundation report ‘Key competencies in early cognitive development. Things, People, Numbers and Words’11 also report a range of risk factors which are associated with language development;

• Adolescent motherhood • High levels of stress or the existence of maternal mental health problems during pregnancy and postnatally • Maternal use of harmful substances • A pre-term birth • Low parental qualifications • Higher number of siblings

The EIF report ‘Language as a Child Wellbeing Indicator’12 also highlighted that prevalence rates for boys are higher than for girls at 8% and 6% respectively.

The outcome is not necessarily inevitable because there is no common cause of Speech, Language and Communication Needs (SLCN), rather a need to consider a range of inherited, biological and environmental factors. What we do know is that parental use of vocabulary is one of the strongest predictors of positive development.

Protective factors in the home learning environment have been found to ameliorate the risk of a child experiencing language delay. The factors include;

• High family income • Degree educated parents • The availability of books in the home and shared reading • Being born first • Childcare from one adult during the first two years • Being a girl

11https://www.researchgate.net/profile/Kirsten_Asmussen/publication/330292418_Key_Competencies_in_Early_Cognitive_Development _Things_People_Numbers_and_Words/links/5c3783c7a6fdccd6b5a19e9b/Key-Competencies-in-Early-Cognitive-Development-Things- People-Numbers-and-Words.pdf 12 Language as a child wellbeing indicator (2017) EIF

8

• High levels of age appropriate infant directed speech that is responsive to the child’s specific interest • Frequent joint attention activities • Enriching pre-school education • Participation in childcare from age two onwards

The Healthy Child Programme (HCP) utilised by the Health Visiting service focusses on early identification of developmental delay and disability and places a responsibility to provide information, support, referral and notification to others. In particular there is a duty to inform the local education authority if it is suspected that a child may have special educational needs. Health Visitors have a specific skill set identifying early risk factors associated with developmental difficulties and when carrying out the HCP health and development reviews are expected to have knowledge and understanding of child development and of the factors that influence health and wellbeing. They need to be able to recognise the range of normal development. Research is beginning to show that nurses have an effect on child language development when supporting families by home visiting.13

The Development Matters framework in the Early Years Foundation stage curriculum is followed by all early years education settings including childminders, private day nurseries, playgroups, children’s centres, nursery schools and foundation units attached to infant and primary schools. The three prime areas of the framework cover children’s communication and language development, physical development and personal, social and emotional development. Less emphasis is placed on identification of risk factors which could indicate developmental concerns unlike the Healthy Child Programme.

What we also know about the pattern of child language development in the under 5’s is that there is high variability. A cohort/population study in Australia14 revealed that how children’s language present at 2 years of age, does not necessarily predict how their language development presents at 4 years of age. The study found that of 19% late talkers at 2 years of age only 5% had language delay at 4 years of age and 14% were typically developing. However, of the 81% of typical talkers at 2 years of age, 75% continued this trajectory, but 6% were impaired who had not presented with language difficulties at all at age 2.

13Robling, M, Bekkers, M-J, Bell, K, Butler, C, Cannings –John, R, Channon, S, Corbacho-Martin, B, Gregory, J, Hood, K, Kemp, A Kenkre, J, Montgomery, A, Moody, G, Owen-Jones, G, Pickett, K, Richardson, G, Roberts, Z, Ronaldson, S, Torgerson, D. Effectiveness of a nurse-led intensive home visitation programme for first –time teenage mothers (Building Blocks): a pragmatic randomised control trial (2016). The Lancet, Vol 387, Issue 10014, P146-155 14 Reilly, S, McKean, C, and Levickis, P (2014) Early Language in Victoria Study (ELVS). https://www.mcri.edu.au/research/projects/early- language-victoria-study-elvs

9

In the light of this information, the report ‘Early Language Development: Needs, provision, and intervention for preschool children from socioeconomically disadvantaged backgrounds’15 proposes an element of ‘over-servicing’ at a population level for children at risk of having SLCN considering the red flags which indicate the need for an assessment by a Speech and Language Therapist without delay as well as the following population risk factors;

• Integrating child, family and parenting factors to estimate a child’s level of risk • Identifying children with multiple vulnerabilities such as both speech and language difficulties and social and emotional difficulties • Monitoring the child’s rate of progress over time

With some minor adaptations and integration, both the health and early education systems and the data which they collect, are well placed to identify children with speech, language and communication needs across the 0-5 age range.

Looking at the wider early years system, there have been a number of reports which have called for better integration of services, particularly for the most disadvantaged families. The Allen Review (2011) called for the setting up of 15 local early intervention places where new methods could be tested for working more effectively to meet children and family’s needs and also recommended the establishment of the Early Intervention Foundation (EIF) to provide evidence of what works and also to support local early intervention projects.

The Frank Field Report (2010) ‘The Foundation Years: preventing poor children becoming poor adults’. Recommended better targeted services for the most disadvantaged families, including better outreach and opportunity to take parenting classes.

The First 1001 Days All Party Parliamentary Group (2015) ‘Building Great Britons’. Set out what it saw as essentials for good local prevention approach;

1. Good universal services 2. Central role of Children’s Centres 3. Universal early identification of need for extra support 4. Good antenatal services

15https://educationendowmentfoundation.org.uk/public/files/Law_et_al_Early_Language_Development_final.pdf

10

5. Good specialised perinatal mental health services 6. Universal assessment and support for good attunement between parent and baby 7. Prevention of child maltreatment

The DfE Report ‘Unlocking Talent, Fulfilling Potential’ (2017) set out a plan for improving social mobility through education. The focus in early years was to close the ‘word gap’ and planned a re- focussing of a targeted response to people and places where the highest need resides.

The Government report ‘Prevention is better than cure’ (2018) announced that it was taking action before and during pregnancy, through childbirth and throughout childhood by;

• Encouraging healthier pregnancies (stopping smoking is the single biggest factor in terms of preventing infant mortality) • Working to improve language acquisition and reading skills in the early years – including supporting parents to help their children’s language development at home, linking children’s language with later school readiness, educational attainment and future life chances • Helping families by taking a whole family approach. Coordinating support for those that need it across a range of important areas including mental health, housing, debt and employment. Reducing parental conflict which has a knock-on effect to children’s emotional and social development

The Health and Social Care Committee in 2019 made six recommendations to Government for the first 1000 days of a child’s life which would reduce Adverse Childhood Experiences, improve school readiness, and reduce infant mortality and child poverty;

1. Proportionate universalism (services available to all, but targeted in proportion to the level of need) 2. Prevention and early intervention 3. Community partnerships 4. A focus on meeting the needs of marginalised groups 5. Greater integration and better multi-agency working 6. Evidence-based provision

In a number of publications, researchers in the Speech and Language Therapy profession have proposed a shift in emphasis in service delivery from one which solely focusses on diagnosing and remediating within child ‘medical’ conditions to one which is grounded in public health principles which focusses on preventable factors within the child’s family such as economic well-being, lifestyle and environmental exposures. By focussing on the social determinants of health, such as family stress, inadequate economic and psycho-social resources, geographical location, ethnicity and socio- economic status, they argue that as a profession, Speech and Language Therapists will be more able to effectively address lifelong development and outcomes taking this approach.

Social determinants create a ‘health gradient’ which results in poorer outcomes for those in the poorest economic circumstances. This stratified need across social groups means that the most disadvantaged have the highest need, but access services less, which often nationally results in a postcode lottery in terms access to Speech and Language Therapy services. The research questions whether services are provided in the right places in terms of where children and families go and also

11 calls for consideration of the concentration of services in areas where there is greatest need. The aim is to achieve equity of outcome, not equity of access to services. The Children’s Commissioner Report (2019) ‘We need to talk: Access to Speech and Language Therapy’16 highlighted that there is wide variation in terms of the amount of spend per child across the country on Speech and Language Therapy. The top 25% of areas spend £16.35, whilst the bottom 25% spends just 58p. The East Midlands were one of the lowest spend areas.

The Government Opportunity Areas have attempted to address this concern and the subsequent Early Years Social Mobility Programme (2019) recommended that Early Speech, Language and Communication Support should happen in the places which were most accessible for children and families, in particular family homes, via local services and in early years education settings.

1.3 Local Context Children’s speech, language and communication in the early years has become an increasing priority in Derby in the last few years. The Department for Education funded the Derby Opportunity Area where Derby was identified as a social mobility ‘cold spot’. After considerable consultation by an initial scoping exercise, this programme targeted improving children’s speech, language and communication skills as a key priority in the Derby Delivery Plan (2017 – 2020)17 with a view to improving children’s social mobility and readiness for school entry. Several pilot projects informed the specification for the delivery programme of work. Each pilot looked at specific aspects for example; how best to involve parents, training and development programmes which may be utilised and the evidence-based identification and intervention tools and methodologies which could be deployed across the sector. A needs analysis looking at prevalence of need, provisions available and workforce to address the need was carried out by Better Communication CIC along with an Independent Speech and Language Therapy service. Better Communication also carried out an external review to report on the outcomes and impact of the pilot projects. The outcomes from the pilots showed that as a city, insufficient effective approaches were available for supporting parents to develop their children’s speech and language at home, there was a high need for workforce development and training across the system. One of the pilots also showed that the health visitor 2- year-old reviews using the Ages and Stages (ASQ3) development assessment tool was identifying insufficient numbers of children with communication and language needs. When another tool was trialled alongside and health visitors were trained about speech and language development, a higher number were identified. The pilots also revealed that two interventions were particularly effective supporting children’s language development at 2 years and 3 years of age when compared to controls. The Wellcomm tool was found to be effective for 2-year olds and Early TalkBoost was especially effective for 3- and 4-year olds. Finally, the pilots revealed that practitioner knowledge and skills improved when wider training about identifying risk and general support strategies was provided alongside training to deliver the interventions as well as onsite coaching for practitioners to enable them to apply newly learned skills in their bespoke settings.

TALK Derby, the initiative which arose from the Opportunity Area programme has provided substantial training for the children’s workforce in the city at an operational level, enabling practitioners to understand more about child language development, how to identify SLCN and also the supportive strategies which can be deployed in the most disadvantaged wards in the city.

16 https://www.childrenscommissioner.gov.uk/publication/we-need-to-talk/ 17 https://derbyopportunityarea.co.uk/

12

Additionally, leadership teams in Foundation Units in schools, Private, Voluntary and Independent childcare settings and Children’s Centres have also begun to self-evaluate their speech, language and communication provision using the Balanced System® Scheme for Schools and Settings. This tool enables the leadership team to plot the strengths and gaps in provision at universal, targeted and specialist tier in the five strands of parent support, environment, workforce knowledge and skills, identification and intervention. Once mapped, an action plan is developed with baseline measures taken. Once the action is completed it is reviewed using the Friedman Outcomes model in terms of how much the setting did (input), how many people/children received it (reach), how well it worked (implementation quality/outcome) and whether it made a difference (impact). TALK Derby has also developed a promotional campaign for the public which is also supported by local businesses in the city.

Simultaneously, following the outcomes of the Opportunity Area pilots, the Public Health commissioners of the Health Visiting service were successful in applying for a funded training programme developed by Public Health England to train all Health visitors in the service around identification of risk, assessment of communication and language and how to provide supportive strategies for parents in the family home. All of the materials were evidence based and developed in conjunction with researchers from the Speech and Language Therapy profession with an interest in Public Health. Work has also taken place with the health visiting service, Children’s Centres and PVI settings in one area of the city to pilot a method of integrating the 2-year development checks and usage of shared tools for identification of need and supporting speech, language and communication development.

An additional programme funded by the Department for Education is also underway called the Professional Development Programme in the Mackworth ward which although disadvantaged, was not part of the scope of the TALK Derby programme. This programme will work with the Private, Voluntary and Independent (PVI) early years education settings in the ward to develop practitioner knowledge and skills around communication and language, literacy and maths development.

The Department for Education Early Outcomes Fund Programme (2019 – 2020) was introduced into the city to develop the strategic response to need and ascertain from key strategic and operational stakeholders and parents what they would like the picture in the city to look like going forward. The programme was tasked to evaluate local data sets to look for patterns of strength and weakness in the current method of delivery across sectors and look at how key parts of the system fitted and worked together across a wide range of different commissioning and service delivery landscapes. The outcome from the work was to develop this document with an additional plan as to how the offer for children and families could be sustained and embedded in the future by strengthening and integrating delivery across the system. An electronic pathway would also be developed which would be easily accessible for parents and practitioners. The pathway would provide supportive information about identifying SLCN, how best to support children’s speech, language and communication development and how and when to seek more specialist help. The needs analysis approach used the Balanced System© in conjunction with Better Communication CIC to carry out both quantitative and qualitative mapping of data, stakeholder perspectives and analysis of provision available across the city. The findings were used to inform the structure of the electronic pathway and also the future service delivery model later described in this document. Better Communication CIC also carried out a review of evidence-based identification and intervention tools

13 which could be used across the age range, building on the work of the Derby Opportunity Area pilot project. The programme also used the Early Intervention Foundation (EIF) Maturity Matrix: Speech Language and Communication in the Early Years with a wide range of stakeholders to take a baseline measure of the maturity of the Derby SLC offer and to look at how effectively it is when creating a system to help children in their early years to thrive.

To date, with the exception of the TALK Derby Programme which reports to the Opportunity Area Partnership Board, none of the other speech and language initiatives report into any of the strategic, cross sector governance groups such as the Health and Wellbeing Board, Children, Families and Learners Board in the city.

1.4 Early Intervention Foundation Maturity Matrix The EIF Maturity Matrix was completed by a wide cross section of operational and strategic stakeholders and a summary of contributions is shown in the table below. The exercise highlighted that despite many initiatives around Speech, Language and Communication driven operationally by Speech and Language Therapists and School Improvement Officers many of which funded by the local authority and DfE, strategically Derby is developing its local early years system at a basic level.

Workforce development has been considerable, however because workforce mapping has not taken place there has to date been no strategy driven by the centre which can make correlations between workforce development and changes or improvements in children’s outcomes.

Leadership in the system has developed to the early progress level since the inception of the Early Outcomes Fund programme with strategic stakeholder involvement and engagement, and some early planning is taking place around measurement of outcomes (previously the only measure was Good Level of Development). There is also some early utilisation of the evidence-base around maternity and early child development. Much of the work has taken place so far within individual sectors or services and work is yet to be done looking at how over-arching principles and methods can be utilised to make the whole more cohesive. Community ownership scored the lowest out of all of the sections. To date, development actions using the tool do not report into any of the strategic forums in the City.

In 2019, Derby received a Written Statement of Action (WSOA) following a Joint CQC and HMI SEND inspection. Parents reported that they felt isolated and could not access the services that they needed for their families and children, there was a lack of co-produced strategy with joined up actions across sectors in education, health and social care leading to confusion among professionals as well as parents. The WSOA report highlighted that there was insufficient oversight and monitoring of the effectiveness of SEND initiatives for example waiting times for specialist services were too long with no co-produced plan in terms of how to address this across the local area/system. Joint commissioning arrangements across sectors needed to be considered to ensure that the diverse needs of children were known and subsequently addressed and supported by professionals. Services in early years were identified as strong, with strengths emerging around early identification of needs, in particular speech and language needs and joint working between Health Visitors and Children’s Centre workers. The report identified that in early years, Health Visiting services were not routinely offering appointments to expectant mothers and that integrated 2 to 2 and a half year checks across health visitor and early years settings was not yet established.

14

KEY ELEMENTS PROGRESS LEVELS 1. Basic Level 2. Early Progress 3.Substantial Progress 4.Mature 1. Strategy Addressing SLCN in the early Partners collaborate to A multi-agency early years The early years strategy has been years is recognised as analyse data on early years strategy is in place, with a clear reviewed and refreshed, taking important but has had little needs and outcomes, narrative on SLCN account of impact impact on planning including SLCN 2. Commissioning Single agency commissioning The local authority and CCG Commissioning is aligned to the Joint commissioning for early years,

for early years, but are working towards joint early years strategy. Investment including SLCN, is extensive and

commissioners recognise the early years commissioning. in early years services is a local routine. Shifts in investment to

Plan need to collaborate to impact Work is underway to priority early childhood intervention on SLCN pool/align budgets 3. Workforce Planning Limited understanding of who Initial workforce mapping There is a strategy for building There is a strategy for building early in the workforce can impact on underway. Speech & early years workforce capacity & years workforce capacity & SLCN and what their learning Language Therapists have key capability including promoting capability including promoting skills needs are role in training the wider skills for SLCN development for SLCN development

workforce 4. Partnership Some partnership dialogue on Identified partnership group Partnership group having Influential and effective partnership early years & SLCN but no responsible for early years positive impact & driving local group

governance goals plan 5. Leadership Increasing awareness of Some senior advocates for Active buy-in to early years goals Senior leaders speak with one voice Lead importance of SLCN early years and SLCN at operational & strategic levels on early years & SLCN 6. Community Ownership Children and families are Family champions involved in Families co-design strategy and Peer support and community

consulted in general strategy development commissioning delivery are prioritised 7. Services and Interventions Some key services are judged to Key services are good & All children receive the Key services are good or excellent.

be underperforming improving. Shared early years mandated Healthy Child Coherent portfolio of evidence- pathways are being Programme checks and take-up based interventions developed of entitlements is high Deliver 8. Information and Data Commitment to information Some information sharing on Information sharing is routine Families access up-to-date and

sharing but there are gaps across key early years services and timely accurate service information 9. Outcomes Recognised that SLCN are Early years (including SLCN) Families generally have a smooth Outcomes show consistent

important to measure outcomes framework in journey through services improvement development 10. Using and Generating Evidence Evaluation is recognised as Stakeholders are reviewing Local leaders and decision- A common evaluation framework is important the latest evidence on makers are skilled and confident used across early years services Evaluate maternity and early child users of evidence

development

15

2. Needs Analysis

Derby is a relatively ‘young’ city compared to England averages. 6.1% of the population is aged 0-4 years of age, putting the 0-4 age range of the population in the top 20% in the country. The five wards with the highest percentage of 0-4-year olds are: Alvaston (7.5%), Arboretum (8.1%), Derwent (8%), Normanton, (9.5%) and Sinfin (8.3%) with some wards falling below the average for England. The lowest two are Darley (4.4%) and Allestree (4.8%).

In terms of disadvantage according to the Better Communication© needs analysis report for the Early Outcomes Fund programme;

‘Derby City is in the 20% of Local Authorities in England with the highest levels of disadvantage regardless of the measure used. In 2019, the Index of Multiple Deprivation (IMD) was renewed and reveals that Derby City has moved from the 55th most disadvantaged Local Authority in 2015 to the 67th most disadvantaged Local Authority (a change of 12 places). In addition, there are signs of positive improvements for young people as the Index of Disadvantage Affecting Children (IDACI) identifies that Derby has moved from the 51st to the 59th most disadvantaged when only considering factors that affect children’.

This data will need to be read with caution in view of the COVID-19 crisis. Indications are that levels of disadvantage for family homes and children could increase in the future.

Based on the Index of Multiple Deprivation (IMD), Arboretum and Normanton were found to be the most disadvantaged wards whilst Allestree, Blagreaves, Littleover and Mickleover were found to be within the least disadvantaged wards in the country.

In terms of predicted speech, language and communication, we know that that child need is closely correlated with disadvantage. The tables produced by Better Communication CIC© show this data starkly (red being highest need, green lowest);

16

©Better Communication CIC

In terms of attainment, Derby’s Early Years Foundation Stage Profile Good Level of Development (GLD) data, which includes a communication and language score is taken at the end of the child’s reception year (age 5 years). In 2019 the data showed that gender (boys), social deprivation and children who have SEND or are Looked After by the Local Authority are the groups of children who are struggling most developmentally by the age of five. When comparing Derby data to other East Midlands Local Authorities and to National data sets, we know that;

• Girls continue to do better than boys with a gender gap of 15.3% against a national gap of 13.5% • Derby is ranked 40/151 Local Authorities for the percentage of children in receipt of FSM (Free School Meals) who achieved a Good Level of Development. This means Derby dropped 10 places in 2019 – Derby has a 38.8% gap between the most advantaged and 20% most disadvantaged children in the population. • 50% of children who are looked after achieve a good level of development. Derby has higher than the national average number of children under 5 years who are looked after (LAC) at a rate per 10,000 population. has higher than the

17

• The percentage of children whose first language is not English achieving a good level of development has improved by 20 places compared to national figures, the number of children behind national averages has narrowed since 2017 to 1% below the national average. • Derby is ranked 19/151 LAs for the percentage of SEN pupils who achieved a good level of development • 79.2% of children achieved GLD in Communication and Language in Derby compared to 81.1% of children in the East Midlands and 82.2% of children nationally • Overall, Derby’s good level of development has risen substantially in the last 5 years.

According to the Better Communication CIC needs analysis and predictive modelling, based on the levels of deprivation and live birth data in the city, it is anticipated that 1391 children (43% of children under 5) in 2019 would not achieve expected Communication, Language and Literacy scores at the end of their reception year.

At age two to two and a half years, children are invited to attend a Healthy Child Programme review with a health visitor or community nursery nurse about immunisations, health promotion, parenting support, and screening tests. The health visitor will also review the child’s development including their social and emotional wellbeing. City-wide data is recorded centrally on a quarterly basis and reported to Public Health England;

Table showing quarterly figures for the number of children who passed the Communication and Language section of ASQ3 2 to 2-and-a-half-year assessment;

Quarter 1 2019/20 = 91.5% (Derby), 89.2% (national)

Quarter 2 2019/20 = 92.8% (Derby), 89.1% (national)

Quarter 3 2019/20 = 92.3% (Derby), 89.4% (national)

These data are currently aggregated at a city wide-level and not reported at individual ward level, which does not allow for trends to be observed with regard to differences in families who live in most versus least disadvantage.

What we do know is that there are differences at ward level in terms of the number of children who received their ASQ 3 two-year-old review. 11 wards were above 90% cut-off for receiving the assessment; the following wards were below - Arboretum (84.5%), Darley (72%), Derwent (73.2%), Mackworth (83%), Mickleover (79.2%), Sinfin (88.7%). In this quarter, five out of six wards were wards where the highest concentrations of children with predicted SLCN reside. Only Mickleover is a ward with a lower predicted risk.

18

Derby CHiMAT (The National Child and Mental Health Network) data shows several wider social determinants which correlate with the number of children who may be at risk of speech and language needs. For example, higher than national average numbers of children living in low income families, family homelessness, children in care, under 18-year-old conception rate and teenage mums, low birth weight, smoking at time of baby delivery, breastfeeding initiation and hospital admissions 0-4 years.

Despite this data, high percentages of children pass the ASQ3 assessment of child development at the two to two-and-a-half-year check. This trend has also been reported nationally. When alternative assessments have been used alongside the ASQ3 (in the Derby Opportunity Area pilot), greater numbers of children with Communication and Language needs have been identified. The pilot found that the ASQ3 only identified children with communication and language difficulties in the bottom 10% of children ie those with the most significant and obvious developmental difficulties. The pilot project also found the ASQ to be less sensitive identifying SLCN when children were learning another language other than English.

In line with national trends, the Derby data shows that Communication and Language scores are lowest when compared to the other four strands assessed using the ASQ3 (Gross Motor skills, Fine Motor skills, Problem Solving, Personal and Social skills). Similarly, high numbers of children passed the ASQ3 assessment of Communication and Language despite training from Public Health England for all Health Visitors in the city this year. The training included knowledge exchange about how to identify language delay. This suggests ongoing coaching and mentoring from specialists is needed around application of formal classroom learning in relation to specific children assessed to ensure all children with language delay at two are identified.

Between 2 and 5 years of age, no additional data is collected centrally in Derby about child development, including children’s communication and language development from Children’s Centres or early years education settings. Children’s Centres, Private Voluntary and Independent (PVI) childcare settings and schools and nursery schools use the Early Years Foundation Stage Development Matters framework to assess, monitor and track child development outcomes, but the analysis of data and outcomes following intervention are not reported or recorded centrally, only shared within the setting with practitioners and parents, including the two year progress check carried out with those children attending an education setting. Work is underway in one ward in the city trialling the sharing of this data in an integrated way.

There are indicative measures which can be used to infer that conditions are being created to provide optimum developmental conditions for vulnerable children/those at risk of language delay between the ages of two and four years of age for example we know that Derby has high levels of take up compared to national averages of children in funded early education places for 2 year old children who live in the 40% most disadvantaged households (80% in 2018). Most of these children have places in PVI settings, 97.2% of which have been judged at least Good by Ofsted (as of 31st March 2020), indicating the children are in receipt of high-quality childcare which is correlated with positive developmental outcomes. Children are targeted for this provision support by staff working in children’s centres via the Golden Ticket scheme. Additionally, the city has early years inclusion funding for 2-year-old children with SEND to encourage take up in this group.

19

We also know that as children move through into the school system in the Nursery and Reception year groups, the highest number of schools who are not good to outstanding reside in the top three quintiles for social disadvantage and it is these schools where children are less likely to achieve a Good Level of Development. The reasons for this are not exactly clear, but some indications which were fed into the needs analysis process suggested that there is high transience in the school populations in this group, different mechanisms for professional development opportunities and school improvement challenge and support due to the wide range of academy chain and trusts which partner schools in the city. An initial workforce development plan for the Early Outcomes Fund Programme revealed, that despite the number of Speech, Language and Communication initiatives in the city, many schools who reside in the most disadvantaged quintiles have not accessed the workforce opportunities which have been provided (free in many cases).

2.1 Special Educational Needs and Disabilities (SEND)

The Derby City Council Insight Pack 201918 showed that the number of Education and Health Care Plans for children aged 0-4 has steadily increased. In 2017, 4 children received a plan, the predicted number for 2019 was reported to be 113, a 414% increase with the number of children and young people with SEND in Derby. Prevalence of EHCPs has increased, whereas the total number of children at SEN support decreased. For those children with SEN support unlike in England, the most common primary need is Moderate Learning Difficulties, whilst similar to England the most prevalent SEN category at EHCP stage is Autism Spectrum Disorder. Nationally, the most prevalent category at SEN support is Speech, Language and Communication Needs. In terms of ethnicity, the group by far with highest SEN need is the White British group.

The Derby City Council Insight pack also reported;

‘Using Mosaic Public Sector, an Experian PLC segmentation product (Experian PLC, 2014), to analyse the population segment types that were known to Derby City Council as having SEND in July 2019, identifies a type known as ‘Family Basics’ that dominates the dataset. Family basics represent households often with many children living in areas of high deprivation who will require support. They have limited resources and have to budget to make end meets. Almost one in three households with SEND children and young people fall into this group, followed by 11% in the type called ‘Urban Cohesion’. This type represents residents of settled urban communities with a strong sense of identity. They will be multicultural, extended families living largely in the suburbs.

Whilst two further types – Aspiring Homemakers and Transient Renters – together represent a further 20% of SEND households, it is the Family Basic and Urban Cohesion groups that are regarded as over-represented based on Derby’s total population that fall into each Mosaic Group. At a type level for these two specific groups, it is ‘Families with Needs’ that are over-represented. These

18 https://www.derby.gov.uk/media/derbycitycouncil/contentassets/documents/schools/fispdf/dcc-send-insight-pack-1920- v2.pdf?fbclid=IwAR2fcMabDY1OyBEG1xI8KqU3WHlCFOfVc6W2f4u596B8As-6TE_i1NU7LTo

20 families will largely be living in low value social housing making limited resources go a long way. Despite being relatively young, health outcomes are poor and unhealthy lifestyle behaviours (such as smoking) are high. They will require support with a range of benefits and are the most likely type to experience issues with debt.’

‘A significant headline for 2019 is that the issuing of Education, Health and Care Plans (EHCPs) between 2014 and 2017 increased by 16.4%, with a further 22.7% increase between the years 2017 and 2019 – to 1,895 in January 2019. Furthermore, it is estimated that not all children and young people in Derby with SEND requiring support have been identified and that in the region of 200 to 3,000 additional children could require assessment. This emphasises the extent of need in the local population and considerable pressure that our system has and will continue to face to ensure that Derby’s children and young people are efficiently assessed and effectively supported in education, health and social care, to improve their outcomes and ensure they have the best start to life’.

2.2 Provision for children Provision available to meet children’s needs across the system from health, children’s centres, library services, early education settings, the voluntary sector and specialist services was mapped as part of the needs analysis processes for the Early Outcomes Fund programme. The mapping was compared to the previous needs analysis carried out for the Opportunity Area pilots in 2017.

By the time of the second needs analysis changes were evident in the workforce development landscape. An independent Speech and Language Therapy service was no longer providing support for provision across the city. Fewer provisions were available across the city despite the extensive input from the Opportunity Area TALK Derby programme, with particular gaps around developing provisions around education setting learning environments for children (triangulated with data from the SEND Peer Review process following the joint CQC/HMI SEND inspection). Additionally, fewer opportunities were available universally for supporting parents and providing universal and targeted intervention development opportunities. Much of the TALK Derby work was focussed at targeted workforce development in the form of classroom training and gaining accredited qualifications.

21

2017-2018 heat map for all of Derby City

LEVEL Family Support Environment Workforce Identification Intervention Specialist Provisions: 26 Provisions: 7 Provisions: 25 Provisions: 28 Provisions: 39 Targeted Provisions: 30 Provisions: 1 Provisions: 28 Provisions: 15 Provisions: 23 Universal Provisions: 12 Provisions: 28 Provisions: 43 Provisions: 21 Provisions: 12

2019 heat map for all of Derby City

LEVEL Family Support Environment Workforce Identification Intervention Specialist Provisions: 26 Provisions: 7 Provisions: 24 Provisions: 28 Provisions: 37 Targeted Provisions: 24 Provisions: 1 Provisions: 20 Provisions: 12 Provisions: 12 Universal Provisions: 9 Provisions: 13 Provisions: 10 Provisions: 21 Provisions: 2

©Better Communication CIC

Provisions from across the system were mapped including services provided by health, the local authority, education settings, library services, Children’s Centres and the Voluntary Sector. In their needs analysis report, Better Communication CIC concluded that there had been a reduction in the core offer at universal and targeted tiers of provision commissioned within the system since 2017. They also suggested that of those provisions that did exist, both currently and in the past at universal and targeted tiers of support, most were commissioned on a spot funding basis, either by the Local Authority in order to support PVI early years education settings, the Department for Education via nationally funded time limited initiatives or by schools and to a lesser degree PVI settings themselves. There is no overarching ongoing commissioned offer which seamlessly integrates speech, language and communication across universal, targeted and specialist tiers of support.

Balanced System® methodology compared the relationship between the number of whole time equivalent (WTE) Speech and Language Therapist sessions commissioned by Southern Derbyshire Clinical Commissioning Group and the number of children on the service caseload. It showed that for every 0.82 WTE therapist (a therapist working 4 days per week) they had an equivalent potential caseload of 1000 children. This showed an increase since last measured in 2018 where the ratio was 0.72/1000 children (a therapist working 3 days per week with a caseload of 1000 children). This supports the findings of the Children’s Commissioner Report in the recently published national survey of Speech and Language Therapy services across the country which showed a significantly lower spend in the East Midlands compared to other regions in England. The workforce is currently only commissioned to deliver a specialist tier intervention service. Careful planning based on the needs of the children at specialist tier will need to take place if any changes are made to commissioning arrangements where SLTs also support the wider system at universal and targeted levels. The Children’s Commissioner Report indicates that addition to, rather than dilution of the SLT service offer is what is needed. The Speech and Language Therapy service reported a 10% increase in referrals year on year.

22

The needs analysis also showed concerns raised by several stakeholders about recent reductions in the whole-time equivalent Specialist Teacher service time in the team which support Autism Spectrum Disorder and also pre-school home based teaching for children with SEND/Portage.

A review of the known evidence-based interventions being utilised across the system was carried out based on the recommendations of the Better Communication CIC advisory report19 and the outcomes from the Opportunity Area pilot project which looked at identification and intervention tools. It was found that very few nationally recognised evidence-based interventions were being used from 2 years of age. One PVI setting in a disadvantaged ward uses the Wellcomm toolkit with excellent impact for the children when comparing before and after intervention assessment outcomes. This tool is also planned to be utilised in a pilot in one locality in the city. The pilot includes health visitors, children’s centre staff and PVI settings all supplementing universal assessment with the Wellcomm assessment. A mini pathway of support will be developed to decide which professional is best suited per child and family to take forward intervention using the materials and the best place that this should happen eg family home, Children’s Centre, PVI setting. The outcomes of the pilot can be used as a template for developing the integrated two-year-old development review.

Many PVI settings and some schools use the EEF recognised Early TalkBoost intervention for 3 and 4 year olds, however this is not consistently used by all education settings in the most disadvantaged wards. Many schools use Speech Link and Infant Language Link or Key Stage 1 TalkBoost for 4 and 5 year olds. Consistent usage of these tools is not routinely used in the schools with the highest predicted needs. Children’s Centres currently use the evidence-based PEEP programme as an intervention supporting parent/child interaction at a targeted level. From a Quality Assurance point of view for commissioners (particularly education settings), most of these intervention tools require that the individual providing the training has a background in the field, completed training to deliver the tools to a certain standard and maintains a licensee relationship with the company or charity who sells the materials to ensure that the most up to date version of training is provided. Maintaining the licensee arrangement with the company or charity also then enables the practitioner to be linked to a local map, so that commissioners can find appropriately trained licensees.

The Better Communication CIC report provides detailed information about principles for identification across sectors at universal and targeted levels of support. The evidence base recommends a wider approach than solely using a single screening assessment. It argues that although screening programmes enable a whole population group or cohort to be subject to a simple process, they also produce a percentage of false positives (those children who were screened and found to be developing at expected levels) and also false negatives (those who failed the test, but were in fact at expected levels). The Ages and stages Questionnaire (ASQ3) is a screening tool and to a certain extent so is the Development Matters framework used as part of the Early Years Foundation Stage Curriculum. The Better Communication Research Programme20 commissioned after the initial Bercow Review reported that Development Matters was in ‘indicative’ measure

19 Gascoigne, M, Wigley, B, Welburn, C (2020). Identification and Intervention for Speech, Language and Communication in the Early Years: A Summary for the Early Outcomes Fund project in Leicester, Derby and Nottingham cities. Better Communication CIC. 20https://www.gov.uk/government/collections/better-communication-research-programme

23 which did not accurately identify all children with SLCN and recommended that supplementary tools in addition to a set of identification practices be used increase accuracy. This method has proved successful in previous SLC initiatives working with PVI settings in Derby. The Better Communication CIC paper produced for the Early Outcomes Fund Programme recommends the following process across the children’s workforce to increase accuracy of identification;

1. Ensuring basic knowledge for all practitioners around early language expected levels and milestones 2. Ensuring basic knowledge among all practitioners around the key risk factors for a child in the early years in respect of SLCN 3. Taking an outcomes/response to intervention approach to identification – having local outcomes statements indicating the shared responsibility for identification and requiring early years settings and practitioners to deploy identification checklists, processes and tools to observe, measure and track children’s SLC 4. Taking an outcomes focused approach to the ‘so what?’ of identification – that there must be a range of universal and targeted interventions available for all those who are identified as having any level of need – identification with no follow up is the worst possible scenario 5. Local Authorities may choose to recommend one preferred tool. In this case the important factor will be the sensitivity and specificity to the population served and the link to the appropriate follow up intervention for those identified as needing support

The paper also recommended that embedding of knowledge at a practitioner/setting level should not rely solely on one-off training sessions, but also utilise the expertise of specialists in the system to provide coaching and mentoring to ensure that tools are utilised at optimum standards and bedded in in each bespoke learning environment.

Better Communication CIC suggest that this is important because children’s needs change over time and also their needs require different elements of support at different times. In the diagram below they show that some children with complex needs will always have specialist tier intervention needs from specialist members of the workforce. This is the current commissioned offer from the NHS Speech and Language Therapy service and specialist support teachers employed by the local authority. However, many children’s needs change and develop particularly in the very ‘malleable’ early years period. For example, a child with a specialist tier language disorder may make good progress in a targeted learning environment which is adapted to meet their specific needs in terms of the physical layout, visual supports available, adaptations in the way adults model language at school and home, supplemented with the offer of evidence based targeted language interventions. The SEND Code of Practice advises that it is the specific ‘recipe’ for support which needs to be guided by knowledge of the wider workforce which is supported by specialists as well as the involvement of specialist services working directly with children. The individual ‘recipe’ for each child should be guided by the child’s response to intervention. Similarly, some children will never need specialist tier intervention support, but may be best supported by the wider workforce understanding how to use evidence based universal supports and access the specialist tier workforce in terms of training, coaching and mentoring.

24

This model of service delivery is more nuanced than the current offer, however is possible. At the first stakeholder consultation event for the Early Outcomes Fund Programme, Worcestershire Speech and Language Therapy service attended the event and discussed their offer and how it is commissioned jointly by health and the local authority and follows the above approach.

Part of the Early Outcomes Fund programme enabled each of the three Local Authorities to attend conferences and Local Government association events to hear about other local areas that have developed more mature systems for supporting children’s speech language and communication in the early years. The most successful models were where high levels of integration had taken place across the system and a reduction or elimination of silo working within individual services which had been found to be less frustrating for parents, reducing the need to tell their story more than once. The Greater Manchester model works seamlessly across the 10 local authorities in the region, each working to common, simplified goals which are overseen by the Mayor (Andy Burnham) and has been modified and developed over the last 10 years. The model has been developed by a consultant Speech and Language Therapist. The model focusses on the critical period of development from late pregnancy to two years of age and has developed new ways to engage with parents via a ‘Strengths Based’ whole family approach. It integrates services, information sharing and communication and integrated care planning around a shared assessment of need. This has led to the system being more able to tackle the wider determinates of health, wellbeing and attainment for better outcomes which are measured/mitigated against at 8 key times in the child’s early years before a final measure with their Good Level of Development at 5 years of age. The model utilises the strength of existing universal and targeted services to deliver prevention and early intervention with a coherent approach, strengthening early years partnerships and reducing duplication and silo working. The Manchester model utilises a ‘place-based’ integrated approach to commissioning and service delivery, helping communities to secure outcomes themselves, breaking cycles of poverty and

25 inequality. The method of working has improved outcomes in early years and the quality of and access to early education settings. The model comprises of four key elements below and is included in the local area 5-year Population Health Plan;

• Effective universal services • An 8-stage assessment pathway • A range of multi-agency pathways • A suite of evidence-based tools and targeted interventions

The conferences also showcased the new tools developed by the BBC called Tiny Happy People.21 The materials have been developed in conjunction with researchers who specialise in early child language development. They are a series of videos of parents modelling key strategies that support child language development from birth to age four years. Additional videos provide play ideas and activities which are tailored to the child’s age and stage. Greater Manchester are trialling the tools within their offer. For example, midwives and health visitors share the materials on their smart phones with parents and parents are encouraged to use the website and keep up to date with the latest information via social media.

Additionally, a Local Government Association Peer Challenge attended in another local authority revealed an emerging offer from Children’s Centres where a wide range of activities and experiences were available for families with vulnerabilities to access which targeted speech and language development as well as wider social and emotional determinants. Families were signposted and supported to attend by a local voluntary sector organisation that had been commissioned by the local authority and were based in children’s centres/Family Hubs. They specifically targeted children aged 0-5 years and provided holistic family support which included help around debt and budgeting, providing grants to support adult welfare and education, domestic abuse, parenting and family routines, child development support, reducing isolation, mental health and housing. The service was delivered by a combination of family outreach, supporting the work of professionals either in the Family Hub or wider and also volunteering support. The organisation has been particularly active supporting families in the Covid-19 crisis.

3. Parent Views

Parents were consulted in a variety of ways for the needs analysis by Better Communication CIC and also the Early Outcomes Fund programme manager. Parents and Carers Together were invited to stakeholder events and a draft version of the pathway content was discussed and shared with representatives from the organisation at a separate meeting. An electronic survey was circulated around education settings and children’s centres and collated by Better Communication CIC, parents and grandparents views were sought at a children’s centre group, a survey was circulated via Derbyshire Maternity Voices parent support organisation to new and expectant Mums and data and commentary taken from a report published by Public Health looking at the health needs of the Roma community. Additionally, a consultation group delivered by the lead for the Maternity Transformation Plan and Derbyshire Maternity Voices was attended and parental views listened to

21 https://www.bbc.co.uk/tiny-happy-people

26 and a parent who is a member of the local voluntary sector consortium was consulted about the design of the integrated two year old review process and fed back views from the local mother and toddler group which she runs.

Parents reported information across several themes;

• A need to feel consulted and involved not just in decisions about their child, but also in how services are commissioned, designed and delivered. • A need for more information about child development generally as well as language development and that this information should be provided across the age range from the antenatal period to 5 years and accessed in a variety of ways eg videos, leaflets, group classes. • Ways to access services in places that work for parents and families that enable them to feel a sense that they have community ownership. • A need for earlier identification of children’s SLCN, however they found assessment sessions for their child anxiety causing because they were not sure what to expect. • Parents wanted services to work more closely together to reduce appointments and the number of times that they had to re-tell their story, particularly when they were asked to fill in questionnaires about their child for several services. They wanted to know that information could be shared to reduce this from happening. They also reported organisations not sharing information with them, leaving them unsure about processes affecting their child. • More parent support groups run by practitioners, not just the groups which they have set up in communities themselves which provide both general advice and also more specific support for children with communication disorders and SEND. There was praise for the parent/child language groups offered at the children’s centres.

27

• Better access to and reinstatement of popular specialist services for example Speech and Language Therapy and Intensive Home Visiting by specialist teachers for children with SEND. There was a common theme about the lack of support from these services in the system for children with SEND and also for children aged less than 3 years of age. • Information was requested about how to access private Speech and Language Therapists if there was insufficient resource in the system and waiting times were too long. • Parents liked Speech and Language Therapists seeing their children in school. • More walk-in opportunities to meet practitioners for ‘off the cuff’ advice. • More availability of favoured interventions such as PEEP and Triple P. • Training and support for education setting staff in terms of how to provide accessible learning environments and how to deploy staff in those environments provided by Speech and Language Therapists, not just face to face intervention work with their child. • Training for education setting staff about speech and language needs and how they can be hidden, presenting as behaviour difficulties. Training for school staff about how to support children’s SLCN and also training for schools about how they can access the Speech and Language Therapy service. • Parents reported that they felt childminders and other early years education settings were compassionate, personable and assessments were fun for their child. Joint working worked well and setting staff were friendly. Parents liked the settings who provided open support with opportunities for ‘come-along’ sessions • The need to have a common process in terms of how the whole system works which is easily accessible “Being able to display the options available for parents/carers and the stages in the process of each option as a straightforward diagram that both parents/carers and professionals can follow.” They also said that they wanted to understand how other pathways in the system fitted in to the ‘whole’ and how they worked for example Single Point Of Access (SPOA) pathway for children with potential Autism Spectrum Disorders. • Parents valued support for their family and their child with SEND from a keyworker to help them to navigate the system particularly at times of transition. • Concerns were raised about the lack of availability of pre-school checks from the Health Visitor service for routine height, weight and hearing screening where SLC concerns could be discussed and identified. • Concerns were raised about funding cuts to Council Children’s Services which support prevention and the impact that this has on children’s language outcomes. Parents felt that there is high need. • Maternal anxiety about birth, delivery method and post-natal ill health leading to bonding and attachment issues with babies. • A lack of advice for bilingual parents about how their child will access new nursery places when they are new to English. • Cultural differences in developmental expectations for children in early years reported by the Roma community because children start school at seven years of age in their country of origin and also cultural differences in terms of how children learn language for example language development being an innate skill vs influenced by the environment/home learning environment.

28

4. Wider Stakeholder Views

A wide range of stakeholders have been consulted drawing together this document. They include a Derby Opportunity Area representative, the designated Clinical Officer for SEND, Paediatricians, Virtual School Team for looked after children, Family Nurse Partnership/Ripplez, Children’s commissioning manager for Speech and Language Therapy, Health Visiting representatives, Children’s Centre practitioners and managers, Speech and Language Therapy service, Public Health Commissioner, Chief Executive of a PVI setting chain and member of Voluntary Sector, Midwifery representative, Inclusion Service Director, Cabinet Member for Children and Young People, Library Services manager, Family Information Service, Educational Psychology, Executive Headteacher, Early Help manager, parent representatives, specialist teaching service, Lead for the Maternity Transformation Plan.

Informal consultation has taken place in a variety of ways. Strategic leads were approached, and individual interviews took place in the Autumn Term of 2019 using a method of collating views in the format of ‘What do you think works well in current provision?’ (Sun) ‘What gets in the way of achieving outcomes for young children?’ (Bug) ‘What would really make a difference if you could change things?’ (Moon). This information was fed into the Balanced System® tools to provide qualitative information for the needs analysis. Subsequently three stakeholder events took place to develop individual ideas into a group consensus for the way forward in terms of action. The first event took place over a whole day in November and was held for all three cities in the project with time to discuss Derby specific issues in the afternoon and develop content for the Derby Speech, Language and Communication Pathway. Two subsequent half day sessions in the New Year 2020 looked at developing an outcomes framework to sit alongside the pathway and the third to benchmark the Derby offer against the EIF Maturity Matrix and seek views on the content of this document, planning a vision for the next 5 years.

The common themes reported by stakeholders that they would like to see developed in the system over the next 5 years were;

• Local services, including early education and childcare, public health, early help, voluntary sector, family support, and primary care are aligned and integrated into a graduated response to best serve the needs of all Derby children under 5 years of age. • A unifying approach across all schools in the city whether they are under Local Authority control or whether they are members of a Multi-Academy trust or chain. • Health stakeholders wanted greater opportunities for co-location of place with Children’s Centres/Family Hubs. • There is a joined up strategic approach by senior leaders/service directors in health and education who act as advocates for children’s SLC development. • A clear information sharing framework which enables all partners to work together to achieve best outcomes for all children. • All children receive timely access to services to meet their needs, so that no child starts school with un-identified needs. • Services to support children’s SLC should be jointly commissioned, with a clear strategy which explains why we do what we do.

29

• The system should be able to predict using population data where/when children will experience SLCN in our City using what is known about ‘at risk’ groups. • We will have a clear description of the set of practices which describe what strong SLC provision looks like and who delivers them at each age and stage. • There will be an electronic pathway which describes the local SLC offer for children under 5 years at each age and stage which also contains supportive messages for parents and is made available via a range of channels for example the local authority Local Offer, Family Information Service, schools portal, health and children’s centre websites. • There is a clear description of the commissioned role of specialist services to support the wider system as part of the core offer as well as providing specialist intervention. • There is a centrally commissioned universal and targeted offer for supporting children’s speech and language development. • Strong feelings about having a highly trained workforce who use the latest evidence-based materials and tools to best support children and identify needs early who also provide effective learning environments which meet children’s needs.

What does this information mean?

What the data tells us is that there are high numbers of children with speech, language and communication needs in Derby. There are also groups of children who are more at risk of experiencing these needs in the under 5’s. In particular, children who are; • Boys • Children who are Looked After or who have SEND • Those who live in the most disadvantaged parts of the city • White British children, with a close second the group of children who are of South Asian heritage

All places and services which provide universal and targeted services need to ensure that the ‘at risk’ groups above are monitored with additional rigour to ensure that needs are identified early. Predictive data also tells us that there seems to be a cohort of ‘missing children’ with SLCN very much like the children reported in the Talking About a Generation report who are not being identified early and move through the SEND process directly to EHCP without following the graduated response/ receiving effective SEN support.

There is a gap in provision before children attend early years childcare settings in the 0-2 years age range. Midwifery services and the Healthy Child Programme delivered by Health Visitors enables a framework to be deployed which captures children who have wider risk factors/social determinants which could be used to identify the young children who could potentially or currently do have delayed language development.

Without data collected at the ages of 3 and 4 years of age which is aggregated at a local area level, it

30 is not possible to anticipate how many children are experiencing SLCN across the early years system. The information from the needs analysis showed that data needs to be collected and shared from a wide variety of stakeholders for example health visiting, children’s centres, speech and language therapy and early years education settings to fully understand the local area picture and need.

There is no data collected across the system which tracks child progress between the two year development assessment by the health visiting service and the collection of GLD data by the Local authority at age 5 years, which means that we do not truly know the total number of children in Derby with SLCN or indeed whether their needs are being ameliorated and how this compares to predicted need.

The provisions provided in the city are not delivered in sufficient quantity at universal and targeted tiers of support and are not always informed by evidence-based practices and tools based on ‘What Works’. Given the high predicted need across the population, particularly in the most disadvantaged parts of the city, this is creating a vortex effect and high demand for specialist tier intervention services. In terms of developing provision, specific focus needs to be paid to; • Developing the language learning environments in early years education settings, so that they offer an effective physical environment, language learning interactions from adults and planned language learning opportunities whose outcomes and effectiveness are monitored in terms of developing the child’s shared and sustained thinking, speech, language and communication and social and emotional/ interaction skills. • Utilisation of evidence-based universal and targeted identification and intervention tools • Evidence based parent support materials which can be used at universal, targeted and specialist tiers of support either verbally, in paper form, used with individual parents, in group formats delivered by practitioners or shared electronically. • The outcomes and impacts of the provisions, need to be measured and monitored by the senior leadership team in Children’s Centres and early years education settings using the Balanced System Scheme for Schools and Settings implemented by TALK Derby project or for wider services by a city wide data collection system which also allows analysis if data at ward level and potentially in the future after data sharing agreement at individual child level which links to the data collected by schools and settings. • That provisions are developed and extended through a process of workforce development training, coaching and mentoring utilising specialists from within the system who will also continue to develop and enhance the offer at specialist tiers and eliminate the artificial ‘gap’ between universal, targeted and specialist tiers of support which currently exists.

There needs to be a strengthening of the universal and targeted SLC offer across sectors in the city with guidance from the ‘centre’ about what great provision looks like. This new model needs to be constantly informed by parent and child feedback based on their ‘lived experiences’ to gain trust and respect in the parent community.

Outcomes and effectiveness should be monitored at a leadership level within services and early years education settings as well as at a city-wide level via data and workforce development dashboards.

31

The new Derby Speech and Language Pathway will act as a repository of evidence-based information and places where support for parents and professionals can be sought with guidance about how to measure outcomes from activity.

There is a need for consistent, evidence based universal public health messages which can be shared and used across the local area, providing consistency and also delivered in formats requested by families such as, leaflets, videos, shared at existing groups for example; ante-natal classes which support the home learning environment and reduce the risk of children going on to experience SLCN or go some way to ameliorating language delay when needs emerge.

Integration of services as well as a common approach and language, will provide a coherent and consistent offer which makes sense to parents, practitioners and services and ensures that children who are vulnerable are identified and supported at the earliest opportunity. Integration needs to be considered in terms of practicalities such as place, clarity of roles and responsibilities; communication and information sharing arrangements as well as philosophy of approach and tools utilised and shared.

The voluntary sector is an essential element of the system which needs to be integrated into the wider whole to help address wider determinants and risk factors which can influence child language and wider developmental and social and emotional skills in young children. Much ground has been gained in the Covid-19 crisis in the joint working between the Voluntary and Community Sector and the Local Authority supporting the most vulnerable families in the city. This work should be built on using best practice from other areas in the country which have looked at how services can be integrated into the wider offer and places for example Children’s Centres.

Utilisation of specialists in the workforce with local knowledge is essential, for example speech and language therapists and specialist teachers can deployed to help to develop the local offer and provision across the area, not just at the specialist level, but also at universal and targeted tiers of support.

There is a need expressed by all consulted stakeholders including parents for a more coherent senior strategic approach which is monitored and developed incrementally over a five year period and is overseen by existing strategic governance structures such as the Health and Wellbeing or Children, Families and Learners Board.

32

5. Speech, Language and Communication Logic Model

Moving forwards, the following logic model has been developed to describe the consensus vision for the future across the city. The model was developed based on needs analysis data, outcomes from stakeholder interviews as well as feedback at the final Early Outcomes Fund Programme stakeholder session in February 2020.

33

34

6. Integrated Model of Working

6.1 Integration

The model described is not a pathway of support, rather a description of how services and places could be aligned and integrated to deliver a speech and language offer in a more streamlined way. The offer can be delivered around three key places – family homes or foster care homes for Looked after Children (LAC), Children’s Centres/Family Hubs and early education settings. Additional places need to also be considered for example libraries (both those under Local Authority control and also those provided by the voluntary sector), and a range of community places visited by parents with their children for example community and toddler groups, in the INTU shopping centre in the City Centre, TV screens in local shops, museums, GP surgeries with particular focus in the areas of the city with the greatest disadvantage. Increasing the dosage or intensity of delivery in areas of increasing disadvantage will deliver a population–based approach which focusses on equity of access and outcomes.

35

Integrated Speech Language and Communication Service Model

Antenatal Midwifery Health Visitor/Family Nurse Children’s Speech GP Practitioner Centre/Early Help and Language Therapist Identifying Universal Pregnancy booking appointment; Ante-natal check; If pregnant with subsequent Provide For women who visit children; protective BBC GP; risk assessment Assessment of risk and protective factors (including Mother’s health and wellbeing Tiny Happy those around SLC development) Opportunistic assessment of People advice Mother’s health and Breastfeeding risks or problems via; wellbeing Overall health and wellbeing of the mother Mental Health Opportunistic Foetal development Screening for any conditions that may have an impact on advice at drop- the mother or baby Feelings about pregnancy in sessions at Children’s Smoking Assessment of risk and protective factors Centre (including those around SLC development) Folic acid and other dietary or lifestyle advice Drop-in advice Parent’s relationship at preparation Breastfeeding for parenthood Assessment of the father’s health and group sessions Mental health wellbeing Identification Follow up appointments; Social situation of risk factors

Mother’s health and wellbeing

Foetal development

Other assessments CAF CAF CAF CAF Universal - Vitamin advice Build relationships Building Signposting to and Progressive relationship promoting resources Health screening Inform of Health Visitor Offer via video screens in Child GP waiting rooms of Support offered in the Children’s Centre and SLT service Parenting and child development guidance and development BBC Tiny Happy support including – BBC Tiny Happy People guidance People SLC advice Activities Follow up assessment and review includes BBC Tiny SLC advice (specific)/library services Happy People SLC website advice/library services and materials https://www.ascel.org.uk/bump-booster Nutritional advice

36

https://motherhubderbyshire.co.uk Follow up assessment and review

https://www.facebook.com/DerbyshireMaternityVoices/ Support offered in the Children’s Centre and SLT service Preparation for parenting classes – BBC Tiny Happy People SLC advice/library services

Referral to specialist services Referral to specialist services Ante-natal PEEP Referral to specialist Targeted/Uni services Referral to specialist services versal Partnership Plus Integrated Joint delivery of activities Programme of ante-natal education based on preparing for birth and early speech and language/boding and attachment advice – universal offer working Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision Booking clinics provided in Children’s Centres with a Regular meetings with GP and Children’s Regular Children’s Centre making Children’s Centre worker and speech and Language Centre staffing to discuss families. meetings to allocate families to Therapist available to discuss children’s centre offer and practitioners/discuss/share register the family. Children’s Centre/Hub meetings to information/plan for families discuss/share information/plan for families with additional needs. MDT decision making around vulnerable families. with additional needs.

New Birth Midwifery Health Visitor/Family Nurse Children’s Speech GP Practitioner Centre/Early Help and Language Therapist Identifying Universal New birth visit New birth visit – assessment of; If subsequent children; Opportunistic For women who visit attendance at GP; risk assessment Screening tests Assessment of risk and protective factors/red Opportunistic assessment of drop-in flags (including those around SLC risks or problems sessions at Clinical assessment Clinical assessment of child and mother development); Children’s Mental health assessment. Centre Feeding

37

Assessment of risk and protective factors (including those around SLC development) Mental health Identification of risk factors/red Physical Health flags

Sleep

Living arrangements

Family relationships

Domestic abuse

Safeguarding risk

Red book review

Other assessments CAF/referral to specialist services CAF/referral to specialist services CAF/referral to specialist CAF/referral to services specialist services Universal - Treatment of any illnesses or problems eg jaundice Build relationship Group activities eg Story Building Signposting to and Progressive Explorers, Stay and Play, Baby relationship promoting resources Advice Share information and advice – Grow, Groovy Movers, Boys via video screens in websites/reading material/mother and toddler Play Child GP waiting rooms of BBC Tiny Happy People SLC advice/library services and and baby groups development BBC Tiny happy materials https://www.ascel.org.uk/bump-booster guidance - BBC people SLC advice Activities Parenting and child development guidance and Tiny Happy https://motherhubderbyshire.co.uk support including – BBC Tiny Happy People People SLC SLC advice/library services advice/library https://www.facebook.com/DerbyshireMaternityVoices/ services via Nutritional advice drop-ins at existing groups Follow up assessment and review at Children’s Centre. Sign post to Children’s Centre offer for SLC/development opportunities

Breastfeeding support

Referral to specialist services Interventions/visits for; Advice around SLC Walk-in Referral to specialist Targeted/Uni development based on sessions; services Maternal mental health ELKLAN Let’s Talk at Home versal and ELKLAN Support for under Identification of Partnership Feeding 5’s risk factors and Plus potential Maternal physical health PEEP language delay

38

Child health Identification of early feeding Referral to specialist services difficulties

Parenting and child development guidance and Child support including – BBC Tiny Happy People development SLC advice/library services guidance - BBC Tiny Happy People SLC advice/library services via drop-ins at existing groups at Children’s Centre including breastfeeding and joint home visits with Health Visitor.

Joint delivery of activities Breastfeeding groups Integrated Children’s Centre groups focussing on child development working Joint home visiting Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision MDT meetings between Midwife and Health Visitor Meetings with GP practice to discuss threshold making for discussing families.

Children’s Centre Hub meetings to allocate families to practitioners

39

Postnatal – 6-8 weeks Health Visitor/Family Nurse Children’s Centre/Early Help Speech and Language Therapist GP Practitioner Identifying Universal 6-8 week check – assessment of; Opportunistic assessment of risks or Opportunistic advice at drop-in sessions at Children’s For women who visit GP; problems Centre risk assessment Maternal mood assessment Opportunistic clinical assessment Drop-in advice at Children’s Centre group of mother and baby. Feeding sessions/joint home visits with Health Visitor. Clinical assessment of Physical Health mother/baby Identification of red flags for speech, language and Sleep communication and feeding difficulties.

Family relationships

Domestic abuse

Safeguarding risk

Well baby clinics;

Assessments as appropriate

Other assessments CAF/referral to specialist services/GP CAF/referral to specialist services/GP Universal - Build relationship Group activities eg Story Explorers, Stay Building relationship Signposting to and promoting Progressive and Play, Baby Grow, Groovy Movers, resources via video screens in Share information and advice – Boys Play Child development guidance - BBC Tiny Happy People GP waiting rooms of BBC Tiny websites/reading material/mother and toddler SLC advice/library services via drop-ins at existing happy people SLC advice and baby groups/baby massage/Voluntary Signpost to voluntary sector services groups at Children’s Centre. sector services. Activities Attend baby clinics/breastfeeding groups/sessions Parenting and child development guidance and support including – BBC Tiny Happy People SLC advice/library services

Nutritional advice

Follow up assessment and review

Breastfeeding support

https://motherhubderbyshire.co.uk

40

https://www.facebook.com/DerbyshireMatern ityVoices/

Interventions in home/groups for; Advice around SLC development based Identification of risk factors Clinical treatment Targeted/Uni on ELKLAN Let’s Talk at Home and Maternal mental health ELKLAN Support for under 5’s Identification and advice for early feeding difficulties Referral to Health versal and advice about early adult/baby interactions when Visitors/Children’s Centres Partnership Feeding PEEP feeding. Plus Referral to specialist services Maternal physical health Baby/adult interaction advice/groups.

Child health Book sharing modelling and advice utilising Bookstart donated books via referral from HV/Children’s Centre Parenting and child development guidance and worker either 1:1 or in group work. support including – BBC Tiny Happy People SLC advice/library services rhyme time groups Child development guidance - BBC Tiny Happy People SLC advice/library services via drop-ins at existing Sign post to Children’s Centre offer for groups at Children’s Centre including breastfeeding SLC/development opportunities and/or VCS and joint home visits with Health Visitor. services.

Referral to specialist services

Joint delivery Health Visitor Well baby clinics in Children’s Centre/in community Integrated of activities Health promotion activities eg oral health, feeding, book sharing, reciprocal serve and return adult/baby interaction Children’s Centre worker, VCS worker and Speech and Language Therapist present working Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision Meetings with GP practice to discuss threshold Hub meetings – regular meetings in making for discussing families. Children’s Centre to allocate families to practitioners, discuss, share information, Children’s Centre Hub meetings to allocate plan for family needs. families to practitioners and discuss and share information/plans for families with additional needs.

Specialist liaison eg paediatrician

41

Postnatal 8 weeks – 1 Voluntary and Community sector Health Visitor/Family Nurse Children’s Speech GP year services/Library services Practitioner Centre/Early Help and Language Therapist Identifying Universal 1-year check – assessment of; If subsequent children; Opportunistic For women who visit advice at drop- GP; risk assessment Child development Opportunistic assessment of in sessions at risks or problems if children Children’s Opportunistic clinical Feeding attend groups. Centre assessment of mother and baby. Physical Health Drop-in advice at Children’s Clinical assessment of Sleep Centre group mother/baby sessions/joint Family relationships home visits with Health Domestic abuse Visitor.

Safeguarding risk Identification of Baby clinics – assessments where appropriate red flags for SLCN and eating and drinking difficulties.

Other assessments CAF/referral to specialist services/GP CAF/referral to specialist services/GP CAF/referral to specialist services/GP Universal - Cradle Time and Rhyme Time groups Build relationship Group activities eg Story Building Signposting to and Progressive Explorers, Stay and Play, Baby relationship promoting resources Online support for families regarding sharing books and Health promotion activities Grow, Groovy Movers, Boys via video screens in library services for young children. Play Child GP waiting rooms of Share information and advice – including development BBC Tiny happy Parenting advice/ groups providing BBC Tiny Happy websites/reading material/mother and toddler Signpost to voluntary sector guidance - BBC people SLC advice Activities People advice and baby groups/baby massage/Voluntary services Tiny Happy sector services. People SLC advice/library Parenting and child development guidance and services via support including – BBC Tiny Happy People drop-ins at SLC advice/library services/risk factors/flags existing groups

42

for review at Children’s Centre. Play

Maternal mental health

Feeding

Maternal physical health

Child health

Physical activity

Follow up assessment and review

Signpost to Children’s Centre offer including SLC/development opportunities.

Breastfeeding support

https://motherhubderbyshire.co.uk

https://www.facebook.com/DerbyshireMatern ityVoices/

Bookstart corner for vulnerable families Interventions in home/groups for; Advice around SLC Identification of Referral to specialist development based on flags for review services Targeted/Uni Bookstart for children with special educational needs Maternal mental health ELKLAN Let’s Talk at Home versal and ELKLAN Support for under Identification of Referral to Health Partnership Volunteering befriending and parenting support for Feeding 5’s early feeding Visitor or Children’s Plus vulnerable families providing BBC Tiny Happy people difficulties Centres. advice. Maternal physical health PEEP Baby/adult Child health Wider children’s centre offer interaction around child development, advice/groups – Referral to specialist services adult learning and Hanen It Takes employment. two to Talk. Parenting and child development guidance and support including – BBC Tiny Happy People Child SLC advice/library services development guidance - BBC Tiny Happy People SLC

43

advice/library services via drop-ins at existing groups at Children’s Centre including breastfeeding and joint home visits with Health Visitor.

Joint delivery Integrated of activities Baby and breastfeeding groups Children’s Centre groups focussing on child development working Joint home visiting to address developmental and wider determinants Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision Regular meetings with GP practice, Children’s Centre Children’s Centre Hub meetings virtual or face making meetings at the ‘Hub’ to allocate families to practitioners, to face to allocate families to practitioners discuss/share information/plan for families with discuss/share information/plan for families additional needs. with additional needs.

Specialist liaison eg Paediatrician

1 year – 2.6 years Voluntary and Community sector Health Visitor/Family Nurse Children’s Speech GP services/Library services Practitioner Centre/Early Years and Education settings Language Therapist Identifying Universal 2 – 2.6-year review – assessment of child Assessment of all areas of Opportunistic For women who visit development via ASQ/additional development using EYFS advice at drop- GP; risk assessment screening/identification of SLCN/Wellcomm in sessions at tool. Flags for review /risk factors. 2 – 2.6-year EYFS review – Children’s Opportunistic clinical assessment of child Centre assessment of mother Food and eating development including and baby. Communication and Language Drop-in advice Physical health at Children’s Clinical assessment of Additional Centre group mother/baby or

44

Mental Health screening/identification sessions/joint toddler assessment of SLC/N eg home visits Sleep Wellcomm with Health Visitor. Family relationships Use of knowledge regarding;

Domestic Abuse Risk factors Identification of Red flags red flags for Safeguarding risk Identification of SLCN and review of SLCN bilingualism and eating and Immunisation status Tracking and monitoring of drinking need difficulties. Well baby clinics Types of SLCN and how Assessments as appropriate/where required children’s SLC can break down Discussing Profiling need and ages and potential stages of sub-categories of referrals to the SLCN service. Recognising communication disorders Parent and child views Parent/child interaction Principles of assessment and observation Case history and the home learning environment Response to intervention Other assessments CAF/referral to specialist services/GP CAF/referral to specialist CAF/referral to specialist services/GP/ASQ SE services/GP Universal - Cradle Time and Rhyme Time groups Build relationship Leadership self-evaluate Building Signposting to and Progressive provision using Balanced relationship promoting resources Online support for families regarding sharing books and Health promotion activities System Scheme for Schools via video screens in library services for young children. and Settings, setting actions Child GP waiting rooms of Well baby clinics to develop offer and development BBC Tiny Happy Parenting groups providing BBC Tiny Happy People evaluating the impact and guidance - BBC People SLC advice Activities advice Share information, guidance and advice – outcome of changes made for Tiny Happy including websites/reading material/mother children, parents and staff. People SLC Signpost to Health Visitor and Children’s Centre and toddler and baby groups/baby advice/library activities massage/Voluntary sector services. Group activities eg Story services via Explorers, Stay and Play, Baby drop- Parenting and child development guidance and Grow, Groovy Movers, Boys ins/advice at support including – BBC Tiny Happy People Play existing groups SLC advice/library services at Children’s Centre/joint Signpost to voluntary sector planning of services activities.

45

Quality First Early Years Attendance at education practice HV allocation meetings to Universal SLC provision discuss cases developed based on quality indicators from the Balanced System, referred to in the Derby SLC Pathway and in the areas of parent support, the learning and communication environment, workforce knowledge and skills, identification practices and intervention/support

Communication Champion Bookstart corner for vulnerable families Interventions in home/groups for; Advice around SLC Identification of Targeted/Uni development based on red flags Bookstart for children with special educational needs Maternal mental health ELKLAN Let’s Talk at Home Referral to specialist versal and ELKLAN Support for under Identification of services Partnership Volunteering befriending and parenting support for Feeding 5’s early feeding Plus vulnerable families. difficulties Referral to Health Maternal physical health Bookstart packs Visitor or Children’s Baby and Centres. Child health/development/physical PEEP toddler/adult development/play interaction Wellcomm groups for children advice/groups Referral to specialist services who are red/amber on and /or home Wellcomm assessment plus visiting Wellcomm activities for families at home for parent advice programmes eg children with SLCN. Hanen It Takes Wider children’s centre offer Two to Talk Outcome planning with the family and link to around child development, Children’s Centre activities and early Years adult learning and Child education setting if child attends. employment. development guidance - BBC Promote Golden Tickets for 2 year old funded Promote Golden Tickets for 2- Tiny Happy early year’s education places for vulnerable year-old funded early year’s People SLC children. education places for advice/library vulnerable children. services via drop-ins at Targeted SLC provision existing groups developed based on quality at Children’s indicators from the Balanced Centre System, referred to in the including

46

Derby SLC Pathway and in the breastfeeding areas of parent support, the and joint home learning and communication visits with environment, workforce Health Visitor. knowledge and skills, identification practices and Discuss intervention/support referrals to service.

Joint delivery Integrated of activities Well baby groups – Children’s centre worker/SLT present Children’s Centre groups focussing on child development/SLCN working Training and development of the workforce including coaching Joint home visiting/Skype calls/sharing of 2-year-old assessment findings virtually or face to face Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision Regular meetings with GP practice, Children’s Centre Children’s Centre Hub meetings – virtual or Virtual or face to face making meetings at the ‘Hub’ either face to face or virtually to face to face to allocate families to practitioners meetings with Children’s allocate families to practitioners, discuss/share discuss/share information/plan for families Centre and Health Visiting staff information/plan for families with additional needs/SLCN. with additional needs/SLCN. to share integrated 2-year-old review assessment findings Specialist liaison eg Paediatrician and gain consensus and plan which service will take forward intervention for children with SLCN and wider additional needs.

2.6 years – 5 years Early Years Education settings Children’s Centre staff Voluntary and Speech GP Community sector and services/Library Language services Therapist

Identifying Universal Assessment of all areas of development using EYFS Assessment of all areas of development using Opportunistic For women who visit Development Matters EYFS Development Matters advice at drop- GP;

47 risk in sessions at Additional screening/identification assessment of SLC/N Additional screening/identification Children’s Opportunistic clinical eg Wellcomm, Child Monitoring Tool, Early Talk Boost, assessment of SLC/N eg Wellcomm (2-5 Centre assessment of mother Speech Link, Infant language Link. years), Child Monitoring Tool, Child and baby. Development Inventories eg UKBTAT Drop-in advice Risk factors = at Children’s Clinical assessment of Risk factors = Centre group mother/baby or • Social disadvantage/low income sessions/joint toddler households/home learning environment • Social disadvantage/low income home visits • Low parental qualifications households/home learning with Health • Family history of SLCN environment Visitor. • Adolescent motherhood • Low parental qualifications Identification of • Maternal mental health problems • Family history of SLCN • Maternal use of harmful substances including • Adolescent motherhood red flags for smoking • Maternal mental health problems SLCN and • Pre-term birth • Maternal use of harmful substances eating and • High number of siblings including smoking drinking • Male gender • Pre-term birth difficulties. • High number of siblings Use of practitioner knowledge regarding; • Male gender Discussing potential Risk factors referrals to the Red flags for review Use of practitioner knowledge regarding; service. Identification of SLCN and bilingualism Tracking and monitoring of need Risk factors Training and Types of SLCN and how children’s SLC can break down Red flags for review development Profiling need and ages and stages of sub-categories of Identification of SLCN and bilingualism for workforce SLCN Tracking and monitoring of need re: targeted Recognising communication disorders Types of SLCN and how children’s SLC can interventions. Parent and child views break down Parent/child interaction Profiling need and ages and stages of sub- Joint planning Principles of assessment and observation categories of SLCN and delivery of Case history and the home learning environment Recognising communication disorders targeted Response to intervention Parent and child views intervention Parent/child interaction sessions in Principles of assessment and observation education and Case history and the home learning Children’s centre settings. environment Response to intervention Ongoing support for children’s centres, voluntary sector organisations

48

and education settings re: evidence-based advice for parents.

Other assessments CAF/more detailed assessment of other prime CAF/more detailed assessment of other CAF CAF areas of learning (Physical Development/Personal, prime areas of learning (Physical Social and Emotional Development) Development/Personal, Social and Emotional Development)

Leadership self-evaluate provision using Balanced Leadership self-evaluate provision using Rhyme Time groups Building Signposting to and System Scheme for Schools and Settings, setting actions Balanced System Scheme for Schools and relationship promoting resources to develop offer and evaluating the impact and outcome Settings, setting actions to develop offer and Online support for families via video screens in of changes made for children, parents and staff. evaluating the impact and outcome of regarding sharing books and Child GP waiting rooms of changes made for children, parents and staff. library services for young development BBC Tiny Happy Activities Leadership monitor staff knowledge and skills children. guidance - BBC people SLC advice identifying and supporting SLC/N using Speech, Leadership monitor staff knowledge and skills Tiny Happy Language and Communication Framework (SLCF) identifying and supporting SLC/N using Parenting groups providing People SLC https://www.slcframework.org.uk/ Speech, Language and Communication BBC Tiny Happy people advice advice/library Framework (SLCF) services via Quality First Teaching using strong Early Years practice https://www.slcframework.org.uk/ Signpost to Children’s Centre drop-ins at activities and early year’s existing groups Communication effective environments monitored via education places. at Children’s Communication Supporting Classrooms Observation Quality First Early Years education practice Centre. Tool; Signpost to voluntary sector services Training and • Effective language learning/oracy development environments for workforce • Effective planned language learning Group activities eg Story Explorers, Stay and re: targeted opportunities Play, Baby Grow, Groovy Movers, Boys Play interventions. • Effective physical learning environment Universal SLC provision developed based on Joint planning quality indicators from the Balanced System, and delivery of Universal SLC provision developed based on quality referred to in the Derby SLC Pathway and in targeted indicators from the Balanced System, referred to in the the areas of parent support, the learning and intervention Derby SLC Pathway and in the areas of parent support, communication environment, workforce sessions in the learning and communication environment, knowledge and skills, identification practices education and workforce knowledge and skills, identification practices and intervention/support here Children’s and intervention/support here centre settings. Communication Champion Utilise BBC Tiny Happy People resources with families Ongoing Clickety Books (speech sounds) support for Early Word Aware children’s

49

centres, Launchpad to Literacy/Letters and Sounds Phase voluntary 1/Clickety Books sector organisations Communication Champion and education settings re: Bookstart Packs evidence-based advice for parents.

. Identification of Targeted SLC provision developed based on quality Advice around SLC development based on Bookstart corner for risk factors Referral to specialist Targeted indicators from the Balanced System, referred to in the ELKLAN Let’s Talk at Home and ELKLAN vulnerable families services Derby SLC Pathway and in the areas of parent support, Support for under 5’s Identification of the learning and communication environment, Bookstart for children with early feeding workforce knowledge and skills, identification practices Wellcomm activities either 1:1 in the centre special educational needs difficulties and and intervention/support. or at home or in groups. SLCN Volunteering befriending and Intervention tools considered may include Wellcomm, PEEP Communication and Language strand parenting support for Adult/child Early Talk Boost, Speech Link, Infant Language Link, vulnerable families, providing interaction Nuffield early language Intervention (NELI) PEEP Early Literacy strand BBC Tiny Happy People advice advice/groups eg Hanen It Early Support Group (children on Takes Two to neurodevelopmental pathway) Talk.

Bookstart Packs Regular advisory WELLCOMM groups for children who are meetings in red/amber on Wellcomm assessment plus education parent advice settings and Children’s Wider children’s centre offer around child Centres. development, adult learning and employment. Training and Promote Golden Tickets for 2-year-old funded development early year’s education places for vulnerable for workforce children. re: targeted interventions. Targeted SLC provision developed based on quality indicators from the Balanced System, Joint planning referred to in the Derby SLC Pathway and in and delivery of the areas of parent support, the learning and targeted communication environment, workforce intervention knowledge and skills, identification practices sessions in

50

and intervention/support education and Children’s centre settings.

Ongoing support for children’s centres, voluntary sector organisations and education settings re: evidence-based advice for parents.

Discuss referrals to service.

Joint delivery of activities Children’s Centre groups focussing on child development/SLC Integrated Joint planning and delivery of group and intervention activity re: SLCN working Inter-professional training and development of the workforce including coaching SLT attends termly school-based planning meetings SLT attends Early Years Panel Joint home visiting/Skype calls Regular joint service level listening exercises to ensure offer meets parental and community needs.

Communicatio n and decision Speech and Language Therapist attends Early Years Panel Children’s Centre Hub meetings – virtual or Regular making meetings and half termly/termly school-based planning face to face to allocate families to practitioners planning meetings (face to face or virtually) alongside other discuss/share information/plan for families meetings to specialists eg STePs team, Early Years Team and with additional needs/SLCN especially around discuss children Educational Psychology service to discuss; times of transition. either face to face or • Cases with potential SEND needing MDT Children have autonomy and influence electronically involvement decision making to • Response to intervention of children receiving discuss/share additional support from settings/school at SEN information support and plan for • Shared planning of package of support and children with additional

51

agreement from each professional about their needs/SLCN role with individual cases especially • Agree coherent team response to supporting around times of needs raised personally by child and/or transition or parents those needing • Plan transitions specialist support from Children have autonomy and influence decision making the SLT service.

Children have autonomy and influence decision making

Model template with kind permission Dulcie McBride www.goldfinch-egg.squarespace.com

NB: All elements in bold indicate, tools, services, advice and methods which support children’s speech, language and communication.

52

Key to making the model work will be the consideration of successful methods of delivering integrated working in particular;

Joint delivery of activities

Ensuring that key activities in the system are planned jointly at each age and stage of the model and around the places where they will be delivered or offered. In the current climate, this may need to be more in the vein of a virtual offer, considering new digital ways of working which have been tested and developed in conjunction with families such as tele-conferencing, electronic assessment forms with the results shared by key stakeholders working around the ‘place’ to ensure more accurate assessment and tracking of child progress planning. Joint training for all professionals working around the ‘place’ will ensure consistency of knowledge and methods of support as well as clarifying communication messages for parents and families. Shared delivery of activities will reduce parents feeling that they need to tell their stories more than once and also simplify methods of working together with families. Fitting evidence-based speech and language activities into existing pathways and service models ensures that families can access support and advice when they visit for another reason and has been a successful model of working in past initiatives such as Sure Start in the city as well as flexibility of provision of outreach support to family homes which was also found to be user friendly for families particularly for those living in particular wards of the city for example Normanton and Arboretum.

Communication and decision making

Working together around places reduces message inconsistency for families. Parents reported frustrations around services not working together and in silos. A regular meeting between staff where casework is jointly discussed allows the offer to be delivered in a bespoke way. It also ensures that planning can incorporate all elements of support which are required to ameliorate family risks and key public health messages can be provided for parents consistently. Using evidence-based resources such as the BBC Tiny Happy People materials means that effective support can be provided for families even before their baby arrives.

There needs to be a clear understanding about when children need support over and above the universal offer and who will deliver more detailed identification/assessment work and subsequently provide intervention. Clear information sharing protocols are required so that all practitioners are clear about which supports have been provided for families. Processes which can support joint communication and decision making include, regular allocation meetings which agree the team member who will support a family and includes where support will take place for example in the Children’s Centre, early years education setting, virtual support or outreach work to the family home. Risk assessments will need to be completed at each tier of support to guide decision making and ensure that a child and family are receiving support at the right level and whether wider assessment is required for example Common Assessment Framework (CAF).

53

Cross cutting themes

In the needs analysis there were several recurrent cross cutting themes reported by parents, services and early education settings;

Integration of individual pathways

The model described cuts across several existing pathways of support for example the midwifery pathway which dovetails into the guiding principles of the Healthy Child Programme/mandated checks delivered by Health Visitors , the graduated response within Children’s Centres offer, the SEND Graduated response, the NHS Speech and Language Therapy service pathway and also the Library Service. The library services offer for children and families has a core purpose to support child development and school readiness (pre-birth to 5 years), parenting aspirations and parenting skills so that parents give their child the best start in life. By incorporating each pathway, it can be seen that in actual fact each fit into one another, particularly when looked at through the lens of the wider societal risk factors which families experience. Consideration will need to be taken into account of the thresholds for each of the service pathways and how they can be integrated into one coherent model.

Utilising intelligence from across the sector to identify risk of SLCN

Several services already monitor wider risk and determinants which could indicate a child or family may need additional support for example midwifery and Health Visitors. Other parts of the system could /have already been trained to include monitoring of risk factors as part of their wider assessment and monitoring of children’s speech, language and communication development (PVI early education settings). Inclusion of risk factors was found to significantly improve wider judgements of risk of SLCN as well enabling sharper decisions made about age and stage of development in early education settings. Coaching and mentoring around individual cases in conjunction with formal educational training programmes has been found to be effective when supporting assessment accuracy in previous speech and language projects in the city.

Services and education settings identify children early and provide targeted intervention for children and families where required, monitoring child outcomes

Another common theme was the need to identify and address speech, language and communication needs at the earliest juncture. The model describes a common approach where all services and places use the same evidence-based identification and intervention tools at key points in a child’s journey. Tools identified as evidence based are referred to in the Derby Speech, Language and Communication Pathway. Using common tools integrates approaches and allows for shared data collection to monitor the effectiveness of the system as the system matures.

54

Common language across the sector

A strengths-based approach has been utilised in several local areas across the country to unify language and to build strong, trusting relationships with parents and between and within services promoting partnership and consistency.

Key themes relating to a strengths-based approach are;

• Effective interpersonal skills are essential to forming successful relationships to support working and partnerships with fellow professionals and also families. • Relationships are one of the strongest predictors of positive outcomes from the interventions and advice offered by practitioners. • The utilisation of effective communication strategies is essential for example using open questions, affirmations, reflective listening and summarising.

Strengths based approaches have been found to;

• Value the capacity, skills, knowledge, connections and potential in individuals and communities. • Create conditions where practitioners work more effectively in collaboration, which has been found to help people to do things for themselves, enabling people to become co- producers of support, not passive consumers. • The approach has broad applicability across a number of practice settings and a wide range of populations. • There is some evidence that use of strengths-based approaches can improve retention in treatment programmes. • There is evidence that use of strengths-based approaches can improve social networks and enhance wellbeing.

Co-production including parent and child’s voice

A city-wide approach to co-production is needed which is developed and delivered cross sector as part of the integrated approach at key points in the child’s journey.

The Listening Fund advises that co-production and consultation is not just an initial exercise, rather an ongoing dialogue which continuously shapes service provision based on parent and child voice and community needs.

To effectively co-produce, a culture of listening is essential, there should be local policies for listening, structures and processes for listening, technologies for listening, resources available for listening, skills across the sector for listening which addresses the politics of listening. The Listening Fund also advises that local areas should consider how to articulate the outcomes from listening to decision making and policy making. There are two levels; ‘Service level’ when making changes to the day to day running of provision and the ‘Strategic Level’ when changes need to be made to strategic plans and goals. Both tiers need to take place within the system of support for children with SLCN.

55

The mechanisms for listening are by;

• Focus groups • Surveys • Ongoing listening within practice • Advisory boards • Activity days • One to ones • Informal ‘open door’ conversations • Case studies of individual children • Suggestion boxes

Seeking the views of young children, especially those with limited language skills may require an adapted approach for example the use of visuals such as picture communication symbols, the use of Colourful Semantics resources or arts-based activities and methods. Additionally, when working with very young children, observation of play schema, paying attention to their fascinations and interests, observations of their characteristics of effective learning can also give many clues about child preferences and views which will inform decision making about child autonomy and decision making. Child and adult voice need to be included in the implementation plan which follows this document and any future speech, language and communication initiatives.

Strategic philosophy of moving to primary and secondary prevention

All stakeholders valued the expertise of specialist tier support and services; however there was a common feeling that there also needed to be a shift in approach to moving to prevention and earlier identification and support available without having to wait for a referral on to specialists. The model ensures that tools and methods are available to children and families at the earliest opportunity, with the safety net of a graduated response to need which can increase or decrease in intensity, depending on the individual needs and circumstances of the child and family.

Agreement regarding most appropriate services to deliver the offer

Across the piece, stakeholders requested clarity about which services would provide support and when in terms of the child’s journey/age and stage of development.

Key universal and targeted services in the model are;

• Midwifery • Health Visiting • Family Nurse Partnership • Children’s Centre staff • Speech and Language Therapist • GP

56

• Library services • Voluntary and community sector • Early years education settings (Childminders, Private Day Nurseries, Playgroups, Nursery schools and Foundation units attached to schools)

There is cross over between many of the services throughout the child’s journey, for example whilst under the care of the Health Visiting Team, children and families may also access the services of Children’s Centres and also access a place at an early years education setting. Depending on response to intervention, any child could move on to the care of specialist tier services, or indeed move down from specialist support back to universal and/or targeted services.

Ongoing monitoring of system maturity

Ongoing monitoring of the maturity of the system is needed by stakeholder forums and strategic boards using the Early Intervention Foundation Maturity Matrix. This will monitor the effectiveness of new initiatives at a macro and micro level of the system in the 10 strands of the Matrix - strategy, commissioning, workforce planning, partnership, leadership, community ownership, services and interventions, information and data, outcomes, using and generating evidence. External review such as the Local Government Association Early Years Peer Challenge process can also be utilised to gain fresh perspectives and views about how well the process is progressing.

Supportive home learning experiences

Methods for engaging with parents to support the home learning environments need development. The Opportunity Area pilot projects found that engagement and maintaining contact over extended periods is sometimes challenging. Ongoing co-production with parents will guide the methodology; however initial findings from the needs analysis suggest that parents would like advice and support around speech and language in the places that they visit already, they would like messages delivered in a way that they find accessible and that they feel supported and respected. They would like information presented in a variety of means, verbal, written and digitally to help them to develop their language learning environments at home. Providing home visiting also enables support to be provided at home if this is most convenient or culturally accessible for the family.

6.2 Assessing need There is a need for a consistent means of assessing speech, language and communication across the system to ensure widespread identification of need as early as possible. Many services and professionals are available for families to access in the 0-5-year age range. By ensuring that as many as possible are skilled in assessment and identification practices, a more widespread population- based approach becomes more possible.

There is a need for a more streamlined approach to assessing need at key points throughout the child’s journey, particularly around the 2 to 2.6-year-old check. Joint sharing of information around risk factors alongside assessment of the child’s age and stage of language development is needed.

57

Utilisation of supplementary universal tools is necessary to reduce the number of false negatives and positives at this age and stage, alongside shared assessment findings and discussion and debate where findings are widely different. The role of the Speech and Language Therapist is crucial in this process to provide clinical leadership around best fit assessment judgements and moderation of assessment findings. This can be carried out in a number of ways for example attendance at and discussion of cases at health visitor allocation meetings and joint home, setting and children’s centre visiting to provide coaching and mentoring. Prior to lockdown, early work was underway to trial usage of the Wellcomm assessment across the Health Visiting, PVI setting and Children’s Centre teams. A Speech and Language Therapist is also being commissioned to provide video reflective practice coaching with Health Visitors to help to embed knowledge gained via the Public Health England training around identification and support for children around the two-year development checks.

Most children attend an education setting between the ages of 3 and 5 years of age. Development Matters judgements can be supplemented with additional assessment and identification tools to ensure accuracy of assessment. Tools such as the Every Child A Talker Child Monitoring Tool, Wellcomm, Early Talk Boost, Speech Link and language Link can be used across the age range. Additional tools are required which can aggregate ages and stages findings from early years education settings to estimate need and compare to national prevalence figures.

Early years education settings also need to use their knowledge from training and development opportunities about risk factors and also principles of quality assessments. Ongoing coaching and mentoring from Speech and Language Therapists can continue this work by attendance at half termly planning meetings to discuss need prioritising settings;

• In the five most disadvantaged wards - Alvaston, (7.5%), Arboretum (8.1%), Derwent (8%), Normanton (9.5%) and Sinfin (8.3%) • Those with the highest density of 0-4-year olds – Arboretum, Normanton, Derwent, Sinfin, Alvaston. • Those schools which have lower percentages of children achieving a Good Level of Development for Communication and Language • The schools or settings which are attended by Looked After Children

6.3 Co-ordination of local service delivery/organisational structures Using a streamlined approach to management structures is essential to the successful implementation of integration in Children’s Centres. Several options will need to be discussed such as;

• Having one senior Clinical lead in each locality hub/Children’s Centre who provides management, clinical and safeguarding supervision to the health visiting team, reporting to the 0-19 service manager • Operational line management from a locality manager with a health or social care background with clinical support and supervision from each of the professional groups

58

• A completely integrated management structure with a locality manager who has a health or social care professional background with shared supervision structures which reports into a wider children’s services structure

Allocation of and monitoring of shared casework needs;

• Consistent availability of IT links to NHS in Children’s Centre/Hubs • Development of Information Governance agreement and processes • A shared understanding and agreement of roles and responsibilities • Senior clinical leadership (Health Visitor/Midwifery) aligned with Children’s Centre management structures at each hub • Close links with locality and wider Voluntary and Community Sector and library services/offer

6.4 Places

Family homes

The Government report ‘Improving the home learning environment. A behaviour change approach’ (2018)22 identified home learning activities which involved;

• Going to the library • Painting and drawing • Playing with/being taught letters • Playing with/being taught about numbers • Songs/poems and rhymes

They reported that it is the quality of caregiver/child interactions during activities of the type above which better predict good language outcomes and later school attainment. They describe three key pillars which drive behaviours known to create a positive language learning environment. They advise three key activities at home – ‘Chat (encouraging talk and most importantly reciprocal communication), Play (exploring in a playful and creative manner), Read (sharing books, parents and children talking together).’ The approach can be deployed by professionals supporting families in the home language learning environment. This provides opportunities for supporting capacity and confidence of parents to try Chat, Play and Read strategies, help support families to create these opportunities by supporting them financially, supporting barriers such as health needs and support to create supportive physical environments either in or near to the home. They suggest that interventions which develop simple messages (including video/imagery) about how to incorporate ‘Chat, Play Read’ through everyday routines are especially effective when the messages are provided by local champions and celebrities. The BBC Tiny Happy People resources have been developed for this purpose.

22 https://www.gov.uk/government/publications/improving-the-home-learning-environment

59

By consistently providing advice using these resources across professional groups a common language and methodology can be deployed either by sharing information via an app, by social media and also face to face at home visits via the use of tablets and mobile phones.

Children’s Centres

The Childcare Act 2006 described the role of Children’s Centres/Family Hubs in supporting children and families;

• Early years provision (early education and childcare) – for example assessing, monitoring and providing support following the Development Matters/Early Years Foundation Stage curriculum across the three prime learning areas (communication and language, physical development and personal, social and emotional development) and the accompanying four specific areas (Literacy, Mathematics, Understanding the World and Expressive Arts and Design) • Social services functions of the local authority relating to young children, parents and prospective parents • Health Services relating to young children, parents and prospective parents • Training and employment services to assist parents or prospective parents • Information and advice services for parents and prospective parents

The Coalition Government placed a greater emphasis on;

• child development and school readiness • parenting aspirations and parenting skills • child and family health and life chances

Which services could be based around Children’s Centres?

• Health Visitors • Family Nurse Practitioners • Midwives • Speech and Language Therapists • Voluntary and Community Sector services • Early Help teams

With outreach to;

• Family homes/foster carers • Early education settings • Voluntary sector organisations • Libraries/community activities

60

In the COVID 19 crisis there may be a need for a digital offer/virtual children’s centre offer. This may create new opportunities to test out integrated ways of working between Children’s Centre staff, Health Visitors and Midwives and Speech and Language Therapists as well as volunteers when supporting children’s speech, language and communication. Plans will need to be made for short, medium and long-term delivery of the offer. In the short term, the health visiting teams are beginning to use the ‘Attend Anywhere’ video conferencing to carry out their developmental assessments following the Healthy Child Programme and are considering digital solutions for delivering their interventions.

In some parts of the country Voluntary and Community sector services have been commissioned to provide support from a base in Children’s Centres/Family Hubs at the heart of the most disadvantaged communities. Universal/Universal Plus support is provided by these organisations which addresses wider risk/determinants in vulnerable families such as debt and budgeting, providing grants to support adult welfare and education, domestic abuse, parenting and family routines, child development outcomes, reducing isolation, supporting mental health and housing and providing volunteer support. The organisations provide outreach and also support families to come ‘through the door’ and begin to access services offered at children’s centres and other places and help with confidence to engage with services. Many of these services have had a higher profile role in the Covid 19 crisis providing support for a wider group of families, delivering food and medicines. VCS organisations in the city are making a strong contribution with this work in the city. Consideration needs to be given as to how this support could continue both during and after the COVID crisis.

Integration of the Healthy Child Programme with Midwifery, Speech and Language Therapy, Voluntary sector and Children’s Centre offer in one place ensures that all risk factors are considered, joint working and sharing of information about families happens and ensures a more cohesive and supportive package of support which addresses all areas of family need including speech and language development. Working more closely around the same place means that joint decision making and planning is more effective.

Co-production with parents and families

Examples of good practice from across the country, particularly in the London boroughs show a variety of ways of co-producing services with parents from suggestion boxes, surveys and interviews to having parents on the management board of each of Children’s Centres driving the development of the offer from a family need perspective. Some centres have community champions who are either voluntary sector workers or parents working within communities, encouraging families to access the support and advice available in the centre and using the community cafes on site as a means to meet and talk to new families. Wider parental engagement and involvement of families in Children’s Centres will help to share public health messages around supporting language development in family homes.

61

Library services

Library services in Derby prior to the Covid 19 crisis have offered a variety of services which directly and indirectly support children’s speech, language and communication. Rhyme time and Cradle Club groups are offered in the four remaining libraries under the umbrella of the Council. The groups follow the national guidelines from the Association of Senior Children’s and Education Librarians (ASCEL) Quality Principles Toolkit It is divided into six outcomes;

• Outcome 1: Rhyme time supports children’s early learning and cultural development • Outcome 2: Rhyme time builds the relationship between parent and child • Outcome 3: Rhyme time is inclusive • Outcome 4: Rhyme time reduces social isolation • Outcome 5: Rhyme time is accessible for parents and children • Outcome 6: Rhyme time is embedded in strategy and enables strong partnerships

The remaining 10 libraries in Derby have now been handed over to the Community and Voluntary sector organisation Direct Help and Advice. Rhyme time groups are currently not available in these libraries. Half of these libraries are situated in the most disadvantaged wards in the city. Consideration may need to be made as to how rhyme time groups can be initiated in these new volunteer run library services with the support and guidance of the Local Authority Library service or other new options to extend the Council Library Services offer across the City.

Library services also provide the Bookstart offer which has wide reach across the city. Integrating the BBC Tiny Happy People ‘Chat, Play, Read’ advice alongside the sharing of this resource will continue to enable consistent messages to be provided with the wider offer. Library workers can also use these opportunities to also promote the group language learning opportunities available at Children’s Centres.

Early Years Education Settings

Stakeholders requested a collective approach across a varied landscape of private, local authority and academy trust /chain providers. All early years education providers follow the Early Years Foundation Stage curriculum and use the Development Matters assessment framework. Practices include assessing and tracking children’s communication and Language Development, but little about the methods or tools. Using supplementary tools to the Development Matters Framework alongside, consistent observation and assessment practices, crisp knowledge of ages and stages of development, reflection on the child’s risk factors around SLCN and wider risk factors enables more accurate judgements about speech, language and communication development and how it fits with a child’s wider developmental picture.

Adherence to the model in its entirety is especially essential for all schools and settings situated in the eight most disadvantaged wards of the city, for others it should be optional to utilise elements based on wider school self-evaluation and discussion with the early years Team or School Improvement Officer.

The diagram below describes the roles and responsibilities of staff working in early years education settings when supporting children’s speech and language;

62

Roles and responsibilities of Early Years Education Staff and Speech, Language and Communication

Role within organisation Responsibilities around SLC/N Responsible to

Ensures clarity of vision, ethos and strategic Governing Board School Governor/Committee/Owner direction. School/setting and community and parents Holds executive leaders to account for the educational performance of the organisation and Ofsted (Leadership and Management) its pupils/children, and the effective and efficient performance management of staff. Trust Board (Multi Academy Trusts)

Oversees the financial performance of the organisation making sure money is well spent.

Utilising six key features;

1. Strategic leadership that sets and champions vision, ethos and strategy 2. Accountability that drives up educational standards and financial performance 3. People with the right skills, experience, qualities and capacity 4. Structures that reinforce clearly defined roles and responsibilities 5. Compliance with statutory and contractual requirements 6. Evaluation to monitor and improve the quality and impact of governance

63

Headteacher/ Senior Leadership Utilises the Balanced System® Scheme for Schools School Governor/Committee/Owner and Settings funded by TALK Derby to; Team/Manager • Analyse the need in the school/setting population • Self-evaluate current SLC provision (family support, learning environment, workforce knowledge and skills, identification and intervention at universal, targeted and specialist tiers of support) • Map SLC provision and gaps • Understand provision • Identify relevant projects that will develop provision and address gaps • Generate an action plan including a range of stakeholders • Evidence requirements identified • Implement changes • Evidence the range of provision • Reflect on new approaches to understand change and sustainability • Evaluate evidence against initial evidence and action plans • Develop a strategic plan for maintaining and developing provision • Decide whether would like to go forward for accreditation • Commission/source development opportunities/resources to meet need

64

Room Leader/Foundation Stage Holds a relevant level 3 qualification in Speech, Headteacher Language and Communication. lead/Childminder Delivers and oversees the quality of the early years SLC provision.

Ensures that the offer follows best practice referred to in the Derby Speech, Language and Communication Pathway at universal, targeted and specialist tiers of support. in the areas of;

• Parent support

• Development and application of the learning environment

• Workforce development

• Assessment and identification

• Intervention

Promotes and models excellent practice at all times by encouraging colleagues to have high expectations of children’s speech, language and communication development, ensuring that all children achieve their potential.

Develops the wider Early Years provision in conjunction with colleagues based on best

65 practice in Early Years education in terms of;

• How adults help children to learn in early years in terms of interactions during planned and un-planned child and adult- initiated play and activities • Communicating and modelling language, showing, explaining, demonstrating, exploring ideas, encouraging, questioning, recalling, providing a narrative for what they are doing, facilitating and setting challenges • Taking account of the equipment that is provided and attention to the environment both indoors as well as outdoors, as well as the structure and routine of the day • How practitioners assess what children know, understand and can do as well as taking account of their interests and dispositions to learning (characteristics of effective learning) and use of information to plan children’s next steps in learning and monitor their progress

Ensures that constructive, respectful, trusting and fair relationships are built with children and their parents where child views are listened and acted upon.

Ensures partnership working takes place with families and carers, so that learning can be shared to improve outcomes.

66

Establishes and maintains a culture of collaborative practice with colleagues to ensure collective responsibility for SLC practice.

Understands the impact of SLCN on learning and behaviour and social and emotional development and ensure this knowledge is shared with colleagues.

Ensures current best practice supporting children whose first language is not English here and here

Contributes to the work of the multi-disciplinary team, ensuring co-ordination of the implementation of programmes and interventions on a daily basis in conjunction with the SENCo.

Plays an active role with all colleagues to support their SLC/N CPD needs in conjunction with the SENCo. Methods of CPD may be formal educational, self-directed study; work based and may involve training, modelling or reflective practices such as coaching or mentoring either face to face or using video.

Seeks information about up to date methods, tools and approaches from the Derby Speech, Language and Communication Pathway

SENCo Has role of Communication Champion Headteacher

67

Can also be a Childminder.

Holds a relevant Level 3 or 4 Speech, Language and Communication qualification

Collects and records all relevant data about children with SLCN.

Predicts children from the cohort who may be at greater risk of SLCN in conjunction with the room staff/teacher

Develops and oversees the Graduated Response for children with SLCN.

Supports the development of SLC provision, using the Derby Speech, Language and Communication Pathway as a repository of resources;

Parents

Ensures that parents receive home language learning resources from the BBC Tiny Happy People resources in a variety of formats depending on parent need eg face to face discussion, group work, sharing information via social media.

Sources and develops parent material/advice/group support for language learning experiences at home when children are identified with SLCN.

68

Ensures a repository of parent advice/group support and links to supportive organisations for children with communication disorders identified by specialists.

Environment

Ensures that all rooms/classrooms have;

• Communication effective physical learning environment • Communication effective language learning interactions • Communication effective planned language learning opportunities

Carries out regular learning walks to monitor the effectiveness of provision using national audit tools eg Communication Supporting Classrooms Observation Tool, SSTEW.

Ensures additional enhancements for children identified with SLCN eg picture communication symbols, visual timetables, interaction and friendship opportunities, noise reduction, re- arrangement of physical space, resources/books related to needs, child views incorporated, learning opportunities differentiated to child’s developmental level.

Ensures specialist advice regarding to adaptation of physical learning environments is followed and

69 reports back to specialists where adaptations are needed.

Workforce

Carries out a self-evaluation of staff knowledge and skills supporting children’s speech, language and communication using the Speech, Language and Communication Framework (SLCF) https://www.slcframework.org.uk/.

Advises leadership regarding staff development needs and training courses which will meet needs.

Reviewing staff progress post training and development using the SLCF and reporting findings about new development objectives to the leadership team.

Identification

Oversees accuracy of EYFS Development Matters judgements in relation to identifying speech, language and communication delay. Supporting judgements with the use of additional tools and methods.

Ensures usage of additional screening/identification assessment tools deployed eg Wellcomm, ECAT Child Monitoring Tool, Early Talk Boost, Speech Link, Infant language Link, The Communication Trust

70

Progression Tools.

Ensures risk factors are considered as part of wider assessment of SLC

Risk factors =

• Social disadvantage/low income households/home learning environment • Low parental qualifications • Family history of SLCN/processing problems • Adolescent motherhood • Maternal mental health problems • Maternal use of harmful substances including smoking • Pre-term birth • High number of siblings • Male gender

Coaches and mentors staff to apply knowledge to practice with regards to wider assessment skills which strengthen professional judgement in conjunction with specialists with regards to;

Risk factors Red flags Identification of SLCN and bilingualism Tracking and monitoring of need Types of SLCN and how children’s SLC can break down Profiling need and ages and stages of sub- categories of SLCN

71

Recognising communication disorders Parent and child views Parent/child interaction Principles of assessment and observation Case history and the home learning environment Response to intervention

Intervention

Ensures availability of evidence based universal and targeted interventions eg Early Years Word Aware, Launchpad to Literacy, Wellcomm, Early TalkBoost, Speech Link, Infant Language Link, Nuffield Early Language Intervention (NELI), Key Stage 1 TalkBoost.

Ensures adherence and consistency of support for children receiving specialist tier interventions.

Draws on the experience of Speech and Language Therapists when needed at school based planning meetings, seeking guidance in the form of training, coaching, mentoring and creating joint working opportunities with therapists alongside Foundation stage leads/teachers/room staff/room leaders via formal training, coaching and mentoring.

Teacher/Teaching Assistant/Room Has relevant level 1 or 3 Speech and Language Headteacher Staff/Childminder qualification. Room Leader/Foundation Stage lead

72

Sources, tools and approaches from the Derby SLC Pathway, developing provision in conjunction with colleagues/Room Leader/Foundation Stage Lead/SENCo.

Provides effective high-quality teaching and learning which considers;

• An accurate assessment of children’s starting points • An understanding of each child’s interests and fascinations • An appreciation of how each child learns best • The subject content that needs to be taught • The context in which learning should be introduced and developed • The child’s age and stage of development including in their home language if the child is bilingual

Utilises and monitors the effects of universal strategies which support children’s speech, language and communication development which considers;

• Adapting adult language and communication • Enhancing the environment • Using resources and tasks • Supporting confidence and self-esteem • Facilitates communication between peers

73

Demonstrates excellent practice at all times by having high expectations for all children’s speech, language and communication development, ensuring that each child achieves their potential.

Ensures that constructive, respectful, trusting and fair relationships are built with children and their parents where child views are listened to and acted upon.

Ensures partnership working takes place with families and carers, so that learning can be shared to improve outcomes.

Maintains a culture of collaborative practice with colleagues to ensure collective responsibility for SLC practice.

Ensures use of current best practice supporting children whose first language is not English here and here.

Understands the impact of SLCN on learning and behaviour and social and emotional development and ensures this knowledge is shared with colleagues and students.

Contributes to the work of the multi-disciplinary team, ensuring co-ordination of the implementation of programmes and interventions on a daily basis in conjunction with the SENCo.

74

Provisions and tools

The recent TALK Derby programme funded by the Derby Opportunity Area has had a significant focus on training the children’s early years education workforce and more recently the wider workforce who may come into contact with children with SLCN at a targeted level. Training has been offered face to face and more recently, by online training opportunities. This has provided knowledge exchange at scale which has been helpful. Not all education settings have signed up to or accessed the CPD sessions. A review of all continued professional development accessed by the early years education workforce is required to ascertain who has received training, whether the education setting is in one of the most disadvantaged wards in the city and the outcomes and impact of the training in terms of outcomes for the workforce, child language development and changes in parental confidence.

A more bespoke, nuanced offer will be needed in the next phase, when a baseline level of training and development has been achieved, which links more specific development outcomes to individual child needs in classrooms and is guided by teacher agency and expectations from CPD. Speech and Language Therapists are best placed to develop this work by a process of more bespoke training sessions, coaching and mentoring. Speech and Language Therapists can also support the development of the wider universal and targeted offer for parents, the learning environment, identification practices and training and support to deliver evidence based targeted interventions. Planning for the specific method of support can be linked to needs raised at setting or school-based planning meetings as well as the prioritisation of children with established SLCN which requires specialist advice following universal and targeted approaches. This more nuanced approach is now being referenced in teacher Professional Development research in the report ‘Teacher CPD. International trends opportunities and challenges’ by the Chartered College of Teaching23 which reports that group based training in central venues for teachers is being found to be less effective in terms of knowledge transfer into the classroom without wider professional development experiences such as coaching and mentoring.

Additional development of services and interventions in early education settings is needed around;

• Ongoing workforce development around the skills needed for identification of SLCN • Training and implementation of evidence-based interventions across the age range. Commissioners either at a city wide or school/setting level also need to be assured that training providers are registered licensees to deliver training to use intervention materials following the Quality Assurance process for each company who supplies the evidence-based tools. • Co-production of provision in conjunction with parent and child views. For example, some stakeholders reported that they were beginning this work by organising events with and for families within the community either alone or with other local schools/settings in the area which would provide enrichment, engagement opportunities and new ways to get to know families. Some PVI settings have developed family activities with parents such as fish and chip suppers which are used as a forum to share messages about how to support speech and language development. One parent support organisation is developing a room in their

23 https://i.emlfiles4.com/cmpdoc/3/6/1/2/9/1/files/48747_chartered-college---international-teacher-cpd-report.pdf

75

offices where parents can make their own visuals and picture communication symbols. These can be shared with school staff based on parent knowledge about what works at home. Observation of how children access the learning space has changed how some PVI settings have developed the learning environment for example moving the book area to less noisy parts of the setting showed that more children were likely to sit and engage with books on their own or with peers or adults for longer periods of time. • Providing a wide range of speech and language materials, advice and support for parents at universal, targeted and specialist tiers of support which are delivered by a range of methods and are accessible to parents for example on the school/setting website, using social media, group activities either inside or outside of school hours, community activities to foster relationships and utilise informal conversations as a means to share support ideas and tempt families to engage with wider family and SLC support activities. • School and setting leadership teams driving improvement in provision using the Balanced System® Scheme for Schools and Settings. An initial workforce development analysis showed that only 50% of school leadership teams are using the tools (as intended), the remaining 50% are being used by teachers or teaching assistants. The value of the tool is that it can be applied across key stages with benefits wider than the foundation stage if deployed by the leadership team. • Leadership teams/SENCos are advised to use the Communication Trust Speech, Language and Communication Framework (SLCF) as a measure before and after training, coaching and mentoring to measure changes in knowledge levels of staff to ensure that trends/outcomes are positive. • Leadership and SENCos are recommended to understand the contents of the training and how it will be applied in their own education settings/schools and to carry out regular learning walks and lesson/session observations to ensure that developed knowledge is being applied in day to day working and is discussed and followed up in staff 1:1s. Before and after measures and information in terms of changes to staff knowledge and skills, the learning environment, joint working with parents, identification of need and intervention should be recorded by the leadership team on the school/ setting Balanced System Scheme for Schools and Settings online tool. • The SENCo should take the lead role as Communication Champion overseeing the provision and implementing in conjunction with the Foundation Stage Lead/setting Room Leader.

Role of Speech and Language Therapists

Development opportunities are best provided by Speech and Language Therapists who provide specialist input into schools and settings. Therapists will already have a working relationship with the education setting and be familiar with key members of staff.

If the local NHS Speech and Language Therapy service is commissioned to provide the full suite of universal, targeted and specialist support for the system, staff within the service will need training and development opportunities. Their skill set in recent years has been focussed on children with complex communication disorders needing specialist tier intervention support. A small number of staff remains in the service that historically provided universal and targeted supports in Children’s Centres and Sure Start. Utilising this organisational knowledge alongside supports from therapists

76 who are currently providing universal and targeted work to the wider system and know the city well may be beneficial. Teachers who are Senior Leaders in Education in Early Years also currently provide support to schools and settings across the city and could be utilised to ensure that the SLC offer develops in tandem with current best practice in wider Early Years pedagogy. Speech and Language Therapists developing the role of communication champions/SENCos in schools and settings will ensure consistency across the piece, make sure that all development opportunities are embedded into teacher and practitioner practice. Tapping into wider research networks which could provide inter-professional learning such as universities and organisations which support cross sector professional development for example the International Professional Development Association (IDPA), NALDIC – the national subject association for English as an Additional Language (EAL) would also be beneficial. Distribution of Speech and Language Therapists across early education settings also needs careful consideration. Therapist allocation should be based on an analysis of the schools and settings which reside in the highest areas of deprivation and/or where school Communication and Language Development scores are lower. This may require annual re-evaluation as provision develops and improves.

Speech and Language Therapy Casework

Speech and Language Therapy casework will consist of a percentage of children per school and setting who are receiving direct therapy, based on a joint prioritisation exercise with the school or setting SENCO and also a wide range of other activities which could include;

• Providing universal advice for families about supporting children’s speech and language development at home delivered in conjunction with education setting staff • Working with the education staff to develop a repository of advice, information and support for parents of children with SLCN, this may include outreach support in family homes • Providing parent support groups in the education setting or remotely which have specific aims to support SLC development at home for children with SLCN/communication disorders • Training to deliver universal and targeted interventions from the evidence based repository in the Derby Speech, Language and Communication Pathway /the Better Communication CIC Identification and Intervention paper • Developing wider universal Oracy pedagogy using a variety of development mediums such as use of video reflective practice coaching, training, mentoring, development of observation and monitoring tools, group supervision • Development of Oracy provision is also available via an Opportunity Area funded programme delivered by Hardwick Primary school and a national exemplar of Oracy approach at School 21. An EAL programme for supporting bilingual children is also available funded by the Opportunity Area. • Supporting identification practice across the school/setting in terms of the usage and deployment of evidence-based tools and practices and methods to identify SLCN when a child is learning more than one language. • Supporting the SENCo/Room Leader/Foundation Stage lead to analyse data and plan groups of children who may need closer tracking, monitoring or intervention/support to achieve a

77

Good Level of Development in Communication and Language and identify children early who potentially may have more persistent needs/SEND. • Development of physical learning environments which support speech, language and communication development and the adaptations which can be made for children with SLCN and communication disorders. • Continuing to develop provision with the leadership team using the Balanced System® Scheme for Schools and Settings, measuring outcomes and impacts of new projects • Providing half termly planning meetings with the SENCo/leadership team to discuss and develop staff CPD, provision and discuss children needing specialist assessment and intervention. • Developing single page plans with the team for those children leaving a PVI setting to start a school place or children starting statutory school which include parent and child views about the optimum learning environment and pedagogical techniques which support inclusion for children with SLCN. • Ensuring that the vast majority of support is provided on-site in the early education setting and that each school and setting has a named Speech and Language Therapist to ensure development of trusting ongoing professional relationships.

Co-ordination of professionals

The SENCo role covers co-ordination of all external professional/outside agency support in conjunction with the Senior Leadership team and joint planning with the Speech and Language Therapist.

Integrated model of support

Basing speech and language therapists in schools and settings has not been possible historically due to low ratio of therapist to school and setting number. Successful approaches to integration in the city have worked where therapists have attended planning meetings regularly in the education settings and also wider multi-professional forums for children with more persistent SLCN/SEND needs.

Moving from targeted to specialist tiers of support

Early Years Panel (PVI settings – face to face or virtual)

The Early Years panel has been in existence for several years and is where casework for the STePs team is planned and prioritised. At its inception a wider representation of professionals attended, particularly from health. Speech and Language Therapists attended this panel to plan visits for new referrals in conjunction with colleagues and agree seamless care for those needing ongoing support.

78

Re-instatement of this process for integrated casework planning and partnership working would be beneficial. Integrated SEND working may include;

• Discussion of children with potential SEND needing Multi-disciplinary team involvement • Monitor the response to intervention of children receiving additional support from settings at SEN support • Shared planning of a package of support and agreement from each professional about their role with individual cases • Support the SENCo to continue to develop the graduated response/SLC provision • Agree a coherent team response to supporting needs raised personally by the child and/or parents • Plan transitions to school settings

School based planning meetings (Foundation Units in schools and nursery schools – face to face or virtual)

Attendance of Speech and Language Therapists at termly/half termly school-based planning meetings which include other professionals for example; Educational Psychology. The planning meetings could focus on;

• Cases with potential SEND needing MDT involvement • Support the SENCo to continue to develop the graduated response/SLC provision • Response to intervention of children receiving additional support from settings/school at SEN support • Shared planning of the package of support and agreement from each professional about their role with individual cases • Agree a coherent team response to supporting needs raised personally by the child and/or parents • Discussion and planning for children who may require more detailed/ statutory assessment based on their response to intervention • Plan transitions into Year 1

Monitoring the effectiveness of the early education school/setting

Key partners who could monitor the effectiveness of the education provider provision are;

• The school improvement team who work with schools under local authority control and in partnership with schools who are members of multi-academy trusts • Multi-academy trust partners/Regional Schools commissioner • Early Years Team providing setting support to PVI settings • Educational Psychology/STePs Team • Speech and Language Therapists • Strategic SEND leads in the Local Authority

79

6.5 Purpose of the Derby Speech, Language and Communication Pathway

The Pathway, developed via the Early Outcomes Fund programme is an online tool which can be accessed by parents and professionals. Once inside the pathway, each group can enter their child’s age and seek advice about evidence-based activities which can support the home learning environment or can help the service or early education provider to develop provision further. They can also seek information about support which is available locally in Derby ‘Places’. Parents and professionals will be able to create their own mini pathway based on their child’s needs and also learn about services, advice and interventions which they may not be aware of in the area or nationally. The information behind the pathway was developed after an intensive needs analysis process which looked at the range of provisions available in Derby and nationally. The pathway, does not follow a linear path, rather a ‘stepping stones approach’ which allows more bespoke means of support based on a child’s needs at any particular given time because we know from the literature that there is high variability in children’s speech, language and communication trajectories across the 0-5 years age range.

Additionally, the pathway has an outcomes framework which allows parents and professionals to make judgements about outcomes for the child, practitioners and education setting provision based on the ‘input’ suggestions in the tool. The tool based on the Balanced System® is intended to sit alongside the integrated model of service delivery described in this document.

6.6 City-wide Public Health messaging

The key public health messaging which will be utilised across the city will be the BBC Tiny Happy People resources. The BBC have been approached and will develop a specific campaign for dissemination of the resources towards the end of the year in 2020 in Derby following learned experiences from a similar project in Greater Manchester. This project will need to be developed in conjunction with the Derby City Council Communications Team. Key partners involved in the work are anticipated to be;

• Midwifery • Health Visiting Team • Children’s centre teams • Voluntary sector organisations • Early years education settings • Library services • Foster carers • Virtual school team • Social care • Community and toddler groups • The INTU centre in the centre of the city • Shops in local communities for example Co-Op, Tesco Express • Museums

80

• GP surgeries – TV screen/consultations • Apps/social media - Instagram • Public transport – buses • Local magazines for example Lots for Tots

6.7 The Wider Workforce

TALK Derby is currently offering training and development opportunities for the wider workforce who potentially could identify and support children with Speech, Language and Communication Needs. Services that have been offered this continued professional development are;

• Library services • Foster carers • Virtual School team • Midwifery • Voluntary sector organisations

These organisations can help to deliver public health messages about supporting children’s speech, language and communication development and also work in conjunction with parents and other services who are core to the offer as well as early education settings to help to identify need and signpost to places where universal, targeted and specialist tier support can be found.

7. Organisational Structures

Stakeholders reported that organisation of children’s services in Derby should be arranged and organised in a way which facilitates a more joined up response to child and family needs. This will require ongoing commitment over an extended period of time and requires a continuation of the co- production work in this programme which used open dialogue, coalescence of a shared vision for children and families in Derby. It also requires an understanding of the time and resources required to influence sustained organisational and cultural change.

Ongoing facilitation is needed from those with expertise in change management and implementation planning.

7.1 Professional respect and relationships There is a need for genuine respect between professionals and organisations. Problems with partnership working were repeatedly heard in the needs analysis. Consistent professional working relationships can be established by;

• Clearly articulated values, vision and behaviour across the system utilising strengths-based approaches.

81

• A joint agreement across organisations regarding joint working and professional relationships. • A mechanism to escalate issues where behaviour has not been consistent with shared values, vision and behaviours. • Transparency, which encourages shared ownership of issues and barriers. • Increased opportunities to learn together across organisations. • Mechanisms to support joint working, care planning and co-ordination.

7.2 Place based model The model above proposes a move to a locality/place-based method of delivery which addresses need in environments where families feel most comfortable and familiar or are places which they visit regularly.

Co-locating professionals is one way of integrating services, however for true integration to take place wider systems and processes as well as governance arrangements need to be purposefully implemented to ensure true partnerships can emerge. Casework and caseloads can be integrated to reduce duplication of effort and improve information sharing around children’s centre allocation meetings. Speech and Language Therapy casework can also be planned and delivered jointly by working closely with early education settings at school and setting based planning meetings. As an aspiration, deeper integration methods can be deployed in Children’s Centres such as;

• Shared NHS/IT links in Children’s Centres. • Development of information governance agreements and processes. • Agreement of Information Governance processes. • A shared understanding and agreement of roles and responsibilities of the staff working from Children’s Centres. • Senior clinical/managerial leadership in each Children’s Centre which feeds into the wider clinical and multi-agency team. • A clear line of report of this tier of leadership into health and locality management structures. • Working arrangements whether they are co-located physically or mobile working with virtual team management.

7.3 Information sharing

Stakeholders requested a gradual process for sharing and understanding local data which would require adherence to local Information Governance regulations. The Greater Manchester Area are developing a digital strategy for sharing information across their integrated early years system where assessment data can gradually be shared and integrated across health, children’s centres, social care and early years education settings to gain an accurate picture of need/prevalence and

82 ensure effective devolution of resources and staffing. The Mayor is proposing that the 10 local authorities move to a names ‘Names not numbers’ approach, where from 18 months children’s development is tracked (especially the children falling into vulnerable group categories) and interventions provided for those children who look like that they are not going to gain expected SLC outcomes at key points on the 8 point pathway. The 10 authorities will have a unified, digitised architecture to allow sharing of data at child level across services.

In Derby, a more gradual approach may be needed across the 5 year period whereby initially information is shared at a cohort level but with an ambition of later shared data at child level about;

• The number of children who reach the expected/above expected level for Communication and Language using the ASQ3 assessment at ward and city level at 2 years of age. • The number of children at expected and above expected levels for Communication and Language at age 2.6, 3.6 and 4.6 years of age from aggregated Development Matters data collected from schools and PVI settings. • Communication and Language Good Level of Development data at the end of the Reception year. • Outcomes for child language development from evidence-based interventions deployed at 2, 3, 4 and 5 years of age. • Health Visiting may be moving to a similar 8-point pathway. Data collection at additional points may need to also be included.

This data can be measured against predicted data based on the number of live births to ascertain if sufficient numbers of children with SLCN are being identified. Additionally, analysing trend data regarding improvements when all providers have access to and have been trained to provide evidence-based interventions and universal supports can also be measured.

Results can be used at an operational level to drive improvement in local service offers and also at a city-wide strategic level to drive commissioning intentions. Consideration will need to be born in mind factors such as;

• Specific needs of local population and ‘hot spots’ where there is high need • Data protection legalities • User engagement and consent following GDPR requirements • Clear guidance regarding processes and expectations of how to access, manage and safeguard information which is shared • Wider data collected from health, nationally and from the local authority which provides indicative information about risk such as the data reported in The National Child and Maternal Health Network (CHiMAT), employment figures, Vulnerability Profiles recently produced by The Children’s Commissioner24, Ofsted result per Children’s Centre, PVI and School setting, training received by services/workforce audit and plan, deprivation score per early education setting. This can be used to predict risk in a focussed, evidence based and efficient manner. • The need to collate this information on a performance dashboard, so that improvements can be monitored at a glance at strategic forums and by heads of service and commissioners.

24 https://www.childrenscommissioner.gov.uk/our-work/vulnerable-children/local-vulnerability-profiles/

83

The dashboard being developed in an iterative way as new data and evidence emerges to support analysis and performance across the system. • Monitoring of outcomes within the outcomes framework in the Derby Speech, Language and Communication Pathway

7.4 Risks and issues

There are a number of risks and issues moving to a new model of working which are influenced by local and national drivers;

• Gaps in staffing across the piece in terms of sickness, attrition. Ongoing training and development opportunities will be needed to maintain ‘collective knowledge’ as well as individual and joint supervision to ensure consistency of approach. • Sign up and agreement from all services and places to new ways of working. • The COVID -19 crisis causing a number of risks notably a reported increase in the number of vulnerable children which is difficult to ascertain at present with a significant reduction in the number of face to face opportunities for professionals meeting children and families. There is a need to consider and develop new methods of working which overcome barriers to face to face working such as new digital technologies. • Many ‘places’ have closed due to social distancing requirements such as libraries, Children’s Centres, PVI settings and schools and there has been a reduction in strategic working opportunities on business that is ‘non-Covid’ related. • Parents have not traditionally been central to service planning at local and strategic levels. New methods for continuously involving a wide cross-section of parent and child views needs to be developed as the new model develops which follow national exemplars. • Information sharing at practitioner and strategic levels. • Development of the model needs to dovetail seamlessly into development actions around SEND and the response to the joint CQC and HMI written statement of action. • A clear workforce plan is needed for the future which will continue to develop the offer building on the work of TALK Derby and other Department for Education funded initiatives such as the Professional Development Programme and Health Visitor training which links into local area/ward level need and development outcomes of children. • Many key staff in services have been re-deployed, particularly in health. Routine development checks are not taking place and continuous development tracking of children in early years education settings is not possible universally for all children at present. • The need for commitment from senior strategic leads in the local authority and health as well as commissioning teams in the Clinical Commissioning Group, Public Health and Local Authority for culture and structural change and provision of infrastructure to support implementation. • Strategic agreement and commitment across the myriad of early years education settings (PVI, Local Authority and Multi-Academy Trust) brokered by the Local Authority is needed in terms of the sign up to the delivery model, integrated approaches, information sharing and shared culture, vision and values. • Ongoing decreased funding for Local Authority and Health commissioned activity which is significantly lower in the East Midlands compared to the rest of the country.

84

• Training and development needed within the Speech and Language Therapy service so that they can begin to provide universal, targeted as well as specialist tier support. • Mapping of workforce availability in terms of whole-time equivalent Speech and Language Therapist time and the needs of the population and system requirements at universal, targeted and specialist tiers of support. This may need to be an iterative measurement monitored over time as the system develops and matures and where it is felt the greatest investment is needed at key points in the system.

8. Integrated Commissioning

The local area has been exploring Integrated Commissioning using the framework taken from the joint Local Government Association and NHS Clinical Commissioners document; ‘Integrated Commissioning for Better Outcomes. A Commissioning Framework’ (2018)25

The document highlights that the process of Integrated Commissioning should be developed in close consultation and co-production with a wide range of stakeholders including the service users themselves and should consider the following principles;

• A focus on the benefits for the ‘3 Ps’: people, places and populations, with the individual person at the heart of the approach. • A focus on outcomes over ‘episodes of care’. • Recognition that integrated commissioning needs to happen at multiple levels: with individuals and their families and carers, with communities and across populations. • Awareness and acknowledgement that commissioning is about more than procuring services; it is about a wide variety of activities which improve the outcomes and lives for people, places and populations. • Awareness that language matters and that words and concepts can have multiple meanings. • A belief that understanding and respecting our differences (of history, culture, legal responsibilities and ways of working) enables us to work better together.

Derby is at the beginning of its journey to develop integrated commissioning. The document suggests considering the following framework when developing integrated commissioning methods and shares a monitoring tool to evidence progress made in the following areas;

1. Building the foundations – based on trust, a shared vision and priorities with strong collective leadership and governance. 2. Taking a person-centred, place-based and outcomes focussed approach. 3. Shaping provision to support people, places and populations. 4. Continuously raising the ambition by seeking to balance a strongly evidence-based approach with the appetite required for appropriate joint risk taking to try something new,

25 Integrated Commissioning for Better Outcomes: a commissioning framework (2018) https://www.local.gov.uk/icbo

85

emphasising a culture of learning and innovation where ‘failure’ is seen as a source of intelligence about what to try next. 5. The integrated governance of the model needs to work within existing governance structures within health and the Local Authority whilst working towards a shared vision for children’s services across the city.

The existing commissioning landscape is complex with little integration at population, place or person level. Key services in this proposed new model are commissioned by very different entities and in very different ways for example;

• The 0-19 Healthy Child Programme is commissioned by the Public Health commissioning team in the local authority and provided by NHS Derbyshire Healthcare Foundation Trust • Children’s Centres are provided by the local Authority. • Library services have a mixed method of commissioning and provision where a small number of libraries are provided by the Local Authority and a larger number now have been procured after a competitive tendering process, now provided by a voluntary sector organisation. • Maternity services are commissioned by NHS Derby and Derbyshire Clinical Commissioning Group – CCG and provided by University Hospitals of Derby and Burton NHS Trust. • The NHS Speech and Language Therapy Service is commissioned by NHS Derby and Derbyshire Clinical commissioning Group and provided by Derbyshire Community Health Services NHS Foundation Trust. • PVI early years childcare providers are a mixture of private and not for profit organisations who receive funding from the Government (Department for Work and Pensions) via the Local Authority for 2 and 3-year-old childcare places, with some supplementation and top up from parents. This depends on family circumstances and working patterns across the age one years to school age range. • Schools can be their own commissioners seeking out services and support to meet the needs identified by their own self-evaluation which becomes part of their bespoke school offer. Schools in Derby are mainly accountable to their Multi Academy Trust and a small number remain under the auspices of Local Authority control. • The Voluntary and Community sector largely seek funding by drawing down grants from grant holders to deliver short and medium-term projects based on local community needs.

The complex arrangements around commissioning and provision of services in the city explain much of the duplication and gaps in services and silo working culture reported by many stakeholders and parents. Alignment of support has taken place in time-limited, early years SLC initiatives. It has also happened via partnerships and working relationships between committed professionals, but no formal structures currently exist to align the vision, strategic direction and delivery at an operational level. The proposed service model could enable the development of an integrated approach which meets the need of people, places and populations. The outcomes framework within the Derby Speech, Language and Communication Pathway and 5-year plan below could be used to monitor the effectiveness of the system.

86

9. Integrated Governance

The NHS Integrated Governance handbook26 (2006) was written to support NHS leaders to deliver safe and effective services, it describes Integrated Governance as…’a coordinating principle. It does not seek to replace or supersede clinical, financial or any other governance domain. Rather it highlights their vital importance and their inter-dependence and inter-connectivity.’

The integrated governance structures needed to support the integrated service delivery model for children’s speech, language and communication, needs to work within existing governance structures in local services (health, local authority, voluntary sector) and early education settings, whilst working towards a shared vision for children’s services.

The document: ‘Integrated Commissioning for Better Outcomes. A Commissioning Framework’ describes the robust governance arrangements when planning integrated commissioning by jointly considering;

• Risk sharing • Making binding decisions together • Resolving conflicting organisational priorities • Developing a shared financial plan • Pooled budgets (where necessary) • Agreed and clearly understood metrics

Evidence of progress towards meeting the above would be measured by;

• Clear accountability and authority vested in joint decision-making arrangements at all levels • A risk sharing protocol agreed by cabinet/NHS governing body (and wider stakeholders in this instance for example early years education settings and schools) • Governance in place which enables constructive resolution of differences and empowers staff at all levels to operate jointly • An agreed plan for organisational change with statutory implications for all partners clearly understood.

9.1 Accountability

An integrated body is required which can develop the model year on year and also ensure adherence to local, national and organisational policies and guidance. In Derby, the groups most suitable would be the Health and Wellbeing Board or Children, Families and Learners Board. These bodies will need to model high levels of commitment, a shared vision and communication and problem-solving skills.

26 https://www.good-governance.org.uk/wp-content/uploads/2017/04/The-new-Integrated-Governance-Handbook-2016.pdf

87

Representation needs to include all of the key stakeholders/organisational bodies including parent representation core to delivery of the model.

This group will need to;

• Develop the five-year plan for the new service model, outcomes measures and KPI measures to monitor improvement. • Manage the risk register. • Work towards alignment of organisational systems and ethos to support service delivery. • Monitor improvements by a jointly developed dashboard/scorecard including usage of the LGA Early Years Maturity Matrix. • Develop the offer in conjunction with co-production opportunities with parents and child views. • Mitigate and seek to learn from complaints and parts of the system which are not working well.

Joint governance arrangements should be led by the board and also align with governance arrangements in each of the ‘places’ where service delivery will take place, bringing together health, local authority, voluntary sector and early education setting managers and leaders to gain consensus about the high quality, safe responsiveness of services, learning from one another cross sector.

9.2 Parent and child engagement

Parent and child engagement should be included at all levels of the system utilising a variety of methods to gain wide consensus and understanding of how the system is developing. Parent and child engagement can be considered in a variety of ways such as;

• Involving parents and children in the development of new policies and models of working • New staff recruitment • Improving access to services • Taking an outside look at how open/transparent information sharing, and decision making is perceived as well as when mistakes are made • How ‘inclusive’ approaches and methods ‘feel’ to children and families • How empowered parents and children feel to make independent decisions and choices • Whether services have identified needs early and appropriate support successfully received

9.3 Clinical Governance

‘Clinical Governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence can flourish.’ (DoH 1998)

88

The Health and Wellbeing/Children, Families and Learners Board will need to be responsible for holding an overview of clinical governance for the model. Leaders and managers/head teachers within services and early education settings will be responsible at an operational level. Integrated governance across services may need to be considered for example around clinical supervision as well as other governance issues such as;

• Safeguarding – mechanisms when joint working • Risk management (incident reporting, risk assessment and business continuity planning) • Quality improvement and clinical effectiveness • Information sharing and information governance (confidentiality, data protection, information security, logistics if sharing record keeping, audit of record keeping and appropriate information sharing)

9.4 Workforce

How staff will be line managed, responsibilities around recruitment, induction and training of the workforce and how parent and child views are incorporated into this process.

Consideration needs to take into account;

• Induction • Mandatory training • Continuing professional development • Appraisals and 1:1s • Performance management • Management of conflicts/grievances • Clinical supervision • Peer support and review • Staff surveys

10. Implementation

Following consultation and agreement about the model, an implementation plan will be required based on the implementation science evidence base. This plan will need to be agreed and developed alongside key stakeholders to agree the exact nature of the key elements which will enable successful delivery.

89

11. Five Year Delivery Plan

The Early Intervention Foundation Maturity Matrix has been used as framework to plan prospective development objectives and outcomes based on the development of this strategic model. It is summarised in the diagram below.

90

Five Year Delivery Plan

Year 1

Age range Maturity Matrix Key Element Outcome

All ages Strategy A local area SLC strategy agreed through a process of formal consultation developed via the early Outcomes Fund programme which covers multi-agency planning and delivery of early years services, taking into account population needs covering universal, targeted and specialist services, pre-term birth risks and risk factors up to age five years, maternal mental health and addresses barriers that disadvantaged families face and recognises wider issues such as parental conflict and multiple disadvantage delivered in accessible places.

Action and implementation plan developed to address children’s speech, language and communication needs in the early years through prevention and early intervention by strategic boards, commissioners and strategic directors/service leads.

All ages Commissioning There is single agency commissioning for early years services, but commissioners are in dialogue about interdependencies.

There is recognition that partners need to commission a more coherent early years system for vulnerable families if they are to have an impact on SLCN.

Dialogue between the local authority and CCG about how to best meet their statutory duty to jointly commission SEND services.

91

All ages Workforce Multi-agency workforce needs are being mapped across the early years, and specifically on speech, language and communication. Capacity and skills audits or training reviews are underway with a focus on the role of health visitors, early years practitioners and teachers, family support in children’s centres, as well as specialist speech & language therapists.

Specialist speech & language therapists have a key role in providing training to the wider workforce

All ages Partnerships Some partner agencies in agreement with the principle of a more joined up approach to the early years, and focusing on SLCN, but levels of engagement are low and the partnership is not yet broad.

There is some discussion of and commitment to a joined up early years approach at partnership boards for children or health and well-being, but no governance structure to deliver early years goals.

All ages Leadership There is an increasing awareness of the importance of speech, language & communication as a child wellbeing indicator, championed by some local advocates, and some support for a more joined up approach to early years goals.

All ages Community ownership Children and families are engaged through formal consultation and engagement mechanisms. Views are taken into account in strategy and service development. This may be generic rather than specific to the early years or to SLCN.

All ages Services and interventions Some services and early years education settings have an understanding of their role they can play in supporting children to develop speech, language and communication skills.

92

Some evidence-based interventions or programmes are being considered or starting to be implemented. This includes intensive home visiting interventions, & two generation programmes which help parents to scaffold children’s learning at home (see service model for details);

• Audit carried out to ascertain services and early education settings already using evidence-based identification and intervention tools, particularly in the eight most disadvantaged wards from the list in the Better Communication CIC Identification and Intervention tools report.

• Audit carried out to ascertain the education settings and services using evidence-based tools to support development of their speech, language and communication friendly environments.

• Audit carried out regarding the services and education settings who have received training from TALK Derby and qualifications achieved.

• Coaching/reflective supervision by a Speech and Language Therapist for Health Visiting Team embeds learning from Public Health England SLC training with specific cases seen at 2-year development check and improves accuracy of identification of SLCN.

• After CPD opportunities, early years education settings and practitioners use the ECAT Child Monitoring Tool to support EYFS judgements as well as wider decision-making skills which improves identification of SLCN at 2 year development checks and for 3 and 4 year old continuous assessments.

• Implementation of Wellcomm Tool improves accuracy of identification of SLCN at 2-year development checks by Health Visitors, Children’s Centre workers and early years education staff and leads to developmentally appropriate delivery of Wellcomm intervention.

93

Roles and responsibilities tool developed for early education settings in conjunction with representative staff.

There is interest in developing shared early years pathways and single points of contact so that families can access support services easily, including for SLCN.

All ages Data collection/use for targeting Early years services are targeted using current data at some priority groups, particularly taking account of family income, although not consistently.

All ages Information sharing There is a commitment to recording and sharing personal data and work is under way on information sharing agreements, for example on sharing NHS live birth data with the Local Authority.

Some sharing and combining of early years data about individual families across agencies.

All ages Information for families Information for parents and carers on early child health and development is accessible, understood and consistently conveyed to families across the early years workforce via the Derby SLC Pathway and also by a cross sector campaign with the BBC (Tiny Happy people). This covers the importance of good speech, language and communication skills, how to promote them, and family entitlements.

The Local Offer and Family Information service website is up-to-date, comprehensive, high quality and responsive to parent feedback linked to the Derby SLC Pathway

94

Year 2

Age range Maturity Matrix Key Element Outcome

All ages Strategy Agreed set of shared values stated in a compact or memorandum of understanding (MOU) signed up to across core and wider supportive services and early years education settings.

System wide LGA Early Years SLC Peer Challenge undertaken.

Action and implementation plan dovetails into Written Statement of Action response to joint HMI/CQC SEND inspection.

Board/governing body level accountability is agreed and monitoring of the strategy happens at this level.

The SLC strategy is linked into other local strategies relating to children, families and communities.

Data from the Early Outcomes Fund needs analysis is included in the Derby Joint Strategic Needs Analysis (JSNA).

All ages Commissioning The local authority and CCG are working towards joint early years/SLC commissioning and are aligning specifications for core early years services such as children’s centres and health visiting as well as SEND services.

There is a common and evidence-based approach to commissioning for good speech, language and communication outcomes including the role of Speech and Language Therapists at universal and targeted as well as specialist tiers of support.

95

Commissioners have an understanding of the market for early years services and an agreed position on how this can be developed to impact on speech, language and communication needs in vulnerable families.

Performance monitoring and reporting are through a single process and it is clear which commissioners are responsible for different parts of the early years system.

The resources used for some maternity and early years services are identified, including Early Years Pupil Premium, & initial analysis of prioritisation, sufficiency and cost-benefit is underway.

Work is under way to create pooled or aligned budgets to sustain funding and achieve early years goals.

Mapping and analysis of resources for maternity and early years services, including childcare places and SLCN, is advanced and is starting to inform resource allocation as part of the early years strategy.

Community and family assets are recognised as important. Peer support, community development and involvement in delivery, and the role of parents as a child’s first teachers are included in the resource analysis.

All ages Workforce The specific role of different workforces across maternity and early years services in responding to speech, language and communication needs is clearly identified, including what can be done through early intervention in universal services.

Workforce needs are analysed and understood, and speech, language and communication skills are part of skills audits. Capacity gaps are addressed through staff training, service redesign or recruitment, taking account of the wider early years system rather than just focusing on individual agencies.

96

Indicators of staff performance, awareness and satisfaction are positive, and many staff champion the importance of speech, language and communication as a child wellbeing indicator.

There are opportunities for some staff in key roles across health, education and social care services to participate in training on SLCN.

All ages Partnerships An identified partnership group has lead responsibility for delivering early years goals, including SLCN, and this links to the work of the local authority and CCGs on SEND joint commissioning and builds on the work/governance arrangements of TALK Derby and other local SLC initiatives.

The partnership group brings together a growing group of agencies including Clinical Commissioning Groups and Public Health. Partners are contributing to the development of the local strategy and action plan.

There is willingness amongst partners to share responsibility, design solutions and take action.

All ages Leadership There is active buy-in and understanding at both operational and strategic levels about the importance of speech, language and communication as a child wellbeing indicator, and a more joined up approach to early years goals. This buy-in is shown by investment of time and resources, and a consistent and visible personal commitment.

The local culture encourages innovation and collaboration in how services are planned and delivered, alongside a focus on using evidence.

All ages Community ownership The views of children and families inform strategy through formal consultation focussed on early years issues and goals.

Some family champions are involved in the strategy development process.

97

There may be some community-led early years projects and services but this is not yet part of a coherent strategy.

All ages Services and interventions Service quality for early years education settings, children’s centres and health visiting is generally good and improving.

0-2 years Most children receive mandated Healthy Child Programme checks, and gaps are known and being tackled. A mini pathway is developed regarding tools, identification and support for SLCN around the integrated 2-year check.

Health Visitors, Children’s Centre Workers and early education settings trained to use the Wellcomm tool shows improved identification a clear path intervention support for parents and demonstrates improved language outcomes for children at 2 years of age.

The children’s centre offer includes a focus on developing early speech, language & communication skills in children under 2 and support for the home learning environment.

All relevant services, including maternity services, early education settings, Troubled Families services, Speech & Language Therapy services, library services and services for children with Special Educational Needs & Disabilities recognise their role in a joined-up approach to SLCN and report on the key indicators.

All early years education settings in the eight most disadvantaged wards have carried out a self-evaluation of their SLC provision using the Balanced System® Scheme for Schools and settings, developed an action plan and routinely monitor the effectiveness of development actions in conjunction with Speech and language Therapists setting and school improvement teams.

Early years education settings develop their model of support in line with the guidance in this document, considering roles and responsibilities of staff, outcome measures for

98

parents, children and staff and utilisation of evidence-based tools and methods which enable effective support.

All early years education settings in the eight most disadvantaged wards use evidence based identification and intervention tools referenced in the Better Communication CIC identification and intervention report for 3, 4 and 5 year olds.

Common processes for referral and assessment are understood and applied across consistent thresholds, and practitioners use a common language to describe how needs are identified, assessed and met.

Organisations are working together to develop provision and utilising the Derby SLC pathways as a repository of advice and support.

Core commissioned activity agreed in the Speech and Language Therapy service specification at universal, targeted and specialist tiers of support and performance outcomes indicators agreed.

An integrated early years pathway for speech, language and communication includes key touchpoints and mechanisms for identifying SLCN, along with appropriate, evidence-based action and follow up.

All ages Data collection/use for targeting Information from early years delivery on the ground is used in strategic needs analyses and service design work.

All ages Information sharing Some information takes place across key early years services. Strategic information sharing agreements are in place but not yet fully operationalized.

0-2 years Live birth data is shared, and information from the health visitor 2-year review is routinely shared with other practitioners working with the child and the local authority.

99

3 and 4 years 3 and 4-year-old EYFS outcomes data is shared with the local authority agreed via provider agreements and common tool identified for sharing.

All ages Information for families Families access up to date and accurate service information in a range of ways, with appropriate support to do so where this is needed via the Derby SLC Pathway. The Local Offer, Family Information service, and education setting websites are signpost to its whereabouts.

Services work together to devise innovative ways of reaching disadvantaged families and those whose first language is not English.

All ages Outcomes An early years outcomes framework which explicitly references early education and SLCN is being developed. The framework will start from the antenatal period and works in conjunction with the Derby SLC Pathway.

All ages Family access and experience Collegiate approach and common language implemented for supporting families who encounter services and early years education settings (Strengths-Based Approach)

Year 3

Age range Maturity Matrix Key Element Outcome

All ages Strategy Integrated model of working agreed focussing on the needs of the person, the place, the population.

Clear accountability and authority vested in joint decision-making arrangements at all

100

levels.

A risk sharing protocol agreed at strategic levels.

All ages Commissioning Market development is underway and responds to the priorities in the early years strategy.

Commissioning is aligned to the local vision and multi-agency strategy for early years services and explicitly addresses speech, language and communication outcomes.

There is some joint commissioning using aligned budgets or partnership agreements and the local authority and CCG have developed a joint specification for speech and language therapy services which includes their role in providing information, training, coaching and support to the wider workforce.

Investment in early years services is a local priority, and local partners pool and align funding to support delivery of the early years strategy.

All ages Workforce The workforce capacity skills and knowledge required to impact on early years speech, language and communication are part of role specifications, recruitment & retention strategies, and competency frameworks.

Systematic skills audits are regularly repeated and outcomes used to drive future planning.

Staff are engaged and report high satisfaction levels; consistently champion early years services; and are recognised for effective practice on SLCN.

Organisations have a learning culture, and feedback informs future training and practice across agencies.

101

There is a strategy for building the capacity and capability of the early years workforce which includes promoting children’s speech, language and communication development and providing effective support for children with lower level needs as well as those with more severe or complex difficulties.

Practitioners across the early years workforce access training in common skills and processes. Training supports delivery of the early years strategy, and there is evidence of good take-up. Settings and services identify language leads whose role is to support their colleagues’ professional development.

All ages Partnerships A broad and active partnership group is responsible for a strategy and action plan to deliver early years goals and is having a positive impact. Governance of delivery of the strategy is clear and partners have a shared understanding of goals, performance and their role in taking action. There is an agreed process for addressing areas of underperformance.

All ages Leadership The local culture encourages innovation and collaboration in how services are planned and delivered, alongside a focus on using evidence.

All ages Community ownership Families are involved in the co-design of strategy, in commissioning and procurement processes, and in governance structures where decisions about early years priorities are made.

The customer journey is considered and used to inform service and workforce development. There are examples where families have successfully challenged local arrangements.

Examples of peer support, community development and involvement in delivery of early years services are in place and seen as part of an overall approach. Work is under way to

102

map and develop capacity of communities & voluntary organisations to contribute to early years goals.

All ages Services and interventions Universal services use recognised tools to screen whole cohorts of children, so that they can target light touch support or identify needs which require specialist assessment and support. All children receive mandated Healthy Child Programme checks as a minimum.

Settings use small group targeted help and two-generation approaches to support the development of speech, language and communication skills. Early years services work well with schools on transition for children with identified needs.

Speech and language therapists and advisory teachers provide modelling, coaching and support for staff in universal settings.

Evidence based early years, parenting and speech & language interventions are embedded in specifications for a number of key mainstream maternity and early years services.

All ages Data collection/use for targeting Practitioners across early years services use shared data (including SLCN at key touchpoints) to target support at priority groups according to the local needs assessment and use a joined-up impact monitoring process for individual cases.

All ages Information sharing Some common processes are in place to enable electronic sharing of personal early years data.

2, 3, 4 and 5 years Outcomes from evidence-based interventions shared with the local authority.

All ages Outcomes An early years outcomes framework which explicitly references SLCN is in place and designed around the priorities in the early years strategy.

103

SMART measures have been agreed, using validated measurement tools where possible, and data is routinely collected and reported.

Family take-up and experience of services by different groups (such as disadvantaged families, and those for whom English is not the first language) are included in outcomes reporting.

Performance against locally defined outcomes is starting to show signs of improvement against baselines.

Service and case audits consider the effectiveness of the local system for vulnerable families and findings are used to inform service redesign.

All ages Family access and experience Families generally have a smooth journey through early years services and get timely and consistent support for children with SLCN. Specialist services (including speech and language therapy) are provided in accessible community settings.

Year 4

Age range Maturity Matrix Key Element Outcome

All ages Strategy Strategy delivered by an action plan which is monitored at senior level.

Progress in delivering the multi-agency early years/SLC strategy has been reviewed and the strategy refreshed, taking account of impact to date including on speech, language and communication outcomes.

Partners routinely share maternity and early years data for needs analysis and identifying vulnerable groups.

104

Early years data and intelligence is included in Partnership needs assessment and influences the decision making and prioritisation in the early years strategy.

The needs assessment has a clear narrative about SLCN touchpoints eg integrated 2- year-old review, 3, 4-year-old EYFS judgements and GLD at age 5 years. Data takes into account incidence of SLCN at those touchpoints captured by health visitors, Children’s centre workers and early education settings and compares it to expected prevalence levels to understand under-identification.

The needs analysis considers the interface with Autism Spectrum Disorders and other difficulties and disabilities and with risk factors such as premature birth, adolescent motherhood, maternal depression and lack of parental qualifications.

All ages Commissioning Joint commissioning is extensive, routine, formally agreed, and covers the whole early years system including maternity services; early education; SEND; speech, language and communication needs; library services; parent and child mental health; health visiting and children’s centres.

All ages Workforce The workforce receives high quality training & supervision on prevention and early intervention in the early years, which includes meeting SLCN.

There is an agreed early years CPD offer which supports the workforce to apply the latest evidence to their practice.

All ages Partnerships Partners actively contribute and engage, and there is some open constructive challenge in partnership groups. There is trust and effective working relationships between key partners such as the local authority, CCG, schools & early years providers.

105

All ages Leadership Senior leaders, including local politicians, speak with ‘one voice’ on the importance of speech, language and communication as a child wellbeing indicator, and are advocates and champions for the delivery of the local early years strategy.

All ages Community ownership Families are routinely engaged in the co-production of strategy, commissioning and delivery plans relating to early years goals. Review and planning of services is routinely informed by experiences of the service users and engagement mechanisms are integrated into business as usual.

Peer support, community development and involvement in delivery are part of the overall early years strategy and make a key contribution.

Parents and community volunteers train alongside professionals and co-facilitate training.

Work is underway to build community capacity further.

All ages Services and interventions Service quality and performance is good or excellent for the majority of services which are key to supporting children to thrive in their early years.

Intelligence from delivery routinely informs strategy, evaluation, commissioning, service & workforce design.

0-2 years Each service is clear how they contribute to the local early years strategy, and help to achieve speech, language and communication goals.

2 years All children receive the mandated Healthy Child Programme checks as well as other locally defined routine checks.

All disadvantaged 2-year olds either attend a high quality nursery or receive appropriate

106

alternative support.

There is a coherent portfolio of evidence-based interventions shown to improve speech, language & communication outcomes which are embedded in service specifications and targeted accurately.

All ages Information sharing Routine and timely information sharing happens across a range of early years services, and is used to inform operational delivery of services.

Strategic and operational information sharing agreements are in place and working well. Information sharing about vulnerable families begins during pregnancy.

All ages Outcomes The early years outcomes framework is embedded and visible within a wider partnership framework of outcomes and indicators. Validated measurement tools are routinely used.

Partners have a clear view of which parts of the system are working well, and use this to inform strategy, hold service providers to account and inform service development.

Outcomes show consistent improvement, and where sufficient improvement is not seen analysis is under way to understand why.

All ages Family access and experience Families have a smooth journey through all early years services, and get timely and consistent support for children with SLCN . They only have to tell their story once and are offered personalised support.

All ages Using evidence well Local leaders and decision-makers are confident users of evidence, able to distinguish between credible research evidence and asserted opinion.

107

Fidelity for evidence-based programmes is monitored and reported on.

All ages Local evaluation A consistent approach to evaluation of impact for maternity and early years services is a recognised goal and work on an evaluation framework is underway.

Local evaluation findings are used to inform tactical and operational decisions as well as strategy and planning decisions.

Year 5

Age range Maturity Matrix Key Element Outcome

All ages Strategy A refreshed strategy responds to local learning about what has worked well and where improvements need to be made.

A robust and up to date early years analysis is in place covering population needs and service demands and provision, based on partnership-wide data. The analysis is routinely used to identify target groups, design services, agree priorities and measures, forecast trends and plan strategy and influences family and community strategies.

All ages Commissioning Commissioning for the local authority and CCG is led by an early years joint commissioner with a single budget and performance management process.

The market is well-developed, and evaluation is routine.

Mapping and analysis of resources for maternity and early years services, including

108

childcare places, SLCN and community assets, is routine & comprehensive and informs future resource allocation as part of the early years strategy.

There is evidence of significant shifts in investment to early years prevention and early intervention. The early years is a key priority in the local budget setting process.

All ages Workforce The professional competencies needed to deliver effective early years services are well understood.

Settings and services receiving formal accreditation for expertise in speech, language and communication are deployed to support others in their learning and development.

All ages Partnerships An influential and effective partnership group actively owns the early years strategy and action plans and leads effective delivery across local agencies. Partners constructively challenge & hold each other to account with a focus on impact for children and families. There are strong partnerships between early years settings of different types, including schools.

The importance of the early years and SLCN is recognised more broadly and prioritised by the Health & Wellbeing Board, and Children, Families and Learners Boards.

All ages Community ownership Arrangements for collecting user experience of early years services are routine and embedded, and families are involved in quality assuring services and leading change.

Peer support, community development and involvement in delivery is a key part of the local portfolio of services and support. Communities are actively providing early years services where this can meet need effectively; they are also part of evaluation and monitoring arrangements.

109

Parent champions have a key role in promotion, prevention and encouraging the take up of services for SLCN.

All ages Services and interventions Family centred practices such as team around the family are embedded in all relevant services and integrated with the activity of universal & specialist services.

Comprehensive pathways are used for a full range of needs. Pathways have been revised to take account of impact, user feedback and new evidence on what works.

All early years support is provided with a focus on child and family outcomes jointly agreed and aligned to a consistent outcomes framework, focussing on their needs and strengths and drawing on national exemplars such as here. Families who need it have a consistent key worker.

Integrated monitoring systems are in place and used across early years services to coherently target interventions at priority groups with different needs identified in the local needs assessment. Services are flexed to respond to demand, using live data.

Universal: Homes, schools and settings are supported to develop the speech, language and communication skills of all children through language enrichment and supportive activities

Targeted: Children benefitting from targeted interventions will have access to evidence- based targeted interventions to develop core speech, language and communication skills delivered in the most appropriate functional context/place. These may include 1:1 and/or small group interventions that are typically designed by specialist practitioners and delivered by those with appropriate training.

Specialist: Children needing specialist intervention for their SLCN receive appropriate and timely provision in the most functionally appropriate context/place for their needs. Progress measures include activity, participation and wellbeing goals in addition to goals relating to their core SLC impairment.

110

All ages Information sharing There is routine and timely sharing and matching of data across all agencies to identify and assess individual and family risks, needs and strengths.

IT systems are designed to support multi-agency approaches and facilitate information sharing.

All ages Information for families Families access up to date and accurate service information in a range of ways, with appropriate support to do so where this is needed.

The Local Offer and Family Information Service is an important part of this.

Data is reported and acted upon about how effectively family information is being utilised across the sector.

Services work together to devise innovative ways of reaching disadvantaged families and those whose first language is not English.

All ages Using evidence well Local leaders and decision-makers routinely draw on reliable evidence to inform resource use and service design, and challenge policy with a weak evidence base.

All ages Local evaluation A common evaluation framework is used across early years services which recognises different standards of evidence. Local evaluations generally use validated measures and some use comparison groups. The consistent approach to evaluation supports experimentation and innovation.

The local evidence base is growing and informs future service development. Other places use the learning to support their own policy decisions.

111

112