We need research on interventions for receptive language impairment in children; more on that in a future post. The following serves as a backdrop for the need for evidence based practice (EBP) more generally in the UK, particularly in schools.
Recent years have seen monumental changes in the structure of Britain’s National Health Service (NHS) and local education authorities (LEAs). These changes have had a significant impact on the commissioning of SLT services within schools. Despite general recognition that demand for these services is increasing, the majority of Strategic Health Authorities reduced their planned commissions for the 2011/12 academic year (CFWI, 2012).
Following an extensive review in 2008, John Bercow, MP, recommended joint commissioning of services for children and young people with speech, language and communication needs (SLCN). In 2010, ex Communication Champion, Jean Gross, documented huge variation in the way in which speech and language therapy services were commissioned in schools, depending on the area. This ranged from 100% funding from Local Education Authorities (LEAs), to 100% funding from the NHS, and every combination in between (Gasgoine, 2012). Schools and early-years settings can also employ Speech and Language Therapists (SLTs) privately (RCSLT, 2011).
From 2013, GP led Clinical Commissioning Groups (CCGs) were to be made responsible for 60% of NHS spending (Imison, Ashton, Steward & Willis, 2011). Decisions made about the commissioning of services by CCGs are ‘rigorous and evidence-based wherever possible’ (Imison et al., pg 11): research is even more important when resources are under pressure because of the potential it has for identifying new was of prevention, diagnosis and treatment (DOH, 2010, para 3.16).
Commissioning of speech and language therapy services is expected to continue to change in the coming years, however what remains certain is that whether services are being commissioned by CCGs, LEAs or schools themselves; commissioners will be seeking evidence for the efficacy and effectiveness of intervention, prior to commissioning that service. The implication for SLTs is that there is a greater demand than ever to prove that what they are doing is the most effective treatment for a given population so to ensure continued commissioning of services.
One way in which SLTs can improve outcomes for service users is to identify gaps in the evidence base and seek to address these in order to meet service users’ needs. Knowing what evidence underpins practice helps assure quality and effectiveness (Stringer, July 2010). EBP involves ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’; combining clinical expertise with the best available evidence from systematic research. (Sackett et al, 1996, p71); it has become integral to the role of SLTs and SSLTs. By drawing upon evidence of effective practice within a service (such as well-documented outcome measures), as well as published scientific evidence, SLT managers can accurately inform commissioners about the type of services that are needed and that are effective.
Ebbels (2014) suggests that if there is evidence for effective intervention then it should be used, however if there is no evidence, a ‘best-fit’ approach should be adopted and combined with clinical experience and then evaluated for its effectiveness; this information can then be used by the wider SLT community to inform further decisions around intervention.
Centre for Workforce Intelligence. (2012). Workforce risks and opportunities; Speech and Language Therapists: Education commissioning risks summary from 2012
Department of Health. (2010). Equity and Excellence: Liberating the NHS. Analytical strategy for the white paper and associated documents. Norwich: TSO. Accessed 25 July 2013 from http://www.pharmacyworkforcenw.nhs.uk/uploads/613b70ea0d2bf619e1ba5640723bfe7f/Equity%20and%20excellence%20-%20Liberating%20the%20NHS.pdf?download=true
Ebbels, S. (2014). Language impairments: A review of the evidence. Effectiveness of intervention for grammar in school-aged children with primary language impairment.
Child Language Teaching and Therapy, 30, 7-40. Accessed 14 March, 2014 from http://clt.sagepub.com/content/30/1/7.full.pdf+html
Gascoigne, M. (2006). Supporting children with speech, language and communication needs within integrated children’s services. RCSLT Position Paper. RCSLT: London
Imison, C., Ashton, B., Steward, K. & Willis, A. (2011). Good Governance for Clinical Commissioning Groups: An introductory guide. London: The King’s Fund. Accessed 25 July, 2013 from http://www.kingsfund.org.uk/sites/files/kf/Good-governance-for-Clinical-Commissioning-Groups-Introductory-Guide-December2011.pdf
Royal College of Speech and Language Therapists. (2011). Guidance on quality standards for local authorities and schools as commissioners of speech and language therapy services in the UK. London: Association of Speech and Language Therapists in Independent Practice. Retrieved 31-07-2013 from http://www.rcslt.org/docs/quality_standards_scools_2011
Sackett, D., Rosenberg, W., Muir Gray, J., Haynes, R. Richardson, W. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal, 312, 71-72. Retrieved 25-07-2013 from http://www.bmj.com/content/312/7023/71
Stringer, H. (2010, July). What is evidence based practice? Bulletin: The official magazine of the Royal College of Speech and Language Therapists. Pg 22.