Brigid Clifton
Head Speech and Language Therapist
St Catherine’s School Grove Road,
PO38 1TT
Ventor Isle of Wight (Angleterre)
Tel.: 0198 852722
Fax : 01983857219

It is the purpose of this paper to demonstrate that the outcomes for children and young people with severe speech and language impairment are positively influenced into adult life through consistent, informed, intensive and collaborative speech and language therapy involvement in their education; an educational environment that is able to address the very particular needs of the young person growing up with a language deficit. This is the type of provision offered at St Catherine’s School. which is one of a small number of specialist schools for pupils with primary speech and language impairment in the U.K.

The children discussed in this presentation all have speech and language impairment which is severe enough to warrant a Statement of Special Educational Need. Some may have a range of additional difficulties, physical and emotional. In most cases they have been identified as having significant communication problems by the time they have reached statutory school age ( 5yr), although a small percentage can slip through the net, to be identified later in their school careers.

In the UK all babies and pre-school children are subject to a range of early years assessments, which are operated by the community health services. The aim of these checks is to support the development of children, inform and skill parents and identify as early as possible those children who may have developmental and educational special needs.

Speech and language therapists play an important part in these early years teams, working in partnership with health visitors and community medical officers.

When a child is identified at a pre-school level as having a speech, language or communication difficulty the first speech and language therapy involvement will usually be the local NHS service, either through the speech and language therapist at a community clinic, referral to an NHS assessment unit or involvement of a local NHS specialist paediatric speech and language therapist. Assessment at this level in pre-school years will often also involve the local education authority through the educational psychologist, placement in a developmental nursery and /or involvement of a specialist teaching team, e.g. Portage teams.

Depending on the child’s progress and the availability of resources at school entry, s/he may attend a language unit, run by the local education authority, or more rarely attend one of the few independent specialist language schools. At this age, this is more likely where the child lives close enough to attend as a day pupil.

In the LEA language unit the provision of speech and language therapy is usually managed via the NHS service, although there may be education funding for part of the speech and language therapy hours. This provision can continue for some years but rarely beyond the age of 11 years, the point at which children in UK move into secondary education.

At 11, children in UK move into Key Stage 3 of the National Curriculum. This is the beginning of secondary schooling – when the style of education changes from essentially classroom based, with most lessons delivered by the class teacher, to a subject based curriculum, where pupils are taught by a number of subject specialists

Two main issues can determine how the needs of the child with continuing speech and/or language disability may be addressed at this stage.

One is the historical perception in education, and some even areas of the speech and language therapy profession, that children with this level of speech and language disability will not make significant further progress in secondary settings, and therefore need to be educated in general learning disability schools. Even when there are evident language deficits which interfere with everyday life, many children will not receive the speech and language therapy input they require because they do not satisfy strict criteria in terms of verbal – non-verbal differences. Bishop (1997) proposes the radical view that non-verbal IQ is irrelevant to the diagnosis of specific language impairment as the core deficits in specific language impairment affect language abilities which are largely independent of the skills measured by IQ tests. She makes the point that decisions on who should receive therapy should be based on whether or not therapy is effective.

Another commonly held view is that the child should be able to be integrated into mainstream settings at this point or earlier, - that inclusive education can meet the child’s learning and social needs and , indeed, s/he will be disadvantaged if this does not occur. As Miller (1999 ) states, in mainstream settings teachers take a largely ‘enrichment’ approach to language , concerned with presenting a wide range of language opportunities and enhancing linguistic experience. This does not help the child with specific and persisting difficulties with language. Few teachers have training in the management of pupils with language difficulties. Parents and teachers readily detect communication problems that lead to reduced intelligibility or immature-sounding sentence structures, but they are much less sensitive to language problems that affect comprehension, vocabulary size or verbal memory. Bishop(1997) It is still a fact in many schools that language is synonymous with literacy, and this is particularly so at secondary level. The needs of the child with poorly developed or disordered spoken language are not met.

In the mainstream secondary setting, pupils are taught by subject-specialist teachers, who may or may not have knowledge of the individual pupil outside the class group. The demands of the secondary curriculum in terms of language comprehension, complexity and conceptual development increase enormously as the child moves through school. Many pupils with language impairment are unable to keep pace without high levels of support. The speed at which pupils are required to master new skills, acquire and integrate new vocabulary, concepts and information increases significantly. While the pupil may have the cognitive ability to access the knowledge, they require high levels of support to make sense of the language associated with that knowledge.

To meet the needs of the child with significant speech and language difficulties in a mainstream setting presupposes high levels of informed collaborative working between teachers and speech and language therapists over most of that child’s school career.

The shortage of speech and language therapy staff in the UK and prioritisation on service provision to early years provision means that there are few places where consistent speech and language therapy support is available to this group of children in mainstream secondary education. The pattern of speech and language therapy involvement, if it is sustained, becomes remote from the child and in most cases is solely consultative.

In this situation, parents, teachers and educational psychologists have to look beyond statutory educational provision to the independent sector, to find environments which can provide the mix of education and speech and language therapy provision which will enable the child to realise their potential and develop their skills. This can sometimes involve parents in confrontation with the budget holders for education – the local education authorities, who have the duty of balancing the needs of the individual child against the realities of local finance. A significant proportion of children lose their chance of specialist education at this point. The provision of the majority of speech and language therapy services from the NHS serves to further complicate matters in this area.

St Catherine’s is an independent non-maintained residential special school which is recognised by the Secretary of State for Education as providing specialist education for pupils with speech and language impairment. The school takes pupils between the ages of 8 years and 19 years, boys and girls ( although there are significantly fewer girls than boys). Although the majority of pupils are residential, some local children also attend as day pupils. The pupils fees are paid by local education authorities, who under the terms of the 1981 Education Act are duty bound to place children in an educational environment which will meet their particular special educational needs. If this provision is not available locally the parents must be given information and support to find an appropriate placement. Pupils may be referred to the school at any point in the educational career. It is not uncommon for referrals to occur at 14 or 15 years, particularly from mainstream schools. Most referrals occur at 11yrs, the point at which the move to the secondary curriculum happens. Other pupils join the school at 16, in order to spend 2 years in the 16+ part of the school where they will follow a vocationally driven curriculum to prepare them for work or higher level vocational courses.

Every pupil has a primary speech and/or language impairment which is of such severity that they are significantly disadvantaged in their access to the National Curriculum. Each pupil has a Statement of Special Educational Needs which establishes their individual requirement for high levels of speech and language therapy delivered in close collaboration with teaching staff.

The speech and language impairments of the pupils cover a wide range of type and co-morbidity. The presenting features of speech and language disorder can result in a broad band of disability and results will differ between individuals. Whatever the aetiology the effects of language disability will be demonstrated in poor learning skills in the classroom. The division between expressive and receptive language disorder is blurred. Pupils can show a range of social and inter-personal difficulties. They may be very ego-centric. Frequently they show some elements of developmental delay, particularly in their social development. Many pupils have perceptual problems, and memory and organisational difficulties are a very common feature of these children. Some have voice and fluency disorders, and there are very often fine and gross motor difficulties, as in the classically dyspraxic children. All pupils have particular problems with learning to use language normally and effectively, as a tool for learning and interacting with others.

The educational needs of the pupils are such that they require that the National Curriculum be modified in terms of pace, content and the amount of time allocated to specific subjects. The curriculum is heavily loaded towards basic skills of oracy, literacy and numeracy, and acknowledges that pupils need significant, focused support to achieve a language base which will enable them to access more difficult and abstract concepts. Vocabulary and concepts are specifically targeted in all subjects. Class groups are kept small, between 8 and 12 pupils per class, but pupils are grouped by age, not in terms of their presenting difficulty. This leads to a mix of ability, learning strengths and weaknesses and pragmatic skills; very important in learning to understand and get on with other people.

St Catherine’s employs 8 full-time Speech and language therapists to work with the pupils on roll. The Speech and language therapists work collaboratively with teaching staff and care staff to ensure that the communication needs of the pupils are recognised and met in all aspects of their school lives. Speech and language therapists at St Catherine’s are an integral part of the education team, and liase closely with care staff and parents as appropriate. The school operates in 2 sectors – 8 yr. to 16yr. and 16plus. Each speech and language therapist is paired with a class tutor and works with a small group of pupils.

Speech and language therapists tend to keep within a Key Stage. These are age bands within the National Curriculum at the end of which there are statutory national assessments. Thus the Speech and language therapists become very familiar with ‘their’ curriculum and the vocabulary, concepts and the learning demands involved.

Speech and language therapists and teachers work together as teams to meet the pupils’ individual needs as communicators as well as their educational needs. This involves a commitment to real collaborative working, joint goal setting (e.g. IEPs and Annual Review aims) planning and learning. The curriculum becomes the vehicle for the development of communication skills in the real-life setting of the classroom. Speech and language therapy aims are focused on the development of skills required to access, understand and retain knowledge as required by the National Curriculum. In order for this to be effective the speech and language therapist has to have involvement in the planning, delivery and evaluation of the curriculum. Liaison sessions are timetabled so that planning time can be ‘ring-fenced’.

The importance of language in the curriculum has been discussed at length in other places.(e.g. Martin & Miller 1999, Merrit & Culatta 1998) There is ample evidence to indicate that while a child with a significant level of language disability may cope with the experiential and highly visual mode of teaching in the early years of education, the demands of the curriculum and the pace of delivery of that curriculum becomes extremely challenging as they move through the educational process. What we must also address is the social understanding of the child, as it is this, probably more than educational issues, which will make the difference between success and failure in adult life.

Interaction, pupil - pupil as well as adult - pupil is a major feature of classroom activity. Speech and language therapists and teachers work together to provide strategies for the pupils to make sense of the learning environment. The work of the Speech and language therapists in the classroom has been increasingly driven by social interactionist principles – that is, that learning happens through interaction between the learner and ‘significant others’. Vygotsky (1962) Establishing a notion of mediation and person centred learning has become important to the style of working throughout the school, and across all disciplines. We have looked at Feuerstein’s approach and also, as a whole school group examined ideas of Accelerated Learning( Smith 1995) and the use of visual and cognitive strategies for developing and scaffolding learning skills, both for pupils and staff!

Speech and language therapy is delivered in 3 distinct strands; individual speech and language programmes, classroom support and social interaction groups.

The complexity and severity of each individual pupils communication disability has meant that they have been identified as requiring high levels of speech and language therapy input to enable them to access the curriculum and learn. A significant amount of what the pupil needs to learn about managing and developing their own communication skills has to be delivered on a one to one basis. It is in the best interests of the pupils to give them specialised individual intervention balanced with the other features of their education. Once the individual programme is in place, the pupil can be supported to practise and master skills in the classroom and beyond . Working with each pupil on an individual basis is therefore an important part of speech and language therapy practice in this setting. As the child moves through the school they have to cope with differing demands; from the curriculum, from their own development and from social expectations. So their needs in terms of language change and develop. The individual therapy programme will mirror these changes and take into account the aims and objectives set for and with the pupil through the Annual review process and Individual Education Programmes (IEPs). Pupils progress against the speech and language therapy objectives are measured by standardised assessment (e.g CELF-R, BPVS) and objective and subjective ratings of progress through the IEP system, Progress is reported formally to each pupil’s Annual Review meeting, which is a statutory requirement of the Statement of Special Educational needs.

Working in the classroom is a logical and effective way to influence the language learning of the pupils. IEP objectives often relate to classroom activity, ( e.g. attention to message, time spent on task,) and the speech and language therapist is in a good position to support and monitor the pupils’ progress in these areas.

The speech and language therapist in the classroom is essentially reactive to the environment and needs of the pupil in the class. The speech and language therapist is acting in a collaborative role to enable the pupil to understand the information, instruction and concepts delivered by the teacher through the structure of the lesson. The partnership between the speech and language therapist and teacher is based on common understanding of the differences between their respective roles and areas of influence. Working together, the different professionals develop confidence in their abilities to acknowledge where their working practice can provide mutual support and the optimal learning environment for pupils with speech and language disorder. Working effectively in the classroom pre-supposes good working relationships with the different subject specialists and knowledge of the content of the curriculum and individual lessons. Communication and shared knowledge between teacher and speech and language therapist are central to this working practice.

The speech and language therapist’s role in the classroom is to focus the pupil on the relevant information, the core concepts and vocabulary, and to some extent bridge the gaps in each pupils knowledge base; addressing the basic concepts and taking the pupil over the necessary ideas at a rate in line with his/her language ability. The speech and language therapist may reinforce the pupils learning strengths, using for example, visual cues, auditory rehearsal or organisational strategies to enable the pupils to experience success in learning and develop their confidence as learners. Organisation, both personal and within a group, is heavily dependent on language skills – pupils need support in identifying their personal organisational style and maintaining it. The speech and language therapist may take a more or less active role during the lesson, at times supporting one pupil, working with a small group, reinforcing vocabulary with the whole group or interacting with the teacher to demonstrate a point. To be successful this approach depends on good communication with the teacher and mutual respect and confidence.

The classroom is the ideal setting for the pupil to practise and extend the skills in language and communication worked on in individual sessions, or in social interaction groups. The speech and language therapist working in the classroom across the curriculum is also in a position to make explicit cross-curricular links between subjects which are so difficult for pupils with language impairment to identify. The curriculum becomes a valuable vehicle for the pupil to develop his/her language skills and the speech and language therapist’s knowledge of classroom activity and curricular issues allows for high levels of carry-over between individual activity and classroom work. Using the curriculum as the language base gives added value to individual language work and allows extra learning opportunities for the pupil.

The third strand of speech and language therapy intervention is the social interaction groups run by the speech and language therapists as a timetabled activity for every pupil in the school. While this conforms to the general requirements of English (Speaking and Listening), the scope of the sessions extends far beyond the explicit curriculum. These children require specific opportunities to learn and practise the skills of using language effectively in social contexts with peers and adults. The issues are not just about effective language, but require a wider realisation of social behaviour and the acquisition of a range of personal skills which will be useful throughout life.

The speech and language therapists at St Catherine’s have developed a framework for Social Interaction which aims to provide a structured and schematic approach to this enormous area.

Looking at the basic skills required, we have attempted to establish a spiral structure, which will allow for the development of basic skills which can be revisited and extended at each year level. Working within an educational setting, where it is possible to predict and match, at least to a point, how social demands will develop has made this process easier.

Taking work on the pragmatics of language as starting point, the skills which should be developed across the Key Stages have been identified. These were then merged under topic headings such as Feelings (KS 2) Getting to know people (KS3 )Talking Things Through (KS4).The various topics are ordered throughout the year so that it is possible to track what is delivered to each pupil and across the year groups.

Assessment is via observation and recording by the speech and language therapist, using written observations and video. As they progress, pupils begin to assess their own progress, using structured observation schedules and video recordings. Video has proved to be a very positive and powerful tool in this area. Being able to observe their own performance in a range of activities has been very useful to pupils, even those who show poor levels of self-esteem in many other areas.

Attention to others and the ability to receive and give appropriate feedback, verbally and non-verbally, is a significant starting point. Self-awareness, developed through group activity, co-operative play and work, monitored by video and photographs, is an important aspect of the social interaction programme. In the early stages listening and attention skills are developed and reinforced in structured sessions.There is an emphasis on awareness of body language and proxemics. As the pupils progress they are given opportunities to learn basic negotiation skills and how to develop dialogue and conversation skills. Later, work on assertion involves how to give opinions, listen to others’ ideas and that it is alright to disagree. Problem-solving in groups and working co-operatively on tasks are recurring activities. Work on higher level language skills such as inference and prediction is targeted at age appropriate levels, as is work on figurative language.

Social interaction continues into the 16 plus sector of the school, where it remains an essential part of the curriculum, not only as a direct focus in course work, but also as part of vocational training. Increasingly, pupils are required to use their communication skills in planning and negotiating activities in school and in the community.

Over the years we have established in school a rich resource of material for Social Interaction activities. Some of these are published schemes, (e.g Rinaldi 1992, Kelly 1995, Rustin and Kuhr 1989).There are also many books of different activities and much material that has been adapted and developed in school to meet the needs of particular year groups. It has been our experience that to meet the needs of the pupils, it is best to take an eclectic approach, rather than to adhere to a particular programme. The framework for Social Interaction allows the flexibility to adapt material to meet the needs of a particular group, while ensuring a measurable and manageable approach. To maintain continuity for the pupils and as part of the continuing professional development of the speech and language therapy team all Social Interaction records are peer audited annually. Each speech and language therapist also presents video of selected Social interaction activity and its rationale for discussion by the speech and language therapy team.

In order to demonstrate efficacy it is necessary to be able to measure how a particular intervention has affected outcomes for the young people targeted. As McCartney and van der Gaag (1996) state the mechanisms for evaluation of speech and language therapy intervention in schools are far from straightforward. As an independent establishment it is imperative that the we are able to demonstrated the ‘added-value’ of integrated speech and language therapy and education for the young people in the school.

At present evaluation occurs at several levels. The pupils development is measured in terms of their individual progress against the aims set for them at Annual Review and termly via IEPs. These aims cover a range of areas; academic, linguistic / communication based and behavioural. The IEP aims in school are matched by individual action plans managed by care staff to develop the pupils personal and social skills in informal everyday environments.

Overall targets for pupil achievement are set annually, using a series of baseline measures of educational skills. CELF-R scores are included in these targets, using raw and standardised scores for each set of sub-skills.

Another level of evaluation is the academic outcome for the pupils. At the end of Key Stages 2 and 3 the pupils take part in the national Standard Attainment Tests (SATs). All pupils follow nationally accredited courses in Key Stage 4 which are externally examined. The level of success in these courses is a measure of the pupils educational progress.

The school as a teaching establishment is accountable to the Department of Education and Employment and as such is inspected by OFSTED. Recent inspection identified the collaborative working practice of the school as a major strength, and highly praised the education given to the pupils. As part of this process parents views on the school were canvassed and there were high levels of parental satisfaction with all areas of the school.

Finally, and most significant, are the lifetime outcomes for the pupils when they move on from St Catherine’s. The degree to which the young people can operate effectively in society is the most stringent measure of the effectiveness of the input that they have received during their time in school.

There is an increasing body of literature which describes the long-term difficulties faced by individuals with all levels of communication impairment. The problems in understanding, establishing and retaining social relationships remain the greatest life-long disability faced by these young people. It is the responsibility of those working with this group of children to ensure that at least they have some idea of how to function as productive and involved members of society.

A recent report on longitudinal research by the Language Development Project has looked at the outcomes for people whose specialist language input ceased at 8 or 9 years of age (Clegg, Hollis & Rutter 1999). This makes very depressing reading. This report identifies a group of young people similar to the pupils at St Catherine’s, but who have received limited educational provision, no speech and language therapy contact after age 9. Without exception this group of young men – now in their late 20’s and 30’s have had difficult and unsatisfactory life experiences. They have had no support in facing adolescence and adulthood with the complexities of a lifelong impairment which is generally unrecognised by the public. The incidence of mental and emotional difficulties is high, and there is little evidence of independent living skills or personal coping strategies which might have helped them deal with unforeseen events. Most of the young men in the study are still heavily dependent on parental support in all areas of their lives and they do not, as a group show evidence of the ability to attract and retain life partners.

Contact with the young people who have moved on from St.Catherine’s gives a much more optimistic picture.

A long-term study of outcomes for pupils from St Catherine’s is only in its infancy. Although the school has specialised in working with pupils with speech and language impairment for 20 years, the extension into 16+ education is relatively recent. Short term feedback from the young people who have moved on from the 16+ part of the school is very encouraging, with a high proportion successfully completing vocational courses in mainstream colleges and moving into work.

Many of the pupils who left the school at 16 remain in contact and return for school events. A few have such severe on-going disability that they remain dependent on family or carers, and will need sheltered living and working environments. The majority are living independent useful lives. Many will carry the problems of communication difficulties throughout their lives, but they have developed strategies to cope.

For all of them, it has been possible to identify progress in their increased competence, self-confidence and good coping strategies.

It is very important for the eventual successful outcome for the pupils that they are taught in an environment which allows all the professionals involved to work collaboratively across territorial boundaries and establish programmes that are relevant to the pupils functional communication needs as well as their educational needs.

Speech and language intervention as an integrated part of the educational process can make the difference between success and failure for the pupil, both in school and beyond. Working in a school specialising in providing education for pupils with speech and language impairment enables speech and language therapists to increase their own knowledge base and develop skills in collaborative working which are rarely available outside specialist settings. The cross-fertilisation of ideas, philosophies and skills between professionals is stimulating and challenging. The range of specific speech and language disorder and the opportunities to work in depth with a small group of children is intellectually exacting. And for the pupils, we are able to provide an educational environment which meets their needs, and is undoubtedly effective.