Guidelines for prevention
 in speech and language therapy

The World Health Organisation defined medical prevention in 3 stages.

PRIMARY PREVENTION:
relates to all activities aimed at "reducing the incidence of a disease within a population and therefore reducing, whenever possible, the risks of new cases". Applied to speech and language this means mainly information and health education, as well as training of all those professionals dealing with a specific population.

SECONDARY PREVENTION:
relates to all activities aimed at "reducing the prevalence of disease and therefore reducing the time of evolution". Applied to Speech and Language, this means mainly screening and early detection of delays or disorders. Early detection and treatment may lead to the elimination of the disorder or to the reduction of the disorder’s progress.

TERTIARY PREVENTION:
aims at "reducing the prevalence of chronic disabilities or recurrence of a disease, thus reducing the functional modalities due to the disease". In Speech and Language disabilities it relates to management of the problem including various techniques of rehabilitation and intervention aiming at preventing further problems arising as a result of a disorder.

Speech and language therapists/ logopedists have, in their history, most commonly provided tertiary prevention. In recent years practice of primary and secondary prevention has become an increasing part of the work of the profession, as has multidisciplinary teamworking. Examples of what this practice can be are given here.

A necessary step to optimise prevention is to include strategies of prevention in all initial SLT’s/logopedists’ education programmes and to give legal competence in it to these professionals as it already is in many European countries.

I. INFORMATION AND HEALTH EDUCATION

SLTs/Logopedists provide information about communication, speech and language development and disorders in educational and health settings and within the undergraduate education programmes for doctors, child welfare workers, social workers, teachers and other therapists. They provide information and advice to parents and families individually when necessary, also through meetings of groups and associations, in the media and in continuing professional development programmes for other professions.

Themes include, for example, normal language development in children; role of hearing, interaction and stimulation; early detection of problems and warning signs; spoken and written language disorders in children, adults and the elderly; vocal hygiene; swallowing problems; referral process and collaborative practice.

Objectives for development
 

• Information should be made available and disseminated appropriately to a range of different professionals and carers who are important collaborators with SLTs/logopedists, such as medical and educational colleagues including doctors, nurses, other health professionals, pre-school and school teachers.
• Inclusion of relevant knowledge and evidence based information on Speech and language disorders and their prevention, detection and management should be made available in the programmes of education and training of educational workers, health - and social care workers.
• Increase public and professional awareness of how communication problems may lead to or relate to other problems for the individual in his social, emotional and educational development and well being and that of his family.
• Frequent public information campaigns on Speech and language therapy and how to access help, improve service provision and information in public health and education.

II. ADVICE AND GUIDANCE TO PARENTS AND EARLY EDUCATION

Advice and guidance to parents and early education are within the remit of the SLT.

There are various strategies for intervention: prenatal preventive work with prospective/expectant parents, regular check – ups for at–risk children, training programmes for parents of children with specific problems, advice to teachers and other therapists, creation of parents groups, information on home–care, feeding and swallowing, referral to other professionals when needed.

Objectives for development:
 

• Appropriate training of other professionals to recognise warning signals is provided.
• Each individual with communicative problems has easy access to speech and language therapy and knows how to contact a SLT/logopedist.

III. EARLY SCREENING OF LANGUAGE DISORDERS.

Screening: Generally SLTs share this competence with other professionals, such as doctors, teachers, nursery nurses, health visitors, psychologists. Several screening tools have been created but they are not necessarily standardised. It is important to distinguish screening, detecting and diagnosing. Screening is the presumptive identification of unrecognised disease or defect by the application of procedures which can be applied rapidly; screening tests sort out apparently well persons who may have a disease from those who probably do not.

Objectives for development:
 

• Development and use of standardised screening instruments and programmes for the training of relevant other professionals in the screening of communication disorders.
• Early screening should be available for every child as early as possible. Further screening should occur during the early years. Screening of children may be conducted by appropriate trained professionals such as Health Visitors / Public Health nurses /paediatricians.
  Diagnosis is carried out by SLTs/logopedists.
• Regular and scientifically conducted data collections of screening results, in order to prepare epidemiological studies.

IV. PROPOSALS
 

• The SLT should be more involved in screening both spoken and written language disorders.
• Prevention work with adults/elderly people should increase.
• Epidemiological studies as well as longitudinal studies on the effects of early screening require further research funding.

V. ETHICS AND PREVENTION

Prevention should be carried out within the ethical code of the CPLOL but there are some specific points that should be highlighted:
 

1. Prevention shall enhance/complement and not replace other measures in the health system.
2. Prevention should be based on acknowledgement of consent and respect of human rights and the privacy of the individual.
3. Prevention shall improve quality of life for all individuals.
4. Prevention and early detection should be followed appropriately with adequate resources provided for further diagnoses and intervention by relevant professionals.

Prevention Committee CPLOL
21^st October 2000