Impact case study database

Our research has brought about a sea-change in policy, service delivery, allocation of funding and professional practice across the UK and influenced international policy to promote the best outcomes for all children.

Impact on policy:* Our work has ensured that child language development and its pivotal role in school readiness, long term wellbeing and tackling social inequalities is now recognised by key decision-making bodies in education, health and social care policy, and a public health approach adopted as best practice in the UK, Ireland, and a number of European countries. In the UK, the 2019-2029 NHS Long Term Plan now highlights speech, language and communication services as a key evidence-based intervention with which to address and reduce health inequalities for children and young people ( IMP1a). The plan draws directly on PUB6 and on a report commissioned by the Royal College of Speech and Language Therapists (RCSLT) and The Communication Trust (TCT) ‘Bercow: 10 years on’, which cites PUB6 and builds on the outputs of GRANT1 ( IMP2a).

In 2018 the Department for Education announced their commitment to “halve the number of children reaching reception year without the speech, language and communication skills they need to thrive by 2028” ( IMP3a). This was backed by GBP18,000,000 of government funding to address children’s early communication development ( IMP4a). The Deputy Head of Children, Young People & Families, Public Health England (CYPF-PHE) states in her testimonial that PUB6 “ galvanise(d) support across government” for this policy initiative ( IMP4a). This government initiative involved multiple strands including a campaign to improve children’s home learning environment for which Law was an advisor and which also cites PUB6 (Hungry Little Minds; Chat Play Read IMP4c; 4d) and a 10-year BBC education campaign for which McKean was an advisor (Tiny Happy People IMP4e). PHE were tasked to lead an important strand of this work and The Deputy Head CYPF-PHE identifies that PUB3 was a key driver for this decision. She comments that it “ pulled everything together and from that work DfE funded us to develop a whole program of work around speech language and communication”. This GBP1,800,000 PHE-led strand (2018–2020) included the development and delivery of training for all Health Visitors (HVs) across England in child language development and methods to support its optimal development ( IMP5a). Between January and December 2019, 3,500 HVs received this training. Furthermore, the team’s research formed the ‘core evidence’ underpinning this training, with PUB3, and PUB6 central to the design of the programme and with much of the team’s wider work cited in the training materials ( IMP5b). This work was further developed in GRANT5 resulting in the publication of an Early Language Identification Measure and Intervention (ELIM-I) for children at risk of poor language development for use by HVs across England at children’s 2-2.5-year review ( IMP1c, IMP1d). McKean and Law delivered training to lead HVs across England in a PHE led program to implement the ELIM-I nationally ( IMP1e).

Major government initiatives are not achieved overnight but rather through sustained lobbying. The CEO of RCSLT emphasises the importance of our work for RCSLT’s government lobbying leading to this announcement – “Our relationship and collaboration with Professor Law and colleagues continues to this day. It is the combination of their research, the evidence from practitioners and the work of RCSLT that provides us with the information that we need to influence government and other key decision-makers.” ( IMP2a).

Through the testimonials from Deputy Head CYPF-PHE and the CEO of RCSLT and relevant publications ( IMP2a; IMP1b), it is possible to track the pathway of impact from our work to these vital DfE, PHE and NHS initiatives. The RCSLT lobbied the All-Party Parliamentary group (APPG) for Speech and Language Difficulties from 2013, building on findings from GRANT1 and PUB1 and with the close involvement of Prof. Law ( IMP1b; IMP3a). These provided the impetus for the commissioning in 2017 of the “galvanising” reports PUB3 and PUB6 published by PHE and the Early Intervention Foundation, respectively ( IMP2a) and which also cite PUB4, 5 and 7. In 2018 Law collaborated with the chair of the APPG to sponsor a Westminster debate – ‘Speech language and communication support for children’ ( IMP3b). In 2018 RCSLT published and lobbied the government with the ‘Bercow: 10 years on’ report ( IMP2a) and the government response identified key initiatives to tackle the issues raised ( IMP3a). In 2018 the DfE announced their commitment to a focus on communication in the early years ( IMP2a). In 2019 RCLST lobbied the newly formed Oracy APPG ( IMP3c) and the NHS long term plan highlighted speech, language and communication services as a key evidence-based intervention with which to address and reduce health inequalities for children and young people, citing our work ( IMP1a).

The testimonial from the Head of RCSLT Scotland ( IMP2c) outlines how PUB1 and later publications have provided the evidence-base for sustained interactions between RCSLT Scotland and the Scottish Parliament, supporting lobbying and stimulating debate. This lobbying of MSPs raised their awareness of the link between speech, language and communication disadvantage, outcomes in later life and the intergenerational cycle of disadvantage, leading to the commissioning of a Communication Summit attended by the Deputy First Minister of Scotland (2016). Law was invited to present at this ( IMP2c). This, in turn, led to debates in the Scottish parliament (26 January 2016), and the contribution of the RCSLT to the development of the Children and Young People (Scotland) ( IMP2d).

In Australia our work has also supported the lobbying of government with findings from GRANT3 (Centre of Research Excellence in Child Language) being submitted to a Parliament of Australia Senate Inquiry into the prevalence of speech, language and communication disorders and speech pathology services in Australia ( IMP6a, 6b).

Our work has also been used to define best practice with respect to public health approaches to child language disorder in the UK in RCSLT guidance disseminated to members through web resources, policy briefing publications and the professional magazine ( IMP2e, 2f; 2g, 2h, PUB1). Our work is also evident in the position statement in Ireland on Developmental Language Disorder (Irish Association of Speech and Language Therapy position paper IMP7b).

*Impact on services: In 2018 a survey of UK Speech and Language Therapists (SLT) covering approximately 68% of local authority areas found that approximately 80% of respondents were applying a public health approach to child language ( IMP8a). In 2019 we conducted interviews with lead SLTs for three services to understand whether and how such approaches were influenced by our research ( IMP8b). The respondents from Nottingham, Stoke and Hackney report several direct applications of our work: 1) PUB1 enabled them to create a culture and ethos of a focus on prevention and social inequalities within their services and to spread this ethos with other services and professional groups. 2) PUB3 is widely used to underpin professional development of the wider children’s workforce who work with SLTs to deliver preventative interventions. 3) the Communication Supporting Classroom Observation Tool (GRANT1) - has supported services to develop the quality of the language environments in early-years classrooms ( PUB2). 4) PUB7 has motivated and shaped initiatives in developing collaborative practices across schools and SLT services in Nottinghamshire (2017) and the North East of England (2017–2019) ( IMP8b, IMP8c). 5) PUB3 is used to inform discussions with commissioners, provide the evidence to back-up decision-making and to engage health promotion teams in NHS trusts to work in partnership. In this way, it is used to protect and develop service provision and workforce deployment. Indeed, the CEO of RCSLT reinforces the importance of our work in protecting services and directing the allocation of funding, stating “ This has the potential to shape the commissioning (and therefore budgets) of speech and language services in Local Authorities over the coming years. This in turn will impact on the ability of Speech and Language Therapists to do the work that they would like and need to do.” ( IMP2b).

In Ireland, several notable child language public health initiatives which coach families alongside school and other staff in strategies to promote robust oral language and promote effective multi-agency working have been developed. A review of these programmes across Ireland (2013 –2017) and a subsequent evaluation were completed by the Centre for Effectiveness Studies, Dublin ( IMP7a). They identify 23 such programmes with national coverage and describe the influence of PUB1, 2 and 3, GRANT1 and 2 on these programmes and their recommendations for their future development ( IMP7a). In Europe and further afield, awareness and adoption of public health approaches to child language are less well accepted. However, a survey of members of our COST Action network (GRANT4) ( IMP 9) found that 76% of the respondents, consisting of academics and speech and language therapists linked to the COST Action, reported that PUBS 1,2,4 and 5 had an impact on the planning and delivery of services in their country (Croatia, Ireland, UK, Iceland, Finland, Bulgaria, Lebanon, Germany, Greece, Poland, Slovakia, Sweden, Cyprus, and Israel).

Impact on practice: As identified above, our work has catalysed and informed the professional development of 3,500 HVs. IMP6 identifies its influence on the practice of SLTs, SENDCOs, Educational Psychologists, Specialist Teachers and other members of the children’s workforce through the ‘What Works’ website. A key output from GRANT1 was a review of intervention evidence ( PUB2). The challenge was how to provide this information to practitioners to inform practice. In response, Law worked with The Communication Trust (TCT) (GRANT2) to develop this accessible database of interventions ( IMP11a; 10b) ( www.thecommunicationtrust.org.uk/whatworks) (2013–to date). In 2017, findings from PUB3 were also added. To date, approximately 27,000 people have registered to use this resource ( IMP10a) the majority from the UK and Ireland but also reaching Europe, Australasia, Africa, Asia and Northern America .

IMP6 summarises findings from a survey and linked qualitative interviews of ‘What Works’ users. From the 857 respondents, 76% of respondents said ‘What Works’ influenced their practice, 80% agreed that ‘What Works’ is an essential tool to support evidence-based practice and 67% used the resource at least every 3 months. Interviews and free text responses demonstrate its widespread use to identify underpinning best evidence for 1) professional development of SLTs and Educational staff; 2) provision of evidence to justify current decisions, (for example, for headteachers prioritising resources); 3) to train SLT students in evidence-based practice, to review and develop provision and to identify new evidence-based methods to support children’s language development.

In sum, we can therefore trace the impact of our research on policy, service delivery and practice across the UK, Ireland, Australia and beyond.