Evidence‐based pathways to intervention for children with language disorders

• Published in: International journal of language & communication disorders 2019-01, Vol.54 (1), p.3-19
• Main Authors: Ebbels, Susan H., McCartney, Elspeth, Slonims, Vicky, Dockrell, Julie E., Norbury, Courtenay Frazier
• Format: Article
• Language: English
• Subjects: Age Factors; Allied Health Personnel; Child; Child Behavior; Child Language; Children; Cost Effectiveness; Critical Pathways; Delivery of Health Care, Integrated; Evidence Based Practice; evidence based practice (EBP); Evidence-Based Medicine; Humans; Intervention; Language Development Disorders - diagnosis; Language Development Disorders - physiopathology; Language Development Disorders - therapy; language disorder; Language disorders; Language Impairments; Language therapy; Outcomes of Treatment; Program Effectiveness; Severity (of Disability); Speech Language Pathology; Speech Therapy; Speech-language pathologists; Speech-Language Pathology - methods; Treatment Outcome
• ISSN: 1368-2822; 1460-6984
• DOI: 10.1111/1460-6984.12387

Background Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs. Aims To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence‐based model of SLT service delivery and a flowchart to aid clinical decision‐making. Methods & Procedures Meta‐analyses and systematic reviews, together with controlled, peer‐reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted. Main Contribution The service‐delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non‐SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT‐specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored. Conclusions & Implications SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need