Outcomes from a community speech and language therapy service treatment waiting list: The natural history of 525 children with identified speech and language needs

Hesketh, Elizabeth; White, Paul; Simkiss, Doug; Roulstone, Susan

Abstract

Abstract

Background
Understanding the natural history of developmental speech and language impairments can support the selection of children whose difficulties are persistent rather than transitory. It can also provide information against which the effectiveness of intervention can be evaluated. However, natural history data is difficult to collect ethically. Furthermore, as soon as an impairment is identified, the behaviour of those around changes, thus creating some level of intervention. Longitudinal cohort studies, where intervention is minimal, or the control arm of randomised trials have provided the best evidence. However, occasional opportunities arise where service waiting lists can provide data about the progress of children who have not received intervention. This natural history study arose within an ethnically diverse, community paediatric speech and language therapy service in the UK where levels of social disadvantage are high.

Aims:
To identify (i) characteristics of the children who attended initial assessment and were selected for treatment (ii) differences between children who did and did not attend reassessment (iii) factors associated with outcomes.

Methods and Procedures
A cohort of 545 children were referred and assessed as in need of therapy. Due to resource constraints, intervention was not available for an average of 12 months. Children were invited to attend for a reassessment of need. Initial and follow-up assessments were conducted by experienced clinicians using service guidelines and the Therapy Outcomes Measures Impairment Scale (TOM-I). Descriptive and multivariate regression analyses examined child outcomes for changes in communication impairment, demographic factors, and length of wait.

Outcomes & Results
At initial assessment, 55% of children presented with severe and profound communication impairments. Children offered appointments at clinics in areas of high social disadvantage were less likely to attend reassessment. By reassessment, 54% of children showed spontaneous improvement (mean TOM-I rating change 0.58). However, 83% were still judged to require therapy. Approximately 20% of children changed their diagnostic category. Age and impairment severity at initial assessment were the best predictors of continuing requirement for input.

Conclusions and Implications:
Although children do make spontaneous progress post-assessment and without intervention, it is likely that the majority will continue to be assigned case status by a Speech and Language Therapist. However, when evaluating the effectiveness of interventions, clinicians need to factor in the progress that a proportion of the caseload will make spontaneously. Services should be mindful that a lengthy wait may disproportionately impact children who already face health and educational inequalities.

Citation

Hesketh, E., White, P., Simkiss, D., & Roulstone, S. (2023). Outcomes from a community speech and language therapy service treatment waiting list: The natural history of 525 children with identified speech and language needs. International Journal of Language and Communication Disorders, 58(5), 1510-1525. https://doi.org/10.1111/1460-6984.12877

• Journal Article Type: Article
• Acceptance Date: Mar 21, 2023
• Online Publication Date: May 15, 2023
• Publication Date: Oct 31, 2023
• Deposit Date: Apr 2, 2023
• Publicly Available Date: May 16, 2024
• Journal: International Journal of Language and Communication Disorders
• Print ISSN: 1368-2822
• Electronic ISSN: 1460-6984
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: 5
• Pages: 1510-1525
• DOI: https://doi.org/10.1111/1460-6984.12877
• Public URL: https://uwe-repository.worktribe.com/output/10604390
• Additional Information: Study aims and objectives were reviewed by the Research Ethics Committee Manager and the Chair of the West Midlands National Research Ethics Service (NRES) committee who concluded that the study did not require review under the NRES scheme.