Speech & Language Therapy

Summary

The requester asked for policies, equality impact assessments, and staffing details regarding Speech and Language Therapy for mainstream and SPC-educated children. Manx Care responded by providing care pathway documents for various conditions and confirmed the release of all requested information.

Key Facts

• Care pathways for mainstream children cover dysfluency, dysphagia, language difficulties, and social communication.
• Children in Specialist Provision Centres (SPC) follow a specific pathway where language difficulties are supported by the SPC rather than direct 1:1 therapy.
• The Dysphagia pathway distinguishes between urgent referrals (within 10 working days) and non-urgent ones (within 28 working days).
• The Learning Disabilities care pathway for SPC children is currently under review.
• The authority confirmed that all information requested was sent.

Data Disclosed

• 2024-11-26
• 2024-12-05
• June 2020
• January 2021
• January 2023
• 10 working days
• 28 working days
• 6 months
• 4-6 sessions
• 6 x sessions
• 10 pages
• 7 documents

Original Request

Dear Sirs Please provide the following information. Any policy, or staff directive in relation to the delivery of speech and language therapy. A) to mainstream educated children B) to children educated in an SPC Please provide any equality impact assessment that has been undertaken for the service and clarity on why such services differ. Please provide the current numbers of speech and language therapists employed by the department Please provide details of their FTE status and caseload Best wishes

Data Tables (1)

Data Tables (reformatted)

Full Response Text

Speech and Language\Paediatrics\Service Planning\Care pathways\CURRENT care pathways 2020\Dysfluency school age 2020.pub Isle of Man Paediatric Speech and Language Therapy

Created June 2020—Review June 2021 Dysfluency Referral received Soon Full assessment 1 or 2 clinic appointments in Stammering Clinic * (SLT discretion on number) Provide advice/ACI strategies to trial at home. With permission speak with school Routine No further assessment Standard dysfluency discharge letter with recommendations to parents and school Option for re-referral Screen assess by using Michael Palin Centre (MPC) screen. Take developmental case history Block of therapy 4-6 sessions Family communication skills/group/ direct strategies/speech/language. With permission discuss with school.
May refer to MPC for second opinion

Routine Assessment 1 clinic appointment in
Stammering Clinic * Triage referral (as ‘soon’) Risk factors = + 6 months of dysfluency and 1 or more
from risk factor list Risk factors = - 6 months of dysfluency and no others
from risk factor list Risk factors = - 6 months of dysfluency and 1 or more from risk factor list Write in-depth re- port and
provide advice to parents Discharge Review 4 or 6 months at SLT’s discretion
Discharge Discharge * It is vitally important that both parents or care-givers attend these initial clinic appointments, ideally in person or via MS Teams if this is not possible.

Speech and Language\Paediatrics\Service Planning\Care pathways\CURRENT care pathways 2020\Dysphagia 2021.pub Isle of Man Paediatric Speech and Language Therapy

Created January 2021—Review January 2023 Dysphagia Referral received1 Referral triaged Referral accepted3 Referral not accepted2 Assessment4 Urgent—within 10 working days Non-urgent—within 28 working days

Serious risk of aspiration Immediate referral to
Children’s Ward Onward referral to Specialist SLT at tertiary hospital5 Management by local SLT4 Discharge6 No further action required by SLT Review7 Follow procedure form
‘Assessment’ Management plan given by SLT at tertiary hospital 1-7 Paediatric Dysphagia Care Pathway Procedure to accompany this flow chart.

Isle of Man Children’s Speech and Language Therapy care pathway
Children attending a Specialist Provision Centre (SPC)- communication (Previously school aged Learning Disability caseload)
Referral accepted Urgency decided at triage (urgent/soon/ routine), waiting time for assessment adjusted accordingly. Assessment SLT assesses child over 1 or multiple sessions (up to 4). Includes phone call to family to gather case history. Report and recommendations written.
Direct intervention required?
For example: Speech sound work where child has sufficiently developed atten- tion, listening and learning skills YES Child placed on waiting list for therapy
Therapy given (in school or clinic as per thera- pist’s availability) 6 x sessions** Therapist demonstrates therapy activi- ties/strategies to school staff (1 visit). Therapist signposts parents/ profession- als to further training e.g. Signalong, Elklan.

NO Recommended review within 3 months?
Child placed on waiting list for SLT to review
Go back to assessment box YES NO Discharge Child discharged from SLT. Parents and school advised they can be re-referred in future if needs change.
Language difficulties need to be supported by SPC rather than di- rect 1:1 input **This needs to be looked at to find an evidence based solution that also offers an equitable ser- Further therapy required?
Yes NO

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4279773 3 December 2024

Dear

We write further to your request, received 26 November 2024, which states:

"Dear Sirs

Please provide the following information.

Any policy, or staff directive in relation to the delivery of speech and language therapy.

A) To mainstream educated children

B) To children educated in an SPC

Please provide any equality impact assessment that has been undertaken for the service and clarity on why such services differ.

Please provide the current numbers of speech and language therapists employed by the department

Please provide details of their FTE status and caseload.

Best wishes"

Our response to your request is as follows: I have enclosed copies of the information that is being released to you.

A) To mainstream educated children

The following documents are attached as reference and form part of the wider service descriptor: a. Language Pathway – School aged b. Speech Difficulty c. Dysphagia d. Dysfluency e. Social Communication f. Selective Mutism g. Voice

B) To children educated in an SPC

The following documents are attached as reference: a. Learning Disabilities existing care pathway, currently being reviewed.

1. Please provide any equality impact assessment that has been undertaken for the service and clarity on why such services differ.

There has been no equality impact assessment undertaken of the Speech and language Service within Children’s Therapy because we have not changed the service specification. Speech and Language Therapy (SLT) provision for children in Mainstream and those in a Specialist Provision Centre differs based on several factors. Firstly these are two distinct service areas, so although the overarching aim will be to support the speech language and communication needs of the child, how this is delivered will be different in these separate settings.

Across both of these services SLT provision is guided by clinical standards and best practice outlined by the Royal College of Speech and Language Therapists. These guidelines are based on research to ensure that therapy is evidence–based and effective. The level and focus of SLT intervention is shaped by the nature and severity of the child’s needs. This is considered alongside their educational environment and the resources available.

A SPC offers an inclusive learning environment, with higher ratio of staff who have additional specialist skills. Provision within the SPC therefore focus on supporting knowledge and skills of staff to support a child’s speech, language and communication needs.

The child’s SLT assessment will support to inform if SLT provision is targeted or specialist.

Specialist Level – Individualised intervention or equipment to support, enable or maintain skills. These children are likely to require multiple episodes of care.

Targeted Level – Children with an identified concern requiring specific advice, programme, equipment or access to training to support their skills and development. Care provided on an episodic basis.

Universal Level – This is a preventative approach which is beneficial for all children supporting skill acquisition and developing a nurturing environment.

To ensure that there is equality of provision across the SLTs in the service, a clinical reasoning tool is completed known as an Intervention Priority Point System (IPPS), example included as reference. Across both services SLT provision is provided on an episode of care basis.

1. Please provide the current numbers of speech and language therapists employed by the department

There are 9 qualified SLTs of varying grades and 1 assistant, currently funded substantive posts within SLT service in Children’s Therapy. However not all these posts are full time as shown below in the FTE status.

1. Please provide details of their FTE status and caseload

SLTs within Children’s Therapy: 2.6 WTE SLT working within Mainstream with an average caseload of 53. 0.5 WTE SLT working within SPC, with an open cases of 110. Some of these children are receiving targeted or specialist provision and others will be on a review system. Please note the numbers of therapists we have given are specific to the relevant questions of the areas of the SLT service; other FTE SLT time is dedicated to Early Years’, dysphagia and other areas.
This does not account for additional or bank hours that funded to support these services. A business case was submitted, with an emphasis to improve the SLT provision for children presenting with Augmentative and Alternative Communication concerns which would have increased the provision for SPC. This included request for SLT staffing, but this was not financed in budget of 2023/24. This business case will be re-submitted for consideration for funding in 2025.

Please quote the reference number 4279773 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision.

More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im. Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

Isle of Man Paediatric Speech and Language Therapy

Care Pathway – Selective Mutism early years and school-aged Referral received Triaged (soon) Referral accepted Clinic appointment for parents alone
Report plus information pack for parents and school School/Nursery visit for observation Consider onward referral
If after 3 months (or 6 months in the case of an EAL child) the child is still not confidently speaking, a referral to SLT can be processed CAMHS NDD clinic If suspected or
diagnosed ADHD, ASD or tics, with symptoms having a significant and impairing impact ECP team If the child’s difficulty is impacting significantly at school and affecting several areas (e.g. learning, emotional wellbeing, attendance, school placement at risk) Early Help & Support If parenting or family sup- port is needed, or it would be beneficial to explore access to additional- services

Other SLT pathway CAMHS GENERIC If there is a
significant mental health difficulty or trauma that is
impacting on all areas of their life – home and school (e.g. very unhappy, anxious, avoiding)
If due in school or already at school, an action plan must be formulated by school in conjunction with SLT (Action plan and targets are owned by school). This will require a visit to school.
If transitioning from EY team, the treating SLT and the school SLT will review within 2 months of entering school. 3– 6 month review in school with mainstream therapist- to review
progress. Manx Care offers up to 2 reviews in school to provide advice and support before discharge. If a request for advice is referred and there is a significant mental health difficulty or trauma that is impacting on all areas of their life – both home and school (e.g. very unhappy, anxious, avoiding) immediate onward referral to CAMHS & Educational Psychology should be made.

Isle of Man Paediatric Speech and Language Therapy Referral received Referral triaged routine Referral not accepted Referral accepted Assessment

Up to 3 sessions: which may include 1. Child seen in clinic or school 2. Parents seen in clinic or home 3. Education staff at school/observation

Created June 2020—Review June 2021 Routine Social Communication descriptor level 1-2 Offer one meeting with Education staff and/parents: Cover: Advice/modelling/classroom strategies E.g. Comic strip conversations Social Stories Visual strategies—timetables, mind maps Social skills group—Talkabout resource Target Ladders Collate information and write report with recommendations for school and home Collate information and write report with recommendations for school and home Discharge Routine Social Communication descriptor level 3-4 Care Pathway—Social Communication—School-age Child in 1st term of school with current PSAC recommenda- tions in place. One 3-6 month review at SLT discretion Offer one meeting with ,Education staff
(and EP if involved) and/parents:
Cover: Advice/modelling/classroom strategies E.g. Comic strip conversations Social Stories Visual strategies—timetables, mind maps Social skills group—Talkabout resource Target Ladders.

Redirect to alternative pathway if indicated

\reiltys\iomgroot\DeptShare_DHSS_Nobles\Rehabilitation\Childrens Therapy\Childrens Therapy Information\Care Pathways\ 2. School Aged\SLT\April 2024 Mainstream Care Pathways Isle of Man Paediatric Speech and Language Therapy Speech difficulty: School age Referral received Triaged (routine) Referral not accepted. *We don’t accept interdental lisps Referral accepted Assessment in clinic
Complete IPPS

Speech Age appropriate Speech Sound Disorder Discharge Letter to referrer/parent with reason for decline and
enclose appropriate info SEVERE IPPS 7

Routine Deliver 3-5 sessions of therapy in clinic.
Up to 2 blocks for lateral /s/ unstimulable sounds and up to 3 blocks if there are 2+nasal fricatives. Consider age and level of
concern (6/7 years of age) clinical dis- cretion/ readiness MILD IPPS 3 OR LESS

Homework
Programme

Clinician to use discretion to decide on
possible 6 month review (to be exception rather than rule) SEVERE IPPS 7

Routine Deliver block of up to 8 sessions per
academic year

Provide school therapy only when an allocated ESO and/or parent is available and child’s attention and listeni

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