ABCD: Advancing Bairns' Communication in Dundee

Poor communication and language skills remain the largest single developmental concerns for young children. When Dundee City Council became part of the Attainment Challenge, an opportunity arose to consider how best to maximise the potential of a partnership between the Council and NHS Tayside in a way that had not been possible before due to lack of funding. The resulting ABCD (Advancing Bairns' Communication in Dundee) collaborative project empowers nursery staff in Dundee to boost communication skills in nursery aged children with the aim of contributing to closing the Attainment Gap.

This exciting and innovative partnership involves speech and language therapists working alongside nursery staff in 16 local authority nurseries, targeted to areas of high deprivation. Staff from both organisations work collaboratively to share skills and knowledge. Nursery staff are trained to carry out four evidence-based programmes with all children and to model and share appropriate strategies with families to support the development of communication skills at home.

Data indicates that targeted skills in children are improving, staff confidence in delivering programmes has increased and families are more knowledgeable about how to support their child's continuing language development. The strong working relationships between nursery staff and speech and language therapists have evolved with a deeper level of trust and understanding of each other's roles.

The challenge

In Dundee, the number of people living in areas of high deprivation is double the national average, with the lowest employment rate in Scotland.

Growing evidence shows that language skills and, in particular, vocabulary, at school entry is indicative of later academic success. However, children living in areas of high deprivation have been found to have a 20 month gap in vocabulary at school entry, when compared to peers from wealthier backgrounds (Waldfogel and Washbrook, 2012). This is highly significant for families, as vocabulary at age 5 years is a predictor of later skills in literacy (Hjetland et al, 2018), skills in English and Maths (Department for Education, 2017) and earnings at age 30 years (Feinstein and Duckworth, 2007).

To tackle this inequality, the ABCD Project seeks to help staff to intervene early and appropriately by increasing their skills, knowledge and understanding of children's language development from ages 2-5.

Actions/approach taken

The evidence-based programmes selected for use in the project focus on improving children's listening skills, vocabulary awareness and narrative. Initially modelled by SLTs, nursery staff are coached to increase their knowledge and confidence in carrying out the programmes independently before embedding in every day practice. As high quality delivery of these programmes maximises the potential for improvement in communication skills in children, SLTs spend time observing nursery staff delivering sessions, offering specific feedback, co-delivering where appropriate and helping to work out solutions arising from any  challenges associated with cascading the programmes to other staff.

In the case of the youngest children, nursery staff are coached using video enhanced reflective practice to reflect on their interactions and the impact these have on the children. Nursery staff then use these skills to demonstrate and share key messages for supporting children's communication development with families, through a variety of family learning sessions.

Families are involved in many ways throughout the project, for example through the use of social media (such as Twitter or Class Dojo), `Stay and Play' sessions and nursery newsletters. Nursery staff carefully consider how best to engage with their families by being creative and flexible, listening and responding to feedback from families in attempts to meet the challenge of encouraging family participation.

Impact and results

Impact is being measured using a combination of confidence scores, reflective evaluations, formal language assessments (Renfrew Action Picture Test and British Picture Vocabulary Scale), informal programme screens and a communication environment checklist. Improvement methodology has also been used to trial adaptations within the settings as required. The learning from these is then shared with the project team and with the nurseries through the programme networks.

To date, the results of the quantitative and qualitative measures mentioned above have been largely positive. Data shows that targeted skills in children are improving e.g. Nursery Narrative Information Assessment increase of six months, Grammar Assessment increase of four months and Teaching Children to Listen Pre and post assessment difference of 1.4. Where families have been involved, some report an increased awareness of, and are tending to use, strategies to develop their child's communication more often. A parent commented: “I've noticed so much progress with S's speech since starting Chattertots. Giving choices works for him so I've been trying to do that and I'm thinking much more about the words I'm using. Maybe I could use more actions though.”

Programmes and strategies have been positively received and are being embedded in nurseries. Education Scotland inspection findings from one of the nurseries in January 2019 reported: “In communication and early language almost all children are making very good progress.... Skilled practitioners support children's communication skills and early language using a range of specific evidence-based interventions. Commendably, data gathered from these interventions shows that they are having a positive impact on children's learning and progression.”

Given the positive impact shown to date, and the enthusiasm and creativity shown by staff in the nursery settings, we are confident that on completion the project will demonstrate that:

  • the children in the project nurseries have all made additional gains in their language development, allowing more of them to begin Primary 1 with age appropriate language skills.
  • the staff in the project nurseries are knowledgeable and confident in supporting language development, delivering the programmes, using the strategies throughout the setting and cascading the programmes to colleagues (due to be formally evidenced through staff survey by September 2019).
  • the families in the project nurseries are more confident and knowledgeable in how to support their child's continuing language development.

Collaboration between two organisations accomplishes more than they are able to achieve alone.

How is the approach being sustained?

A sustainable plan has been developed to support the ongoing delivery of these programmes which the nurseries can maintain independently.

Programme-specific networks are led by SLTs for sharing new ideas/problem solving together across the nurseries in order to continue to deliver quality programmes to the children. In time the SLT will withdraw from these networks and they will be self-sustaining.

SLTs are also focusing on working with nursery staff to engage with families and using advice from external services to understand that it is essential to view parents/carers as adult learners. This ensures that the opportunities for sharing strategies with families are many, varied, appropriate and responsive to the families in each nursery.

To ensure the ongoing use of targeted strategies when children are moving on to school, an information session has been created which introduces the programmes, provides ideas for use in the classroom and offers opportunities to explore the associated resources in order to maintain the skills the children have learned in nursery.

Lessons learned

Key to the success of the initiative has been the recognition of the need to use research to think differently about service delivery to improve outcomes for children. Law et al. (2000) suggest for example, that co- location fosters understanding of each other's roles, increases trust and improves professional relationships. Equally, Bercow (2008) would argue that addressing the needs of children with speech, language and communication needs requires paying more attention to building workforce capacity. Similarly, Joyce and Showers (2002) established 0% implementation of training with demonstration alone, compared with 95% when coaching was provided.

The new model of delivery therefore prioritised co- location and focussed on coaching to build workforce capacity, support project sustainability and ensure continuation of the programmes once SLT's reduced their time in nursery.

Co-location resulted in SLTs working as part of nursery teams two days a week for 24 months in each nursery allowing staff time to establish relationships, gain a thorough understanding of each other's roles and provide high quality, in-depth training and coaching. Levels of mutual trust grew, helping to develop a confident, skilled workforce providing sustainable early intervention for language development.

Coaching resulted in increased staff confidence and increased skill in programme delivery making it easier to embed strategies throughout the daily work of the children.

Next steps

Speech and language therapists have been involved in sharing this innovative practice at a national level in a number of different ways such as attendance at the National Learning Festival and NHS Scotland learning events. For the last two years, one of the SLTs has organised an annual national Education/SLT one day conference focussing on communication skills related to attainment, at which contributors shared good practice.

Contact Information

For further information on this case study, please contact

Lesley Gibb
Education Manager (0-5)

lesley.gibb@nhs.net
01382 433950)

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