Better communication: better parenting

Kim Hartley outlines the importance of speech and language communication to good parenting and child development.

Speech, language and communication (SLC) between parent and child is fundamental to all areas of a child's development and to their life-long relationship.

Parents' own SLC competence directly affects their ability to access and benefit from parenting support and other services and is a risk factor for social and economic disadvantage (Law et al. 2007). It also affects their ability to interact positively and establish good relationships with their child and support their child's SLC development (Prior et al. 2007; Snow and Powell 2004; Hart and Risley 1995; Snowling and Stackhouse 1996).

Professor Susan Deacon, in her 2011 report, noted: Poor literacy is far more likely to be blamed on our schools than recognised as the product of a lack of communication and emotional development in the home as a baby or toddler (Deacon 2011).

A child's SLC development and eventual adult SLC competence affect their social and emotional development; physical and mental health; access to education, employment, justice, services generally; and ability to positively contribute to society, including, in turn, being good parents to the following generation.

Compelling evidence

The evidence linking SLC competence with educational, economic and social disadvantage is compelling. A Scottish Government-commissioned review (Law et al. 2007) showed that people with communication support needs (or SLC challenges often identified as literacy difficulties) are more likely than the general population to:

• Experience negative communication within education, healthcare, criminal justice system and other public services
• Be misjudged in terms of cognitive and educational level
• Be unemployed or employed at an inappropriately low level
• Be victims of crime
• Be convicted of crime
• Have difficulty accessing information required in order to utilise services
• Live in socially deprived areas

On school entry, more than 50% of children from disadvantaged backgrounds have transient speech and language difficulties (Lock, Ginsborg and Peers 2002) compared to 7.4% average of the general child population (Tomblin et al. 1997).

Over 60% of people in youth justice estate have difficulties with speech, language or communication (Bryan et al. 2007) and a SLC screening exercise at Polmont Young Offenders Institution found that 70% of young men had significant communication problems (Hamilton 1999).

In mental health services, a study found that 62% of children in psychiatric populations had speech and language impairment. 28% had previously been identified with 34% previously undetected (Cohen et al. 1993). And for economic activity, a study of young unemployed men found that over 88% were described as presenting with some degree of difficulty with language (Elliott 2009). Another study of young people not in education, employment or training (NEET) showed that 100% of those who completed the speech and language therapy assessments presented with some degree of SLC need, of which 50% had severe difficulties, that is language levels more than two years below their chronological age. Only 21% had previously been referred for speech and language therapy (Lanz 2009).

In December 2011, the EU's Employment, Social Policy, Health and Consumer Affairs Council noted that communication difficulties put children unnecessarily at risk of poor educational, social and economic progress, and that prevention, early detection, follow-up and appropriate intervention could be very effective in avoiding or minimising the consequences of such problems. It has invited member states to strengthen efforts in raising public awareness of communication disorders in young people (Council of the European Union 2011).

Taking action

Parts of the UK have taken strategic action to optimise the SLC development of children and young people, both universal to support all parents and targeted support for vulnerable parents. Most notably, John Bercow MP (2008) led an independent review of services for children and young people with SLC needs in England on behalf of the then Department for Children, Schools and Families. The 'Bercow Review' set out 40 recommendations to improve services across five themes:

• Communication is crucial - a key life skill at the heart of every social interaction and vital to children's successful development
• Early identification and intervention is essential to maximise each child's chance of overcoming their communication need and succeeding
• A continuum of services designed around the family for children with communication support needs
• Joint working is critical to deliver services that provide effective support
• The current system is characterised by high variability and a lack of equity

The review led the UK Government to invest around £55 million over three years in Better Communication: An Action Plan to Improve Services for Children and Young People with Speech, Language and Communication Needs. Jean Gross (2011), 'communications champion' for England, recently published her final report on the impact of the action plan. She reports that, in two years, there has been:

• Increased awareness of the centrality of good communication skills to children's learning, wellbeing and life chances. Activity has... provided practical support to those front-line workers and to parents
• Some measurable improvements in the percentage of five-year-olds achieving age- appropriate levels in the 'Language for Thinking' early years foundation stage profile
• A reduction from 23% to 18% of parents who were concerned about their child's speech and language development reporting that they did not receive any help
• Some helpful policy developments at government level such as the joint work of the departments of education and health to establish communication and language as a prime area of children's learning
• Increasing recognition of communication skills as a priority in local strategic planning leading several local areas to develop a community-wide strategy to promote improved communication skills for all children. For example the 'Stoke Speaks Out' early years campaign which has reduced the percentage of three to four-year-olds with language delay from 64% in 2004 to 39% in 2010

Gross attributes the success of strategies like those in Stoke on Trent to changes to parenting behaviour as a result of providing parents with information about how they can support their child's language development. She records both a high need and a high demand for such information. In 2011, a survey of 3,000 parents commissioned by Gross found that 82% believed that more information on how children develop speech, language and communication would be helpful. The survey also exposed widespread lack of knowledge about children's speech and language development. For example, only a quarter of parents knew that, on average babies, say their first words between 12 and 18 months. A similar survey by the National Literacy Trust in 2011 found a fifth of parents-to-be believe it is only beneficial to communicate with their baby from the age of three months and one in 20 believes that communicating with their baby is only necessary when they are six months or older.

Gross concludes that much remains to be done to help parents become as aware of when children should be talking as when they should be walking. She suggests several good practice success factors including:

• Approaches which build capacity in the children's workforce - sustained professional development that changes adults' interactions with children and helps them provide communication-supportive environments
• Approaches for children, young people and adults which build on their strengths rather than focusing on their weaknesses

The economic impact of investing in SLC development has been revealed by health economists in a report commissioned by the Royal College of Speech and Language Therapists (Marsh et al. 2010). It showed that every £1 invested in enhanced SLT for children with specific language impairment generates £6.40, derived from improved communication leading to improved educational achievement and, in turn, increased adult earnings. This adds up to an estimated annual net benefit of £58m in Scotland.

Unfortunately, unlike England (and Northern Ireland), Scotland does not have a SLC action plan. Children and young people's (CYP) policy, for example the Early Years Framework, makes little reference to communication skills and none to their crucial role in children's development. This and many other policies implicitly assume that all those parenting and working with CYP, with and without communication support needs, know how to encourage language learning.

There is some local good practice. For example, the SLT-led Fairer Scotland and Health Improvement-funded 'Before Words'* project in Moray, developed in response to health visitor requests for parent information. It has developed accessible, illustrated parent information with captions at a reading age of nine covering ante-natal to word-joining stages. They emphasise the relationship between attachment and developing communication in children. The illustrations depict a range of family situations and focus on everyday tasks as opportunities to communicate. The project has two strands - universal distribution throughout Moray and targeted intervention with more vulnerable families. Experience shows that parents like the resources; identify with the illustrations; use them to reassure and inform; and work with the advice. Professionals find them easy to access and use; use the resources as a talking point or programme structure; and appreciate them as part of information in training.

However, although effective, such examples are isolated, short-term and unsustainable within current service budgets.

A few vulnerable parents will benefit from the Family Nurse Partnership which is founded on good person-centred communication between nurse and mother. However, getting communication right between service providers and parents more universally (and with a skilled, targeted approach for disadvantaged parents) could achieve at least some of the benefits of the Family Nurse Partnership with a much wider population of parents and children, at a fraction of the cost.

Given the evidence and experience in other parts of the UK, the Royal College of Speech and Language Therapists believes that Scotland needs a strategic approach to children and young people's speech, language and communication.

The national parenting strategy can be a foundation for a better Scotland by enabling parents, both with and without SLC needs, to receive parenting support and other services so that, in turn, they can optimise their children's SLC development.

*For more information contact Gretel McEwen - gretel.mcewen@nhs.net