1 of 90

Early Language Identification Measure and Intervention Training��

2 of 90

Housekeeping

Early Language Identification Measure and Intervention Training

2

1. Session Rules

2. Break

3. Let us not talk over each other

3 of 90

Welcome to the ELIM & Intervention Training Session

This is an opportunity to:

Discuss the ELIM and Intervention – its use, and benefits
Collaborate with local partners

Early Language Identification Measure and Intervention Training

3

4 of 90

Session Content

Early Language Identification Measure and Intervention Training

4

No.	Topic
1	Background and Context SLC Programme Overview Development of ELIM & Intervention
2	How to use the ELIM & Intervention – Assessment
3	How to use the ELIM & Intervention – Conversation
4	Break
5	How to use the ELIM & Intervention – Intervention (Behaviour change model & collaborative working)
6	Further Information, local needs and resources

5 of 90

Context

The Early Language Identification Measure (ELIM) and Intervention is a universal offer for use with all children attending their 2-2 ½ Year Review

The ELIM and Intervention can be used alongside the ASQ-3

Designed for use with existing speech, language and communication local resources and pathways

Early Language Identification Measure and Intervention Training

5

6 of 90

Public Health England and the Department for Education’s Best Start in Speech, Language and Communication Programme aims:

To improve the rate of early identification of need in the early years; and increase the number of children who are ready for school by the age of 5.
To equip health visitors/ nursery nurses with additional skills and knowledge to support families in promoting early language acquisition in the home learning environment.
Identify risk factors for speech, language and communication needs (SLCN) through assessment.
To support improved health and wellbeing outcomes including school readiness.
Making timely and appropriate referrals and pathways for children when speech, language and communication needs are identified.

Early Language Identification Measure and Intervention Training

6

7 of 90

The ability to communicate is a fundamental human right

8 of 90

Communication skills are a foundation for

FRIENDSHIPS

LEARNING

EMOTIONAL WELLBEING

BEING PART OF A COMMUNITY

9 of 90

How many children have SLCN?

10 of 90

Impact of poor communication skills

Behaviour

2/3 of 7-14 year olds with serious behaviour problems have language impairment

Criminality

65% of young people in young offender institutions have communication difficulties

Mental health

40% of 7 to 14 year olds referred to child psychiatric services had a language impairment that had never been suspected

11 of 90

How does Hackney compare with the national picture?

Taken from ‘Local Authority Interactive Tool’ (LAIT)

Latest data available is pre-COVID, we know that COVID has had a huge impact on the communication skills of many children under 5 and that a greater proportion are ‘not ready for school’ when starting Reception (Kindred²)

12 of 90

Campaigns and Government Initiatives�

Early Language Identification Measure and Intervention Training

12

13 of 90

Who influences or plays an important part in the SLC development of a child in your local area?

Early Language Identification Measure and Intervention Training

13

Q

14 of 90

Early Language Identification Measure and Intervention Training

14

Child

Parent/ Carer

HV

EYP

VCS

SLT

15 of 90

A place-based approach to speech, language and communication

Early Language Identification Measure and Intervention Training

15

This place-based approach to speech, language and communication can be found in the Best Start in Speech, language and Communication Guidance document on gov.uk.

The diagram describes a place-based approach where local services work together to improve children’s outcomes and reduce inequalities. It depicts the idea of a “town” where those in nurseries, schools, libraries, community clinics, hospitals and GP surgeries all have a role to play in promoting speech, language and communication.

The arrows show where the ELIM and Intervention work fits into the approach.

Whilst the initial steps of the ELIM and Intervention will be carried out by the health visiting skill mix team, the outcomes and intervention involve the whole community – including those in early years settings and speech & language therapists who have an important role to play in child speech, language and communication development.

16 of 90

Best Start in Speech, Language and Communication Programme Aims

The provision of enhanced training for health visitors to identify Speech, Language and Communication needs (SLCN) and to support more appropriate / rapid referral

The development of guidance to support local areas to develop evidence-based Speech, Language and Communication Needs (SLCN) pathways

The development of a new early language identification measure (ELIM) and intervention

Early Language Identification Measure and Intervention Training

16

Public Health England and the Department for Education’s Best Start in Speech, Language and Communication Programme aims to improve the rate of early identification of need in the early years; and increase the number of children who are ready for school by the age of 5.

The programme started with the development of a speech, language and communication pathway for England, which local areas can use to update existing SLC pathways or create new ones.

The next step was to help refresh practitioner knowledge of speech, language and communication development in the early years with a ’train the trainer’ cascade model, and over 3000 health visiting and community staff were trained.

The final step was to create a method of identifying those children most at risk of having communication difficulties later in life, including parents in the conversation.

More Information if asked:

Q. Why were health visitors trained in the SLC cascade?

For their CPD – to equip health visitors and their teams with additional skills and support them to understand/refresh their knowledge about the development of SLC in young children (including the home-learning environment), and aid appropriate timely and appropriate referrals when SLCN is identified.

17 of 90

ELIM & Intervention Development

Focused on health visitors and their skill mix teams who have responsibility for the 2-2½ year review

Research version of the ELIM included:
Communication milestones
Words that the child says (parental report)
The family
Practitioner observation of the child
Parental concern

The best predictor of the child’s performance on the gold standard measure was the combination of the word list and practitioner observation

Early Language Identification Measure and Intervention Training

17

18 of 90

Early Language Identification Measure and Intervention Training

18

Three steps…

The Early Language Identification Measure and Intervention is a three step process which consists of:

Step 1:

50-word vocabulary list
Practitioner observation

Step 2:

Practitioner & parent/carer conversation

Step 3:

Intervention (Targeted or referral)

* Steps 2 and 3 must be underpinned by review of progress

** Note that not all children will need to move onto step 3

It is anticipated that steps 1 and 2 (word list, observation and conversation) of the ELIM measure are carried out primarily by the health visitor alongside the 2-2 ½ year review as part of the Healthy Child Programme.

Step 3 (Offering tailored support) could be offered by those working most closely with the child and their parent/carer (health visitor, member of health visiting team, speech and language therapist, early years practitioner) individually or in combination

19 of 90

What is special about this combination?

The sensitivity of this combination was high – identifying 94% of children with potential difficulties (see summary report/ full report)

The specificity was lower, demonstrating the integral role to be played by the conversation in helping identify the best way of addressing the child’s needs

Children with scores of 17 or below on the word list or any concerns with the observations warrant further investigation

Early Language Identification Measure and Intervention Training

19

20 of 90

The ELIM and Intervention at the �2 – 2 ½ Year Review ��

Early Language Identification Measure and Intervention Training

20

21 of 90

Preparing Parents for the ELIM & Intervention

Let parents know what is going to happen prior to the review

- create a standard guidance letter/text that goes to all parents

Give parents guidance which prompts them to think about their child’s speech and language

Early Language Identification Measure and Intervention Training

21

22 of 90

Early Language Identification Measure and Intervention Training

22

23 of 90

STEP 1: ASSESSMENT� �Identifying Need��( and observation)��

Early Language Identification Measure and Intervention Training

23

WORD LIST

24 of 90

Exploring the parent/carer perspective �

It is important that the parent/carer feels listened to and validated and that the practitioner gains initial insight into their perspective

Acknowledge that the parent/carer may have been sent the ASQ-3 and ask if they have completed this. If so, use the feedback they give you within the questions you ask

You may then want to use an opening questions such as:
Q. Can you tell me how you feel your child is getting on with their speech and

language development?

Q. Can you tell me about the languages that your child hears and uses?

Early Language Identification Measure and Intervention Training

24

25 of 90

Word List Guidance

Fill in the word list with the parent to:

Ensure that the word list result is accurate

Support parents whose literacy level is low

Support parents who speak English as an additional language or have a low level of English

Early Language Identification Measure and Intervention Training

25

26 of 90

Using the Word List��

Start by asking the parent/carer which words they have heard their child using and check off any that are on the list*

Review the list with the parent. Show/ read out the unticked words and ask – what about these? Have you heard your child say any of these?

*Note: It is important that these are not words that the child simply copies

Early Language Identification Measure and Intervention Training

26

27 of 90

Additional Word List Guidance

If a child says a word differently (for example, they say ‘tar’ instead of ‘car’) but the parent/carer is clear that this is the word intended, the word should still be ticked

If a child speaks more than 1 language at home, they are to tick the word if they say it in either of their languages.

If the child says a completely different word for the same item (that is, ‘cup’ for ‘juice’, ‘motor’ or ‘brum’ for ‘car’, ‘dog’ for ‘cat’) do not tick it as correct.

If you know that the word used is local dialect, please tick it

Early Language Identification Measure and Intervention Training

27

28 of 90

Additional Word List Guidance

Early Language Identification Measure and Intervention Training

28

This is the final version of the ELIM Assessment, featuring a Word List and practitioner observation.

More information:

The word list has been adapted from the 50-word list in the Sure Start Language Measure (SSLM)

The ELIM Word List contains 50 words which were selected from evidence-based research (see full report for more information).

It is designed to capture the range of words children might use at this age

The list of 50 words includes:

some which you would expect almost all children at this age to say (for example, mum/mummy

some which only very few children will say (for example, gentle).

* Reassure the parent/carer of this as they may worry or be concerned if they think their child should be saying all

the words.

If the question is asked:

Using the word list in another language

– if translated, the words should not be changed:

e.g. - mummy/mum should be the same word in the other language: mum = ‘mère’ (French) or ‘mamá’ Spanish;

- bed = ‘lit’ (French) or ‘cama’ (Spanish)

29 of 90

Early Language Identification Measure and Intervention Training

29

✓

20

Scoring the ELIM Word List

Q

✓

30 of 90

Bilingualism / Multilingualism Guidance

Early Language Identification Measure and Intervention Training

30

Multilingual

Bilingual

31 of 90

Languages that the child is exposed to

Bilingualism or multilingualism can be of benefit to children later in life
Parents should use the language that they are most comfortable with, and should not be guided to speak to their child in English (especially if they lack confidence in their own use of the language)
It is important that parents/carers foster interaction with their child, e.g. through songs/nursery rhymes, in the language in which they feel most comfortable which is most immediately important to the child (used by other family members).

Early Language Identification Measure and Intervention Training

31

Bilingualism or multilingualism is the norm in most parts of the world and is very common in many areas in the UK.

There is no inherent reason why bilingualism should be a problem for the child – in fact, further on in the child’s development it may be an advantage.

Historically parents/carers were sometimes told to speak English to their child so that their English improves but this sort of guidance should not be given nowadays with younger children – especially if the parent/carer does not feel very confident with their own use of English.

Bilingualism or multilingualism can be of benefit to children later in life

Parents should use the language that they are most comfortable with, and should not be guided to speak their child in English (especially if they lack confidence in their own use of the language)

It is important that parents/carers foster interaction with their child, e.g. though songs/nursery rhymes, in the language in which they feel most comfortable which is most immediately important to the child (used by other family members).

32 of 90

Languages that the child is exposed to (contd.)

During the Step 1 ELIM and Intervention Assessment:

it is important to note which language(s) the child speaks at home
when conducting the word list, parents/carers can tick whether their child uses the words in either language
it does not matter which language the child uses for the different words, rather that he or she uses a range of different words
if the child is putting words together it does not matter which languages they use. It is the language development that we are interested in.

Early Language Identification Measure and Intervention Training

32

During the Step 1 ELIM and Intervention Assessment:

The practitioner should show interest in the specific language that the child uses.

Language use varies from family to family depending on: whether parents/carers speak the same language; whether there are others in the household who speak other languages; the attitude and the importance attached to a given language in the home.

It is important to note which languages the child speaks at home (this can be recorded on the practitioner template)

Young children commonly switch between languages according to how they experience the word: e.g. first language for “mum” but use the English word “ball” as it is used by their siblings who attend school.

When conducting the word list, parents/carers can tick whether their child uses the words in either language

it does not matter which language the child uses for the different words, rather that he or she uses a range of different words

Ii the child is putting words together it does not matter which languages they use It is the language development that we are interested in at this stage.

33 of 90

Watch this Example of Bilingualism

Early Language Identification Measure and Intervention Training

33

Q

34 of 90

STEP 1: ASSESSMENT ��Identifying Need��(word list and )��

Early Language Identification Measure and Intervention Training

34

OBSERVATION

35 of 90

Guidance for the observations

ELIM observation guidance notes for each behaviour

Communicative intent: What you are looking for here is evidence that the child is relating to the parent/carer e.g. showing them a toy of interest, perhaps pointing to something familiar in the room.

Intelligibility: This refers to the child’s ability to convey meaning verbally to the parent/carer.

You want to detect any situation in which the child’s speech is very difficult

to understand – even for the parent/carer

Early Language Identification Measure and Intervention Training

35

36 of 90

Guidance for the observations (contd.)

Combining words: Have you seen and heard the child putting 2 words together. These are not full sentences often just 2 ideas put together – for example, ‘mum dinner’, ‘dad go’, ‘blue fish’, ‘dog bark’.

Turn-taking: This question refers to the child’s reciprocal turn taking with the parent/carer, whether verbally or non-verbally. Do they have more than 1 “exchange” – can they keep a turn going?

Early Language Identification Measure and Intervention Training

36

Combining words: Have you seen and heard the child putting 2 words together. These are not full sentences often just 2 ideas put together – for example, ‘mum dinner’, ‘dad go’, ‘blue fish’, ‘dog bark’. It is also interesting to note if the parent/carer joins in perhaps by extending what the child has said

Turn-taking: This question refers to the child’s reciprocal turn taking with the parent/carer, whether verbally or non-verbally. Do they have more than 1 “exchange” – can they keep a turn going?

- If this does not happen naturally you might give the child a toy and ask them to give it to their parent/carer and ask them to

respond. It is important to note here that this is really about observation rather than “testing” the child’s performance, but this

type of activity can elicit turns

37 of 90

Guidance for the observations (contd.)

5. Understanding: You are looking for an indication that the child is able to understand what an adult says to them.

It is important that you observe rather than relying solely on what the parent/carer says they understand.

6. Attention: The final observation focuses on the child’s attention.

Do they just buzz around the room (fleeting) or do they focus on one thing/toy for a period of time (single channelled)?

Early Language Identification Measure and Intervention Training

37

5. Understanding: You are looking for an indication that the child is able to understand what an adult says to them.

It is important that you observe this rather than relying solely on what the parent/carer says they understand because children often learn to understand routines and are not necessarily understanding the words that their parent is using.

6. Attention: The final observation focuses on the child’s attention.

Do they just buzz around the room (fleeting) or do they focus on one thing/toy for a period of time (single channelled)? At this age many children continue focusing on something even when the parent/carer is talking about something else, but some children are able to switch their attention between the toy that they are enjoying playing with and what someone else is saying and then switch back again once they have responded (accepts direction).

38 of 90

Early Language Identification Measure and Intervention Training

38

✓

On the ELIM and Intervention template there is a table of observable behaviours for the practitioner to complete.

Complete the first five questions by ticking ‘yes’ if you are able to observe the behaviour in the child and ‘no’ if you are not able to observe the behaviour.

Circle the relevant option for ‘Attention’ (question 6).

Create an ELIM observation score by adding up all the ‘yes’ ticks for behaviours 1 to 5, and an additional point if either ‘Single channelled’ or ‘Accepts adult direction when playing’ has been circled for question 6.

If the child’s attention is ‘fleeting’, the score for that observation is ‘0’.

You should arrive at a score which is a whole number between zero and six. Please record this score in your local system.

39 of 90

Early Language Identification Measure and Intervention Training

39

If you have observed all the behaviours indicated tick “no concern”

If you have not observed all the behaviours indicated tick “concern”

ELIM Observation	Please tick
	Concern	No concern

Scoring the ELIM observation

For questions 1-5 place a tick next to each observation to indicate whether you have or have not observed that behaviour.

For question 6 please circle one of the three types of attention. If you circle ‘Fleeting’ you should explore this further in the

Step 2 conversation.

40 of 90

Early Language Identification Measure and Intervention Training

40

41 of 90

STEP 2: THE CONVERSATION

Early Language Identification Measure and Intervention Training

41

42 of 90

The Conversation

Engage parents/carers and give them a sense of ownership and involvement in their child’s development
Address parent/carer concerns
Explain the assessment outcome and whether there is any need for intervention
Signpost all parents/carers to resources to help them support their child’s speech, language and communication development

* This step is followed by the Step 3 Intervention, Offering Tailored Support for some children

Early Language Identification Measure and Intervention Training

42

43 of 90

Concerns about Behaviour

Ensure that parents/carers have the opportunity to discuss any additional concerns about their child’s behaviour and development.

Acknowledge concerns such as:

Sleeping
Toileting
Being difficult to manage

The practitioner’s role is to:

Support parents/carers with guidance, and signpost to local/national resources
Help parents/carers to understand their child’s behaviour

Early Language Identification Measure and Intervention Training

43

During the review, ensure that the parents/carers have the opportunity to discuss any additional concerns about their child’s behaviour and development.

Acknowledge concerns about behaviour:

Parents/carers often share concerns about a child’s behaviour at the 2 to 2½ year review, for example sleeping, toileting or generally being difficult to manage.

Parents/carers need support with this in the form of guidance and signposting to local or national support as necessary, but most of all they need your support to understand their child’s behaviour.

Behaviour and language development are commonly linked

Children who are very active and distractible commonly have limited language skills

Language development may be an indicator of difficulties in other areas or indeed the other way around

44 of 90

Scoring the ELIM Observation - Data

Early Language Identification Measure and Intervention Training

44

45 of 90

Scoring the ELIM Observation - Data

Early Language Identification Measure and Intervention Training

45

46 of 90

Actions Post Assessment Step 1

Early Language Identification Measure and Intervention Training

46

47 of 90

Parent / Carer Concerns

Always ask about parent/carer concerns and include this in your decision about whether additional support is required

If parents/carers express concern about their child’s speech, language and communication despite the assessment indicating that the child has no identified speech and language needs – listen to the concerns and signpost to local resources and relevant online materials (Tiny Happy People etc).

If parents do not express concerns but the word list and your observations suggest there may be a need, this should be discussed with the parent in the conversation and actions agreed with them.

Early Language Identification Measure and Intervention Training

47

48 of 90

Signposting

Direct all parents to:

Local facilities to encourage ongoing language development
Online materials and resources

Q. Can you think of other sources of information for parents:

- Where could you signpost parents to nationally, and in your local areas?

Early Language Identification Measure and Intervention Training

48

Q

49 of 90

Signposting Resources

Tiny Happy People

Hungry Little Minds

I CAN

Communication Trust

Early Language Identification Measure and Intervention Training

49

50 of 90

Parent Pathway (pdf)

Early Language Identification Measure and Intervention Training

50

51 of 90

The Parent Pathway

Early Language Identification Measure and Intervention Training

51

52 of 90

10 minutes

Early Language Identification Measure and Intervention Training

52

53 of 90

Early Language Identification Measure and Intervention Training

53

54 of 90

STEP 3: INTERVENTION�-�Offering Tailored Support

Early Language Identification Measure and Intervention Training

54

55 of 90

Aim of the intervention

An approach to SLC development support that is:

equitable
consistent
Feasible

And draws on theories of:

Shared decision-making
Engagement & partnership
Strengths-based approaches

Early Language Identification Measure and Intervention Training

55

56 of 90

Successful Support: Parent/Carer Views

Key Characteristics:

It’s not (just) what you do…..it’s the way that you do it……

Ensuring families do not feel blamed for their child’s difficulties
Practitioners’ language and communication
Shared decision-making
Tailoring
Trust and partnership between parent/carer and practitioner

Early Language Identification Measure and Intervention Training

56

The co-design work with parents/carers and practitioners identified a number of characteristics of successful tailored support:

The importance of ensuring families do not feel blamed for the child’s difficulties

Care must be taken that discussions with parents/carers do not imply that their interaction style or the time they spend interacting with their child has caused the language difficulties they are experiencing.

Explain to parent/carers that changing their interaction style can improve their child’s language development; also that their interaction style has not caused their language difficulties (this can sometimes be difficult for parent/carers to understand).

Talk about the fact that children differ in how easily they can learn language in the same way some children may be more physically coordinated than others. For children who find it more difficult we have to model language use and behaviour for them - responsive interaction or responsive communication.

The more they can integrate these behaviours into their daily routines the easier their child will find it to learn

language.

The importance of practitioners’ language and communication

The language used by practitioners to talk about children’s difficulties, and what parents/carers could do to help support their child is important. The language used should avoid implications of blame and judgement, and invite the parents/carers in as an equal in a process of shared decision-making and goal setting.

In this way the appropriate target behaviour and context for the specific family can be agreed. Inviting parent/carer’s opinions; acknowledging what they are already doing to help their child; and negotiating what works best for them are important ways to encourage a sense of partnership and respect.

The importance of shared decision making

A shared decision-making approach is vital to successful support. This will ensure the goals chosen are manageable for parent/carer; and also takes into account and values what the parents/carers are already doing to support their child’s language development and accommodate the child and family’s preferences.

The importance of tailoring

As you will see there are a number of ways we suggest tailoring. Our work with parents/carers showed us that both the targeted behaviour and the context within which the family will choose to practice it need to be tailored to the individual family’s context and preferences for them to engage.

Without this tailoring there is a risk of the intervention not being manageable for the family and also of making them feel judged, patronised and/or set up to fail. Furthermore, the level of support different families would need in order to change the chosen behaviour varies depending upon the unique barriers and enablers present for that family.

The importance of trust and equal partnership between parent/carer and practitioner

Relationships of trust between practitioners and parents/carers are vital. Clearly all the points above are important for developing trust. In addition the co-design work with parents/carers showed that demonstrating interest, engagement, and expertise in interaction with the child at the review, facilitates trust in the practitioner.

One very practical and powerful way to do this is for the practitioner to play with the child themselves and, without drawing attention to it, to model responsive interaction with the child. It is also essential for the practitioner to use a communication style which invites partnership, dialogue, and shared decision-making. For example, asking for parent/carer opinions, acknowledging and valuing what the parent/carer is already doing to support their child and making a range of possible suggestions which they can choose from rather than being overly prescriptive.

57 of 90

Practitioner Need

Early Language Identification Measure and Intervention Training

57

Practitioner Questions

How can I support a family?

Which resources should I use? There are so many!

What should I choose for which families?

What can I do with the families who cannot engage with advice and support?

What can we do about variability between practitioners?

58 of 90

How to use the Intervention

The practitioner offers the family support which is tailored to their specific context
The nature of this support is informed by the answers to the questions in the step 2 conversation
The goal is to increase parents/carers’ use of specific ‘responsive interaction’ behaviours for 10 to 15 minutes per day as part of their daily routine

This does not replace onward referral if the child meets criteria for speech and language therapy/other referral in local pathways

Early Language Identification Measure and Intervention Training

58

59 of 90

Tailored Support

Universal signposting to information, services and support
Level of support needed is based on practitioner judgement
Planned with the parent/carer
Looks at the barriers and enablers of a family
Self-directed or coaching approach

Early Language Identification Measure and Intervention Training

59

60 of 90

Responsive Interaction

What do we mean by responsive interaction?

Watch the video of Dr Michelle Peters working with parents and their children.

Early Language Identification Measure and Intervention Training

60

Q

Q. What are the adults doing that might support speech, language and communication development?

61 of 90

Responsive Behaviours for Parents:

get down to your child’s level
follow your child’s lead and interests
pause and wait for your child to show you what they are interested in
listen, watch and respond to their communication – this can be words, points, sounds or movements
describe what your child is doing or looking at – imagine what they are thinking and feeling and say that
show them you are having fun and use an interesting voice
if they do communicate, copy what they say or mean to say and add a word
try to use fewer questions and instead describe what is happening.
when you do ask questions try to keep them open – where, who, when and why rather than Yes/No questions

Early Language Identification Measure and Intervention Training

61

62 of 90

The COM-B Model

The intervention design applies the COM-B model

Early Language Identification Measure and Intervention Training

62

To increase the frequency and consistency of parent/carer’s use of ‘responsive interaction’ as part of their everyday routines.

Michie, S., L. Atkins, and R. West, The behaviour change wheel: a guide to designing interventions. 2014 Silverback Publishing.

With a target behaviour of intervention, certain conditions are necessary for that behaviour to occur. These conditions can be grouped into the categories of Capability – Motivation and Opportunity.

In this ‘behaviour system,’ capability, opportunity, and motivation interact to generate behaviour that in turn influences these components .

Capability is defined as the individual’s psychological and physical capacity to engage in the activity concerned. It includes having the necessary knowledge and skills.

Motivation is defined as all those brain processes that energize and direct behaviour, not just goals and conscious decision-making. It includes habitual processes, emotional responding, as well as analytical decision-making.

Opportunity is defined as all the factors that lie outside the individual that make the behaviour possible or prompt it.

The single-headed and double-headed arrows in the diagram represent potential influence between components in the system. For example, opportunity can influence motivation as can capability; enacting a behaviour can alter capability, motivation, and opportunity.

63 of 90

The COM-B Model (contd.)

Early Language Identification Measure and Intervention Training

63

COM-B	Theoretical Domains Framework Domain and description of enablers
Capability	Physical skills: Have skills to follow a child’s lead in play or share a book Have literacy skills to share a book
	Knowledge: Able to choose age appropriate books, toys and activities Know what kinds of questions to ask during book sharing/shared activities and how to follow child’s interests
	Decision making: Able to decide on what they need to change to achieve their goal and choose that goal
	Regulation: Able to monitor their own use of the new behaviour and make and stick to an action plan to do it

What can parents/carers reasonably be expected to do according to their individual situations?

Every family will have unique needs, and these need to be identified to develop an appropriate support plan.

This table from the ELIM and Intervention guidance handbook uses the COM-B model and lists specific barriers and enablers which families might experience when trying to use responsive interaction behaviours.

The barriers and enablers are categorised under Capabilities, Motivation and Opportunities; and covers a series of skills – Do they? Can they? Are they?

Depending where the barriers lie, this dictates the type of support that could be offered. This can also help a practitioner decide upon the level of support that might be needed.

In the motivation section the barriers and enablers identified as being important were whether families believe. Can they help their child?

64 of 90

The COM-B Model (contd.)

Early Language Identification Measure and Intervention Training

64

Motivation	Belief about capabilities and optimism: Feel they can make the change and increase the use of this behaviour Feel making the change is worthwhile and that there is scope to increase their responsiveness
	Beliefs about consequences: Feel child will engage and so will respond or benefit Feel the chosen behaviours are best for the child and other behaviours (e.g. TV viewing) are not equally good – have reason to change Feel that what they do will make a difference
	Intentions and goals: Have definite intention to try to increase their use of the behaviour Able to set a clear goal and create action plan for implementing it
	Emotion: Do not feel embarrassed at trying new behaviour and/or being judged Do not feel overwhelmed by additional demands

65 of 90

The COM-B Model (contd.)

Early Language Identification Measure and Intervention Training

65

Opportunity	Physical Opportunity A: Have the books and toys needed to use this new behaviour including books in home language Have access to playgroups, drop-ins or other contexts to support the use of these behaviours
	Physical Opportunity B: Have a family and/or social network to draw on to support them Have access to/making use of childcare for siblings or child
	Social Opportunity: See others in their social group using the responsive communication behaviours in a range of contexts Have a family and/or social network to also use the behaviours with their child Have opportunities for supported ‘together time’ which is intrinsically rewarding for child and parent/carers

66 of 90

Discussion Point – Collaborative working

Q. How could health visiting teams, early years practitioners and speech and language therapy teams work together to ensure that families whose children will not be referred, but need guidance, are supported in a tailored way?

Early Language Identification Measure and Intervention Training

66

Q

67 of 90

Self-Directed or a Coaching Approach?

Families with most enablers in place and the only gaps falling in the orange category – Capabilities – are likely to require a self-directed approach.

Early Language Identification Measure and Intervention Training

67

Families with a large number of enablers NOT in place, who do not have the knowledge, skills, confidence, or beliefs that they can do the behaviours and fit them in to their family life (that is, gaps in the orange and purple categories – Capabilities and Motivation) are likely to require a coaching approach.

68 of 90

Self-Directed or a Coaching Approach?

The next decision is whether the family also needs additional physical or social opportunities.

Does the family also need additional physical opportunities to access toys and books and to use their available resources at home to chat and play (gaps in the blue category – Physical Opportunity )?

Does the family need additional social opportunities to access childcare and social support in the community ( pink category – Physical and Social Opportunities )?

Early Language Identification Measure and Intervention Training

68

69 of 90

Self-Directed or a Coaching Approach?

Choose the responsive interaction behaviour to target

Discuss how specific kinds of talk and interaction support children’s language development to improve more rapidly
Explain how some children find it harder than others to pick up language and communication. For these children there is a need to model language use and increase responsive communication to help them to learn from those around them
Show a short video of a parent/carer interacting with their toddler and engaging in responsive communication in everyday contexts which has some of the behaviours tagged and explained and reinforce the messages, pointing out and labelling some of the responsive behaviours
Explain that some children need us to communicate very clearly with them and to demonstrate behaviours so they can learn from us
Ask the parent/carer to choose 1 responsive behaviour they would like to do more to help their child’s language and communication development

Early Language Identification Measure and Intervention Training

69

70 of 90

Ideas for Responsive Behaviour discussion

A picture list or cards of the responsive behaviours can ‘scaffold’ this discussion.

Early Language Identification Measure and Intervention Training

70

Responsive Behaviours	Get down to your child’s level Follow your child’s lead and interests Pause and wait for your child to show you what they are interested in Listen watch and respond to their communication – this can be words, points, sounds or movements Describe what your child is doing or looking at – imagine what they are thinking and feeling and say that.	Show them you are having fun and use an interesting voice If they do communicate copy what they say or mean to say and add a word Try to use fewer questions and instead describe what is happening. When you do ask questions try to keep them open – where, who when and why rather than Yes No questions
Example cards

71 of 90

Ideas for Responsive Behaviour discussion

A picture list of the contexts and recording the outcome of your discussions could support reflection and goal setting

Early Language Identification Measure and Intervention Training

71

Context	Bath time Getting out and about in the pram to the shops or park Breakfast, lunch or tea time	Nappy change time Playing with toys Sharing books	At the library or toddler group Bedtimes Any other ‘together time’

Q

72 of 90

Self-Directed Approach – record, review, reflect

Support the parent/carer to record their chosen behaviour and chosen ‘Together Time’ – for example, “I will find a special quiet time before bed to sit and read a book together”.
Discuss with the parent/carer their preferred method for recording and being reminded to try this every day
Discuss with the parent/carer their preferred option for reflecting regularly on how things are going – for example, using a paper diary, making audio recorded notes on their phone, contacting their health visiting team
Encourage modelling, review and reflection activities
Provide motivational materials

https://www.bbc.co.uk/tiny-happy-people/2-to-3-year-old-child-development-activities

Early Language Identification Measure and Intervention Training

72

Support the parent/carer to record their chosen behaviour and chosen ‘Together Time’ – for example, “I will find a special quiet time before bed to sit and read a book together”.

Discuss with the parent/carer their preferred method for recording and being reminded to try this every day – for example, using a paper diary, a reminder on their phone, a text message from an automated texting system.

Discuss with the parent/carer their preferred option for reflecting regularly on how things are going – for example, using a paper diary, making audio recorded notes on their phone, contacting their health visiting team.

Encourage modelling, review and reflection activities – leave ‘exercises’ encouraging families to look on Tiny Happy People and note what the parent/carer on the video did well to support their child and/or to think of other things they could have done to increase their responsiveness.

Provide motivational materials – leave a list of web resources which the parent/carer can explore which provide motivational information about why responsive interaction is so important and modelling that it can be a fun way to connect with their child. If this feels like too much information for the family, consider sending a link to each web resource weekly through an automated texting system.

73 of 90

A Coaching Approach

Help the parent/carer to record their goal and agree a schedule for visits to work together on this goal.
At subsequent visits watch a video with parent/carer showing families trying out the chosen responsive behaviours in the chosen together time. Support reflection about what the families on the video did well and what else they could have tried. (see Tiny Happy People resources)
Model the behaviour with the child – for example, “Shall we start by sitting down with him/her so that we are on the same level”.

Early Language Identification Measure and Intervention Training

73

74 of 90

A Coaching Approach (contd.)

4. Encourage the parent to join in the play if they feel comfortable.

5. Ask them to reflect on whether they think the chosen behaviour had an effect on how their child interacted.

6. If the parent/carer was confident enough to have a try ask them how that felt.

7. Set a goal for the following week and use a paper diary to record it and set reminders.

Early Language Identification Measure and Intervention Training

74

75 of 90

A Coaching Approach contd.

8. Repeat the modelling/coaching sessions ~ weekly until the parent/carer is confident they are integrating the behaviour in their daily routines.

9. Judge whether to continue coaching with a new responsive interaction goal or suggest parent/carer chooses a new goal and works on it independently.

10. Agree when and how you will check in with the family and review the child’s progress.

Early Language Identification Measure and Intervention Training

75

76 of 90

Physical Support

The intervention aims to support parents to integrate responsive interaction into their usual daily routines, so special toys are not necessary
For families where resources are extremely limited, consider tackling the barriers to access to toys and books and signposting to local resources
Signpost to the the Tiny Happy People videos about using everyday objects to support play

Early Language Identification Measure and Intervention Training

76

https://www.bbc.co.uk/tiny-happy-people/parent-hacks/zj6fvk7

The responsive interaction behaviours targeted in this intervention do not require the provision of any specific play materials . Indeed the goal of the intervention is to support families to integrate responsive interaction into their usual daily routines.

In general, no additional toys or children’s books are likely to be required. However in some cases, where the family identifies ‘playing with toys’ or ‘sharing books’ as their preferred ‘together time’ and where the family resources are extremely limited, practitioners should consider a support package to address access to toys and books.

This may involve support to access toy libraries and the local library. As in the case of ECEC early years provision many barriers to access to these resources exist.

Ideas for supporting parents locally:

local co-design of support packages to identify barriers and enable access to local libraries
toy libraries for families who need this support
development of resources to support families to use everyday materials available at home to develop play and language.
books provided through ‘Book Start’
a set of recommended books to be held in large numbers by local libraries to enable parents to try out the approaches at home
a set of videos are developed demonstrating responsive interaction (developed locally or signposting to helpful videos in the Tiny Happy People resources

77 of 90

Q. What do you think are the most important aspects of the ELIM and Intervention?

Early Language Identification Measure and Intervention Training

77

Q

78 of 90

ELIM & Intervention Aspects to Remember

This is a three-step process*
The importance of the step 2 conversation
Recording of data and Reviewing progress
The importance of collaborative working
Supporting families and guiding them to support their child’s SLC development

* (Note: Not all children will need Step 3 Intervention)

Early Language Identification Measure and Intervention Training

78

79 of 90

Flow Diagram

Early Language Identification Measure and Intervention Training

79

Close

Review

HR2/ASO/27 Months HR

Initial Assessment

Integrated

(Professional / Keyword / Parent)

HR2

(Professional / Parent / Child)

Assessment

Score below

Referral

Score above

No referral

Review

80 of 90

Practitioner CPD

a) Speech, Language and Communication Modules on E- Learning for Health

Working with families to support Speech, Language and Communication development
Supporting Children with Speech, Language and Communication Needs (SLCN)
Early identification of SLCN in children and how to support families

All Our Health – Session on Speech, Language and Communication

Early Language Identification Measure and Intervention Training

80

81 of 90

SLC Interactive Pathway

Early Language Identification Measure and Intervention Training

81

82 of 90

ELIM Pathway

Early Language Identification Measure and Intervention Training

82

HR2/ASQ/27 Months HR

Initial Assessment

Integrated Review

(Professional / Keyworker / Parent)

HR2

(Professional / Parent / Child)

Assessment

Score below

Referral

Score above

No referral

Close

Review

Invitation Letter

Support with resources & follow up

Review ELIM &ASQ (communication) score

83 of 90

Speech,Language and Communication needs in Hackney

84 of 90

“Research indicates that speech, language and communication needs (SLCN) can have a crucial impact on a range of long term outcomes which can in turn affect an individual’s quality of life in several domains.…Research has suggested that timely assessment and intervention is advisable and can play a role in minimising difficulties as well as improving life outcomes.”

Barr, Clare (2014) A Systematic Literature Review (2000-2013) of the Long Term Outcomes for Children with Speech, Language and Communication Needs. Other thesis, Queen Margaret University

What research tells us:

85 of 90

Support and resources – Special Time tinyurl.com/HackneySpecialTime�

86 of 90

Reflection Logs

What were you pleased to notice during today’s Special Time?

When did your child use their best communication skills?

What did your child want to communicate about?

What did you do to support your child’s communication skills?

How did you feel? How would you describe your child’s emotion?

87 of 90

Useful Local Links

88 of 90

Online Resources

89 of 90

?�Questions

Early Language Identification Measure and Intervention Training

89

90 of 90

Thank you

If you have any queries, please contact: BestStartInLife@phe.gov.uk

Early Language Identification Measure and Intervention Training

90