In October 2020, Public Health England (PHE) released 'The Best Start in Speech, Language, and Communication,' a comprehensive guidance document aimed at ensuring a coordinated approach to early years services for children aged 0-5. Below are the key components of the guidance, my critical insights, and areas for improvement.
Overview of the Guidance
The guidance consists of three essential sections. Part 1 provides recommendations for commissioners and service leads in early years, emphasizing the need for a strategic approach and inter-agency collaboration. Part 2 offers supportive evidence, including developmental norms and recommended messages. Part 3 presents real-life case studies from across the UK.
While the guidance contains a wealth of valuable information, it can be challenging to navigate due to its density. While I appreciate the emphasis on auditing early years services and understanding local assets, I have mixed feelings about the narrative created. The guidance fails to address the root causes of speech, language, and communication needs (SLCN) and may inadvertently exacerbate existing problems.
A Continuum of Need
The guidance proposes organising support across a continuum of need, encompassing universal, targeted, and specialist tiers. This approach allows for fluid movement between levels of intervention. Additionally, the guidance introduces a 'targeted selective' tier for groups considered 'at risk' of developing SLCN, such as those with low income or limited parental qualifications. It promotes shifting from an expert model to empowering everyone working in early years to develop the skills needed to support SLC.
A Life Course Approach
The Best Start guidance advocates for a life course approach to speech, language, and communication. By considering the entire 0-5 age range, the guidance highlights the importance of tailored messaging and support for children, families, and professionals. It acknowledges the wide-ranging impact of language and communication on various aspects of life, including education, socialisation, and employability. However, the guidance falls short in addressing the systemic issues that underpin inequalities.
Prevention is Better Than Cure
The guidance demonstrates a strong focus on prevention, promoting language development messaging from an early stage to prevent problems from arising. While referrals to speech and language therapy typically occur after the 2-year health check, a more preventive approach would involve providing support and messaging from conception. This expanded role of speech and language therapists would involve influencing and training at a broader level, beyond specialist therapy.
Know Your Patch
Understanding the local population and the determinants of health, such as poverty and literacy levels, is crucial in tailoring services effectively. Comparing the incidence of SLCN with the expected prevalence helps identify disparities and their underlying causes. Mapping local assets and identifying gaps in provision contributes to a comprehensive and equitable local offer that benefits all children.
Final Thoughts
The Best Start in SLC guidance has served as a catalyst for discussions on necessary changes and evaluating existing services. It successfully advocates for an integrated early years pathway, aiming to break down siloed working. However, the guidance falls short in its emphasis on vocabulary intervention as the primary solution, overlooking the broader aspects of language and communication. Addressing underlying issues is vital to support children effectively and promote positive life outcomes, as vocabulary intervention alone cannot address health inequalities and social injustice.
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