A speech and language assessment tool was used to screen all kindergarten children across targeted primary schools within the Wagga area. The results were used to tailor an intervention program aimed at whole class participation, which was linked with the Kindergarten syllabus outcomes in the Board of Studies key learning areas.

The classroom teachers, teacher's aides, and relevant language support personnel were trained by the Speech Pathologist on implementing this program, and targeting speech and language goals within the curriculum. Post assessment of the children occurred approximately six months after initial testing, and revealed the participants improved across all measured areas of speech, language, vocabulary, and sound awareness tasks.

To provide a curriculum based intervention program aimed at remediating speech and language problems via whole class and small group activities within schools.

An audit of intake referrals for Speech Pathology services at Wagga Community Health Centre (WCH) indicated children were frequently referred when in year 1 or 2 at school. The Speech Department needed to address the issue of late referrals and promote early intervention. The early intervention program was designed to provide curriculum based intervention aimed at remediating speech and language problems within a classroom environment.

The advantage of targeting schools at this point was the 100% capture rate, as all children attend school. Early intervention targets those at risk, aiming to prevent delay, educate, promote health, and help avoid problems with literacy, socialisation, and behaviour (Law, Garret, and Nye, 2003).

Primary health and health promotion lies at the core of this project, in addition to continuing to strengthen the relationships and rapport between NSW Health and both Catholic Education (CE) and Department of Education (DET) facilities.

After consultation with representatives from local CE, and DET schools, it was identified that early intervention for speech and/or language impaired children could be addressed using;

1. A screening tool
2. A classroom based intervention program, and

Education sessions involving Kindergarten teachers and parents of the children.

The following steps were then taken:

• A screening tool aimed at assessing speech, language, sequencing, sound awareness, and vocabulary was designed by a Speech Pathologist at WCH.
• Baseline measures of language use (nouns, verbs, adjectives, conjunction, prepositions, and questions) and sound awareness skills were taken.
  • Results identified a proportion of Kindergarten children had pre-literacy, language and/or speech skills that were below average.
• Surveying the classroom teachers and relevant personnel on how they would like to be supported.
  • The teachers reported they had difficulty identifying language problems in the classroom, and also how to target speech activities with a big group of children.
  • They identified that ongoing support (phone, email, and face-to-face) was required during the project phase.
  • Parents reported they would like feedback on their children’s performance, and education on how implement speech or language goals.

NSW Health is striving towards helping people access the health care they need, utilising integrated primary health and community care services. The SPinS program is community based, focusing on early intervention with all populations, including Aboriginal and/or Torres Strait Islanders, and strengthening primary health.

This project aligns directly with the goals to develop cross-agency screening, assessment, and intervention strategies in the community across departments such as DET, and CE, as well as building partnerships. By implementing this program across educational institutions, the capture and inclusion rate is high, as all children are required to attend school.

The planning and implementation team consisted of a speech pathologist, classroom teachers, teacher's aides, language support personnel, and the school Principal.

1. The kindergarten children were pre-tested prior to the implementation of the program
2. Once the results had been analysed, the Speech Pathologist gave an in-service to the
   a. Teachers on how to implement the program, and coordinating speech and language focused activities.
   b. Parents, on how to work effectively with their children on speech and/or language goals
3. The Speech Pathologist designed a classroom based, syllabus married, key learning area focussed intervention program for each kindergarten class participating in the pilot (5 classes altogether).
4. The SPinS program was implemented in the classroom, as part of everyday activities, by the classroom teacher and relevant aides.
5. A separate speech focused group was designed on a pull-out model from the classroom, where identified children worked specifically on their speech errors under guidance from the Speech Pathologist
6. The teacher and/or volunteer parents worked on speech and language tasks designed by the speech pathologist, in the children’s group-time program at school
7. The teachers received support by the Speech Pathologist (both face-to-face, via telephone and email) during implementation of the program.
8. The children were re-assessed approximately six months after the program was rolled out.

Schools were identified for the roll out of this program within the CE system by the key stakeholder involved on their behalf, and the Speech Pathologists identified the schools to be targeted from the DET based on need within the school. The program is currently in its second year, and through the promotion of its ongoing success, an increasing number of schools are requesting to be involved.

Once the program had been implemented into the classroom for a period of six months, the Speech Pathologist conducted the post-assessments. Each child was assessed using the same pre-assessment tool. The results indicated that students improved across all the areas of speech, language, sound awareness, sequencing, and vocabulary.

• 70% average increase in the children’s ability to identify sounds within words (a necessary skill required prior to beginning reading and writing)
• Graph 1.1 shows the increase in other sound awareness and sequencing targets.
• Increases across the board in vocabulary, e.g. noun use (2), pronouns (3), adjectives (4), verbs (5), prepositions (6), questions (7), negatives (8), and conjunctions (9), as shown in Graph 1.2

 Graph 1.1

Graph 1.2

The Kindergarten children were ranked according to their performance on this task. This data will be kept until the children are in year 3 and complete their first Basic Skills test. We intend to investigate whether a child's performance on their Basic Skills Test can be predicted in Kindergarten.

It is the combined stakeholders goal that by targeting speech and language skills from early in Kindergarten, the literacy performance of children across the Riverina will improve. Another identified benefit was the increase in referrals to other early intervention services, e.g. audiometry and occupational therapy.

Put simply, sustaining change is about education, support, building rapport, and ongoing reviews to ensure changes are continuing to be positive and successful. This program involves educating the community, e.g. teachers and parents, about how to identify problems in kindergarten children, then how to remediate those problems through structured and unstructured tasks focusing on speech and language targets.

This education component will be sustained with regular in-servicing provided by the Speech Pathologist, as part of their health promotion and prevention role in the community. The post-assessment phase also allows the progress of the children to be monitored, ensuring improvements are being made.

There is great potential for future roll-out of the same or similar programs across educational institutions. The GSAHS Speech Pathologists have formed a working party to investigate the potential widening of this project across the area. With the DET's implementation of the Best Start program across the Riverina, the GSAHS Speech Pathologists are currently in consultation about how we can work together to ensure that speech and language problems are identified at the earliest possible point, and how to provide sustainable, equitable services.  With the focus on Early Intervention, the Speech Pathology department is also investigating the broadening of this program into "prior to school" settings to capture children at the earliest point possible.

Law, J., Garrett, Z., Nye, C. (2003) Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD004110. DOI: 10.1002/14651858.CD004110.

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Greater Southern Area Health Service
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