Perceptions of staff on embedding speech and language therapy within a youth offending team

Abstract

The purpose of this research was to ascertain the views of staff and managers within a youth offending team on their experiences of working with a speech and language therapist (SLT). The model of therapy provision was similar to the whole-systems approach used in schools. The impact of the service on language outcomes is reported elsewhere (Gregory and Bryan, 2011). A questionnaire was sent to all staff asking about their experiences related to working with a speech and language therapist. Eight telephone interviews were then conducted to explore the questionnaire findings further and to gain a management perspective on speech and language therapy within a youth offending service (YOS) team. Staff were largely positive about their experience of working with a SLT. Understanding the nature of the presenting communication difficulties and having strategies to manage these were linked to improvements in wider working practices, which managers linked to culture change. The whole-systems model of service delivery appeared to have potential application to youth justice contexts. Direct access to the SLT to support communication aspects of their work was particularly important to the YOS staff. Further research is needed to examine the optimum model of speech and language therapy in youth justice settings, and the potential contribution to criminal justice outcomes such as prevention of re-offending.

Keywords

Intervention speech and language therapy young offenders

I Background

Approximately 6% of children have speech and language difficulties in the absence of other developmental problems (Law et al., 2010), but this figure may rise to 30% (Enderby and Pickstone, 2005) or even 50% (Locke et al., 2002) in areas of lower socio-economic status. Some of these children may recover from these difficulties particularly if they receive speech and language therapy intervention, but research has shown that the educational needs of children with identified speech, language and communication difficulties (SLCD) often persist throughout the lifespan (Durkin et al., 2009). SLCD may also be associated with other developmental conditions such as learning difficulties and disabilities and autistic spectrum disorders, which also persist into adolescence and beyond (O’Brien and Bell, 2004). During adolescence young people are continuing to develop language skills that are important underpinnings of educational performance and social development (Nippold, 2004). Theories of on-going language development into early adulthood include those of Pinker (1994) and Ravid and Tolchinsky (2002). It is well established that spoken language abilities are essential for the development of written language skills that underpin educational achievement (Dockrell et al., 2011; Durkin and Conti-Ramsden, 2010).

Young offender populations show over-representation of young people with a wide range of developmental problems (Loucks, 2007), and support to manage such difficulties is variable and inconsistent (Talbot, 2010). Language impairment is a risk factor for low educational attainment (Conti-Ramsden et al., 2009) and mental health problems (Clegg et al., 2005), both of which are risk factors for offending. Also, evidence is emerging to suggest that language impairment may be a direct risk factor for offending in boys (Brownlie et al., 2004; Mouridsen and Hauschild, 2009). Studies suggest that at least 60% of young offenders present with SLCD in England (Bryan, 2004; Bryan et al., 2007). High incidence figures in young offender populations are also reported in Australia, Canada and the USA (Cohen et al., 1993; Sanger et al., 2001; Snow and Powell, 2008).

Young people are often aware of their communication difficulties, and research has emphasized the need for specific measures to address both low levels of language in adolescents (Snow and Powell, 2008), and more specific language impairments (Brownlie et al., 2004). However, many young people do not receive the support they need to develop oral language skills (Clegg et al., 2009). There has been concern about the lack of support for young people with communication difficulties, particularly those in contact with criminal justice services (Bercow, 2008). The ability of young people who are in contact with criminal justice services to access education is restricted if they lack adequate language skills but they also need intact language skills to enable them to benefit from verbally mediated programmes designed to prevent re-offending.

Delivery of speech and language therapy within young offender populations is beginning to be explored. A number of project reports describe the development of speech and language therapy services embedded within young offender institutions (Bryan et al., 2007) and within youth offending teams in the community (Gregory and Bryan, 2009). The model of speech and language therapy provision has some similarity to that described within schools as a whole-systems approach (Leyden et al., 2011).

The I CAN Primary Talk programme is an example of a whole-systems approach (I CAN, 2007). Within a whole-systems approach, communication issues are addressed by training all staff, implementing communication initiatives across the whole population and addressing wider communication issues such as modifying language used to make the curriculum more accessible to all, including those with language difficulties. Any targeted intervention for some pupils with particular needs is an addition to the overall language enrichment provided across the school. Whole-systems approaches rely on effective collaboration between speech and language therapists, the school staff and other support agencies involved. The whole-systems approach has been shown to be effective in school populations (Leyden et al., 2011) and may have some applicability to youth justice populations where most of the interventions are verbally mediated – many within group settings – such as enhanced thinking skills and anger management.

There is a need for further research related to the efficacy of speech and language therapy per se for offender populations, but there is also a need to consider the potential role of the speech and language therapist within youth offending services. The current study reports the findings of a questionnaire completed by youth offending team staff and data from follow-up interviews with a range of staff pertaining to their experiences of working with a SLT, and their perceptions of the contribution of speech and language therapy to the work of the youth offending service. The provision of speech and language therapy within the team is outlined in Gregory and Bryan (2009), and the nature of the SLCD presented by the young people and the language outcomes for the young people are reported in Gregory and Bryan (2011).

II Methodology

A study of language outcomes for young people receiving speech and language therapy within an intensive supervision and surveillance programme (ISSP) provided by a youth offending team showed that 75% of the young people demonstrated an improvement in their language scores on standardized tests (Gregory and Bryan, 2011). The ISSP is used for prolific or more serious young offenders who are deemed to require intensive support as an alternative to custody. The young people on the ISSP are aged between 11 and 18 years. The programme consists of intensive input (up to 25 hours a week) for three months and then reduced contact for a further three months (reducing to a minimum of five hours a week). The aim of the ISSP is to address the young person’s offending behaviour and to reduce the risk of re-offending by supporting him or her in accessing education or training and positive community activities.

The SLT worked 3.5 days per week within the ISSP for a 12-month period. The team had no previous access to speech and language therapy services. The SLT’s role was to provide training for all staff on the nature of language and communication difficulties and strategies to support young people with these difficulties. Training included coaching, formal sessions to the team and informal training at weekly team meetings. Communication plans were also developed to meet each young person’s specific communication needs within their overall ISSP intervention programme. The SLT suggested resources to support the young person, and gave information on how to adapt existing resources and interventions in the light of the information about the young person’s level of language functioning. In addition, individual specific intervention was usually conducted by the key worker (the member of the YOS staff assigned to co-ordinate a young person’s care), but also by joint sessions delivered through the key worker and SLT working together, or by individual sessions delivered by the SLT. The evaluation described here was taken 10 months into the project.

The degree to which the SLT was involved in delivering the communication plan depended on factors such as complexity of need, staffing, other timetabled activities and the skill level of the key worker. Support for individual key workers was given on an individual basis by talking through resources as already described, and by the key worker and the SLT working together with the young person.

The views of staff and managers within the ISSP on their experiences of working with a SLT and the contribution of speech and language therapy to the team were evaluated by a two-stage process:

short questionnaire to all ISSP staff and managers;

eight telephone interviews conducted with a range of staff by an independent researcher who had not had any contact with the staff.

The aim of the interviews was to explore issues raised within the questionnaire responses in more depth. The project had all necessary permissions required by the youth offending service. It was recognized that the staff were being asked to comment on the speech and language therapist they were working with; however, this is inevitable where a single practitioner is involved, and potential disadvantages were balanced by the importance of gaining the views of the staff involved. In order to distance the evaluation from the individuals involved, the independent evaluator had no direct contact with the staff, the staff were aware from the outset that the evaluation would be taking place, all correspondence regarding the evaluation came from the evaluator’s University, and distribution and collection of questionnaires did not involve service managers (or the SLT) having access to the data. All staff completing a questionnaire had the option to volunteer for a subsequent interview, and only staff who volunteered were contacted.

III Questionnaire to all staff

The questionnaire (Gregory and Bryan, 2009) was developed by the researcher and sent to each member of staff to capture the staff’s perceptions of the:

role of the SLT;

influence of speech and language therapy on delivery of the ISSP programme;

how speech and language therapy input affected delivery of the programme;

staff experiences of working with a SLT.

The draft questionnaire was discussed with the ISSP manager, and one question was modified to reflect feedback related to information that was not accessible to staff. Fourteen open questions were included in which staff were also requested to give examples related to any views expressed.

It was agreed that questionnaires would be placed in the staff post trays on one particular day. Completed questionnaires were collected in an envelope at the youth offending team offices and sent on to the researcher unopened. Staff also had the option to post the questionnaire themselves. Staff were informed that the questionnaire would not be read by managers or the speech and language therapist.

Three staff members returned the questionnaire by post and the rest were returned by envelope. Twenty-three questionnaires were distributed, and 21 were returned to the researcher. This represents an 87% response rate. Staff did not have to give their name unless they were willing to be contacted for an interview.

Of the 21 completed responses:

two were from managers;

five were from Youth Justice Officers (YJO) who are team leaders;

13 were from Youth Justice Workers (YJW) with experience in post ranging from three months full time to 10 years;

one was from a student social worker.

In order to maintain anonymity, the evaluation information given below will not identify the grade of staff.

IV Interviews

All staff gave their names on the questionnaire indicating that they were willing to be interviewed. A total of eight interviews were undertaken by the independent researcher by telephone. The sample was purposefully selected, from those available at the YOS in the agreed call slots, to include staff with the full range of experience of working with young people, and to include programme staff and managers. Eight telephone interviews took place with three Youth Justice Workers who varied in experience from three months full time to five years, one Youth Justice Officer (team leader) and two managers. The aim of these interviews was to probe what it was like to work with the SLT. In addition, staff with managerial responsibilities were asked about the engagement of staff with speech and language therapy and the impact of speech and language therapy on the work of the ISSP. Open questioning was used with probes to gain more information on any issues raised in the questionnaires. Interviews took 30–40 minutes.

The questionnaire and interview data was analysed using thematic analysis (Miles and Huberman, 1984). Seven themes emerged, and these are described below.

1 The value of speech and language therapy to the ISSP

All of the respondents and interviewees were positive as to the value of speech and language therapy within the ISSP.

Very useful and helpful experience for both staff and young people.

Yes, definite benefits. Having worked across the wider Youth Justice Service [I] can see it having benefits across the service.

Individual help was great. Joint sessions went down well.

All of the respondents stated that they would support routinely having a SLT within the ISSP / youth offending team.

Definitely: the team was better equipped to deal with communication issues.

Twenty respondents stated that they had no issues in working with the SLT. One respondent noted that some staff had shown initial resistance, but that this resolved over time as the SLT began to be ‘seen as a valuable part of working effectively with young people’.

Three interviewees added that the SLT had engaged staff very well, but they also mentioned a small minority of staff who did not engage easily with new ideas. They stated that the SLT had been assertive and had focused initially on staff who were enthusiastic. Once the less engaged staff saw positive results, they were more confident about embracing the new ways of working. One interviewee stated that about 10% of staff had only engaged superficially with the communication plans and had not changed their practice. Possibly these staff needed a higher level of support with managing communication difficulties than the SLT could offer.

Sixteen respondents stated that they could not think of any further improvements to the speech and language therapy service. Of the remaining four:

two suggested that the SLT should be full-time or have more time in the ISSP;

one requested more supervision in implementing the communication plan;

one requested more training for staff;

one suggested that all youth offending team clients should have access to speech and language therapy (i.e. including those clients known to the youth offending team but not within ISSP).

Four interviewees added that the young people were challenging to work with. However, they all stated that the SLT had engaged the young people very well and that after one or two sessions they all enjoyed it. All had a clear perception that without speech and language therapy, the ISSP would not be so effective. One interviewee felt that the SLT had achieved an excellent balance between working herself with the most needy young people, and enabling staff to incorporate communication issues into their work.

2 The role of SLT

The role of speech and language therapy was viewed by all respondents as:

assessing all young people coming into the ISSP;

identifying appropriate goals and tasks to develop or improve communication skills;

increasing staff understanding of communication difficulties.

Most of the respondents also mentioned a speech and language therapy role in:

helping staff to manage young people with communication difficulty.

Four respondents commented on the value of ongoing evaluation of the communication work.

The respondents all viewed speech and language therapy as having a direct benefit for the young people in terms of both improving language and communication skills, and in assisting the young person to cope with the intensive support and supervision programme.

Nineteen of the 21 respondents gave specific examples of the contribution of speech and language therapy to the ISSP. Examples are given below:

This work was an outstanding factor in boosting his self-esteem.

With one young person in particular, the skills learned with speech and language therapy have had an impact on his anger management issues and his ability to control his emotions by empowering him to communicate more freely.

Previously he would become very upset, angry and would shout and become verbally abusive when he did not like something. Over time he has learnt how to stay calm, express what he is not happy about and have a discussion. Great improvement.

All respondents stated that the SLT assisted in:

making a positive contribution to ISSP;

helping young people to comply with ISSP by improving communication between young people and staff;

providing valuable assessment and direct advice for managing communication difficulties and improving communication skills.

The interviewees discussed particular aspects of the speech and language therapist’s role that had assisted the delivery of the ISSP. Four of the interviewees were positive about the speech and language therapy assessment, adding that:

Speech and language therapy can contribute to the assessment process with no overlap. It flows across a few areas.

Provided an opportunity to look at different things … We were blinkered to communication needs. Probably nationally as well.

The speech and language therapy reports give scores of where the young people are operating at, gives proof of what workers were saying.

The communication assessment was noted by three interviewees to lead to tailored intervention:

meeting diverse needs: we talk about it but didn’t do it; she’s changed this.

One interviewee felt that assessing language and communication levels for group work was very difficult for staff. A further interviewee was clear that the speech and language therapy assessments were ‘very valuable’ in enabling staff to tailor their work appropriately to the young person’s level of language ability. The interviewee went on to state that many of the materials used within the ISSP assumed that ‘one size fits all’. However, information and support from the SLT enabled staff to adapt the work sheets and to re-write information so that the young people could understand them.

3 The SLT’s contribution to the skills of the team

The interviewees expanded on the skills that the SLT herself brought to the ISSP team. They cited her knowledge and her professionalism, and were positive about the SLT joining in with programme activities:

‘mucking in’ at the same time as ‘protecting’ her specialist role.

She was described as a good motivator. She had spread enthusiasm via demonstrating results and increasing the confidence of both the young people and the staff in engaging with communication issues. The speech and language therapist was seen as approachable, and as having time for staff.

4 Culture change

Three interviewees commented on the value of the communication plans for young people with SLCD, and linked this to a change in the culture of working in the ISSP. These interviewees were aware of a small number of colleagues who did not share their view. They felt that speech and language therapy should be entirely provided by the SLT and not extended into YOS staff roles.

Three interviewees mentioned that the speech and language therapist attending review meetings and team meetings was particularly helpful. They also stated that the level of training provided by the SLT was more than adequate. This suggests that direct contact with the SLT to support the delivery of interventions is important to the YOS staff in enabling them to deliver the ISSP programme. They also stated that their own awareness of communication difficulties had increased, and they showed awareness of the effect that communication difficulties can have on a young person:

once you can communicate better, it improves a lot of issues, home, anger management, their situation.

changed my practice for the better, definitely.

One interviewee commented that the ISSP is:

not an easy place to get recognition.

but that SLT had rapidly had a very positive impact. All stated that understanding communication issues and having resources and support from the SLT had enabled them to do their job more effectively. The SLT was noted by three interviewees to have embedded in the programme very quickly:

She has changed [the] culture.

5 Communication plans

With respect to the communication plans and accompanying resources provided by the SLT for young people with SLCD, all the respondents were very positive about the communication plans developed by the SLT and implemented by the Youth Justice Workers. Two noted that the ability of the staff to implement the plans varied. Examples of comments were: ‘informative, individually tailored and extremely effective in producing required outcomes.’

In addition, four of the respondents noted that the SLT was always willing to explain the plans, answer queries and respond to any issues arising from delivery of the communication plans. The interviewees gave specific examples of communication plans:

A young person with bad recall, no eye contact and poor posture. After working on the communication plan, he passed an interview to go back to College to re-take his GCSEs [national, age 16 examinations in the UK].

Two of the interviewees mentioned that the younger clients had particularly benefited from speech and language therapy:

With the younger end we have probably struggled to engage. Speech and language therapy is a new tool to help … Seeing young people more as being children helped to link to other developmental needs.

All respondents felt that the level of support provided to staff was sufficient.

[SLT] always found time to help you to go through it.

a lot of input.

One interviewee had gained support from the SLT with individual sessions, but had also run joint sessions with the SLT that were helpful for the client.

6 SLT influencing outcomes for young people

In terms of how speech and language therapy influences outcomes for young people in the ISSP, the responses were unanimously positive. The respondents identified:

immediate gain for the young people’s communication skills: ‘raised self esteem and general language improvement.’

gains for staff in understanding communication difficulties: ‘helped us to understand the young person better.’

gains in terms of young people engaging with the ISSP, thus improving overall outcomes: ‘it has helped with his negotiation skills when agreeing dates, times and details of ISSP appointments’; ‘young people engaging to a higher standard overall.’

gains in supplying appropriate information to agencies such as the Courts to facilitate appropriate management: ‘provide explanation for behaviours and previous non-compliance. This has directly influenced sentencing in Court.’

All respondents were able to give examples of positive results, and none volunteered negative examples:

enabling a young person to say when they are not happy … decreasing the risk of breach.¹

success in getting all the way through [the programme] and speaking in Court for the first time … judiciary commenting favourably.

One interviewee gave an example of a particularly difficult young person who had benefited from speech and language therapy. He was a 17-year-old boy who did not mix well and was described as ‘a pest’. He was 6′1″ (1.84 m) tall and attracted labels such as ‘troublesome’ and ‘defiant’. The SLT showed that his language comprehension was at the level expected of a 7-year-old. This resulted in staff responding differently to him. Also, the SLT worked alongside the YOS worker to ensure that the young person could access the programme. This young person was able to remain in the programme although he had been regarded initially as someone for whom a breach¹ was likely. However, one of the interviewees added that young people with communication difficulties can get additional punishments from Court. He thought that this occurred because Youth Courts try to engage young people more by asking questions etc., and, if the young person does not reply, negative assumptions tend to be made. He felt that magistrates were generally unaware of communication difficulties and commented very favourably on the value of speech and language therapy assessment information and reports to Courts. (More detailed case examples are given in Gregory and Bryan, 2009).

7 Future of SLT within the ISSP

Four interviewees were clear that potentially not having a SLT within the ISSP in the future would be a detrimental step.

if we don’t, we’ve lost.

losing a valuable resource … increase in locking up children.

One interviewee was clear that the benefits of having a speech and language therapy service were noticeable to others. Some of the young people stated in their final reviews that speech and language therapy was particularly helping them (these were young people who either did not speak much or who struggled to communicate). Receiving youth offending teams, who took clients after the ISSP programme, had also commented on improved communication for some clients whom they had known previously. Also magistrates had commented positively on the improvement in communication skills seen in some young people.

One interviewee also stated that speech and language therapy was a priority service that he would include if he were asked to design a youth offending team. The interviewee thought that if necessary it would be worth reducing some face to face time with youth offending team workers if a SLT could be included in the team. He also stated that speech and language therapy should be available outside the ISSP programme since many young people only spent a short period of time within the ISSP. He felt that young people would suffer directly through not having language and communication problems recognized and through not having an opportunity to develop in these areas. He felt that those young people with comprehension problems would be particularly disadvantaged as their problems are so often not recognized. Another interviewee stated that value for money had been demonstrated, but also commented that speech and language therapy was missing from areas where these young people have contact earlier than YOS, such as in units for young people who are excluded from education.

V Discussion

The aim of the study was to obtain the view of the youth offending ISSP team staff and managers on the contribution of speech and language therapy to the youth offending team. The views of staff were generally positive, but the use of an independent researcher at a distance from the team did enable both questionnaire respondents and interviewees to raise some negative issues. Comparison of staff views comparing YOSs with and without access to speech and language therapy would be helpful to address a possible positive bias caused by the staff working with a single therapist.

The staff perceived that speech and language therapy was useful and contributed to positive outcomes for the young people. The extent to which this was due to speech and language therapy per se, rather than to the combined effect of the programme needs further research. Staff recognized that increasing their own awareness of SLCD and how to manage these difficulties increased their ability to deliver all aspects of the ISSP. They also perceived that SLCD contributed to young people being viewed as ‘difficult’. Some initial resistance to working with a SLT was evident with the majority of this resistance being rapidly overcome, although there was a suggestion that up to 10% of staff had not accepted that managing communication difficulties should be incorporated into their work and had not changed their practice. These staff may have needed a higher level of training and support than the SLT could offer, but there may be other reasons as to why they were unhappy with their workload; collection and analysis of these reasons were beyond the scope of the study.

The speech and language therapy input was individualized so it is not possible to determine exactly what element of the input was effective, but the insights from the staff suggest that a number of elements of the input were helpful. This included the assessment information that assisted staff in understanding why the young people demonstrated some behaviours, the communication plan that assisted staff in tailoring language use in their interventions, as well as the input for the speech and language therapist directly or with other staff. Staff appeared to value having access to the speech and language therapist to assist them with meeting communication needs within the delivery of the ISSP programme. This may suggest that assessment-only and advice-only services are not adequate to meet the needs of YOS staff who are dealing with young people who have SLCD, but further research would be needed to verify this.

The model of therapy intervention was suggested to be akin to a whole-systems approach used in school settings, and the findings from the staff suggest that the multi-faceted approach was perceived by staff to be useful to them in enhancing their work. Possibly the level of service provided (3.5 days per week) was unusual, but staff did perceive added value from contact with the SLT. Further research is needed to examine exactly which aspects of the model of speech and language therapy provided are effective within a youth offending team so that resource limited speech and language therapy provision can be effectively targeted. Similarly, the efficacy of other models of input such as consultancy models could be evaluated.

The staff were aware of the wider benefits of understanding speech, language and communication difficulties; for example, in sharing the information with social workers and other agencies, providing useful information to Courts, and the potential value of speech and language therapy to the wider youth offending team. Further research would be needed to ascertain whether including a speech and language therapy service within a youth offending team has any impact on the outcomes of the team’s work; for example, levels of engagement, rates of breach or rates of re-offending. However, there is also a need to investigate whether speech, language and communication needs could be met prior to contact with youth justice services, such as within services for young people who are excluded from school or deemed to be at risk of offending. This is important because the negative impact of communication difficulties on engagement with criminal justice processes has been documented by other researchers (Snow and Powell, 2004) as well as by the staff in this study.

The perspective of the youth offending team was also positive in relation to the notion of speech and language therapy input contributing to culture change arising from recognizing and addressing communication difficulties. In terms of youth justice agendas, addressing individual skills deficits that may underlie educational failure or prevent employment is a policy imperative (HMSO, 2006), so there appears to be potential for speech and language therapy to contribute to achieving criminal justice agendas, but further research would be needed to verify this. The findings suggest that increasing youth justice staff’s awareness of communication difficulties and enabling them to adapt provision to an appropriate language level may be beneficial to youth justice staff in managing young people with complex difficulties.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Notes

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