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

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:

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:

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:

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.

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.