Preface:

The Ontario Association for Families of Children with Communication Disorders (O.A.F.C.C.D) has recently revised the " OAFCCD Provincial Model of Speech and Language Service Delivery for Children" to reflect recent changes and initiatives. OAFCCD originally developed the model because we believe it is important that planning for future services is based on a provincial framework or vision for the provision of speech and language services. The need for a model is particularly important as publicly funded agencies are faced with reduced or finite resources and must clearly define their service delivery systems and outcome expectations. The recently initiated review of Policy/Program Memorandum 81, an inter-ministerial agreement, has provided an opportunity to consider a new service delivery framework for the school aged children and we believe that the model could be helpful.

There is presently no legislated mandate for any Ministry or agency to provide speech and language services. Despite the lack of a mandate, premier services have historically been provided in some health facilities, schools and other community agencies. These services are greatly valued by their communities, with demand that far exceeds service capacity.

The development of an effective and cost efficient service system should involve all of the stakeholders planning together within a provincial framework. Ministries and community agencies should be talking to each other and working together to ensure the development of a service delivery system that meets all of the needs in an efficient and effective manner. Planning decisions should involve input from the consumers of this service, in this case the families of children with communication disorders.
 

INTRODUCTION:

The ability to communicate is one of the defining characteristics of humans. The ability to communicate effectively is an essential skill in modern society. Children who have communication impairments are at a disadvantage in every way, including their ability to be educated.

Communication Disorders, which include speech and language disorders, are the largest disabling conditions in society, affecting 6-10% of the general population,. Speech disorders may involve saying sounds incorrectly, stuttering or voice difficulties. Language disorders involve difficulties in understanding and expressing thoughts in correct sentences. The primary goal of parents and communities is to allow all children, regardless of their particular circumstances, to develop the skills needed to live, work and contribute to society.

There is clear evidence that speech and language intervention is effective and the earlier the treatment is begun, the better the result. Professional intervention can make a big difference. Children who get help are more likely to feel better about themselves, get along well with others, be more independent, read better, stay in school, and be employed. Without help, children are more likely to develop behaviour problems, be in trouble with the law, end up on welfare, and have poor relationships with others.

It is crucial, therefore, that we have a province-wide approach to delivery of speech and language services.
 

PRINCIPLES OF SERVICE DELIVERY:

OAFCCD believes that an effective speech and language delivery service is based on the following principles.

1. Speech and Language Services should be publicly funded, available in every community in a timely manner, regardless of diagnosis, or family circumstances.

2. Services should be equitably distributed with mandatory provision and funding, and local coordination of services which recognizes and responds to unique community characteristics.

3. Provincial standards should be in place to ensure on-going identification of children at risk for communication disorders.

4. Healthy development of speech, language and hearing should be promoted.

5. Early and on-going intervention should be provided.

6. Services should be delivered to children in an environment that is as familiar and natural as possible, and the travel distance should be kept to a minimum.

7. Speech and language programming should be integrated into the child's learning environment as much as possible.

8. A full range of speech and language services should be available using a variety of delivery models to best meet the needs of the child.

9. Specialized speech and language services should be available for the children that require them (i.e. augmentative communication, audiology).

10. Parents should be empowered through training, support and recognition of their role. Parents are vital partners in the delivery of speech and language services.

11. Services should continuously support the child and significant others (teachers, educational assistants, parents, caregivers, etc.) to allow the child to meet the changing demands as she/he progresses toward adulthood.

12. The service system should be seamless with smooth transitions between service providers.
 

OAFCCD PROVINCIAL SPEECH AND LANGUAGE SERVICE MODEL

Key Components of the Speech and Language Service Model:

1. Prevention/Promotion:

The prevention of communication disorders should be a priority of the service system. Healthy community strategies should include:

• provision of quality prenatal care to all pregnant women

• health programs to reduce the incidence of premature births

• appropriate treatment for birth defects such as cleft lip and/or palate

• public awareness programs, such as those developed through the Preschool Speech and Language Initiative

• parent education regarding the need for language rich learning environments and speech and language stimulation

• provision of high quality, language rich learning environments in publicly funded preschool programs

• strong emphasis in the educational curriculum on the development of oral and written communication skills

2. Identification:

The value of early and on-going identification is well documented. To ensure early and on-going identification of speech and language disorders, the service model should include:

• early identification of high risk infants through Healthy Babies, Healthy Children and other initiatives

• education programs to help parents, family doctors, and child care providers identify problems and obtain referral to assessment services

• provincial standards for screening mechanisms to identify communication problems and make referrals to professional services

• support and training for school personnel, and especially classroom teachers, to enable them to identify students with communication disorders and make referrals for hearing, speech and language disorder assessments

3. Intervention:

The value of intervention is well documented. It is essential that qualified professionals be publicly accessible in every community to provide speech and language assessments, and appropriate programming. Intervention services, as best suited to the needs of the child, should be continuously available as child progresses toward adulthood, and include:

• parent/consumer empowerment through recognition of their role, and the provision of parent support and training

• delivery of services to children in a familiar environment in the local community, e.g., day cares, preschool and school classrooms

• integration of speech and language programs into natural learning environment with strong linkage to curriculum expectations

• range of delivery options including individual and group therapy, waiting list management, mediator and consultative models, and classroom based programming

• specialized speech and language services (i.e. augmentative communication services, Audiology and Autism services)

• adequate services to meet the unique needs of sparsely populated areas, in rural and northern parts of the province

• seamless transitions between service providers and at school entry or transfers

• appropriate use and supervision of support personnel

• support and training for classroom teachers, educational assistants, classroom volunteers and families to enable them to participate in speech and language programs, and adaptive communication strategies.

• consumer and family/caregiver perspective on success of treatment, or adaptive strategies

• regular evaluation of progress and monitorong by qualified professionals to identify changing programming needs

4. Evaluation:

Evaluation is a key component of speech and language services. Service system should be subject to evaluation of both efficacy and cost effectiveness. The evaluation system should include:

• controlled studies of screening, assessment and intervention programs to evaluate efficacy/effectiveness

• service delivery evaluation to determine cost-effectiveness

• consideration of consumer satisfaction with service delivery and outcomes
 

MODEL IMPLEMENTATION:

To a certain extent, many elements of this model are already in place. Some communities are already providing high quality, effective services and it is very important that these services be maintained. The difficulty is that there is no mandate to ensure that the services are provided to every community, and there is inconsistency across the province. OAFCCD is, therefore, asking for the following steps to be taken to enable the development of a province-wide comprehensive speech and language service.

1. The provision of speech and language services must be mandated through legislation or required through regulations.

2. To avoid duplication and eliminate gaps, the provision of services should be organized as follows:
 

• The Ministry of Health should continue to take the lead, through the Preschool Speech and Language Initiative, with the provision of preschool services.

• The Ministry of Community and Social Services should take responsibility for all children in Treatment Facilities and Detention Centres, or other MCSS funded programs.

4. Funding for speech and language services is currently provided by three Ministries; the Ministry of Education and Training, Ministry of Health, and Ministry of Community and Social Services. This funding should be protected through designation for speech and language services only. This funding should be consolidated and directed to the responsible Ministry.

5. A funding ratio for speech and language pathology services should be established. The province of British Columbia has a ratio of 1:1500 for school speech and language pathology services and this ratio is recommended for Ontario. (In 1997, the best ratio in Ontario was 1:2250 and this should be the immediate goal for all school boards - See OAFCCD "OAFCCD Service Delivery Model Analysis on School Speech-language Pathology Ratios and Costs" April 1998). The ratio will need to be even lower in rural and northern areas, where travel between schools is difficult or time consuming.

6. Agencies and school boards that are responsible for the provision of speech and language services should be provided adequate designated funding to meet the minimum SLP ratio and provide a full range of intervention service options.

7. Mechanisms should be developed to monitor the services and ensure that all children across the province have access to speech and language services. It is important that community agencies work together to coordinate service delivery, minimize fragmentation, and ensure seamless transitions.
 

Conclusion:

OAFCCD believes it is important that speech and language services are available to all children. Providing these services to children has important benefits for both the children and the community as a whole. The child is better prepared to be a contributing member of society, and the community is saved the costs of dependency and potential delinquency.

OAFCCD looks forward to working with representatives of the government, professional organizations and our community partners as we all strive to provide high quality speech and language services to the children of Ontario.
 

SUPPORT DOCUMENTS:

OAFCCD Key Issues, May 1999

"Support for Speech and Language Services in Educational Settings" by Genese Warr-Leeper, Professor, University of Western Ontario

OAFCCD " Provincial Model of Speech and Language Service Delivery for Children (April 1996)"

Ontario Association of Speech-Language Pathologists and Audiologists, "Speech-Language Pathology Services in Ontario Schools", 1996

"A Continuum of Speech and Language Services Will Enhance Educational Outcomes", March 1998

"OAFCCD Service Delivery Model Analysis on School Speech-Language Pathology Ratios and Costs", April 1998

Fact Sheet "Did You Know That...." by Genese Warr-Leeper, University of Western Ontario, 1994

"Inter-Agency Coordinations Subgroup, Advisory Council on Special Education" Report to Minister's Advisory Council on Special Education, June1997