B. Cobertura terrestre
2. Cobertura terrestre dentro del Área Natural Protegida
This study aimed to explore the views of communities who were perceived by speech and language
therapy services to be‘underserved’ by their service. The communities identified included carers of
looked-after children, minority ethnic groups and families of low SES. The views of these communities on speech and language development and engagement with services were explored using focus groups that
were held with established parent groups and which were accessed with the support of Barnardo’s. A
thematic framework was used to analyse the data, which revealed themes, both within and between the
communities. The data suggest that, although parents were confident about how to support children’s
language development, they were less informed about the nature of speech and language impairments and the function of speech and language therapy.
Research questions
1. What are the beliefs about development, delay and disorders of speech and language of people from groups who are perceived by speech and language therapy service professional leads to
be underserved?
2. What are the reported practices of these people with respect to the development, delay and disorder of speech and language in their children?
Methodology summary
A summary of the methods is provided in Figure 20; the methods are described in detail in Chapter 1 (see Methodology overview).
Investigating views of underserved groups
SLT leads at the six case study sites were asked to identify groups within their geographical areas that could be considered to be ‘underserved’ by the SLT service
Underserved groups:
• carers of looked-after children (two focus groups; n = 11, n = 9) • people from minority ethnic groups (two focus groups; n = 9, n = 11)
• families from areas of low socioeconomic status (two focus group; n = 4, n = 5) Participants were recruited from pre-established parent groups in the
underserved communities and focus groups were undertaken with the support of gatekeeper/participation workers. The focus groups explored: • language development and environment
• signs of SLCD
• causes of speech, language and communication difficulties • responses to concerns about speech, language and communication difficulties/child with PSLI
Data were analysed using thematic framework analysis See Chapter 1, Early years practitioners
Findings
Following the familiarisation stage of the analysis, and using the a priori issues from the research questions, a thematic framework was developed. Data were charted using this framework and the characteristics of each theme were identified. The findings are presented for each focus group separately. A final stage of analysis looked across the groups with regard to each of the main themes.
Carers of looked-after children
Two focus groups were held with carers of looked-after children. Participants in the first group were part of
a local authority group based in the north-east of England (n= 11; one male, 10 female) and participants
in the second group were engaged with an independent fostering agency in the south-west of England
(n= 12; two male, 10 female). The length of experience of fostering ranged from 18 months to 8.5 years
(mean 4.3 years). A number of the carers also had their own biological children. The report of the discussion from this group is presented in terms of the key themes identified in the group discussion.
Language development and environment
The carers described the children who they cared for as typically receiving little language input before being placed with foster carers, children who had been previously discouraged from speaking and/or who tend to regress when they have contact with their birth parents. The carers described the strategies that
they use to facilitate children’s language development. Their ideas were not novel, for example start early,
keep talking, singing, don’t criticise and encourage socialisation and engagement. They described the
efforts that they made to try and support the development of social/pragmatic communication skills with children who have lacked previous opportunities to develop important communicative functions, for example learning to argue, contradict and interact:
They don’t get the opportunity to develop that skill, um not necessarily a debating skill but a
conversational skill where it can be safe to disagree.
F1078 It is not clear if the carers see this as a speech and language difficulty per se. Hence, there is an overlap between actions that facilitate language development and their responses to what they consider to be speech and language concerns. They emphasised how quickly children progress when they are with adults who talk to them and provide one-to-one input.
Signs of speech, language and communication difficulties
The signs that the carers mentioned seemed to reflect their experiences of children who had been taken into care, for example a lack of attempts to communicate or adults not engaging with children:
It’s just not natural human behaviour for a small child not to want to babble.
F1078 Causes of speech, language and communication difficulties
Similarly, when giving their views on the causes of speech, language and communication difficulties, these seemed to reflect their experiences of children who had lived in atypical environments, for example children who are neglected, lack adult input, lack experiences, have a reduced need to communicate and have a lack of language input. They considered that previous discouragement from speaking impacts
negatively on children’s language development:
There are a lot children who are fostered, I think a lot of it’s the same, either they’ve been ignored,
nobody asking their opinion, nobody’s wanted their opinion. And all these signals come from every
different direction.
Responses to concerns about speech, language and communication difficulties
The carers frequently described children whose language environment before being taken into care was
less than optimal. As already mentioned, when they described supporting these children’s language they
did not always describe a clear difference between what they provided for children with delayed language
and what they provided for all children coming into their care. They described‘talking all the time’,
discouraging others from talking for the child, using picture cards and games, reading and singing. There seemed to be a lack of agreement about whether help would be sought sooner if the child had other difficulties or if the speech/language delay was an isolated concern. Some also described supporting children without accessing support from speech and language therapy services:
For me it would only be something that I couldn’t deal with so if it was a child stuttering or
stammering and tell them to slow down and listen no matter how long it takes. I haven’t had a need
to go seek other professional help.
F1083 Other issues
Carers made suggestions including speedier access to speech and language therapy, assessment in the home, awareness of previous experiences and consideration of the gender of the SLT:
Even the difference between a male therapist and a female therapist could make a huge difference. F1083
In their view some professionals lack understanding of looked-after children’s possible experiences and
speech and language challenges.
Carers described working to facilitate the language development of the children in their care. They seemed to recognise specific types of difficulties that children might experience based on their previous, less than optimal environment.
It is possible that carers have different views on what constitutes a significant enough problem to merit involvement from SLTs, with their views being tempered by their knowledge that looked-after children have previously experienced environments that may not have been conducive to language development
and that they may well‘catch up’ when they are in a more positive environment.
Minority ethnic groups
Three focus groups were held with two different minority ethnic groups. The first was a support group for
the Somali community based in south-west England (n= 9; all female). The research team met with this
group twice to collect data. The second was a group for RAS based in north-west England, which was
accessed through Barnardo’s (n = 11; all female). All of the participants were first-generation immigrants
to the UK of African descent, some of whom were refugees or asylum seekers (it was not considered appropriate to collect specific data regarding their status/background).
These were group discussions and, in two of the groups, not all participants spoke or understood English fluently. In these cases other group members acted as informal translators and appeared to summarise the group discussion in response to specific questions posed by the interviewers. It was therefore difficult to capture consensus compared with diversity.
Somali support group
Language development and environment Ideas about typical speech and language development (ages
eating with children, keeping the child close to the mother, children talking to each other, lots of eye contact, singing and talking to babies and using actions to support spoken language. Television was viewed as a positive aspect of the communication environment:
Mum is start talking to the baby cause the baby doesn’t understand, that’s how it develops.
EM0101
Causes of speech, language and communication difficulties The group described and appeared to
agree on two types of causes, which appear to be broadly intrinsic and environmental. There was specific description of the apparently high incidence of autism among this community.
Agents that were mentioned as possible causes of speech, language and communication difficulties included injections, air pollution, global warming (because of wars), the English weather, learning two languages and a lack of organic, fresh food:
She believe that the problem we have with children speech is that, children that can’t talk, is because
of the war, the food we eat, and the weather.
EM0102 It was mentioned that the reason for a particular child being affected by one of these agents was because
of‘God testing’ parents by giving them a child with a disability; also mentioned was the possibility that
having a child with a disability was a punishment for sins. However, the group members agreed that
mothers’ behaviour did not cause PSLI and no sense of guilt was expressed:
That is right no guilt, it comes from God and you just try your best and then if it doesn’t work then
that is it. We always think that anything comes to us, if you are sick or your child is sick, or anything
happen in your life, you have to accept because you don’t, we don’t question.
EM0202
Signs of speech, language and communication difficulties When talking about children with speech
and language difficulties there were few signs that were agreed on, although the participants mentioned frustration, lack of concentration and deafness. The age at which lack of speech would elicit concern varied from 6 months to 2 years, with comments also relating to experience of family members who started to talk much later:
Then you can start worrying, but then again we are in denial because they say that your grandfather didn’t talk until he was 6 years old.
EM0101
Responses to a child with primary speech and language impairment Responses included both
medical and non-medical approaches. Typically, a mother may take her child to the general practitioner or health visitor. The child may also be taken to the mosque at the same time as or before being taken to the health-care practitioner. At the mosque the parent may receive instructions from the imam, passages
from the Qor’an may be read over the child or over water/honey that is then given to the child or the child
may be prayed over. Neighbours will be consulted about their experiences and advice sought:
We have a saying that‘100 people will advise you when you are sick’.
EM0202 In response to specific questions, participants agreed that cutting of the lingual frenulum occurred and
that honey that has been blessed by the imam may be given to the child to‘taste’. This group also
reported that they might consult doctors outside the UK. One person described being told that a tablet could be given to a non-speaking child as a cure/treatment. There did not seem to be agreement about if
a child would be hidden from other community members if he or she had communication difficulties or if the mother would be in denial about the child’s difficulties. To help a child with a disability (they did not always specify PSLI) they suggested that:
She will always support him and bring him what he wants and so for example he is playing with a toy and it rolls away, she will always support him in getting what he wants.
EM0102 Suggestions for supporting language comprehension when a child has difficulties included signing and using body language.
Other issues This group also described the things that would encourage families to feel positive about
health-care professionals in general (and they were asked if these would apply to SLTs). This included the use of appropriate body language (facial expression, shaking your hand), taking care to ask families for their views and parents feeling that the health-care professional is the expert and that is the reason for consulting him/her. However, they also felt that health-care professionals did not spend sufficient time assessing a child. Refugee/asylum seeker group
At this focus group a fictitious case study was used to stimulate discussion (see Appendix 31). The group divided into two groups for discussion. Most of the women spoke English reasonably fluently but the facilitators felt that a small number struggled to understand fully.
Language development and environment The participants considered the following to be important in
facilitating language development: reading with, and talking to, a child, telling stories, imitation, not using ‘baby talk’, interacting with small babies, singing, a big garden, trips out and providing toys. There were mixed views about the impact of television:
It’s due to us as parents to encourage talking to the children, to prompt them to start talking early,
things like reading them books, telling them stories. Even, even, they say children don’t really
understand, but it’s not like when you spend time with them like reading the books or anything, it’s
not like it’s a waste of time. They still do pick up a few things.
EM03
Causes of speech, language and communication difficulties Intrinsic factors were mentioned, such as
genetic causes, prematurity, inability to lift the tongue, laziness, being a‘slow learner’ and prenatal
maternal alcohol consumption.
In terms of environmental factors there was some discussion about the social context of this community in the UK, for example small, fractured families; stressed, withdrawn, isolated or depressed mothers who may not talk to their children a great deal; tension at home; exposure to multiple languages; and bewitchment:
. . . it could be like the mother’s depressed and the mother is not even having time to spend time to
read to her, to spend time to, to help her with anything at all so probably could be an issue.
EM03
Signs of speech, language and communication difficulties One participant reported on a traditional
view that if a child cries for its mother‘ma ma ma ma’ it means that there is something wrong but if it
cries for its father‘da da da’ then there no significant problem.
Parents would be concerned if the child was not talking (even when at nursery), was not making any sounds or did not understand language. The point at which they would be concerned varied and there was some suggestion that communicative behaviours that would be a cause for concern in the UK would
Responses to a child with primary speech and language impairment One participant suggested that time should be spent with a child before identifying a concern and that parents should watch and try to
help their child. Participants also mentioned talking to their own mother, a‘spiritual man’ or a pastor.
There were varying views about whether or not to seek advice from a doctor, partly related to whether or not the difficulty arose in their country of origin, where they report that it is more likely that people will wait for a child to mature. They also reported that lack of speech may not be given priority as is it not seen
as a‘sickness’. Isolation was considered to have a detrimental effect on help seeking for this community in
the UK, together with a limited understanding of UK services, which may limit interactions with and responses to services:
We don’t know how this country runs, we don’t know anywhere where to get advice, you don’t know
whom to ask it.
EM03 In terms of specific interventions, participants suggested saying words for the child to repeat. One participant described how her own grandmother told her to stop stammering and hit her. Another participant reported that stammering is not viewed as a serious problem.
Other issues There appeared to be varied knowledge of and degrees of trust of professionals among
this group.
Summary of the data from minority ethnic groups
These two groups of women from minority ethics groups, all of whom were African and many of whom were RAS, gave a range of views about speech and language development, delay and interventions. They provided some previously unreported ideas about the causes of language delay, such as global warming and prenatal maternal stress.
Their responses to concerns about speech, language and communication included professional, religious and community responses as well as direct intervention with their child. Lack of confidence in professionals
and/or lack of awareness of professionals’ roles may be significant. Views about television were not
unanimous and positive views may in part be linked to mothers’ perceived lack of proficiency in English.
The responses of these two groups of women from minority ethnic groups suggest that there may be some translation issues. Additionally, as only two small groups of participants were included, these data should be treated with caution; however, this may indicate an area that merits further investigation. Families from areas of low socioeconomic status
Two focus group were held (n= 4 and n = 5) with parents from an established group for young mothers
in an area of low SES in the north-west of England. This group was accessed through, and is run by,
Barnardo’s. All participants were mothers of children aged between 6 months and 2.5 years and so
unsurprisingly the discussion focused more on younger children. One parent reported having training in childcare.
Language development and environment
The groups did not add any novel ideas about language development that have not been reported elsewhere in previous research. The participants described a number of positive influences including imitation and repetition (by the child). Talking to and reading to their child (including bedtime stories) was emphasised. Not asking questions was mentioned as something that they had been told by a SLT. Adults viewed using exaggerated intonation positively:
The way you say things helps‘em remember the words.
Fathers were considered to sometimes lack appropriate interaction with young children and babies:
He just reads the story like he’s reading the paper.
LSES1 06 One group talked much more explicitly about play. Some considered that playing alone had positive benefits. Singing was discussed by one group: