Norfolk Primary Care Trust, Norwich, UK.
Int J Lang Commun Disord. 2010 Mar-Apr;45(2):182-203. doi: 10.3109/13682820902836286.
Sure Start has been a flagship policy for the UK Labour Government since 1998. Its aim was to improve the life chances of children under five years of age who live in areas of socio-economic disadvantage by means of multi-agency, multidisciplinary Sure Start Local Programmes (SSLPs). Speech and language therapists have played a key part in many SSLPs, and have had the opportunity to extend their roles. Despite the scrutiny paid to Sure Start, there has been no comprehensive analysis of speech and language therapists' contribution to date. Studies have focused on individual programmes or small samples: there has been no attempt to collate the full range of practice. As Sure Start evolved and Children's Centres emerged, it became vital to learn from the Sure Start experience and inform the mainstreaming of practice, before the window of opportunity closed.
The survey aims were, firstly, to identify the range of practice amongst speech and language therapists working in SSLPs, highlighting new practice, and, secondly, to categorize the practices according to the tiered model of UK health and social services of the Royal College of Speech and Language Therapists (RCSLT 2006).
METHODS & PROCEDURES: An online mixed-method, semi-structured survey was designed to elicit primarily quantitative and categorical data. A total of 501 Sure Start Local Programmes were invited to take part. A total of 128 speech and language therapists responded, giving a response rate of 26%. A descriptive analysis of the response data was undertaken.
OUTCOMES & RESULTS: A total of 103 respondents (80%) reported maintaining a clinical role as well as extending their roles to include preventative services. Of those 103 respondents, 69% were able to see referred children at a younger average age and 80% saw them more quickly than before Sure Start. A wide variety of preventative practice was identified. A widening of access to speech and language therapist was reported in terms of venues used and hours offered. Respondents reported on their use of evaluation or outcome measures, which was at a higher rate for new practice than for established practice. A total of 121 respondents (95%) reported at least one example of new practice; 103 (80%) reported at least one use of evaluation or outcome measures. The tiered model of UK health and social services provided an effective way of categorizing practice.
CONCLUSIONS & IMPLICATIONS: A categorized record of Sure Start speech and language therapist is presented that may contribute to establishing a broad curriculum of practice for speech and language therapist in the early years. The effectiveness of the practices is not investigated: suggestions are made for further research to develop the evidence base.
自 1998 年以来，“起点”计划一直是英国工党政府的旗舰政策。其目的是通过多机构、多学科的“起点”地方计划（SSLPs）改善五岁以下生活在社会经济劣势地区的儿童的生活机会。言语治疗师在许多 SSLP 中发挥了关键作用，并获得了扩展其角色的机会。尽管对“起点”计划进行了审查，但迄今为止，还没有对言语治疗师的贡献进行全面分析。研究重点是个别计划或小样本：没有试图整理实践的全部范围。随着“起点”计划的发展和儿童中心的出现，在机会之窗关闭之前，从“起点”计划中吸取经验并为实践的主流化提供信息变得至关重要。
该调查旨在首先确定在 SSLP 中工作的言语治疗师的实践范围，突出新的实践，并其次根据英国皇家言语治疗师学院（RCSLT 2006）的分层模型对实践进行分类。
设计了一项在线混合方法、半结构化调查，以主要征集定量和分类数据。共有 501 个“起点”地方计划受邀参加。共有 128 名言语治疗师做出回应，回应率为 26%。对回应数据进行了描述性分析。
共有 103 名（80%）受访者报告维持临床角色，并将其角色扩展到包括预防服务。在这 103 名受访者中，69%的人能够以更年轻的平均年龄看到转介的儿童，80%的人比“起点”计划之前更快地看到他们。确定了各种预防实践。在使用场所和提供的时间方面，报告称获得言语治疗师的机会有所增加。受访者报告了他们对评估或结果措施的使用情况，对于新实践而言，其使用率高于既定实践。共有 121 名（95%）受访者报告了至少一个新实践的例子；103 名（80%）报告了至少一个使用评估或结果措施的例子。英国卫生和社会服务的分层模型提供了一种有效的分类实践的方法。
提出了一份经过分类的“起点”计划言语治疗师记录，这可能有助于为早期的言语治疗师建立广泛的实践课程。实践的有效性没有被调查：建议进一步研究以发展证据基础。
