Moor House School & College, Oxted, UK; Division of Psychology and Language Sciences, University College London.
Faculty of Social Sciences, University of Stirling, UK.
Int J Lang Commun Disord. 2019 Jan;54(1):3-19. doi: 10.1111/1460-6984.12387. Epub 2018 Apr 25.
Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs.
To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making.
METHODS & PROCEDURES: Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted.
The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored.
CONCLUSIONS & IMPLICATIONS: SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.
儿科言语治疗师（SLT）的角色通常涉及为特定儿童规划个性化干预措施，与家庭和教育工作人员协作，提供建议、培训和指导，并提高认识。目前建议采用分层服务提供方法，以便为有更大需求的儿童提供越来越专业化和个性化的服务。
通过检查（1）不同层次语言障碍儿童干预的有效性证据和（2）这些层次中的 SLT 角色，来激发关于 SLT 服务提供的讨论，并提出基于证据的 SLT 服务提供模型和流程图以辅助临床决策。
讨论了针对语言障碍儿童的干预措施的元分析和系统评价，以及在最近没有系统评价的情况下进行的对照、同行评审的小组研究，同时还讨论了 SLT 在这些干预措施中扮演的不同角色。突出了证据基础中的差距。
提出的服务提供模式类似于教育服务中常用的分层模式，但将个性化（第 3 层）服务分为第 3A 层：由非 SLT 提供的间接干预，和第 3B 层：由 SLT 提供的直接干预。我们报告了干预有效性的证据，说明每个层次最适合哪些儿童，SLT 可以在每个层次中扮演的角色以及这些角色的有效性。关于向所有儿童提供的普遍干预措施（第 1 层）和针对语言薄弱或有缺陷的儿童的针对性干预措施（第 2 层），越来越多的证据表明，当工作人员经过高度培训和良好支持时，由教育服务主导的方法可以有效。目前关于第 1 层和第 2 层的 SLT 特定角色的额外益处的证据有限。关于个性化干预（第 3 层），复杂或广泛的语言障碍儿童可以在接受直接个性化干预（第 3B 层）后取得进展，而语言障碍较轻或较少的儿童在干预由 SLT 管理但由其他人间接提供（第 3A 层）时也可以取得进展，如果他们接受过良好的培训和支持，并受到密切监测。
SLT 在所有层次都有贡献，但在临床服务优先排序成为必要的情况下，我们需要确定每个层次的相对益处和成本效益。有充分的证据表明 SLT 可以提供直接的个性化干预，我们应该确保为广泛和/或复杂语言障碍的儿童提供这种服务。在提供缺乏证据的服务模型的情况下，我们强烈建议 SLT 调查其方法的有效性。
