APPENDIX 12
Memorandum from the Association for all
Speech Impaired Children (AFASIC) Northern Ireland
I hope that your committee will be willing to
accept a submission from us on behalf of children in Northern
Ireland who suffer from Speech and Language Impairment. I realise
that we are a few days late in getting our submission to you:
this has been caused by our need to collect some information to
help justify our point of view and by our inexperience in producing
such a document. As we are a new organisation we did not have
the information we needed to hand.
I trust that the format and content of our document
is along the lines which your Committee expects and is used to
receiving. As parents, this is the first time we have attempted
anything of this nature and are consequently working in the dark.
I should be interested to hear any pointers or criticisms you
may have. Needless to say if any clarification or further information
is required we would be keen to try to provide it.
CONTENTS
1. Background information on AFASIC NI
2. Collection of Evidence
3. Definition of Speech and Language Impairment
4. Incidence of Speech and Language Impairment in
Northern Ireland
5. Responsibility for providing help in Northern
Ireland
6. Educational Provision for Speech and Language
Impaired children in Northern Ireland
7. Conclusions
8. Recommendations
9. Bibliography and references
Annex 1. Information obtained from Education and
Library Boards
Annex 2. Information obtained from Health and Social
Services Boards
Annex 3. Information obtained from Speech and Language
Schools/Units
BACKGROUND INFORMATION
ON AFASIC NI
AFASIC (Association For All Speech Impaired
Children) was founded in England in 1968 as a parent led organisation
to help children and young people with speech and language impairments,
and their families. AFASIC provides information for parents and
professionals and produces a range of helpful publications. AFASIC
organises conferences and workshops throughout the year. Members
meet in local groups in many areas of the UK. Today AFASIC is
one of the UK's top 500 voluntary organisations, recognised as
an authority in its field and working in partnership with other
established and respected organisations.
The Northern Ireland group was formed in November
1997 following a public meeting called by Brian Hamilton, a parent
concerned at the lack of help available for his son at secondary
school level. The meeting was addressed by Tony Curtis, the National
Development Officer of AFASIC, and was attended by over 100 concerned
parents and professionals.
The Northern Ireland branch of AFASIC is in
the early stages of its life, organising activities for the year,
raising funds so that we can get off the ground and publishing
the first edition of our newsletter as a means of passing information
and advice to the parents of affected children in Northern Ireland.
We also arranged for Madeleine Starr, the Chair of AFASIC, to
make a presentation to the Northern Ireland Forum for Political
Dialogue, Education Committee, in December 1997.
We have identified the need for research to
be carried out into speech and language impairment in Northern
Ireland, as between the four Health and Social Services Boards
and the five Education and Library Boards in Northern Ireland,
there does not seem to exist a set of statistics relating to this
field for the whole of Northern Ireland. We are currently approaching
the National Lottery Board to obtain finance to investigate the
gap between the level of incidence and the range of educational
facilities provided. Your request for information regarding the
level of expenditure has therefore caught us at the point of identifying,
from anecdotal parental evidence, that a problem exists with the
amount of educational support available, and actually carrying
out research to prove this gap empirically.
This report therefore relies on national averages,
backed up by a limited range of information which we have gathered
from sources in Northern Ireland very quickly. We trust that it
is sufficient to make you aware that not enough provision is made
for these children and that money needs to be spent to give these
children a meaningful standard of education.
COLLECTION OF
EVIDENCE
AFASIC NI only became aware of the Committee's
investigation into Special Needs Education on the 12 March 1998.
As you had requested a reply by Friday 3 April 1998 we had very
little time to gather any in-depth evidence. The steps which we
took were:
(A) We contacted all five Education and Library
Boards with the request for a range of figures. One board, the
North-Eastern Education and Library Board, replied answering only
seven of the sixteen questions which we asked. They have not provided
information as to numbers affected by speech and language impairment,
the numbers in special schools and the numbers on waiting lists.
The South-Eastern Education and Library Board and the Southern
Education and Library Board replied answering all questions asked.
The Western and Belfast Boards had not replied at time of writing.
A sample of the letter sent to the boards, along with the replies
from the North-Eastern Board, the South-Eastern Board and the
Southern Board can be found in Annex 1.[5]
(B) We contacted all four Health and Social
Services Boards with a request for statistics. All four Boards
replied. A sample of the letter sent to the Health Boards, along
with their replies can be found in Annex 2.1 Unfortunately, each
Board defines and collects its data in a different manner and
we were unable to use most of the information provided.
(C) We wrote to the Principals of the ten
schools in Northern Ireland which provide education to children
with speech and language impairment. We asked a range of questions
and gave them the opportunity to express views which might not
otherwise be heard. Three of the schools replied in writing, a
fourth replied by phone (notes taken at the time of the conversation
are enclosed), one was unable to reply due to illness, one was
unwilling to reply stating that all information could be obtained
from the Education and Library Board (who, in fact, did not reply)
and nothing was heard from the remainder. Annex 31 contains a
sample of the letter of request, along with replies received.
(D) We used some of the evidence provided
in Madeleine Starrs' presentation to the Education Committee of
the Northern Ireland Forum for Political Dialogue.
DEFINITION OF
SPEECH AND
LANGUAGE IMPAIRMENT
There are some children for whom speech and
language does not develop as expected. They may experience difficulties
with any or all aspects of speech and language—from moving
the muscles which control speech, to the ability to understand
or use language at all. Different categories of impairment can
include phonological or articulatory difficulties (including oral
dyspraxia); expressive difficulties (including sequencing and
word findings); receptive difficulties (comprehension); semantic/pragmatic
difficulties (understanding and using language appropriately,
social interaction). Sometimes these difficulties are unrelated
to any other difficulty. Sometimes they are related to physical
difficulties or general learning difficulties. Some children may
have both a specific language difficulty and other disabilities.
Communication difficulty can be broken down
into two groups—that which is an outcome of a physical or
intellectual difficulty, such as cerebral palsy or Down's Syndrome,
and that which stands alone and may be said to be a primary or
specific impairment.
Within the range of primary or specific impairment,
it is possible to identify a continuum or spectrum of need, from
dyslexia at one end of the scale to autism at the other. Within
this spectrum is a group who can be said to have a specific language
impairment (SLI), some of whom will share characteristics with
those with dyslexia and others with those with autism. It is this
group "in the middle" which is AFASIC's primary concern.
The criteria for admission to the schools which
replied to our request for information demonstrate this. In general,
the children will have intelligence within the range found in
a mainstream classroom, no other emotional or behavioural problems
and a significant difference between their performance and verbal
IQs.
Parents are usually the first to recognise that
their child may have a difficulty. A study by AFASIC in 1993 reported
that in 83 per cent of cases parents were the first to notice
their child's communication difficulties, often before the advent
of intelligible speech (reference 5). All professionals should
be taught to respect the initial concerns of parents, whose anxieties
are very often justified.
INCIDENCE OF
SPEECH AND
LANGUAGE IMPAIRMENT
IN NORTHERN
IRELAND
There is currently no one body of knowledge
to enable us to identify the group of children suffering from
SLI clearly, and no clear differentiation between disorder and
delay. However, it is generally accepted, using the most recent
statistical surveys, that there are in the region of 250,000 pre-school
children with SLI, and a further 250,000 school-age children with
SLI in the UK. There is no reason to suppose that these statistics
do not apply equally well to Northern Ireland. This would give
us figures of 6,000 pre-school children and 6,000 school-age children
with speech and language impairment in the Province. In a recent
research project in inner city Belfast, 60 per cent of a sample
group of nursery children (age three to four years) presented
with mild to severe language delay. (reference 3)
In terms of severe, specific, long-term SLI,
which will persist into adulthood and require long-term provision,
the figure we currently work to, and which is generally accepted
by professionals in the field, is 0.2 per cent (Professor David
Hall, reference 2). Based on 1996 figures, there will therefore
be 706 school-age children in Northern Ireland with severe, specific,
long-term SLI.
Can these figures, which have been arrived at
by applying national rates of incidence, be justified? Look at
the returns which have been given by the Health and Social Services
Boards (Annex 2).[6]
Note, that of the Boards which returned figures in the time allowed,
there is a variation in the terms and categories used, with little
specific detail of children with SLI as their primary disability.
The one exception is Foyle Health and Social Services Trust (one
of three trusts in the Western Board). In their covering letter
they state "The number of children detailed on the attached
information in Community Clinic, Severe Language Impairment and
Hearing Impairment would have speech and language impairment as
their sole or primary impairment.". These figures are:
| | |
| |
| Speciality | Current | Waiting List for Assessment
| Waiting List for Treatment | Totals
|
| | |
| |
| Community Clinics | 287 |
45 | 640 | 972 |
| Severe Language Impairment | 161
| 12 | 153 | 326
|
| Hearing Impairment | 51 |
0 | 14 | 65 |
| | |
| |
| Totals | 499 | 57
| 807 | 1,363 |
We realise that this is a very crude form of evidence, but
it is all we have—in fact, in the absence of detailed research,
it is all anyone has. The fact that one trust, in one board, has
identified 1,363 children as having speech and language as their
only or primary disability seems to support the statistical figure
of 12,000 for the whole of Northern Ireland. What is striking
is the figure of 326 children having been identified as having
severe language impairment. From this we could say that perhaps
the statistical figure we arrived at earlier of 706 for the whole
of Northern Ireland is conservative! Even more striking is the
comparison of numbers receiving treatment—499—to the
numbers waiting for treatment—807.
RESPONSIBILITY FOR
PROVIDING HELP
IN NORTHERN
IRELAND
Despite the importance of speech and language therapy for
children and young people with speech and language impairments,
the legal responsibility for providing this therapy remains unclear.
A Code of Practice for the Identification and Assessment of Children
with Special Educational Needs will be introduced into Northern
Ireland in September 1998. A draft copy of the Code of Practice
has been in circulation for some time and many of the provisions
have already been put in place by the Education and Library Boards.
The Code of Practice states that while the prime responsibility
for provision of speech and language therapy to children with
special educational needs rests with the Health and Social Services
Boards, the ultimate responsibility rests with the Education
and Library Boards.
"where speech and language therapy for a child whose
statement specifies such therapy as educational provision is not
provided by a health authority, ultimate responsibility for ensuring
that the provision is made rests with the Board (Education and
Library) unless the child's parents have made appropriate alternative
arrangements" Draft Code of Practice on the Identification
and Assessment of Special Educational Needs. Department of Education,
Northern Ireland, 1996. (S4:29)
Health and Social Services Boards have an absolute right
in law to refuse to provide speech and language therapy for a
child who needs it, if they claim the financial inability to do
so. Education and Library Boards have no such right, but, as recently
as 1996, the education authority in the London Borough of Harrow
unsuccessfully took court action against the local health authority
over its failure to provide speech and language therapy for a
child who needed it.
Authorities seeking to avoid responsibility for providing
speech and language therapy sometimes still argue that it is a
non-educational provision, and therefore the responsibility of
the health authorities. However, the fact that therapy is more
often than not provided by health does not make it a non-educational
provision.
"We do not see how to teach a child to communicate by
speech can be any different from teaching him to communicate by
writing, both are clearly educational." The Lancashire
Judgment. (R v Lancashire County Council ex parte CM 1989)
"occasions when LEA's could determine that speech therapy
constitutes non educational provision are now likely to be rare"
Department for Education, 1993
"Speech therapy for statemented children who are unable
to progress with their education and who have a communication
difficulty is a special education provision. Although LEA's are
still entitled to look, in the first instance, to DHA's (District
Health Authorities) for the provision of speech therapy, if the
DHA is unable to make this provision, it must still be secured
by the LEA" Under Secretary of State for Health, December
1993
"LEA's are obliged to accept the responsibility of providing
speech therapy if specified in a statement (Section 3) where the
health authority will not or cannot do so" Local Government
Ombudsman 1995
Therefore, the situation that exists is that the Education
and Library Boards have the responsibility of providing speech
and language therapy for children with special educational needs,
but the Health and Social Services Boards are actually providing
the service—and this includes the funding. We feel that,
as an acknowledgement of their responsibility to provide speech
and language therapy, the Education and Library Boards should
be provided with the financial resources to purchase such therapy
from the Health and Social Services Boards. This is the situation
in Scotland, where new monies were given to local education authorities.
EDUCATIONAL PROVISION
FOR SPEECH
AND LANGUAGE
IMPAIRED CHILDREN
IN NORTHERN
IRELAND
Most children learn how to communicate by using language
which they learn as a natural process at their mother's knee.
Armed with this skill, they go to nursery school, then primary
school, where the state begins to educate them in reading, writing
and maths, amongst other subjects. Children who do not have language
will not be capable of this natural progression, as they will
not understand what is happening in the classroom and will not
be able to communicate back to the teacher. For the teacher, the
task could be compared to trying to teach, in English, a child
who can only communicate in French. The child must first be taught
language before anything else. The teacher in a mainstream class
of 20 to 30 children has neither the skill nor time to do this.
The specialists who teach language to these children are the speech
therapist, and the SEN teacher who has been trained to deliver
an integrated language package in conjunction with the speech
therapist. Their services are not available in mainstream schools.
Therefore, to have a meaningful education, the child must attend
a speech and language school or unit. Specialist help, which is
not normally available in a mainstream school, constitutes special
educational needs. Any child requiring special educational needs
must have their needs assessed, and they must have the protection
of a statement of special educational needs. From our contacts
with parents throughout the Province it is clear to us that many
children with speech and language impairment have neither specialist
help nor a statement.
What are the range of educational facilities available to
children with speech and language impairment in Northern Ireland?
There is one school—Thornfield House—which caters
solely for children with SLI. It covers Key Stage 1 to 4. In fact,
it is the only provision for Key Stages 3 and 4 in the Province.
It has places for 76 children, of which only 10 to 15 will be
Key Stages 3 and 4.
There are nine speech and language units attached to mainstream
schools:
Carrick Primary School, which has places for 10 children
in Key Stage 1 only, Enniskillen Model Primary School, which has
places for 18 children in Key Stage 1 and 2.
Gibson Primary School, which has places for 10 children in
Key Stage 1 only. Ballygolan Primary School, which has places
for 20 children over Key Stages 1 and 2. Greenwood House Primary
School, which has places for 20 children over Key Stages 1 and
2.
Killard House Primary School, which has places for 27 children
in Key Stage 1 only. Knockmore Primary School, which has places
for 24 children in Key Stage 1 only. Belmont House Primary School,
which has places for 18 children in Key Stage 1 only. St. Francis
De Sales School for the Hearing Impaired, which has places for
20 children over Key Stages 1 and 2.
All of these schools/language units are very good—we
do not dispute the expertise or dedication of the staff involved
in these units, but if you add up the above provision you arrive
at a total of 243 places, mostly in Key Stage 1 and with only
10 to 15 places in Key Stages 3 and 4. Compare that to the demand
which we have earlier identified as being 6,000 school age children
with speech and language impairment, of whom 706 will have problems
that persist into secondary level and beyond.
Let me emphasise this:
243 places for 6,000 children
10 to 15 places for 706 children
We realise this is a very crude comparison but it does highlight
the scale of the problem. There needs to be a dramatic increase
in the number of special school places for children with speech
and language impairment.
We are sure that you are as shocked by this comparison as
we are and that you would want to know if there are any indicators
to back up this analysis. The following have been extracted from
the replies I received to my requests for information for this
report.
— Southern Education and Library Board—74
children with SLI as their primary disability, only 10 places
in their language unit, though they claim only five on the waiting
list for the unit. No outreach programme to support children with
SLI in mainstream schools.
— South-Eastern Education and Library Board did
not supply this information and the Western and Belfast Boards
had not replied at time of writing.
There does seem to be a large number of children identified
as having SLI as their primary disability in each of the two board
areas who supplied figures, compared to the number of special
school places available. We would query why, with such a large
discrepancy apparent in each Board, the waiting lists for admission
to the units are so low? Speech and language therapy is not available
in mainstream schools. As language precedes literacy, it is unlikely
that any child with SLI will be able to access the curriculum
and everyday educational facilities at a mainstream school. Therefore
these children require specialist provision in a language unit
or school where they can receive intensive speech and language
therapy, and where the teaching is language-intensive. That being
so, why are there not 327 children on the waiting lists for the
two language units in the South-Eastern Education and Library
Board and 64 on the waiting list in the Southern Education and
Library Board? We would also ask what is happening to these children,
considering that one Board operates no outreach support and the
other a limited programme supported by only two teachers?
CONCLUSIONS
In the limited time available to us we have been unable to
provide extensive, statistical proof of our contention that the
quantity of special needs education available for children with
speech and language impairments is woefully inadequate in Northern
Ireland. We contend that from the pointers we have provided the
following conclusions can be agreed:
(1) That upwards of 6,000 children in Northern Ireland
will have considerable educational problems because of speech
and language impairment, and will require help in a special school
or language unit for part of their school life.
(2) That approximately 706 children will require specialist
provision for their entire school life.
(3) That children with speech and language impairment
require help from speech and language therapists outside the scope
of mainstream education. By definition this constitutes special
needs education and these children should be covered by the protection
of a statement of special educational needs.
(4) That the number of special school places available
for these children is totally inadequate.
RECOMMENDATIONS
AFASIC NI would make the following recommendations to the
Committee:
A. It should be made clear to the Education and Library Boards
that the provision of speech and language therapy for children
with SLI is an educational issue, and their legal responsibility.
This does not appear to be the case at the moment, as is demonstrated
by two quotes from letters sent to AFASIC NI in response to enquiries
for this report.
"You have asked for the number of speech and language
therapists working solely in an educational setting. I would suggest
that you direct this enquiry to the local health trusts who are
the employers of this professional group." North-Eastern
Education and Library Board
"Speech therapists are employed by the health boards
and the numbers are not known to the education board." Southern
Education and Library Board
B. In recognition of this fact, the Education and Library
Boards should be supplied with separate monies in order to purchase
speech and language therapy for special schools. This is the situation
in Scotland. It is worth noting that this action would not only
reflect the accountability of provision, it would also free up
the budget currently spent by the Health Boards in special schools
so that they could improve their speech therapy services in other
areas.
C. There needs to be an increase in the provision of speech
and language schools and units throughout the Province. The ratio
of places available to children needing help is shockingly low.
Every child who needs a place in a special school or unit in order
to obtain a meaningful education, should have one for as long
as the need exists. More funds need to be committed to this objective.
D. An awareness campaign should be undertaken amongst professionals
in both the health and education sectors. Early recognition of
speech and language impairment is vital in getting help to these
children. The earlier they get help, the less they will fall behind
in their education. It was apparent from the replies received
that SENCO's in mainstream schools are given very little or no
training in the problems of children with communication disorders.
E. We recommend that a study is carried out into the exact
level of incidence of SLI in Northern Ireland, and an analysis
made of the type and range of facilities which are required to
meet this need. We would suggest that this is undertaken by the
Department of Education for Northern Ireland, in conjunction with
representatives of the Education and Library Boards, the Health
and Social Services Boards and organisations representing those
in special education in need of speech and language therapy. A
study of this type was carried out by The Scottish Office, Education
and Industry Department which resulted in an excellent report
The Education of Pupils with Language and Communication Disorders.
It is important to realise that facilities for these children
are delivered by five separate Education and Library Boards and
four separate Health and Social Services Boards. There is a real
need for a unified response to this problem which will cover all
of Northern Ireland.
BIBLIOGRAPHY
1. Crystal, D (1984) Language Handicap in Children,
National Council for Special Education
2. Hall, DBM (1996) Health for All Children, Report
of the Third Joint Working Party on Child Health Surveillance,
third edition, Oxford University Press
3. Therapy Weekly, 5 June 1997
4. Response from AFASIC to Excellence for All Children,
the DfEE Green Paper on Special Educational Needs
5. Alone and Anxious, AFASIC, 1993, page 5
6. The Lancashire Judgement (R v Lancashire County
Council ex parte CM 1989)
7. Draft Code of Practise on the Identification and Assessment
of Special Educational Needs, Department of Education Northern
Ireland, 1996 (S4:29)
8. AFASIC Presentation to the Northern Ireland Forum for
Political Dialogue, Education Committee by Madeleine Starr (Chair
of AFASIC) 11 December 1997
6 April 1998
5
Not printed. See p. xxix. Back
6
Not printed. See p. xxix. Back
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