Applying evidence to practice by increasing intensity of intervention for children with severe speech sound disorder: a quality improvement project

Abstract

Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; school progression and overall well-being. The evidence base shows that intervention for children with SSD is more effective and efficient when provided intensively in relation to the number of target sounds elicited in sessions (dose) and number of sessions per week (frequency). Southern Health and Social Care (HSC) Trust's baseline intensity of speech and language therapy (SLT) intervention was similar to that often found in current practice across the UK,where ~30 target sounds were elicited (dose) in once weekly sessions (frequency) over a 6-week block, followed by a break from therapy. This quality improvement (QI) project aimed to increase intensity of intervention for children with severe SSD within Southern HSC Trust's community SLT service to improve outcomes for children and their parents. QI methods supported accurate identification of ten 4-5 year olds with severe SSD and increased the intensity of their intervention over a 12-week period by measuring a range of data and speech outcomes. Findings showed a sustainable increase of dose (number of targets elicited per session) to levels recommended in the research (≥70). However, it was difficult to sustain increased frequency of appointments (to twice weekly) because of contextual factors such as sickness, etc. Accommodating this, measuring days between appointments captured an overall increase in the number of appointments attended across time. Child speech outcomes improved for direct speech measures and parent ratings of intelligibility. The intensive model of intervention has been implemented for children identified with severe SSD across Southern HSC Trust's community service with ongoing audit and development, and findings have been disseminated.

Keywords: PDSA; PRIMARY CARE; Paediatrics; Quality improvement.

Figure 1

Theoretical model explaining the difference in child speech outcomes resulting from different models of intervention intensity (Note: created by the fourth author and used with permission). SSD, speech sound disorder; QI, quality improvement.

Figure 2

Driver diagram (Note. created by the first author and used with permission). SSD, speech sound disorder; HSC, Health and Social Care

Figure 3

X-bar chart showing the mean WIS capturing increased intensity of intervention pre-and post-implementation of the QI project (across 24 weeks) (Note: created by the first author and used with permission. The solid line around which the data points cluster is the centre line (capturing the mean) and the dotted lines above that (the upper control limit (UCL)) and (where shown) below that (the lower control limit) are set at ±3 SDs from the centre line. They support detection of meaningful process change where data points may fall beyond the control limits or are not randomly distributed (special cause variation)). QI, quality improvement.

Figure 4

X-bar chart showing the mean number of days between appointments pre-implementation and post-implementation of the QI project (QI project starts on day 13) (Note: created by the first author and used with permission. The solid line around which the data points cluster is the centre line (capturing the mean) and the dotted lines above that (the upper control limit (UCL)) and (where shown) below that (the lower control limit) are set at ±3 SDs from the centre line. They support detection of meaningful process change where data points may fall beyond the control limits or are not randomly distributed (special cause variation)). QI, quality improvement.