Don’t barter her education needs for her health needs

Seeing a debate on this topic on Twitter, here is an edited copy of the letter I sent off when I unearthed that executing my child’s therapy was planned to be entirely delegated to school staff. The points are general, but I chose to focus on why I thought that delegating sound production work in the proposed way was wrong, wrong, wrong on every conceivable level. My blog post on the topic is here

Dear School,

 I  wanted to share with you the reasons why I feel strongly that it is wrong for teaching staff to deliver speech-sound therapy programs. 

1) Does this fit with what already happens?  I really value the role of the teacher in helping my child to overcome her barriers to learning and friendships. I think a successful linked-therapist relationship would support the teacher in this. Putting formal obligations on the teacher to carry out discrete and unconnected sound-drill tasks may end up ‘pushing out’ other activities. 

2) Is this evidence based? Research studies, funded by the NHS and referenced by RCSLT, indicate worse outcomes when therapy programs are implemented by school staff rather than SaLT staff. They however show broadly comparable outcomes from group-based interventions compared to 1:1 interventions. Hence, where resource constraints bite, it would be more logical to look for opportunities to group children with similar needs, rather than diluting the children’s access to a qualified speech professional.



3) Is this consistent with SaLT code of practice?  Delivering therapy is the responsibility of the speech and language therapist. The professional standards issued by RCSLT (Royal College of Speech and Language Therapists) define the following concepts: delegation, up-skilling and enhancement. Enhancement broadly refers to advising parents. Up-skilling refers to the speech therapists’ role in supporting other professionals (e.g. recommendations for making lessons more accessible). Delegation refers to passing on of tasks to an assistant – described in the document as another member of the SaLT team. 

Drilling a child in sound production is clearly a discrete and specific speech therapy task. I see this as an example of delegation rather than up-skilling the teacher/TA to better carry out their usual role.  I agree that phonics have a link with sound production, but a dysfunction serious enough to need a 1:1 therapy plan is by direct implication not expected to timely self-resolve with the normal input.

The RCSLT professional standards place onerous requirements around delegation which place the responsibility on the SaLT to train, supervise, document and actively support their ‘assistant’. Moreover, the SaLT has no actual authority to delegate the tasks to the teacher. The teacher/TA is not a healthcare assistant. 

The SaLT remains responsible for the therapy. Blurring the lines by delegating to the teacher makes accountability a problem if the therapy procedure is misunderstood or not carried out.



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My sources of information:

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Direct versus indirect and individual versus group modes of language therapy for children with 

primary language impairment: principal outcomes from a randomized controlled trial and 

economic evaluation

Boyle, McCartney, O’Hare and Forbes

NHS funded RCSLT cited research study

http://onlinelibrary.wiley.com/doi/10.1080/13682820802371848/abstract 

Indirect language therapy for children with persistent language impairment in mainstream 

primary schools: outcomes from a cohort intervention.

 International Journal of Language and Communication

McCartney, Boyle, Ellis, Bannatyne and Turnbull

NHS funded RCSLT cited research study

http://strathprints.strath.ac.uk/16466/1/strathprints016466.pdf

Speech and language therapists’ clinical responsibility around delegation and the provision of 

training to the wider workforce 

RCSLT policy statement 

https://www.rcslt.org/members/docs/training_wider_workforce