title: Speech and language therapy in Sure Start Local Programmes: a survey-based analysis of practice and innovation.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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
  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.
  
  
  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
  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.
authors: Norfolk Primary Care Trust, Norwich, UK. Alison.Fuller@norfolkpct.nhs.uk
authors: Alison
authors: A
authors: Fuller
mesh_terms: D002675:Child, Preschool; D003479:Curriculum; D018479:Early Intervention, Educational / Q000458:organization & administration*; D055317:Evidence-Based Practice / Q000458:organization & administration; D019538:Health Care Surveys; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007223:Infant; D020407:Internet; D007808:Language Therapy / Q000379:methods / Q000458:organization & administration*; D008282:Mainstreaming, Education / Q000458:organization & administration*; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011364:Professional Practice / Q000458:organization & administration; D012947:Social Work / Q000458:organization & administration; D012959:Socioeconomic Factors; D013070:Speech Therapy / Q000379:methods / Q000458:organization & administration*; D006113:United Kingdom