title: Who gets help for pre-school communication problems? Data from a prospective community study.
abstract: OBJECTIVE
  Pre-school communication problems are common, with implications for school readiness and educational achievement. Help is available from a variety of community healthcare providers. This study examined the extent to which help is received, and the predictors of service receipt.
  
  
  METHODS
  Prospective community study, in Melbourne, Victoria.
  
  
  METHODS
  At age 4 years, we assessed the speech, receptive and expressive language and fluency of 1607 children and gave feedback to their parents. At age 5 years, 983 families provided data on service use for communication problems between and 4 and 5 years. We compared service use between participants with and without impairment, and used logistic regression to estimate the strength of association between potential predictors (gender, socio-economic status, maternal education, English-speaking background status, family history of speech and language problems and parent concern) and service use (binary outcome).
  
  
  RESULTS
  Data were available for both communication status and service use for 753 children. Only 44.9% of the 196 children with communication impairment received help from a professional. Furthermore, 7% of the 557 that did not meet criteria for communication impairment nevertheless received help from a professional. Parent concern was the strongest predictor of service use (adjusted odds ratio = 9.0; 95% CI: 5.6-14.8).
  
  
  CONCLUSIONS
  Both over- and under-servicing for communication problems were evident. This study shows that accessing help for communication problems requires more than simply informing parents about the problem and having services available; there is a need for systematic support to get the right children to services.
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Vic., Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia.
authors.forename: J
authors.initials: J
authors.lastname: Skeat
authors.forename: M
authors.initials: M
authors.lastname: Wake
authors.forename: O C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: P
authors.initials: P
authors.lastname: Eadie
authors.forename: L
authors.initials: L
authors.lastname: Bretherton
authors.forename: S
authors.initials: S
authors.lastname: Reilly
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D002675:Child, Preschool; D003142:Communication; D003147:Communication Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration; D055812:Community-Based Participatory Research; D005192:Family Health; D005246:Feedback; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education / Q000523:psychology; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D011446:Prospective Studies; D036301:Qualitative Research; D012574:Schools; D017678:Sex Distribution; D012923:Social Class; D013070:Speech Therapy / Q000458:organization & administration; D014739:Victoria
keywords: access to health care; child development; health services research; speech and language delay; speech and language therapy