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Co-producing a preventative intervention for children at risk of early language and behaviour difficulties


Catherine Pape

Powys Teaching Health Board, GB
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'Be Here Be Clear' is a new intervention which has been co-produced to target families with young children at risk of early language and/ or behavioural difficulties.

Speech and Language Therapists ('SaLT's) are playing a more prominent role in public health; with early language recognised as a wellbeing indicator (Early Intervention Foundation 'EIF', 2017). Within my role as SaLT for Flying Start; the Welsh Government's anti-poverty programme, my work centres around early intervention and prevention. There is an established link between the development of language and behaviour (Law, 2009) but no published interventions designed to address both; either as a therapy or a preventative intervention. It is challenging identifying families who may benefit from targeted preventative intervention; and part of the project was looking at how Health Visitors could use a new tool (Family Resilience and Assessment Instrument and Tool, 'FRAIT') to help target referrals.

I have spent a year as a Bevan Commission Exemplar; undertaking a project to co-produce an intervention with families. With colleagues from SaLT; Health Visiting and Action for Children (who are commissioned to deliver parenting support in Powys) I have worked with families to develop 'Be Here Be Clear': a short intervention involving strength-based enhancement of adult-child interaction ('ACI') using video feedback.

I am currently in the evaluation phase of the project; which will be complete by December 2018. Early indications are as follows:

The co-production phase was critical to the direction the project took. Initial ideas were moulded by invaluable input from families and other professionals. Involving Dads was a priority from the outset; and the Fatherhood Institute supported me in this.

Behaviour change theory has been used to inform some of the methods used; with small 'nudges' used to great effect (e.g. parents selecting and writing down their own targets in their own words)

Feedback from families undertaking the programme has been very positive; with improvements noted in expressive language

positive changes in ACI are evident from the pre and post input videos

referrals were lower than anticipated; and we need to look again at how we can correctly identify families with children 'at risk' early enough for the intervention to be truly preventative

the families who engaged the most enthusiastically were those with experience of speech, language and communication needs ('SLCN'); either in older children or other family members. This could be a potential route for targeting families likely to benefit from the programme; as a family history of SLCN is in itself a risk factor for the child.

I am in the process of applying to undertake a research study which would take 'Be Here Be Clear' a step forwards by co-designing a manual which would enable the approach to be standardised and tested. I would love to share my journey so far with colleagues in integrated care.


1- EIF, Language as a Child Wellbeing Indicator2017.

2- Law J, Plunkett C. The interaction between behaviour and speech and language difficulties, 2009. Technical report. In: Research Evidence in Education Library

How to Cite: Pape C. Co-producing a preventative intervention for children at risk of early language and behaviour difficulties. International Journal of Integrated Care. 2019;19(4):342. DOI:
Published on 08 Aug 2019.


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