The child, the process & the expertise: Identification of priority children from preschool referrals to speech and language therapy

Abstract

This study concerns the decisions and expertise of speech and language therapists (sits) working with preschool children, in particular, the selection and prioritisation of newly referred youngsters for therapy.

The literature review covers three aspects: the difficulties of identifying communication disorders in preschool children; the nature of speech & language therapy knowledge; the nature of the selection and prioritisation task. These three aspects provide the theoretical foundations of the study and gave rise to the selection of a multimethod and predominantly qualitative methodology.

Using a series of knowledge elicitation tasks, the selection and prioritisation decision was explored. A small group of expert slts participated in semistructured interviews, case history analyses, focus group discussions and card sorting exercises. The results are summarised under three headings: the child, the process and the expertise.

The study identifies areas considered significant in the discrimination of priority children. In particular, the co-consideration of the child's communication skills and the supporting communicative context emerged as the key categories. Features within these categories associated with priority and nonpriority children were identified.

The process emerged as one whereby sits collected and evaluated baseline descriptions of the child and context. As these findings accumulated, they were judged as to their diagnostic and prognostic significance, as evidence of progress and as potential causes for sit concern.

Substantial consensus was demonstrated between sits suggesting that the knowledge elicited emanated from a body of knowledge rather than being idiosyncratic. Even where variation occurred, patterns were evident, reflecting the possible existence of theories-of-action related to differing working contexts.

The results are presented as theories-of-action which underpin slts decisions. As such they will be of support to junior sits in their understanding of the selection and prioritisation task and to more experienced slts in making their own decisions explicit.