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The Small Talk Project: The Small Talk Project: Developing a hearing, speech and Developing a hearing, speech and language screening tool for language screening tool for vulnerable children vulnerable children Authors: Annette Jackson Nikki Worthington Margarita Frederico Beverly Joffe

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Page 1: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

The Small Talk Project:The Small Talk Project:

Developing a hearing, speech and language Developing a hearing, speech and language screening tool for vulnerable childrenscreening tool for vulnerable children

Authors:Annette Jackson

Nikki Worthington

Margarita Frederico

Beverly Joffe

Page 2: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

AcknowledgementsAcknowledgements

Funders include: Baker Foundation, private donor, Berry Funders include: Baker Foundation, private donor, Berry Street and FaHCSIAStreet and FaHCSIA

Endorsed by DHS (Victoria) Research Coordinating Endorsed by DHS (Victoria) Research Coordinating CommitteeCommittee

Ethics approval from La Trobe University, Berry Street and Ethics approval from La Trobe University, Berry Street and VACCAVACCA

Page 3: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

The Small Talk ProjectThe Small Talk Project

The aim of the project is to develop and trial a screening tool to identify hearing, speech and language difficulties in vulnerable children

Screening tool for non speech pathology professionals working with child protection client group

Tool aims to be culturally appropriate and can be used with children from Indigenous and non-Indigenous backgrounds

The target age range for children being screened falls between 4 and 7.11 years

Page 4: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

Trauma – Abuse & NeglectTrauma – Abuse & NeglectHow it effects communicationHow it effects communicationResearch has shown that vulnerable children can exhibit a range of communication deficits including:-Expressive language deficitsDifficulty articulating feelings and needsDifficulty producing coherent narrativesDifficulty understanding the abstractDifficulty with pragmaticsHearing problems

Page 5: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

Impact of Trauma on the BrainImpact of Trauma on the Brain• Impacts on structures in the brain include:

Reduce number of neurons if we don’t use them (e.g. neglect) Impact on how the brain is developed, beginning with brainstem Reduce size of hippocampus Reduce oxygen to “Broca’s area” - speaking about emotions

• Impact on neurochemical reactions in the brain that respond to threat and danger include:

Cortisol and adrenaline (epinephrine) (fight, flight) Endorphins (freeze)

• Patterned repetitive activity leading to changes in how limbic system (e.g. amygdala) processes and responds to threat

Page 6: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

Ways in which abuse and neglect can Ways in which abuse and neglect can impact on language and impact on language and

communicationcommunication•Not experiencing sufficient language opportunities, i.e. neglect (e.g. lack of interaction, lack of play, lack of other stimulation, left on own for long periods of time, actively discouraged to talk)

•Exposed to trauma, such as abuse – unspeakable trauma, flight or freeze reactions, affect dysregulation, physical dysregulation, poor attention, only negative interactions.

•Physical harms, such as head injuries, underdeveloped parts of the brain, poor hygiene, emotional causes of physical harm.

•Impact on how child processes information – focused on threat and threatened by ‘new’.

•Impact on how child perceives relationships & therefore their willingness to communicate.

Page 7: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

The Small Talk ProjectThe Small Talk ProjectVulnerable children with undiagnosed speech, language Vulnerable children with undiagnosed speech, language and hearing problems may be disadvantaged in terms of:and hearing problems may be disadvantaged in terms of:

Developing social skills, friendships and confidenceDeveloping social skills, friendships and confidence Learning and literacyLearning and literacy Being more difficult to identify as suffering abuseBeing more difficult to identify as suffering abuse Carers finding it difficult to communicate and understand Carers finding it difficult to communicate and understand

children.children. Underlying meanings for some of children’s behaviours Underlying meanings for some of children’s behaviours At increased risk of suffering abuse and traumaAt increased risk of suffering abuse and trauma Therapeutic outcomesTherapeutic outcomes

Page 8: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

The Small Talk ProjectThe Small Talk Project

Vulnerable children are not readily referred for speech and language assessment because:

Some communication problems can be difficult to identify The child’s behaviour can ‘get in the way’ of detecting

language difficulties Family are unable to recognise or acknowledge child’s

communication difficulties Case workers are focused on ensuring the child’s safety

and providing a resolution to trauma and abuse ( and are likely to overlook communication per se)

Page 9: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

Development of the screening toolDevelopment of the screening tool2005: Initial draft screening tool (developed by Professor Anne

Ozanne School of Human Communication Sciences and piloted by Take Two).

1st Pilot findings of 100 children suggested.1. A high, unmet need for speech, language and hearing assessments

within this particular cohort of children2. A possible re-development of the tool to reflect a more specific age

range.

2007-2008 A proposal was put together and the Small Talk project was successful in attracting funding

2008: Dr Beverley Joffe, La Trobe University, took on role of modifying and re-developing the tool.

2009: Employed key staff, set up reference and working groups and began formal project.

Page 10: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

MethodologyMethodology 2nd pilot of 10 children using draft tool and survey of

workers in 2010 Consultation with Royal Children’s Hospital and Austin

CAMHS and Dr Bruce D Perry (ChildTrauma Academy) re tool and process

Currently in process of recruiting 150 children (with or without identified speech and language problems) where:

Workers/carers complete screening tool and background information

Child is assessed by speech pathologist or speech pathology students

Results of assessment and screening tools are then compared to see if screening tool is a valid and reliable predictor of which children would benefit from a more detailed specialist assessment.

Page 11: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

The Small Talk ProjectThe Small Talk Project

““The immediate impact of this project will be the provision of a The immediate impact of this project will be the provision of a pre-assessment tool made available to direct service workers pre-assessment tool made available to direct service workers and carers to identify hearing, speech and language and carers to identify hearing, speech and language developmental difficulties quickly” (Jackson, 2007)developmental difficulties quickly” (Jackson, 2007)

The importance of speech and language in a child’s overall The importance of speech and language in a child’s overall wellbeing must not be underestimated.wellbeing must not be underestimated.

For those children who have suffered abuse and trauma it is For those children who have suffered abuse and trauma it is imperative that any issues that they may have communicating with imperative that any issues that they may have communicating with others are identified early so that appropriate intervention can be others are identified early so that appropriate intervention can be provided.provided.

The Small Talk Project aims to provide a reliable, valid tool that can The Small Talk Project aims to provide a reliable, valid tool that can be used quickly and easily by those professionals who work with be used quickly and easily by those professionals who work with vulnerable children vulnerable children

Page 12: The Small Talk Project: Developing a hearing, speech and language screening tool for vulnerable children Developing a hearing, speech and language screening

Partners involved with Small TalkPartners involved with Small Talk La Trobe University – School of Social Work – led by Assoc. Prof. La Trobe University – School of Social Work – led by Assoc. Prof.

Margarita Frederico and overall project leaderMargarita Frederico and overall project leader

La Trobe University – School of Human Communication Sciences – La Trobe University – School of Human Communication Sciences – led by Dr Beverly Joffe and Nikki Worthingtonled by Dr Beverly Joffe and Nikki Worthington

Berry Street – Led by Assoc. Prof. Annette Jackson, Carly Black, Berry Street – Led by Assoc. Prof. Annette Jackson, Carly Black, Margaret Kascamanidis and Naomi Ralph.Margaret Kascamanidis and Naomi Ralph.

Northern Home Based Care – Led by Craig Cowie and Deb CollardNorthern Home Based Care – Led by Craig Cowie and Deb Collard

Victorian Aboriginal Child Care Agency - Led by Dr Peter Lewis and Victorian Aboriginal Child Care Agency - Led by Dr Peter Lewis and Julie TooheyJulie Toohey