Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study

Ameliorating poverty-related communication and swallowing disabilities: Sustainable Development Goal 1

PURPOSE

More than 700 million people globally are still living in extreme poverty. No poverty (Sustainable Development Goal 1, SDG 1), is considered to be the greatest global challenge. This paper aims to outline the effects of poverty on communication and swallowing disabilities across the lifespan and steps to take for its amelioration.

RESULT

Poverty and disability are in a vicious cycle with each being a cause for and a consequence of the other. Poverty has incontrovertible and significant ramifications for communication and swallowing disabilities across the lifetime from pregnancy to old age. The individual, family and social burden and costs of these disabilities have lifelong economic and social consequences.

CONCLUSION

Considering poverty is a known and important determinant of communication and swallowing disabilities, the most potent weapon is to focus on preventing and ameliorating poverty-related communication and swallowing disabilities in children. A call to action is issued to speech-language pathologists to take steps towards this goal. This commentary paper focusses on Sustainable Development Goal of no poverty (SDG 1) and also addresses zero hunger (SDG 2), reduced inequalities (SDG 10), and climate action (SDG 13).

Economic evaluation of the Happy Talk pilot effectiveness trial: A targeted selective speech, language and communication intervention for children from areas of social disadvantage

Purpose: This study presents a cost-effectiveness analysis of a targeted selective pre-school intervention programme, "Happy Talk", which focuses on language development, by simultaneously enhancing parental interaction and the pre-school environment.Method: Happy Talk (delivered to 77 children) is an add on intervention, and is compared to usual care, adopting a healthcare perspective. Cost-effectiveness analyses were carried out using the Pre-school Language Scale 5- Total (PLS-5) for baseline analysis and the Child Health Utility Instrument (CHU9D) in a secondary analysis.Result: Baseline cost-effectiveness analysis showed Happy Talk was more effective (6.3 point change in total PLS-5 standard score - effect size 0.463SD and more expensive (€82.06) than usual care (cost-effectiveness ratio is €13.02 per unit change). Employing a proxy to estimate monetary net benefit, the benefits outweigh the costs, showing that it is cost-effective. However, results do not persist when health-related quality of life outcome measures are considered.Conclusion: Findings suggest a targeted selective public health approach, could be considered value for money to reduce the societal burden of children with low levels of speech, language and communication. However, measurement of longer term outcomes and a larger trial are required, to definitively inform policy changes.

The Importance of Access to Bilateral Hearing through Cochlear Implants in Children

Children with hearing loss require early access to sound in both ears to support their development. In this article, we describe barriers to providing bilateral hearing and developmental consequences of delays during early sensitive periods. Barriers include late identification of hearing loss in one or both ears and delayed access to intervention with hearing devices such as cochlear implants. Effects of delayed bilateral input on the auditory pathways and brain are discussed as well as behavioral effects on speech perception and other developmental outcomes including language and academics. Evidence for these effects has supported an evolution in cochlear implant candidacy in children that was started with unilateral implantation in children with profound deafness bilaterally to bilateral implantation to implantation of children with asymmetric hearing loss including children with single-side deafness. Opportunities to enhance the developmental benefits of bilateral hearing in children with hearing loss are also discussed including efforts to improve binaural/spatial hearing and consideration of concurrent vestibular deficits which are common in children with hearing loss.

The relationship between language difficulties, psychosocial difficulties and speech-language pathology service access in the community

BACKGROUND

A range of factors may impact whether children access speech-language pathology (SLP) services, beyond their communication difficulties. For instance, co-occurring psychosocial difficulties may amplify children's observable difficulties, leading to greater access. It is important to examine such associations because they may reflect inherent differences between children with language difficulties who access services and those who do not, indicating under-servicing for subgroups in the community.

AIMS

The first aim was to examine possible differences in psychosocial difficulties between children with language difficulties who did versus did not access SLP services in the past 12 months. The second aim was to examine the unique contribution of psychosocial difficulties to service access, over and above language difficulties and other common predictors of service access.

METHODS & PROCEDURES

Analyses were carried out on data gathered from 808 eleven-year-old children who took part in the Early Language in Victoria Study (ELVS). Children were categorized as having language difficulties based on their CELF-4 Core Language Score with a cut-point of > 1.25 SD below the mean. The primary outcome measure was access to SLP services in the past 12 months. Comparison and predictor variables included children's psychosocial difficulties, language skills, relevant demographic variables (gender, caregiver education) and prior SLP access.

OUTCOMES & RESULTS

A total of 42 children with language difficulties who had accessed SLP services had significantly greater psychosocial difficulties than those who had not (SDQ Total Difficulties, U = 53.00, z = -4.080, p < 0.001). Using binary logistic regression, a model examining child gender, caregiver education, psychosocial difficulties (internalizing and externalizing behaviours), language difficulties and prior SLP access (in earlier years) was significant χ² (8) = 137.285, p< 0.001, with increased externalizing difficulties (OR = 1.213, p < 0.001), increased communication difficulties (OR = 0.949, p < 0.001), and prior SLP access (OR = 7.430, p < 0.001) identified as unique predictors of service access.

CONCLUSIONS & IMPLICATIONS

The results indicate that children with language difficulties who have comorbid psychosocial difficulties are more likely to access services than those who do not. Accordingly, children with language difficulties who access clinical services may require interdisciplinary support, while children without co-morbid psychosocial difficulties may be under-referred for SLP services. What this paper adds What is already known on this subject There is evidence that a range of personal and contextual factors impact the likelihood of a person accessing healthcare services beyond the specific issue of concern. What this paper adds to existing knowledge In this population-based study, we provide statistical evidence that children with language difficulties who had higher levels of psychosocial difficulties were more likely to access SLP services than those who had lower levels. What are the potential or actual clinical implications of this work? Children with language difficulties who access SLP services may require support for psychosocial difficulties, while children who do not have comorbid difficulties may be underserviced in the community.

Health-related quality of life, service utilization and costs of low language: A systematic review

BACKGROUND

Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology.

AIMS

To review the literature systematically on how LL is associated with HRQoL, service utilization and costs.

METHODS & PROCEDURES

A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis.

OUTCOMES & RESULTS

We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored.

CONCLUSIONS & IMPLICATIONS

LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments; and (2) the service use and costs specific to LL, especially non-healthcare costs.

Paths to language development in at risk children: a qualitative comparative analysis (QCA)

Background

Childhood language development is related to long term educational, employment, health and social outcomes. Previous research identifies a complex range of risk and protective factors which result in good and poor language outcomes for children, however children at risk are an underrepresented group in these studies. Our aim is to investigate the combinations of factors (paths) that result in good and poor language outcomes for a group of 5 year old children of mothers experiencing adversity.

Methods

This mixed methods study utilised longitudinal data from a randomised control trial of sustained home visiting (MECSH) to determine the language outcomes in at risk children. Mothers were randomly assigned to a comparison group at entry to the study (prior to child’s birth). Their children who were retained at entry to school completed language assessments (n = 41) and were participants in this study. Influence of 13 key factors derived from the extant literature that impact language development were explored. Regression was used to determine the six key factors of influence and these were used in the Qualitative Comparative Analysis (QCA). QCA was employed to examine the necessary and sufficient conditions and paths affecting language development linked to good and poor language outcomes. A post hoc analysis of the risk and protective paths to good and poor language outcomes was also conducted.

Results

Thirteen distinct pathways led to good language outcomes and four paths to poor language outcomes in five year old at risk children. A variety of condition combinations resulted in these outcomes, with maternal responsivity, toddler development and number of children in the home being key. High and low maternal education influenced both good and poor language development.

Conclusions

The paths to good and poor language outcomes were different and complex. Most paths to a good language outcome involved protective factors, though not always. In addition, paths to poor language more often involved risk factors. The varied patterns of risk and protective factors point to the need for interventions across the first five years of life in both health and education for families which can respond to these risk and protective patterns.

Trial registration

The original RCT was retrospectively registered in the ANCTR: ACTRN12608000473369.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1449-z) contains supplementary material, which is available to authorized users.