RCSLT Justice Dossier
Royal College of Speech and Language Therapists Speech, Language and Communication Needs in the Criminal Justice System and Best Practice responses to these DOSSIER OF EVIDENCEJanuary 2012 Evidence of Speech, Language and Communication Needs in the CJS:Over 60% of people in youth justice estate have difficulties with speech, language or communication (Bryan et al, 2007). A survey at Polmont Young Offender’s Institution found that 70% of young men had significant communication problems (Polmont, 2003). Youth Justice Studies have shown varying levels of need. In one study a high proportion (74%) of young people with the youth offending team had below average communication skills, which is significantly more than the average population (approximately 10%). There is a high level of severe communication difficulty (42%) which is significantly higher than the average population (Crew, Ellis, 2008).In another study all new entrants to the Intensive Supervision and Surveillance Programme (ISSP) were screened and 65% (49) required speech and language therapy intervention. A significant number (20%) scored at the ‘severely delayed’ level on standardised assessment and 6% as ‘very severely delayed’ (Gregory, Bryan, 2009).Another study showed that over 60% of service users have speech, language and communication needs (SLCN). This proportion mirrors what previous studies, above, have identified (Heritage, Virag, McCuaig, 2011). In comparison a separate study showed that there is a high level (91%) of communication disability in young people known to the youth offending team. This is significantly greater than in the general population (10%) (Brooks, 2011).Women Specifically over 44% of women in the criminal justice system have communication difficulties (Wagner et al, 1983). It is important to note that the incidence of communication problems is higher among women offenders than for the general population.Impact of SLCN - education and employment:Low education and speech and language and literacy difficulties are risk factors for offending (Tomblin et al, 2000).Young people not in education, employment or training (NEET)A study of young unemployed men found that over 88% were described as presenting with language impairment, having some degree of difficulty with language (Elliott, 2009).A study into young people not in education, employment or training (NEET) showed that 100% of the individuals who completed the speech and language therapy assessments presented with some degree of SLCN, of which 50% had severe difficulties i.e. language levels more than 2 years below their chronological age. Only 21% had previously been referred for speech and language therapy (Lanz, 2009).SLCN and challenging or criminal behaviour:The association between speech and language disorders and behaviour difficulties is well established (Humber and Snow, 2001). Studies show substantial proportions of children with specific language impairment experience social and behavioural problems as they reach secondary school age, and thatthese problems increase over time (Redmond et al, 2002), as they cannot access the curriculum and becoming increasingly frustrated (Tomblin, 2000).Two-thirds of seven to 14 years olds with severe behaviour problems have communication needs (Cohen et al, 1998). Research in Sheffield has shown that children about to be excluded from school showed high levels of speech, language and communication needs (Clegg et al 1999). Lindsay et al (2007) found, ‘Parents reported that children and young people had low levels of selfesteem during secondary school and high levels of emotional distress.’SLCN and mental health / mental illness:Up to a third of children with untreated SLCN will develop subsequent mental health issues (Clegg, Hollis and Rutter 1999).There is evidence that children may be misdiagnosed as having a conduct disorder or mental health problem when in fact they have an undiagnosed SLCN (Lanz, 2009).Cohen and Lipsett (1991) found even very young children with undiagnosed speech, language or communication difficulties were perceived as being more delinquent/ difficult by their mothers than a matched control group. SLCN and the court processThe Prison Reform Trust’s report ‘Vulnerable Defendants in Criminal Courts’ found that the evidence for communication difficulties in children within the criminal justice system added to their vulnerability in navigating the court system (Talbot and Jacobsen, 2009).Many young people with SLCN lack the language skills to understand what is happening to them or the implications of what is being asked of them (Snow and Powell, 2004). For example, many people have difficulty under standing commonly used vocabulary within the justice system, including words such as ‘victim’ and ‘breach’.A lack of awareness of the impact of communication difficulties on a young person’s (or parent’s) ability to understand spoken and written instructions by justice professionals risks jeopardising their compliance with court orders and instructions. This in turn leads to a lack of appropriate support for young people with SLCN and risks persistent misunderstanding between them and staff, which can lead to further experiences of failure, frustration and sometimes escalating behavioural problems (Humber and Snow, 2001).Impact of SLCN on rehabilitation / reducing reoffending:There is a mismatch between the literacy demands of programmes and skills level of offenders, which is particularly significant with respect to speaking and listening skills (Home Office Findings 233, 2009). To access education and treatment programmes an offender requires GCSE level English A-C (Davis, Lewis, Byatt, Purvis and Cole, 2004). However around one third of offenders have speaking and listening skills below level 1 (equivalent to age eleven) of the National Framework (Davies at el, 2004) and are unable to access these programmes due to their poor language and literacy skills. Although Government has provided an estimated ?130m for prison education to improve literacy skills and provide anger management and drug rehabilitation courses, studies show nearly two-thirds of offenders are unable to access these programmes because of their poor language skills (Ryan, 2002).Evidence shows that around 40% of offenders find it difficult or are unable to benefit from and access verbally mediated interventions such as anger management and drug rehabilitation courses (Bryan 2004).It was noted that young people without communication difficulties requested clarification and would persevere with tasks they found difficult, however, those with SCLN rarely indicated that they had not understood or needed help; instead, they gave up (Lanz, 2009).Current identification of SLCN:The Prison Reform Trust project found that less than two thirds of prisons conduct some sort of screening or assessment of prisoners and for the most part these focussed on general literacy and numeracy skills (Talbot and Jacobsen, 2009). This shows that speech and language difficulties will remain an unidentified problem.Levels of awareness of communication difficulty have been found to be very low in both the historical and present environments of these young people and very few of those assessed, even those presenting with severe communication difficulties, had been identified as having communication difficulties prior to the assessment process with the youth offending team (Lanz, 2009).It was noted that young people without communication difficulties requested clarification and would persevere with tasks they found difficult, however, those with SCLN rarely indicated that they had not understood or needed help; instead, they gave up. (Gregory, Bryan, 2009).In another study all of the young people referred for assessment had speech, language and communication needs. However only 3 of the young people (out of 32) referred for assessment had been previously known to the speech and language therapy service (Brooks, 2011).SLT Impact at each phase of the criminal justice pathway:Speech and language therapy interventions can help prevent and reduce the re-offending rate by increasing oral communication skills by enabling the individual to access a wider range of rehabilitation programmes and subsequently empower them to change their offending behaviour (Crace, 2006).Pre-Disposal / Police, Courts:The purpose of the study was to explore the potential benefits and risks of different intermediary models at trial by conducting mock examinations of a “child” witness (role-played by an adult). The results from using an intermediary showed that a number of anticipated benefits had been realised. The results showed that the defence lawyers had increased understanding of appropriate questioning of children as a result of working with the intermediary during the pre-trial briefing (Davies, Hanna, Henderson and Hand, 2011).Community Disposal:A study in Leeds showed that post intervention assessment results demonstrated significant gains in language and communication skills evidenced by an average gain of 2 standard deviations on standardised assessments. Of the young people who completed the intensive supervision and surveillance programme with identified expressive language difficulties, 88% made significant gains on standardised assessment. These results indicate that speech and language therapy intervention is effective in improving language levels in young people aged 10- 18 years despite their often chaotic lives, substance misuse and years away from formal education (Gregory, 2009).This study also showed that there was evidence at an individual level that gains in communication skills led to wider gains in the young people’s engagement with education and training. The intensive supervision and surveillance programme staff were able to evidence these gains in terms of the young people’s overall progress. The staff made significant gains in their knowledge and confidence working with young people with communication difficulties. This was evidenced by the increase in their confidence ratings from an average of 2.9 up to an average of 7.8 (on a scale of 1 – 10). The staff were able to incorporate communication aims and activities into their sessions (Gregory, Bryan, 2009). In another study 17/19 youth offending team practitioners rated speech and language therapy at the highest level for critical impact on the management and outcome of youth offending team cases (Brooks, 2011). A two-year project looked at levels of speech and language therapy and found that young people with moderate communication difficulties benefited significantly from six sessions of therapy, with progress reported in almost all the areas tested. However the results showed that those with more complex and severe needs showed less progress and concluded that those with more complex needs benefit from more individualised and tailored intervention packages (Heneker, 2011).Custodial Sentences:At HMP Brinsford and Werrington the training received by induction officers enabled them to accurately record if a vulnerable young person had a speech, language or communication disability (Bryan, Freer, Furlong, 2004).In Red Bank secure children’s home, five out of seven young offenders in one section had a learning difficulty and challenging behaviour. Staff were involved in physically restraining these young offenders on two to three occasions every day. After receiving communication training and guidance from the speech and language therapist, the staff were able to reduce the number of restraints used to two per week. This example of a positive practical intervention has been repeated many times throughout Red Bank (Boyd, 2007).SLT – Recommended roles:A report from Derbyshire recommended a three tier approach to providing intervention to people who offend. At the basic universal level all staff would be trained to increase their awareness of communication. At the second and targeted level the focus would be on the cohort of staff who require more advanced training and support including detail on how to use the communication screening tool. The third tier is the provision of direct intervention from specialist speech and language therapists (Heritage, Virag, McCuaig, 2011).Best SLT service models: Outreach arrangements appear more viable where an speech and language therapist is supported by staff from the institution (or where funding for such staff is possible). Both establishments are currently providing LSA or Administrative Support enabling the speech and language therapist to provide more input to the regimes. There is potential for any institutions served by an outreach arrangement to gain training and support for staff from the speech and language therapist. The current speech and language therapists suggest that Technical Instructor Grade 2 would provide staff able to benefit from speech and language therapist training and able to effectively contribute to speech and language therapist provision within the regimes under the supervision of an SLT (Bryan, Freer, Furlong, 2004).In Ealing a two-year project found that young people with moderate communication difficulties benefited significantly from six sessions of therapy, with progress reported in almost all the areas tested. However the results showed that those with more complex and severe needs showed less progress and concluded that those with more complex needs would benefit from more individualised intervention packages and further research is needed in this area (Heneker, 2011).Actual Speech and Language Therapy Provision along the Justice Pathway:A scoping survey of SLT services in Scotland (Ann Clark, Ellie Barrow and Kim Hartley, 2012) showed the total SLT input across all of Scotland at all stages of justice pathway for all ages of victims, witnesses, accused and convicted offenders was equal to3549hrs in 2010 when 218 offenders were “seen” by an SLT and 4254.5 hrs in 2011 (to Nov.) when 156 clients “seen” by an SLT. Pathway PhaseEnglandScotlandWalesPre-Offending Little known of - accounts for only 12% of current SLT inputSLT active in Early Years provision Pre-Disposal Sandwell point of arrest diversion pathfinderLittle known of - accounts for only 12% of current SLT inputCommunity Disposal Bolton Bradford Camden (Youth Inclusion Project)Cheshire Derby DudleyExeter, East & Mid Devon GloucestershireKent LeedsMertonMilton Keynes SalfordSheffieldLittle known of - accounts for only 12% of current SLT inputGwynedd, M?n, and Denbighshireyouth offending service Wrexham youth offending service North Wales Probation Custodial Sentence Management Red Bank Secure Children’s Home HMYOI HindleyHMYOI Feltham HMYOI WetherbyBroadmoor Secure Hospital Rampton Secure Hospital Roycroft Unit and Prudhoe Hospital (Northumberland, Trust)St Andrews Hospital Accounts for significant bulk of current input at 50% of total SLT input. HM YOI Polmont – 14 hrs / weekHMP&YOI Cornton Vale – 7 hrs / weekCommunity ReintegrationLittle known of - accounts for only 14% of current SLT inputNote: No information is available in respect of SLT provision in the ioNorthern Ireland CJS. REFERENCES An evaluation of the literacy demands of general offending behavioural programmes, Home Office Findings 233, (2009)Brooks V, Report outlining the findings of a 13 month pilot project examining the effectiveness of speech and language therapy for young people known to Exeter, East and Mid Devon Youth Offending Team.Bryan K, Freer J, Furlong C. Language and communication difficulties in juvenile offenders. International Journal of language and communication difficulties, 2007; 42, 505-520.Bryan K, Freer J, Furlong C. Speech and language therapy provision for young people in prison, Third project report. 2004Bryan K. Prevalence of speech and language difficulties in young offenders. International journal of Language and Communication Disorders, 2004; 39, 391-400Clegg J, Hoiis C, Rutter M. Life Sentence. RCSLT Bulletin 1999; 571, 16-18.Cohen N, et al. Language achievement, and cognitive processing in psychiatrically disturbed children with previously unidentified and unsuspected language impairments. Cohen N, Lipsett L. Recognized and unrecognized language impairment in psychologically disturbed children. Child symptomatology maternal depression and child dysfunction. Canadian Journal of Behavioural Science 1991; 23, 376-389.Crace, J. Talking your way out, Guardian, Tuesday 28 February 2006: A short course in oral communication skills is providing the nest way to stop prisoners offending.Crew M, Ellis N. Speech and Language Therapy within Bradford Youth Offending Team, 2008Davis, K. Lewis, J. Byatt, J. Purvis, E and Cole, B. (2004) An evaluation of the literacy demands of general offending behaviour programmes. Findings 233, 1-4.Davies E, Hanna K, Henderson E, Hand L. Exploring the benefits and risks of intermediary models, Questioning child witnesses, September 2011 Elliott N. Results from a PHD. An investigation into the communication skills of long-term unemployed young men, 2009.Gregory J, Bryan K. Evaluation of the Leeds Speech and Language Therapy Service Provision within the Intensive Supervision and Surveillance Programme provided by the Leeds Youth Offending Team, 2009Heneker, S. Ealing Youth Offending Speech and Language Therapy (YOSALT) Project, November 2011 Heritage M, Virag G, McCuaig L. Better outcomes for young offenders. Exploring the impact of Speech and language therapy in Youth offending teams in Derbyshire, 2011Humber E, Snow PC. The language processing and production of skills of juvenile offenders: A pilot investigation. Psychiatry, Psychology and Law 2001; 8, 1-11. Lanz, R. Speech and language therapy within the Milton Keynes YOT, a four month project. 2009Polmont Young Offender’s Institution, 2003 Ryan C. Porridge with attitude in the Guardian, 7 May 2002.Redmond SM, Rice ML. Stability of behavioral ratings of children with specific language impairment. Journal of Speech, Language, and Hearing Research 2002; 45, 190-201. Snow P, Powell M. Developmental language disorders and adolescent risk. Current Issues in Criminal Justice 2004; 16:2.Talbot J, Jacobsen J. Vulnerable Defendants in Criminal Courts. Prison Reform Trust 2009.Tomblin JB, et al. The association of reading disability, behavioural disorders and language impairment among second-grade children. Journal of child psychology and psychiatry 2000; 41:4, 473-482.Wagner C, Gray L, Potter R. Communicative disorders in a group of adult female offenders. Journal of Communication Disorders, 1983; 16, 269-277Ann Clark, Ellie Barrow and Kim Hartley; Unmet Need in Scotland’s Criminal Justice System; RCSLT Bulletin February 2012. Available on request from bulletin@. Royal College of Speech and Language TherapistsJanuary 2012 ................
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