Speech and Language Therapy
within the
Milton Keynes Youth Offending Team
A summary report outlining the findings of 4 month pilot
project examining the speech, language and
communication needs of the young people accessing the
Milton Keynes Youth Offending Team.
December 2008 – March 2009
Produced by
Rachel Lanz
Speech and Language Therapist
Executive Summary
A 4 month pilot of Speech & Language Therapy one day / week within the YOT in
Milton Keynes was undertaken to investigate the speech, language and communication
needs of young offenders, particularly targeting those who were not in education,
employment or training (NEET). During the course of the study, other young people,
about whom there were concerns, were also seen.
100% of the NEET group who completed the 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.
communication disability.
54% of the young people assessed had a severe
Only 21% had previously been referred for Speech &
Language Therapy.
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.
Levels of awareness of communication difficulty were very low in both the historical
and present environments of these young people & very few of those assessed, even
those presenting with severe communication difficulties, had been identified as having
communication difficulties prior to the assessment process.
Recommendations for future SLT input to the MK YOT are made.
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BACKGROUND INFORMATION
There is an increasing amount of evidence that indicates a high percentage of people
who offend have some type of communication difficulty (Pryor, 1998 and Bryan,
2004). Often these speech, language, communication difficulties pass undiagnosed yet
will have an impact on the individual’s ability to access services and interventions
(Cohen et al, 1993). The Bercow Review has recently highlighted the importance of
Speech and Language Therapy (SLT) within the youth justice system.
The Milton Keynes project began in December 2008 when one day a week of speech
and language therapy time was allocated to the Milton Keynes Youth Offending Team
(YOT). The purpose of this time was to assess an identified group of young people for
speech, language and communication needs (SLCN). The initial group targeted were
those young people who were ‘Not in Education, Employment or Training’ (NEET) as
they were identified as being at most risk of re-offending and therefore a priority group
for assessment. However, as the project progressed some young people who were not
part of this group but who were prolific offenders or who presented informally with
some SLCN were also seen.
The results of the pilot project are outlined below.
METHODOLOGY
The Speech and Language Therapy Service Manager met with the YOT to explain the
role of the SLT and discuss the types of SLCN and their implications that the young
people accessing the team may be experiencing. The role of the SLT within the YOT
was also discussed.
A referral form was developed and distributed among the YOT workers who explained
the purpose of the speech and language therapy assessment to the young person and
obtained their consent for assessment.
The assessment process consisted of direct work with the young person where a case
history was taken and formal assessments were carried out. It also involved indirect
assessment where information obtained via the ASSET was referred to as well as
discussion with those team members already working with the young person. The
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ASSET is the national assessment tool for Youth Justice Services, including YOTs and
is approved by the Youth Justice Board for England and Wales .
Where there were no external concerns expressed about a young person’s language or
communication skills, a decision to embark upon full language & communication skills
assessment was made by the speech and language therapist who used professional
judgement to identify whether the young person’s speech, language and communication
skills fell within normal limits for their age.
The assessment was only undertaken
where the consent of the young person had been previously secured. If they were
identified as having a SLCN then a judgement was made as to whether these difficulties
were mild, moderate or severe. The severity of the language difficulty was determined
by the deviation of the individual’s responses from the mean. Mild difficulties were
indicated if the standard score fell within -1 to
-1.5 standard deviations (SD) from the
mean; approximately 16 out of 100 people in the population would have language
difficulties at this level of severity. Moderate difficulties were indicated if the score fell
within -1.5 to -2 SD; approximately 6 out of 100 people in the population would have
language difficulties at this level of severity. Severe difficulties were indicated if the
score was -2 SD or more; less than 2 out of 100 people in the population would have
language difficulties as severe as this.
Language Assessments
One or more of the following assessments were used for direct work with the
individual:
Clinical Evaluation of Language Fundamentals – 4th Edition (CELF -4)
British Picture Vocabulary Scales (BPVS)
Test of Adolescent and Adult Language – 4th Edition (TOAL)
Test of Language Competence – Extended Edition (TOLC)
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Sample group
The sample group were initially taken from the NEET group as indicated above
however, other young people who were prolific offenders or about whom there was felt
to be some degree of SLCN were also referred.
Table 1. Referrals
Actual Number
Percentage %
Referrals who were NEET
12
40
Referrals in education /
Employment or Training
18
60
30
100
Actual Number
Percentage %
30
100
4
13.3
Total
Table 2 Attendance
Total referred for
assessment
Total failed to attend
(3 were NEET)
Total who failed to
complete assessment
process
2
6.7
(1 was NEET)
Total people referred
who completed
assessments
24
80
5
Table 3 Referrals By Gender
Actual Number
Percentage %
20
83
4
17
24
100
Male
Female
Total
The age range of the young people seen was from 13 years 6 months to 18 years 3
months with an average age of 15 years and 3 months.
RESULTS
The speech and language therapy results indicate that a high number of young people
accessing the Milton Keynes YOT have SLCN when compared with their age peers.
Table 4 – Identification of SCLN
Actual Number
Percentage %
Within normal range
3
14
Performance below
average
21
88
6
Identification of SLCN
90
80
70
60
50
40
30
20
10
0
Language normal
Language below average
14
88
Series1
Table 5 – Breakdown of SLCN
Mild difficulties (worse than
Actual Number
Percentage %
7
33.3
1
4.7
13
62
21
100
84% of the population)
Moderate difficulties
(worse than 94% of the
population)
Severe difficulties (worse
than 98% of the population)
Total
Of the 21 young people who were found to have some degree of SLCN only 5 were
previously known to the Speech and Language Therapy Service (24%). Of the young
people who had been previously referred, none had received any recent support.
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Table 6 – Breakdown of SLCN by gender
No. of
Percentage of males
No of
Percentage of
males
%
females
females %
Within normal range
2
10
1
25
Mild difficulties
5
25
2
50
1
5
0
0
12
60
1
25
20
100
4
100
(worse than 84% of the
population)
Moderate difficulties
(worse than 94% of the
population)
Severe difficulties
(worse than 98% of the
population)
Total
Gender and Severity of Language Difficulty in
percentages
60
40
20
0
Within
normal
Mild
Moderate
difficulties difficulties
Severe
difficulties
Male
10
25
5
60
Female
25
50
0
25
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Table 7 – SLCN within NEET group
No. in NEET group
Percentage of NEET
group
Within normal limits
0
0
Mild difficulties (worse than
4
50
0
0
4
50
8
100
84% of the population)
Moderate difficulties
(worse than 94% of the
population)
Severe difficulties (worse
than 98% of the population)
Total
Table 8 – SLCN within Education, Employment, Training group
No. in non-NEET group
Percentage %
3
19
3
19
1
6
9
56
16
100
Within normal
limits
Mild difficulties
(worse than 84% of the
population)
Moderate
difficulties (worse
than 94% of the
population)
Severe difficulties
(worse than 98% of the
population)
Total
BPVS results summary
The BPVS measures the understanding of words and provides an age equivalent score.
The age scores ranged from 5 years 5 months to 15 years 9 months. The average
chronological age of the sample was 15 years 3 months but the average age on the
BPVS was 10 years 3 months. Consequently, the young people were scoring on
average 5 years below their chronological age. In addition, 6 of the 24 young people
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achieved ‘within normal limits’ on their CELF (overall language) assessment but
presented with some degree of difficulty on the BPVS (RECEPTIVE vocabulary)
assessment, which tends to reflect functional language ability related more to IQ and
life experience rather than specific language difficulties
General observations
During case histories, only one young person indicated that they experienced
difficulties in understanding and expressing themselves.
All other young people
assessed, reported that they experienced no difficulties at all with spoken language.
They did not appear to be aware of their difficulties, probably as they had had no other
experiences of communication, having had lifetime difficulties and / or because their
self – other awareness and meta-cognitive skills are poor.
During the assessment process, individuals often asked for repetition of questions but
rarely indicated if they had not understood or if they needed help with a particular task.
Instead, they tended to simply say ‘don’t know’ and move onto the next question.
Interestingly, those who presented with language skills within normal limits for their
age tended to persevere with questions that initially they found difficult and also had
more sophisticated repair strategies. For example, they were able to identify which
word in particular that they were struggling with or they would repeat the sentence to
themselves as they worked out the answer.
DISCUSSION
A literature review undertaken in 2007 by Angela Sloan, Specialist Speech and
Language Therapist, indicates that there is a high prevalence of SLCN in children
/young people with social, emotional and behavioural difficulties (SEBD) (e.g. Burgess
and Bransby, 1990; Warr-Leeper, 2002). Many studies include those young people
with anti-social or offending behaviour, for example, Pryor (1998) and Bryan, (2004)
and those who have been excluded from school (Ripley and Yuill, 2003).
The results of this pilot study concur with those previous research studies that have
found a high incidence of SLCN in those individuals with SEBD including offending
behaviour. Table 4 reveals that 88% of the sample group presented with some degree
of speech, language and/or communication need. This percentage is higher than the
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normal population with research indicating that approximately 10% of children in the
general population will have some long term SLCN (Lindsay et al, 2002).
% with Speech Language /
Communication Needs
100
80
60
40
20
0
Normal
population
10
MK YOT sampled
population
88
As highlighted above, these results are in line with other studies that have been carried
out in YOT’s or Young Offender Institutes (YOI’s). Bryan et al (2007) found that 6690% of young people at a secure college had language skills below average for their
age. In addition, Crew (2008) identified that 74% of a sample group accessing the
Bradford YOT had some level of SLCN. The results from the Milton Keynes project
will have some degree of bias as the sample group assessed had been identified by the
YOT team as likely to have some type of communication difficulty. However, these
figures still indicate that SLCN are prevalent in those young people accessing the
Milton Keynes YOT.
Broomfield et al (2004) reported that 12% of children referred to a speech and language
therapy service presented with a severe SLCN. Within the MK YOT sample, it was
found that 54% of those assessed had a severe communication disability. The original
plan was to target the NEET group, with the hypothesis that there may be underlying
SLCN which were compounding their difficulties in engaging in either employment or
education. The hypothesis appeared to be borne out, as all those from the NEET group
who completed the assessments presented with some degree of SLCN; 50% of them
presenting with severe difficulties, which put them in the bottom 2% of the population
for speech, language and communication achievement. However, within the young
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people in the care of the MK YOT over half of the young people presenting with severe
language difficulties were apparently able to access training, education or employment,
suggesting there are also some ‘protective’ factors at work for some young people.
Despite this high prevalence of SLCN within this sample only 5 out of 24 young people
(21%) had previously been referred for speech and language therapy in the past and
none were currently in contact with the service. This finding is in line with other
research that indicates many SLCN difficulties in children/young people with social,
emotional, and behavioural difficulties including offending behaviours, are often
undetected (Cohen et al, 1993).
When examining the type of SLCN in relation to gender it is noticeable that of the
males assessed the majority presented with severe SLCN (60%) whereas of the females
assessed only 25% had severe difficulties. In contrast, 50% of the females had only
mild difficulties whereas only 25% of the males had mild difficulties. 25% of the
females who participated were within normal limits for their age whereas only a 10% of
the males were within normal limits.
It was noticeable from the assessments, that many of the young people had particularly
poor receptive vocabulary (understanding of words), even when they achieved ‘within
normal limits’ for their age on the CELF 4. This area of difficulty is likely to cause
them significant problems in particular in understanding language in formal settings
such as police interviews, court, job /college interviews and so on.
Although there was such a high percentage of individuals with SLCN and severe needs
in particular, only one of the young people reported that they experienced difficulties
with understanding/expressing themselves.
Even those with severe language
difficulties felt that they could understand everything that was said to them. Their own
self reports were therefore not reliable indicators of how they coped with spoken
language, and would not therefore be a suitable form of assessment for young people
with SLCN. Consequently, staff working with these young people need to be aware of
communication difficulties as a possibility when confronted with apparent noncompliance, indifference or hostility and feel confident to refer onto to other agencies
for further assessment. Staff also need to have an understanding of the implications of
having a SLCN and remedial strategies which can be employed in everyday interaction
so they are able to support that person appropriately.
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Poor awareness of their language difficulties and poor repair strategies are common
features within the language impaired population, particularly those with Specific
Language Impairments (SLI). It is known that individuals with poor repair strategies
require explicit teaching of these skills, for example, different ways of asking for
clarification.
Individuals with normal language development will automatically
identify when they have misunderstood and seek to resolve the breakdown in
communication. If an individual is firstly unaware that they have a difficulty and
secondly unaware of how to repair a breakdown in conversation, then their language
difficulties can easily be missed. They may appear quiet, unresponsive and passive,
alternatively, they may present with more challenging behaviours and ‘act out’ or
become aggressive when overloaded with language.
In order for the young people to successfully access the intervention and support being
offered, their language levels need to be identified and any difficulties addressed. It is
likely that many young people are failing to understand what is being asked of them
particularly in formal settings such as police interview and court. Given the poor
language levels indentified in this sample group it is probable that the young people are
therefore unable to fully access the support being provided by agencies such as YOT
and are not making informed decisions or choices.
CONCLUSIONS
There is a significantly higher percentage of young people with SLCN accessing the
MK YOT than the average population. In addition, those with an identified need tend
to have severe difficulties. All those within the NEET group that completed the
assessment process had a SLCN. These SLCN have in the main, not been previously
identified. These findings are in line with other research projects that have addressed
the area of SLCN in young people who offend. Most of the young people are unaware
of their own difficulties and believe that they are able to understand everything and able
to express themselves fully.
All young people who are involved with the MK YOT should have their
communication skills screened to identify whether there is a possible SLCN. This
process would be facilitated if the ASSET contained a communication section which
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could be completed by case workers and identified those individuals requiring more
detailed assessment. As the young people themselves are unable to identify their own
difficulties, it is necessary for the YOT staff to be skilled and confident in identifying
and dealing with communication difficulties.
There is also the need for all those professionals within the Youth Justice System who
are working with the young people directly to be aware of the implications of SLCN
and to adjust their own language accordingly. For example, in police interviews,
meetings with solicitors, court hearings and so on.
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RECOMMENDATIONS FOR FUTURE SLT INPUT IN MK YOT
A high level of need for speech and language therapy input has been identified within
the MK YOT. Ongoing speech and language therapy support should be used to:

Train all staff to identify and support communication difficulties at a basic level

Train all staff in the potential implications of SLCN

Support staff in planning one to one/group work for young people accessing
YOT to ensure their communication difficulties are taken into account.

Support staff to implement the SLCN screening tool as devised by Marnie Crew
and Juliette Gregory until/if a communication section is added to the Asset

Develop a more detailed referral form and process so that all staff know who to
refer and how to complete the process.

Review existing packages of care, service leaflets etc to assess suitability for
young people with SLCN

Increase other professional’s awareness within the Youth Justice System of the
types and severity of SCLN amongst the young people, for example, police,
solicitors, courts etc.

Undertake individual/group work with the young people where appropriate to
address:
o Learning strategies to support their communication
o Developing social skills (for example, Talkabout programme)
o Poor vocabularies or word finding difficulties
o Problem solving skills
o Developing narrative skills
o Listening and attention skills

Support existing groups within YOT both in terms of planning and delivery.
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REFERENCES
Bryan, K., (2004) Prevalence of speech and language difficulties in young offenders.
International Journal of Language and Communication Disorders, 39, 391-400.
Bryan, K., Freer, J., and Furlong, C., (2007) Language and communication difficulties
in juvenile offenders. International Journal of Language and Communication
Disorders, 42:5, 505-520.
Burgess, J., and Bransby, G., (1990) An evaluation of speech and language skills of
children with EBD problems. College of Speech and Language Therapy Bulletin, 453.
Cohen, (1993)
Crew, M., and Ellis, N., (2008) Speech and Language Therapy within Bradford Youth
Offending Team. Pilot project
Lindsey, G., and Dockrell, J., with Mackie C,. and Letchford, B., (2002) Educational
Provision for Children with Specific Speech and Language Difficulties in England and
Wales, Cedar and Institute of Education, University of London.
Pryor, A.,
(1998) A systematic assessment of the prevalence of communication
difficulties within a small group of young offenders.
MSC thesis, University of
Reading.
Ripley, K., and Yuill, N., (2003) Patterns of language impairment and behaviour in
boys excluded from school. British Journal of Educational Psychology, 75, 37-50.
Sloan, A., (1997) Speech and Language Therapy and The Youth Inclusion Support
Project (YISP) in Brighton and Hove. Pilot project,
Warr-Leeper, G., Wright, N., and Mack, A. (1994) Language disabilities of anti-social
boys in residential treatment. Journal of Behavioural Disorders, 19, 159-169.
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