'Team Speech Sounds'-How Speech and Language Therapists Work With Parents of Young Children With Speech Sound Disorder: A Focus Group Study.

backgroundSpeech sound disorder (SSD) is common amongst children on speech and language therapy caseloads, with most of these children being between 2 and 6 years old. SSD that persists into a child's school years can have a lasting impact on literacy development, socio-emotional outcomes and well-being. Effective intervention in the preschool years is therefore vital. Evidence shows speech and language therapists (SLT) believe working with parents is essential for a child's progress, and positive relationships between SLTs and parents facilitate engagement with home practice. However, little is known about what practising SLTs do to support parents to deliver effective home practice or how they form positive relationships with parents.

aimsIn this study, we explored SLTs perceptions and experiences of their current practices when working with children up to 5 years and 11 months with SSD and their parents. Our focus was on the techniques and strategies SLTs use to support parents to implement effective intervention at home with their child, how they develop effective working relationships with parents and the barriers and facilitators to supporting parents effectively. METHODS AND PROCEDURES: We used a qualitative, focus group methodology. Fifteen SLTs, recruited via social media and professional networks, participated across four 2-h online groups. Participants had a range of years of clinical experience, worked across public and independent sectors and came from different geographical locations. Groups were recorded, transcribed verbatim and analysed using Reflective Thematic Analysis. OUTCOMES AND

resultsWe constructed four main themes: (1) Individualisation, flexibility and sufficient time allow for an accessible service. (2) SLTs' individual circumstances and attitudes influence how they support parents. (3) SLTs work to ensure the fidelity of home practice. (4) Nurturing relationships is fundamental. CONCLUSIONS AND IMPLICATIONS: We demonstrate that what SLTs do to support parents aligns with the COM-B model of behaviour change: SLTs develop their own and parents' capability; they individualise provision to allow parents the opportunity to access it and build relationships to support motivation. This works towards the desired behaviour-engagement with and fidelity of home practice. Our study builds on emerging research into the use of behaviour change theory, highlighting building relationships as fundamental to SLTs and parents. SLTs need to reflect on the impact of their own personal circumstances. Support for parents needs to be individualised to create opportunities, while ensuring adherence to the evidence so that home practice is delivered with fidelity. WHAT THIS PAPER ADDS: What is already known on the subject Speech sound disorder (SSD) is common in Speech and Language Therapist's (SLT) paediatric caseloads. SSD that persists into school years can have a long-term impact. SLTs believe that working with parents to support home practice is important, but little is known about what practising SLTs do to support parents to deliver effective home practice, how they form positive relationships with parents or how they perceive working with parents. What this paper adds to existing knowledge Our study explored how SLTs work with parents to ensure home practice is delivered with fidelity and what they do to build effective relationships. Our findings suggest that SLTs use strategies which align with behaviour change theory, by building on parents' and their own capability and, by adapting to individual families to maximise opportunities for parents to become effective implementors. Importantly, building relationships with parents not only supports the motivation of parents but also of SLTs. What are the potential or actual clinical implications of this work? Our results suggest that relationships between SLTs and parents underpin effective home practice. Developing these relationships takes time and skill. Building relationships with parents and helping them to understand what they need to do and why is likely to have a positive impact on the parents' ability to implement home practice. These relationships may allow SLTs to skill up parents more effectively and support the individualisation of the intervention approach, which is important to both parents and SLTs. SLTs should be cautious however to ensure that the boundary between adherence to the evidence base and effective individualisation to optimise outcomes for the child is maintained.