A randomised controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment

Aims to compare language outcomes following direct individual therapy [speech and language therapist (SLT) working individually with a child], indirect individual therapy [speech and language therapy assistant (SLTA) working individually with a child], direct group therapy (SLT working with a small group of children) and indirect group therapy (SLTA working with a small group of children) for primary school-age children with persistent primary receptive and/or expressive language impairment relative to a comparison group receiving current models and levels of SLT service. Concludes that SLTAs can act as effective surrogates for SLTs in the delivery of services within primary schools to children with primary language impairment who do not to require the specialist skills of an SLT. Generalising the central estimates of the relative cost of different therapy modes to other educational/health systems is possible, but the precise differences reported in resource use need to be qualified by the level of programme intensity and other characteristic features of education and therapy services that may differ from those observed in this trial. Further research is needed into effective interventions for receptive language problems and also investigations of the efficacy of the relationship between dose and treatment effect in both expressive and receptive language. Research is also needed into models of integrative service delivery, cluster models of delivery via integrated community schools, and the involvement of class teachers, classroom assistants and parents/carers. There is also a need for studies to identify the characteristics of children who are most likely to succeed with indirect intervention approaches, and also to evaluate alternative methods of working with those who may benefit from different modes. Finally, research to refine the therapy manual would also be helpful