The Project
The ESCALATER Project aims to gain a comprehensive understanding of how health visiting services are identifying and supporting children’s speech language and communication needs including the tools and interventions they use and the effects these have on services, families and children.
In 2020, a new approach to identifying and offering help to young children who are likely to have difficulties with language and communication was launched in England. This is called ELIM-I: Early Language Identification Measure and Intervention. Members of Health Visiting teams were trained to use ELIM-I when they visit families for their child’s 2-2½ year review. We do not know if or how ELIM-I is benefiting children, families and services.
This research aims to find out:
- how ELIM-I is used in practice.
- if ELIM-I is bringing about positive changes for children, families and services.
- if changes are needed to make sure all children can benefit and practitioners can use ELIM-I easily.
- if there are differences in the benefits of ELIM-I depending on how it is delivered.
- if benefits are experienced fairly by socially disadvantaged children, children from different regions or who speak languages other than English.
The study has four phases. We will:
- interview health visitor leads and do a national survey to map if and how ELIM-I is being used.
- work with six health visiting services, which are very different from each other. We will interview health visitors and families and look at the information services routinely collect to understand what happens when ELIM-I is used in different ways.
- use national data to compare services before and after ELIM-I is introduced and between services that are using ELIM-I with those that are not. We will compare children’s language and communication development at the end of the Early Years Foundation Stage when children are aged 5, and numbers of children referred for Speech and Language Therapy.
- look at how much ELIM-I costs.
Throughout we will consult parents/carers of young children with and without language and communication difficulties to embed a family perspective into the research.
The study has been funded by the NIHR and will run for 30 months in 2025 – 2027. We will be publishing a number of reports as the study progresses.
ESCALATER Survey of Health Visitor Team Practice
One of the first pieces of work we will complete is a survey of health visitor teams’ practice in England.
Children’s early language and communication development sets the stage for their learning, relationships, and wellbeing across childhood. Around 14% of two-year-olds have difficulties with language and communication. Early help has the best chance of preventing future long-term problems.
In England, 14% of 2 – 2½ year olds do not have the language and communication skills expected for their age, limiting their life chances in terms of education, wellbeing and social relationships. The Healthy Child Programme and the work of HV teams are vital to give children the best possible start in this fundamental area of development.
The ELIM-I was developed by Public Health England (PHE) and training was cascaded across services in 2021 to address this challenge.
You can read the handbook and guidance published by PHE here.
You can read more recent guidance on its use and supporting resources published by Newcastle University.
The survey is designed to allow us to understand how health visiting (HV) teams assess and support Speech Language and Communication at the 2-2 ½ year review and whether teams use the Early Language Identification Measure and Intervention (ELIM-I) or other tools. This study will inform future health visiting policy and practice and the support families and young children receive.
We aim to gain a comprehensive understanding of whether and how health visiting services are using the Early Language Identification Measure and Intervention (ELIM-I) and other tools. We also aim to learn how the use of different terms affect services, practitioner and family experiences of the Healthy Child 2 – 2 ½ year review, and child and service outcomes.
We will publish a summary of the findings of patterns of use of the ELIM-I and other tools. We will also use the information you share to analyse National Pupil data and Community Services data to see whether the differences in if, when and how ELIM-I is used affects:
- Children’s Early Years Foundation Stage Profile results
- Identification of children with SLC Needs
- Onward referral to Speech and Language Therapy
- Onward referral to Community Paediatrician
- Identification of children with SEND before the age of 5 years
FAQ for Health Visitor Leads completing the survey
Why am I being invited to take part?
We are inviting you because:
- You are a member of a health visitor team who has a key role in delivering and/or managing ELIM-I.
Or
- You are a member of a health visitor team who is not yet using the ELIM-I, but may be using other identification and support tools.
Do I have to take part?
No. You are free to choose, and your decision will not impact your work with your employer or any work you do. You may want to discuss with your friends and colleagues. If you join and then change your mind, you can withdraw up to two weeks after completion of the survey. Please see the “Can I withdraw from ESCALATER?” section
What will I be asked to do if I agree to take part?
We are asking all HV services across England to complete an online survey. You will be sent a link to the survey via email with guidance on how to complete it. You will be asked to answer questions about your HV service, and what tools and interventions your team uses to support identification and support for children with Speech Language and Communication Needs at the 2-2 ½ year review. The survey should take no longer than 30 minutes to complete online.
We would like to collect information about you and your HV service to enable us to contact you about the findings of the survey and for us to understand the range of roles, experience and provider and commissioning organisations of the people who respond to our survey.
Your details will remain confidential. We will publish summary information about the range of people who respond to the survey, but we will never publish anything which allows you to be identified.
By completing this survey you are indicating that you give consent for the data to be used as described in the survey and in the following. Your decision as to whether or not you take part will have no impact on your work with your employer or on your use of ELIM-I or otherwise as a HV team.
What will happen to the results of the study?
We will share the results with all the health visitor teams who take part. We will also actively share them with decision makers, and NHS funders. We will make easy-to-understand summaries which are openly available.
We also intend to publish the results in scientific journals, conferences, and newsletters. You and your service will not be identified in any report or publication.
Can I withdraw from the ESCALATER study?
After you complete the survey you can withdraw for up to 2 weeks after submission. You don’t have to give a reason. Withdrawal will not affect your work with your employer. If you would like to withdraw, you can do this by emailing a member of the research team at an email address listed at the end of this document and in the survey.
What are the benefits of taking part?
There may be no direct benefit to you. By taking part, you will help us learn about the ELIM-I implementation, including what could be done differently. You will be helping us learn more about how to better support young children who have language and communication difficulties. The results of this study will help us understand the benefits and impact of SLC early identification and intervention tools and plan strategies to support implementation of successful approaches.
What are the disadvantages and risks of taking part?
We do not anticipate any disadvantages or risks of you taking part other than the time commitment required.
Who has reviewed the ethics of this study?
All research in the NHS is looked at by an independent group of people, called a Research Ethics Committee, to protect participants’ interests. This study has been reviewed and given a favourable opinion by the Medical Sciences Interdivisional Research Ethics Committee (Ethics number: MS IDREC 2149888).
Expenses or payments
You will not be paid to take part in this study. If you agree to take part on a telephone call, we will contact you so that you do not have to pay for the call.
Who is responsible for the information collected for the study?
The University of Oxford is the Sponsor and data controller for the study. They are responsible for looking after your information, using it properly and complying with your rights. If you wish to exercise your rights under the UK data protection legislation, you should contact the University of Oxford. You can find more about this at https://www.ox.ac.uk/privacy-policy.
Will my taking part in this study be kept confidential and anonymous?
The University complies with its duties and obligations under the Data Protection Act 2018 which incorporates General Data Protection Regulations (GDPR). We will follow ethical and legal practice and all information which is collected about you for the purpose of this research study will be handled in strict confidence and securely stored by Oxford University.
Data from the survey will be downloaded as soon as possible and questions relating to consent and personal contact information removed and stored separately from the remainder of the survey as soon as possible. A unique identifier will be assigned, and all data will be assigned that number. Linkage between the consent and unique identifier will be kept separately in secure Microsoft 360 Sharepoint area only accessible via password. Reporting of the survey findings and participants will be at summary data level and will not allow for individual sites or participants to be identified.
Responsible members of the University of Oxford, and regulatory authorities and the relevant NHS Trust(s) may be given access to data for monitoring and/or audit of the study to ensure that the research is complying with applicable regulations.
How will my data be stored?
All electronic data, will be stored on the University OneDrive, which is password protected. All data will be stored in accordance with Oxford University guidelines and the Data Protection Act (2018).
What is the legal basis for processing personal data
Data protection legislation requires that we, the University of Oxford (whose legal name is The Chancellor Masters and Scholars of the University of Oxford), state the legal basis for processing information about you. In the case of research, this is a ‘task in the public interest’. The University of Oxford is the sponsor for this study and is responsible for looking after your information and using it properly.
We will need to use information from you for this research project. These will include your name and contact details. People who do not need to know who you are will not be able to see your name or contact details. Your data will have a code number instead. People will use this information to do the research or to check your records to make sure that the research is being done properly.
We may share data about you outside the UK for research related purposes. In this case this is because a data processor or third party based outside of the UK is required to process the online survey data according to the instructions set out by the sponsor (i.e. the purposes set out in the protocol and related agreements).
If this happens, we will only share the data that is needed. We will also make sure you can’t be identified from the data that is shared where possible. This may not be possible under certain circumstances. If your data is shared outside the UK, it will be with the following sorts of organisations:
- Cloud service providers
- Organisations providing a service (IT, translation etc.)
We will make sure your data is protected. Anyone who accesses your data outside the UK must do what we tell them so that your data has a similar level of protection as it does under UK law. We will make sure your data is safe outside the UK by doing the following:
- (some of) the countries your data will be shared with have an adequacy decision in place. This means that we know their laws offer a similar level of protection to data protection laws in the UK
- we use specific contracts approved for use in the UK which give personal data the same level of protection it has in the UK. For further details https://ico.org.uk/for-organisations/uk-gdpr-guidance-and-resources/international-transfers/
- we do not allow those who access your data outside the UK to use it for anything other than what our written contract with them says
- we need other organisations to have appropriate security measures to protect your data which are consistent with the data security and confidentiality obligations we have. This includes having appropriate measures to protect your data against accidental loss and unauthorised access, use, changes or sharing
- we have procedures in place to deal with any suspected personal data breach. We will tell you and applicable regulators when there has been a breach of your personal data when we legally have to. For further details about UK breach reporting rules https://ico.org.uk/for-organisations/report-a-breach.
How long will you keep the data?
Once we have finished the study, we will keep some of the data so we can check the results. We will write our reports in a way that no-one can work out that you took part in the study. We will keep your study data for the minimum period of time required by the funder.
Confidential data (for example your name, contact details and audio-recorded interview) will be destroyed six months after we have finished analysing and writing up the data for the funder and the Department of Health and Social Security. Anonymised research data will be separated and will be held securely for a minimum of 10 years after the study has finished in accordance with Sponsor requirements and data legislation. After this time the data will be disposed of securely.
What categories of personal data will be collected and processed in this study?
We will be collecting personal data (name, organisation you work for and work email address/work phone number).
Who are the recipients or categories of recipients of personal data?
The ELIM-I study team who are based at the University of Oxford and Northumbria University will have access to your information to contact you to arrange an interview, and for quality control purposes, such as auditing the data collection process. We may send recordings to an external professional transcription company with whom Northumbria University has a contractual and data processing agreement in place. Your data will not be shared outside the UK.
What are your choices about how your information is used?
You can stop being part of the study at any time, without giving a reason, but we will keep information about you that we already have. You have the right to ask us to remove, change or delete data we hold about you for the purposes of the study. We might not always be able to do this if it means we cannot use your data to do the research. If so, we will tell you why we cannot do this.
You can find out more about how we use your information, including the specific mechanism used by us when transferring your personal data out of the UK by:
- sending an email to cristina.mckean@education.ox.ac.uk
- calling us on 01865 274024
- contacting the University’s Data Protection Officer protection@admin.ox.ac.uk
- looking at the University’s privacy notice available at: https://compliance.admin.ox.ac.uk/research-data.
Who is running the study?
The research is being carried out by a group of experienced healthcare professionals and researchers from the University of Oxford, Newcastle University, Northumbria University, and the Institute of Health Visiting. This study is sponsored by the University of Oxford who have overall responsibility for the management of the study.
Who is paying for the study?
The study is funded by The National Institute for Health Research (NIHR), Policy Research Programme (project number NIHR207059). There is a steering group who meet regularly to advise the research team which includes experienced researchers, health and social care professionals and service users.
What if there is a problem?
If you have a question or concern about the study, you may contact the Chief Investigator Professor Cristina McKean or Professor Lindsay Pennington.
If you wish to complain about any aspect of the way in which you have been approached or treated, or how your information is handled during the course of this study, contact Cristina McKean cristina.mckean@education.ox.ac.uk or you may contact University of Oxford Research Governance, Ethics & Assurance (RGEA) at rgea.complaints@admin.ox.ac.uk If your complaint is in relation to how your data is being used or processed, you can contact the Information Commissioners Office. All of these contact details are given at the end of this page
We do not expect any harm to come to you by taking part in this study. In the event that something does go wrong, and you believe that you are harmed by taking part in this study, you have the right to pursue a complaint and seek compensation through the research sponsors of this study, the University of Oxford.
The investigators recognise the important contribution that volunteers make to medical research and will make every effort to ensure your safety and wellbeing. The University of Oxford, as the research sponsor, has appropriate insurance in place in the unlikely event that you suffer any harm as a direct consequence of your taking part in this study. If something does go wrong, you are harmed during the research, and this is due to someone’s negligence, then you may have grounds for a legal action for compensation. While the Sponsor will cooperate with any claim, you may wish to seek independent legal advice to ensure that you are properly represented in pursuing any complaint.
Contact us
If you have any queries, please do not hesitate to contact us. We will be happy to support survey completion with a phone or Teams call if this would be beneficial.
Key contacts:
Nadine.Fitzfussell@education.ox.ac.uk
