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. Sign up to our mailing list to keep up to date.
Take part: 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. Read the handbook and guidance published by PHE. 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
Further information for Health Visitor leads completing the survey
If you are completing this survey, the following text provides some additional detail about the information we will collect.
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 above. 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.
Anonymised data will be retained for 10 years. You will receive a confirmation email after completing the survey with these contact details and a copy of your responses. If you wish to withdraw your consent you will be able to do so for up to two weeks after completion. After that time it will not be possible to withdraw.
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.Fitzfussel@education.ox.ac.uk
