JCPSLP November 2017

who present with primary social, emotional or behavioural difficulties (Benner, Nelson, & Epstein, 2002; Bryan, Freer, & Furlong, 2007; Hollo et al., 2014; Ripley & Yuill, 2005; Snow & Powell, 2011; Stringer & Lozano, 2007; Tommerdahl & Semingson, 2013). The results of a recent meta-analysis show that it is likely that four out of five children with SEBD have unrecognised language impairment (Hollo et al., 2014). Numerous studies confirm an increased prevalence of SEBD in children with communication impairments, and vice versa (Benner et al., 2002; Botting & Conti-Ramsden, 2000; Cross, 2011; Ripley & Yuill, 2005; Stringer & Lozano, 2007). Academic achievement is consistently identified as a protective factor against antisocial behaviour, youth offending, and drug misuse (with the inverse, academic failure, a risk factor) (Snow & Powell, 2011; Snow, 2014). If it is possible to identify primary school-aged students who, because of significant SEBD, are at risk of academic failure and school disengagement, it may be possible, through the use of targeted, evidence-based interventions that support language and literacy skills, to alter their educational trajectories and prevent future social marginalisation (Law, Plunkett, & Stringer, 2012). Both locally and internationally, most research on the topic of co-occurring social, emotional, behaviour and communication difficulties in the field of speech-language pathology has taken the form of prevalence studies. Interventions targeting social and emotional well-being and functioning in students with SEBD are reviewed in the literature; however, fewer interventions that directly target communication are available. Law, Plunkett and Stringer (2012) have published a review of communication interventions that have targeted behaviour in children between the ages of 5 and 11 years of age. They reviewed 19 studies that all showed a positive impact on the students involved; however, there was a high level of heterogeneity between studies. Interventions trialled included speech and language interventions at both and individual and classroom level, as well as functional communication, peer and behavioural interventions that have been delivered in school, clinic, and home environments. This review highlighted the need for ongoing research in which both communication and behaviour are considered, with collaboration between SLPs, psychologists and other health professionals. For SLPs working in Australian primary schools, there is an ongoing need to advocate for assessment, intervention and support for these students, to reduce their risk of disengagement from school, or the later emergence of offending behaviour that may result in contact with the law. In recent years, understanding and insight into the particular communication needs of adolescents in the youth justice system has grown (Bryan et al., 2007; Snow & Powell, 2011). With increasing recognition of the school-to-prison pipeline (Christle, Jolivette, & Nelson, 2005), learnings can be extrapolated to younger, vulnerable primary school age students. Indeed, conceptualising the provision of services to primary school students with SEBD as preventative intervention is warranted. Of critical importance is the provision of evidence-based instruction for these vulnerable students, to ensure the transition to literacy is made in the first three years of school (Snow, 2014). Clinical insights Current provisions for students with SEBD In Victoria, a staged approach to managing challenging behaviour generally includes a recommendation for

supporting a student with SEBD with the formulation of a behaviour support plan (BSP). A BSP is a school-based document designed to assist individual students who have experienced harm, are at risk of harm, or have caused harm to others (Victorian Department of Education and Training, 2017). This document is developed jointly by school staff and the student’s parents or carers, allows the expectations and planned supports for a student to be communicated clearly, and documents any known triggers for unwanted behaviours. Guidelines for promoting positive behaviour place a strong emphasis on the importance of clear communication between all parties involved, including the student (Victorian Department of Education and Training, 2013). If indicated, Victorian government schools may make an application for a student in the severe behaviour category under the PSD. To be eligible to receive additional support and funding, students must meet the criteria outlined in Table 2. It is at the point of application that students are often referred to a SLP to ensure they meet the exclusionary criterion of not presenting with a language impairment. Standardised language assessments are used to measure language at a word and sentence level, but are often not sensitive to subtle higher level language difficulties that affect discourse or pragmatic skills. The criterion of excluding language impairment is at odds with both the Australian and international literature that demonstrates the high rate of co-morbidity between SEBD and communication difficulties. A growth in alternative educational settings, offering smaller classes and individualised programs, has been seen across Australia in recent years (McGregor & Mills, 2012). Mainstream settings may refer students who are at risk of disengagement and not able to participate in the classroom to these alternative programs. These settings are predominantly for secondary school students; however, alternative (often temporary) placements are available for primary school-aged students in some locations. Support may also be available from psychologists and counsellors, in both mainstream and alternative school settings; however, the success of behavioural interventions with students with undiagnosed complex communication difficulties is likely to be less than optimal if specialist SLP services are not also made available to these students. Despite the current provisions for intervention and support, students with severe SEBD are at the highest risk of being suspended and excluded from school (Armstrong et al., 2016; Graham et al., 2010). While all students are required to attend school full-time until the age of 17 in the state of Victoria, students with SEBD are known to often have reduced attendance, and may be removed before the completion of the school day. Disrupted education experiences have long-lasting implications for the acquisition and development of language and literacy skills (Stringer & Lozano, 2007) and for opportunities to be exposed to and acquire prosocial interpersonal skills. A current service example A speech-language pathology role was instigated in a Victorian Department of Education and Training specialist unit for primary school students with SEBD in an outer metropolitan area of Melbourne. Students are referred to this specialist unit by their mainstream school and attend the unit for three or four days per week for the duration of two consecutive school terms, while remaining enrolled in their mainstream school the remaining one or two days. Teaching staff at the school have a variety of professional

127

JCPSLP Volume 19, Number 3 2017

www.speechpathologyaustralia.org.au