Program Overview - Current Services
First
Words is an integrated system of preschool speech and language services serving
the City of Ottawa and is coordinated through the lead agency of
Pinecrest-Queensway Health and Community Services. A multi disciplinary team
provides health promotion, assessment, and treatment and facilitates transition
to school for children between 0 and 6 eligibility for senior kindergarten.
The
mandate of First Words includes a health promotion component. Education is an integral part of the program
and is provided to all who request it including but not limited to parents,
caregivers, health professionals, and the general population. An outreach worker and community Speech and
Language Pathologist reach out to the community agencies and partner with them
in the delivery of health promotion workshops/activities specifically designed
to educate parents and providers in language stimulation strategies as well as
normal speech and language milestones.
A variety of workshops are offered to the community by direct
facilitation or in a train-the-trainer format.
Workshops are provided to parents, early childhood educators, community
workers, volunteers, home childcare providers and speech and language
professionals. Hanen workshops are also
provided on a regular basis. Lunch and
learn opportunities are offered to working parents. The Speech Pathologists provide informative presentations to
pediatric grand rounds at the Children’s Hospital of Eastern Ontario as well as
education to students in early childhood education, home childcare providers,
SLP students as well as to the medical students. First Words strives to respond to any request for education
received by the community and adjusts its formats, times and locations
accordingly.
Public Screening Clinics are offered twice a
week throughout the city on a walk-in basis.
The First Words Screening Clinic
calendar and the program newsletter "Chatterbox" are mailed on a
quarterly basis to:
Other program flyers or resources are also occasionally
included with this mailing. The Screening Clinic calendar and Chatterbox
newsletter are also posted on the First Words website.
Referral
to this program can come from parents, caregivers, physicians etc. Any community member who has questions about
their child’s speech and language development is welcome to call the Ottawa
Health Information Line staffed by City of Ottawa Registered Nurses and the
Nurses will provide advice and refer families to the First Words community
screening clinics should it be necessary for the child to be assessed. The Nurses have been trained and are
provided with comprehensive information by a First Words Speech and Language
Pathologist in order to best serve the callers.
Of
course, First Words could not possibly meet its health promotion mandate
without the partnership of and requests from community agencies such as
Childcare/daycare centres, homes for young single parents, Crossroads, private
businesses, OEYCs, resource centres, special needs agencies, shopping centres,
cinemas, libraries, private schools, etc.
The
intervention services function as a result of a strong partnership between a
number of community agencies. Each
agency provides information, awareness, early identification and/or treatment
services and models its treatment plan based on the needs and diagnosis of the
individual child.
·
Pinecrest-Queensway Health and Community Services (Lead Agency)
·
Children’s Hospital of Eastern Ontario (CHEO)
·
Ottawa Children’s Treatment Centre (OCTC)
·
City of Ottawa (Ottawa Public Health Information)
·
Children’s Integration Support Services
Client therapy is
provided in at least 11 community sites including community health centres,
community resource centres, children’s treatment centres, colleges, parent
resource centre and in a local primary school.
First Words is a successful initiative thanks
to its Steering Committee which is comprised of representatives from school
boards, children’s hospital, children’s treatment centre, children’s aid
society, Headstart Nursery schools, OEYC, child care sector, public health, and
young single parent’s network.
Impact of Best Start
Initiative:
The Best Start plan
will have a significant impact on First Words speech and language for young
children in Ottawa. As background, the system was first developed and
implemented in 1997 with the mandate to serve children from 0 – entry into SK
and a prime priority of identifying children at as young an age as
possible. During the first seven years,
there was no increase in the original 1999 base funding.
Best Start specific
funding for the Preschool Speech and Language Initiative (PSL) takes two forms:
·
The first was restoration funding
announced in Best Start Phase 1 in the fall of 2004. The intent of this funding
was to restore the ability of PSLs to meet their existing provincial targets
with regards to numbers served and wait times.
Due to historic salary pressures and other operating pressures, this
restorative funding had limited impact on numbers served or reducing waiting
times;
·
Additional funds through the recent
Best Start announcement (to be phased in over several years) will be required
prior to the program being able to respond to the expanded mandate.
The Best Start
Initiative will extend the age of eligibility for children to receive PSL
services. The policy framework suggests integration of the services offered
through First Words into the neighbourhood early learning and care hubs, or
ensuring strong linkages between the hubs and the First Words services. In order to expand our population base (to
entry to grade 1), additional funding will be required. For the outreach programs (health promotion,
screening clinics), depending on the designation of neighbourhoods and the
determination of hub structures, First Words would need to determine how best
to allocate resources taking into account the specific spatial and design
requirements for the direct
intervention services.
A summary of the
current services and community locations is listed in the following section of
this document. This includes an
analysis of the current service targets and the current challenges the program
faces in meeting the targets with the existing resources. As the table and the
gap analysis indicates, the gaps primarily lie in the direct speech-language
intervention component of the program, the health promotion programs are
meeting the provincial targets.
The
following submission is a broad statement of intent and will require further
development and ongoing collaboration with our valued First Words and school
board partners.
2005/06 Budget for preschool speech and language
services - Ottawa
Funding Source
|
Budget
|
SLP Staffing
|
CDA Staffing
|
|
Ministry of Children & Youth
Services |
$1,572,352 |
6.4 FTE (general pop) |
2.0 FTE |
|
Children’s Hospital Eastern Ontario |
$530,000 |
4.95 FTE (in and out patient) |
0.2 FTE |
|
Ottawa Children’s Treatment Centre
(OCTC) |
$578,395 |
8.7 FTE (special needs only) |
|
|
Children’s Integration Support Services
(CISS) |
$101,052 |
1.0 FTE (headstart nursery) |
|
|
Total Preschool Speech Funding=
|
$2,781,799 |
21.05 FTE |
2.2 FTE |
|
Current Situation |
Targets |
Gap |
|
Average age at identification = 34
months |
30 months |
4 months |
|
Wait time to 1st Intervention
= 33 weeks |
20 weeks |
13 wks |
|
# Waiting for assessment =
97 (first quarter 0-06) |
50 children |
47 children |
|
# Assessed/year = 1515 |
1500 |
No gap |
|
# Children served during the year = 3946 |
4000 |
54 children |
|
# Child served by end of year = 5187 |
5190 |
3 children |
|
# Children transitioned to school = 654 |
700 |
46 children |
|
# Parents who will self refer for
service = 777 |
750 |
No gap |
|
A single phone number for common intake
will be maintained = number exists |
Single phone
number |
None |
|
At least the following interventions
will be provided: |
Parent training, caregiver consultation,
SLP group therapy, mediated group therapy, SLP individual therapy, mediated
individual therapy, home programming, monitoring and parent consultation |
No gap as
the program provides all these interventions |
|
Public awareness and parent education
sessions will be provided = a variety of parent workshops as well as
caregiver training and public awareness events are offered weekly in a
variety of formats and locations |
Public awareness and parent education
sessions will be provided |
No gap |
Deliverables: As noted in the illustration of service
gaps, the current funding does not enable the program to meet all provincial
expectations in wait times and age of
identification. Of particular concern
is the need to continue to implement strategies so that we can identify
children as early as possible. To meet
current objectives, resources are required to reach out to parents with children under two and to provide intensive
early language strategies and coaching.
This will increase the percentage of children identified and reduce the
age of identification. In addition, to meet the additional children
(beyond SK to grade one) additional resources would be required.
First Words is actively reviewing their
service delivery model in order to identify efficiencies as well as more
effective grouping. The program staff
has also undertaken the task of developing guidelines to establishing length of
therapy which will be reflective of severity and disorder.
Ratio: The average caseload ratio for SLPs is
1:150-175 across the provincial PSLs.
First Words has a variety of SLP services offered to children which
includes services. Of course, the SLPs
at children’s treatment centres serve a high needs population who require a
specialized service and cannot be expected to carry a caseload even close to
the provincial average. In Ottawa,
their 8.7 SLPs served ~400 children/families at OCTC. Also, 1.0 FTE SLP at CISS touched ~277 children.
It is challenging to determine the
average caseload that an SLP carries given the variety of services offered to
children with very varying needs. If
the caseload ratio includes the total number of SLPs in a PSL then the current
caseload in Ottawa is 1:188 children.
If we were to remove the number of SLPs serving only those with highly
specialized needs (8.7 FTE) then the
average caseload would be 1:312 children.
Regardless of the formula and criterion used to determine the average
caseload, that of SLPs in the Ottawa PSL is greater than the average thus
requiring increased funding for the PSL to attempt to reach its deliverables
and be comparably funded to other PSLs.
Gap Analysis under Current Mandate
Resources required to meet MCYS deliverables under
current mandate
|
Needs |
Resources Required |
Budget Required[1] |
|
Require additional SLP funding to reach age of identification
deliverable |
1 FTE SLP 1 FTE ECE |
$100,000.00 $71,000.00 |
|
Require additional funding to reduce wait times |
3 FTE SLP |
$300,000.00 |
|
Require
additional funding to reduce the caseload of First Words SLPs to 1:175 in
order to retain and continue to recruit experienced clinicians |
6 FTE SLP |
$600,000.00 |
|
|
0.5 FTE Admin Support |
$38,000.00 |
|
Operating cost
to locate increased number of staff (e.g. rent, telephone, computer support) |
|
$75,600 |
|
TOTAL
INCREASE IN YEARLY BUDGET REQUIRED |
|
$ |
|
Start Up Needs with additional staff
under current mandate |
One Time Start Up Resources Required |
|
Operating Costs/set up
(e.g. computer purchase, office set up, telephone purchase etc) |
$80,400.00 |
Change
in mandate under Best Start Initiative
(Upon receipt of
increased funding)
Best Start will increase the expectation and mandate of the
program. In many ways First Words is
well positioned to respond to this Initiative as it already has a strong
partnership with other agencies including children’s services and its
programming is well integrated in many ways.
First Words sees this Initiative as an opportunity to increase access
and services to a larger number of parents/children, agencies and service
providers. The direction from the
Ministry of Children and Youth Services has been that the expansion of services
will include:
Opportunities for Integrating into Hubs
Services that would be
provided and expanded to support Best Start
The goals would be
to:
Target populations:
Activities:
·
Develop a general awareness campaign for the multicultural and/or
hard-to-reach population
·
Link with schools by developing a collaborative model where PSL is
invited to meet parents when they register their child to daycare at school or
to JK/SK in association with school SLP
·
Partner with well baby clinics, Public Health and/or IHP community
clinics to give information and strategies for children from birth to grade 1
·
Expand our Lunch and Learn program for working parents which includes
workshops and information sessions in their workplace
·
Enhance screening opportunities at high-volume family/children events
·
Establish outreach to playgroups and develop training for those
outreach workers
·
Re-energize the offering of You Make The Difference and Learning Language
and Loving it throughout the city
·
Develop a strategy to communicate high risk indicators and red flags to
the public and present to key professionals in the community
·
Expand the offering of existing workshops e.g. Primary Language
Literacy Project
·
Create new workshops and programming around language and literacy
·
Participate in the development and delivery of the ECE training
curriculum in community Colleges (Algonquin, Cite Collegiale)
·
Develop partnership with the SLP University program to develop joint
programs and/or health promotion activities
·
Offer mentoring in health promotion experiences to SLP graduate
students
·
Link with Teacher Colleges in Ottawa (University of Ottawa, Carleton
University) to offer education and training opportunities in regards to
promoting speech and language development and the link to early literacy
skills, written language skills and future success at school for preschoolers.
·
Investigate partnership and collaborative activities with existing
community agencies or organizations working specifically in literacy:
ABC-Canada organization, Clear Net Research, etc.
·
Enhance partnership with Ottawa libraries through an health promotion
vision (focus group for needs, education and training to workers; activities
for parents, partnerships)
·
Develop partnership with Early Literacy Specialists for collaborative
community activities focusing on language and early literacy skills in daycare
centers and schools
·
Continue existing and develop new outreach strategies to physicians
e.g. articles in medical journals, breakfast/lunch information sessions as well
as assist in the implementation of ‘Getting it Right by 18 months’.
B. Enhance school board speech and language
therapy services for SK population
First Words has not tracked the services delivered to
the children once they exit the current PSL system. The program has a strong partnership with the school boards
around transitioning children from the PSL into school services and anticipates
that this collaborative relationship will continue to grow for the benefit of
the children. The nature of the
enhancement of service that First Words will provide will depend upon what
service is offered to that individual child through their school board. This will increase the complexity of the tracking
of needs and services each individual child will receive therefore lending
itself to a need for an increase in for Clinical Coordination and
Administrative Support.
Current services offered to children in SK:
·
CCAC offers
direct therapy for moderate to severe articulation, fluency, and voice but not
language.
To estimate the staffing needs for First Words to
respond to the expansion of services to the SK population, the total population
of children age 6 was used so as to ensure the inclusion of children who are
not registered in SK but are at home, in daycare or are in a private school and
not receiving any publicly funded speech and language services.
An increase in SLP FTEs as well as increased Clinical
Coordination and Administrative Support will be required to respond to this
portion of the increased mandate. As
per calculations below, the estimate is for an additional 5 FTE SLPs.
C. Provide services to children of SK age but
not enrolled in public or catholic school boards
The children of SK age who are not registered in public or catholic
schools are children who do not have access to any publicly funded speech and
language services. Under a new Best
Start mandate, First Words would accept these children (12% of 1825) into the
caseload of the SLPs/CDA at a ratio of 1:100.
Calculations for resources required for all children SK age (enrolled in school or not)
|
Total number of Children age 6 |
12% Prevalence of speech and language delay |
Number of SLPs required at 1:100 ratio |
|
10,025 |
8200 in
SK x 12% = 984 with only approximately half continuing to need more intensive
services during their SK year = 492 children |
5 FTE SLP |
|
|
1825
children of SK age not enrolled in public or catholic school therefore not
receiving any publicly funded speech and language service therefore all 12%
of them requiring PSL services = 219 children |
2
FTE SLP |
Total resources required to meet service expansion under
Best Start:
|
Needs |
Resources Required |
Yearly Budget Required[2] |
|
A. Health Promotion & Early Identification |
1 FTE SLP 1 FTE CDA 1 FTE ECE 1 FTE Outreach
Worker |
$100,000.00 $75,000.00 $71,000.00 $57,000.00 |
|
B. Enhance school board
speech and language therapy services for SK population |
3.5 FTE SLP 2.0 FTE CDA |
$350,000.00 $150,000.00 |
|
C. Provide services to children of SK age but not enrolled
in public or catholic school boards |
1.5 FTE SLP 1.0 CDA FTE |
$150,000.00 $75,000.00 |
|
Increased need
for Clinical Coordination with increased number of staff and number of
children and sites |
0.5 FTE
Clinical Coordination |
$50,000.00 |
|
Increased need
for Admin Support with increased number of staff and number of children and
sites |
1.0 FTE
Administrative Support |
$62,000.00 |
|
Operating cost
to locate increased number of staff (e.g. rent, telephone, computer support) |
|
$120,000.00 |
|
|
|
|
|
TOTAL
YEARLY BUDGET |
|
$1,126,000.00 |
|
Start Up Needs under Best Start |
One Time Start Up Resources Required |
|
Operating Costs/set up
(e.g. computer purchase, office set up, telephone purchase etc) |
$87,000.00 |
Summary of
Budgets Requested in this Proposal:
To meet deliverables under current mandate:
10 additional SLP FTE: $1,000,000.00
1 additional FTE
ECE: $ 71,000.00
0.5 additional
FTE Administrative Support: $ 38,000.00
Operating Costs $ 75,600.00
---------------------
Total Increase
to Annual Budget: $1,184,600.00
One time start up budget: $ 80,400.00
To meet deliverables under Best Start expanded mandate:
One time start up budget: $ 87,000.00
6 additional SLP FTE (health
promotion and SK services): $
600,000.00
4 additional CDA
FTE: $
300,000.00
1 additional ECE
FTE: $ 71,000.00
1 additional
Outreach Worker FTE: $ 57,000.00
1 additional
Administrative Support FTE: $ 62,000.00
0.5 additional
Clinical Coordination FTE: $ 50,000.00
Operating Costs $ 81,900.00
--------------------
Total Increase
to Annual Budget: $1,126,000.00
Total of request
for current mandate + Best Start Expansion = $2,478,000.00
Final Budget
Note: An annualized index-funding is
key to supporting any influx of new positions in order that staffing is
protected from erosion due to cost of living.
_________________________________ ________________________________
Caroline
Desrochers Date Wanda MacDonald Date
Program
Manager Chair of First Words and Infant
Hearing
First Words Program
Steering Committee