The paper describes the initial stages in the development of a screening instrument designed to identify children with impaired language development at the age of 2 1/2 years. The pilot study comprised 40 children seen for routine developmental surveillance at one of the Community Health Centres in City and Hackney District Health Authority. The screen was found to be both sufficiently sensitive and sufficiently specific to warrant further investigation. The discussion highlights a number of pertinent issues which have arisen from the study and which the authors consider to be of relevance to others considering the development of equivalent procedures.

This paper examines the effects of two different types of treatment provided for young children with a specific language impairment (SLI). Two groups of seven children matched for language skills were ran domly allocated to one of two treatment conditions. In the first, the children were given group treatment three times a week over a seven week period. At the same time the parents were provided with weekly sessions encouraging them to focus on specific aspects of their child's interaction and language development. In the second condition, children were provided with group treatment equivalent to that in the first condition but parents were not provided with the additional support. Change was measured using video analysis of parent/child interaction in a fixed context before and after the intervention. As predicted, child initiations increased following both groups providing input to children. The parents who were involved in the intervention increased their use of specific referent terms directly relevant to the nonverbal context. How ever, very little difference was noted in the behaviour of parents who were not involved in intervention. The clinical implications of these findings are discussed.

This paper presents a video coding system designed as a synthesis of a variety of other methods which is being used as a measurement of clinical outcome. It has been developed for a current study investigating the effectiveness of intervention to improve the language and communication skills of three-year-old language-impaired children and their parents. Five coding categories are used, three relating to the adult input (discourse structure, communicative function and linguistic behaviour) and two to the child input (discourse structure and linguistic behaviour). The coding system is discussed in relation to a series of hypotheses developed for the intervention study.

Limited resources, increased demand and current commissioning structures has put the rationalisation of health care high on the agenda. Any prioritisation process needs to be clinically led and client driven so reactive ad hoc arrangements are minimised and structures for good practice enabled. This paper argues that the current context be used as an opportunity to critically evaluate the services speech and language therapy aim to provide. By defining our aims and demonstrating the range and boundaries of our effect we can be proactive in structuring our services appropriately. Such an exercise currently underway in City and Hackney is outlined which aims to: describe an optimum structure for provision and the resources required, propose possible models within current resource and highlight the gap between the two.

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