EPB0059

Written evidence submitted by the Royal College of Speech and Language Therapists

1. About us

1.1. The Royal College of Speech and Language Therapists (RCSLT) is the professional body for speech and language therapists, students and support workers working across the United Kingdom. We have around 17,500 members. We promote excellence in practice, provide leadership, set professional standards and influence health, education and justice policies.

2. Executive summary

2.1. The Royal College of Speech and Language Therapists is pleased to provide a submission on prison education.

2.2. Over 60% of people in contact with the justice system have speech, language and communication needs[i]. Most of these needs are unidentified and unmet.

2.3. Undetected or untreated speech, language and communication problems can lead to low levels of literacy, poor educational attainment and difficulties accessing verbally based treatment, rehabilitation or education programmes.

2.4. Unmet communication needs can often manifest as disruptive or challenging behaviour.

2.5. It is recognised that the biggest stabilising effect on release from prison is if someone gets employment. Improving the language, literacy and social skills of individuals can significantly reduce the number of them who go on to offend[ii] [iii] [iv] [v] through skill acquisition which provides them with ability to gain employment on release.

2.6. Prisons need to be providing appropriate support to identify and respond to speech, language and communication needs and enabling people to develop vital skills they require to be employed to help break the cycle of re-offending.

3. The Royal College of Speech and Language Therapists recommends:

3.1. All prisons must ensure they have identification systems for speech, language and communication needs and strong referral routes into speech and language therapy.

3.2. Given the high prevalence of speech, language and communication needs in prisons, it is essential that all prisons must have access to speech and language therapy.

3.3. All prisons need to be aware of speech, language and communication needs.  Training in communication should be mandatory for all staff. We recommend that all prison and education staff complete The Box communication training[vi].

3.4. All contracts for education must ensure that they include a focus on supporting people with speech, language and communication needs as well as SEND.

4. How school exclusion policy impacts on youth custody

4.1. The most common reason for pupils being excluded from mainstream education is disruptive behaviour; research shows that many children and young people who are excluded, or at risk of exclusion, have behavioural difficulties which co-occur with communication needs.

4.2. Research shows young people who have been excluded from school are over-represented in the criminal justice system:

-          a study of the educational background of young people in custody showed that 88% of boys and 74% of girls had been excluded from school[vii].

-          36% of boys and 41% of girls said they were 14 years or younger when they were last in education[viii].

4.3. Research demonstrates a clear link between behavioural difficulties, communication needs, and

school exclusions:

• A study of secondary age pupils at risk of school exclusion found that for a high proportion of the pupils, language difficulties were a factor in their behaviour problems and school exclusion[ix].
• In a study of pupils at risk of exclusion from school, two thirds were found to have speech, language and communication needs[x].
• A review of 26 studies found that 71% of children formally identified with emotional and behavioural difficulties (EBD) experienced clinically significant language deficits, and 57% of children with diagnosed language deficits also were identified with EBD[xi].

4.4. Given the high prevalence of communication needs in young people with behavioural difficulties, all teachers and other staff working with pupils at risk of exclusion should be trained in recognising communication needs.

5. Prevalence in the justice system

5.1. Speech, language and communication needs are more prevalent in the offending population than in the general population[xii].

5.2. Evidence shows that over 60% of young offenders have speech, language and communication needs.  Recently published Youth Justice Board experimental statistics found that 71% of young offenders have speech, language and communication needs[xiii] on self-reported measures.

5.3. Communication problems persist into adulthood and evidence confirms that similar numbers of communication difficulties are found across the adult prison estate[xiv].

5.4. Conditions which are strongly associated with language and communication difficulties, such as learning difficulties, autism and psychiatric conditions, as well as conditions associated with ageing, such as dementia and stroke, are shown to be very prevalent in the adult prison population. This indicates a greater need for access to speech and language therapy.

6. The impact of speech, language and communication needs

6.1. Most people involved in the justice system have unrecognised speech, language and communication needs. This is because their needs are not identified before entry into the justice system. 

6.2. People are often unaware or unable to articulate their needs or have found coping strategies to live with their difficulties. Speech and language therapists report it is often the people with the most significant needs who have the least insight into their own difficulties. 

6.3. Communication skills are fundamental and foundational. They are not simply expressive skills (our ability to make ourselves understood), but also receptive (our ability to understand). You cannot deal with any other issue if a person cannot understand what others are saying, cannot express themselves and their own needs.

6.4.  There are significant demands on spoken and written language in prisons. Speaking and listening skills are essential for people to cope with the demands of the prison regime.  This includes:

      compliance with day-to-day procedures and routines (following instructions and orders, understanding routines)

      taking part in offender treatment or rehabilitation programmes (which are often ‘talking’ based and the verbal context of these programmes can disadvantage people with speech, language and communication needs)

      participating in education, training programmes or re-settlement activities.

      accessing healthcare advice and treatment (which relies on understanding and relaying information verbally and in writing)

6.5. Where communication is not identified and supported, this can lead to frustration and result in disruptive, aggressive, and even violent behaviour.  In custodial settings, this behaviour can lead to physical interventions to manage this behaviour, segregation, and isolation for the person.

7. Poor identification

7.1. Due to the high prevalence of speech, language and communication needs in prison, all people should be screened on entry. However, at present this does not happen across the custodial estate.

7.2. To highlight individuals in need of additional support within the first 14 days of arrival into youth custodial settings the Comprehensive Healthcare Assessment Tool (CHAT) is used.  It is administered by healthcare staff within youth custody establishments. Screening information is kept on healthcare records and appropriate onward referrals are made. However, recent research has found that a higher score on the CHAT did positively not correlation with onward referral.

7.3. There is no screening tool used in the adult prison estate to identify speech, language and communication needs. This results in significant unmet and unsupported needs. 

7.4. For some time, education teams have been carrying out separate screenings. A LDD tool was introduced by the Ministry of Justice through their contract with education providers. This includes consideration of dyslexia and dyscalculia. However, this data is frequently not shared between therapy, mental health and education teams, exacerbating silo working.

7.5. Appropriate identification of speech, language and communication needs will ensure appropriate strategies are put in place to support the person and all interventions and education programmes are modified to the needs of that individual.

7.6. Those identified with possible difficulties should be referred to speech and language therapy for a full assessment of their need.

8. Lack of staff understanding

8.1. Staff receive little training in supporting people with communication needs. Training is crucial to ensure that all staff have the right skills and knowledge to work with vulnerable people with complex needs.

8.2. Where communication is not supported and understood, this can result in disruptive, aggressive and challenging behaviour. Staff can misunderstand and misinterpret challenging behaviour and punish the person for “bad behaviour” rather than getting to the root of the problem. In custodial settings, this behaviour can lead to physical interventions to manage this behaviour such as restraint and segregation and isolation for the person.

8.3. The Royal College of Speech and Language Therapists recommend that all education and prison staff must be trained to recognise and support speech, language and communication needs. It would be beneficial for all staff to have training in recognising and supporting individuals with speech, language and communication needs as part of their induction given that over half of the population are likely to have needs in this area.

8.4. Training should not be viewed as a one-off event, but as continuing professional development (CPD).  It should also be tailored to the needs of different staff providing more in depth knowledge to those who have greater interaction with people with speech, language and communication needs.

8.5. The Royal College of Speech and Language Therapists has developed “The Box”[xv] a communication training programme to help staff understand how to modify their own communication and provide strategies to optimise their one-to-one engagement with young people. We recommend that this is made available for all staff.

9. Access to education and learning 

9.1. Evidence suggests that around 40% of people struggle to access verbally mediated or language-based interventions[xvi]. This is because many people do not have the age-appropriate communication skills or sufficient vocabulary to access these programmes.

9.2. To support access to education, speech, language and communication needs must be identified and supported.

9.3. To access education and treatment programmes an offender requires GCSE level English A-C[xvii].  However, many people have poor literacy and poor numeracy. Education providers must be aware that individuals will require tailored and adapted programmes, intervention and support.  Without such support people will be unable to access education due to their poor language and literacy skills.

9.4. All interventions must be aimed at the appropriate levels for the person and accurate screening and assessment of speech, language and communication needs underpins this.

9.5. Prison education needs to move from general group provision to a form of educational provision that focuses on the individual’s difficulties.

9.6. Education staff need training and support to enhance their awareness of language and communication issues, and to enable them to manage these difficulties within the provision offered.

10. Employment and the skills needed by employers

10.1. Our economy has become increasingly dependent on communication-based employment, the fitness of a person of the 21st century will be defined increasingly in terms of his or her ability to communicate effectively[xviii].

10.2. Many employers believe the ability to communicate effectively is an essential job skill, and good or excellent communication or interpersonal skills are routinely demanded in job requirements[xix]. 

10.3. The Confederation of British Industry (CBI) defines employability skills as including good communication and literacy[xx].  However, people are leaving prison without such employability skills and this is hampering the ability of them to obtain a job[xxi].

10.4. Employment has been identified as a route out of poverty and enables people to improve their life chances[xxii]. Communication is central to raising attainment and has been identified as crucial to social mobility and increased life chances[xxiii]. 

10.5. Prisons need to equip people with the skills they require to be employed. A focus on developing these core enabling skills is essential if people are to thrive.  Education providers have a role to play in developing effective approaches to support access to education, with a focus on personalised approaches to learning.

11. What needs to change? 

11.1. Education providers need to change the way they work and cooperate better with health colleagues.

11.2. Education providers must be strongly encouraged to provide accessible education programmes. This must include appropriate access to speech and language therapy.

11.3. The importance of working collaboratively with specialists in communication such as speech and language therapists must be recognised.

11.4.  The Royal College of Speech and Language Therapists recommends:

• All prisons must ensure they have identification systems for speech, language and communication needs and strong referral routes into speech and language therapy.
• Given the high prevalence of speech, language and communication needs in prisons, it is essential that all services must have access to speech and language therapy.
• All prisons need to be aware of speech, language and communication needs.  Training in communication should be mandatory for all staff. We recommend that all prison and education staff complete “The Box” communication training.
• All contracts for education need to ensure that they include a focus on supporting people with speech, language and communication needs as well as SEND.

Submitted by the Royal College of Speech and Language Therapists, January 2021

References

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