1. Communication: From babbling to talking
Early Identification and Intervention
of Speech and Language Delays
By Roxane Belanger and Elaine Hendry
Speech Language Pathologists
If you have come to debate that … this is not the place. I will not let you.
Language is learned from birth (before birth some say) – milestones are set to follow the development of a child’s lgg and to identify those at risk..
Milestones that I present today will be clear milestones form 0 to 3 … these milestones are based on research and identify the kids that are within the 15th percentile.

2. Contact Information
Roxane Belanger, Speech Language Pathologist
First Words Preschool Speech and Language Program of Ottawa
mobile phone:
Elaine Hendry,
Speech Language Pathologist
Ottawa Children’s Treatment Centre
x2931
First Words
OCTC

3. Objectives
Through attending this session, participants will be able to:
Identify the role of the Early Years Professionals in early identification of children at risk for speech and language delay
Use the Ottawa Red Flags document and apply 6 risk indicators in the assessment and referral of young infants with possible speech and language delay
Know how to refer families to First Words, the Preschool Speech and Language Program in Ottawa and to the Ottawa Children’s Treatment Centre (OCTC)

4. Communication … the foundation !
Language is the greatest predictor of a child’s success later in school / in life
Communication development may be the best indicator of a developmental delay
(Wetherby & Prizant, 1996).
Surrender your imagination to these words …
When a male octopus spots a female, his normally grayish body suddenly becomes striped. He swims above the female and begins caressing her with seven of his arms. If she allows this, he will slip his 8th arm in her breathing tube. This is how octopus mate.
Cherries jubilee on a white suit? Wine on an alter cloth? Apply club soda immediately. It works beautifully to remove stains from fabric.
When Dixie opens the door to Tad, she is stunned, because she thought he was dead. She slams it in his face and then tries to escape. However, when Tad says “I love you”, she lets him in. Tad kisses her passionately. When Brian interrupts, Dixie tells a stunned Tad that she and Brian were married earlier that day.
If you were able to read this
…it demonstrate an ability to read and write
…think about what the words have done (you know what might happen next if you ever meet a striped octopus, you might look for club soda in the supermarket on your next outing, you share with millions of other people the ups and downs of daytime drama “All my children”.
… that writing is clearly an optional accessory
the real engine of verbal communication is the SPOKEN LANGUAGE
we acquired as children
When serious health or physical impairments are not present, a delay in language development may be the first evident symptom that a child is not developing normally.

5. Prevalence of speech and language disorders in preschool children
Approximately 10% of all preschool children have a speech and language disorder in the absence of a sensory, cognitive and/or neurological impairment:
language disorders (60%)
articulation and phonology disorders (20% – 25%)
fluency disorders (5% to 15%)
voice disorders (1%)
Many of these children first present as
LATE TALKING TODDLERS.

6. Section 1
WHY WE DO WHAT WE DO?

7. The reasons we do this!

8. So children can grow up to be successful adults!

9. Early Identification & intervention: it happens BEFORE 30 months!
Language is rooted in research: Clear pediatric research show the importance of early, early, early experiences and intervention!
But there still is a trend or a tendency to think that:
children have time to learn language ! (they don’t)
children can make up the lag with time at 3, 4 and 5 years of age! (they won’t)
CHILDREN LEARN LANGUAGE starting at birth!
Key milestones at 6 months, 12 months, 18 months and 24 months need to be reached.
If not, the child is already off the trajectory.
“Children are wet cement!” - The best window of opportunity for intervention is between the ages of birth to 30 months.
Early Identification & intervention: it happens BEFORE 30 months!

10. Early experiences are critical to overall brain development.
Grounded in research and pediatric litterature
What the science says about the “ideal” system for the child …
Early experiences are critical to overall brain development.

11. The developmental “scoop” : Earlier is better!
Early cognitive development is primarily driven by biology
Ages 0 to 3 provides the greatest window of opportunity to affect neurological and behavioral growth and impact (Rossetti, 2001)
Variables for success: early ID and parent involvement
“Children are wet cement!” - The best window of opportunity for intervention is between the ages of birth to 30 months.
Early cognitive development is primarily driven by biology. Under the age of 30 months, there is a high correlation between communication and intellectual abilities.
Application – Act now! Don’t wait and see ! Know the developmental milestones and refer in a timely fashion.
Early intervention and intervention before the age of 30 months have better and faster outcomes for the child.
Application – Pediatricians and family doctors will see children regularly (i.e. check-ups, vaccines). You can refer children at 12 months, 18 months…

12. Early is better… Early identification …
Early experiences affect brain structure : "use it or lose it" principle (Carnegie Task Force on Meeting the Needs of Young Children, 1994; Ounce of Prevention Fund, 1996).
Early core deficits may lead to a cascading effect on neurodevelopment that arise from impoverished social interaction.
(Mundy & Burnette, 2005)
Early identification …
Underscores the importance of developmental interventions

13. BUILDING THE BRAIN!
Everything in the infant environment contributes to brain development: noise, light, touch, voice, and smell of caregiver.
Correlation between the intensity of the stimulation
= +++connection between parent&child
= +++ more brain development
Get the parent involved. Families need to know about the importance of the “drip-drip” effect – that the rich daily life experiences makes a difference
Experiences in early life activate gene expression
and result in the formation of critical pathways
and processes. Billions of neurons in the brain
must be stimulated to form sensing pathways,
which influence a person’s learning and
behaviour, and biological processes which affect
physical and mental health.
Correlation well-established between intensity of the stimulation:
and the connection between parent and child
and brain development: building pathways for learning and health

14. Early Years Professionals are an integral part of the early years initiative!
EYPs have a direct and daily contact with infants and young children
EYPs are important to families! You are in the best position to talk and tell families the importance of early experiences (talk, touch, read, play) and early referrals
New provincial initiatives are in place!
Help families access services earlier. Pediatric literature shows that caregivers and parents are “accurate descriptors of children’s behavior”.
Application – Listen to parents and empower them in the identification and access to services’ process. For this , you need to know milestones, stages and ages and community resources. FW screening clinics HAVE NO WAITING TIME

15. Why is Early Experiences and Early Identification so important?
Early intervention may
provide better and faster outcomes for the child (early experience affect brain structure, “use it or lose it” principle),
prevent a cumulative delay
prevent or decrease the severity of language delays in preschoolers,
enhance school readiness,
and increase later academic success in school.
Why is Early Identification So Important
Brain Research. Recent advances in brain research show how the environment sculpts the young child's brain, as neurons form connections and mature in response to stimulation. The environment has the greatest potential to influence the child's developing brain during a child's first few years of life. Early experiences affect brain structure because the brain operates on a "use it or lose it" principle (Carnegie Task Force on Meeting the Needs of Young Children, 1994; Ounce of Prevention Fund, 1996). If a child does not have adequate emotional, physical, cognitive, and language stimulation, neurons can be lost permanently.
School Readiness. Language development is one of the most critical school readiness skills. A child's capacity to talk and the size of their vocabulary when they enter kindergarten is predictive of success in school. Children with language problems in preschool are likely to face poor educational achievement at school age and are at increased risk to develop emotional and behavioral disorders (Baker & Cantwell, 1987; Prizant, Audet., Burke, et al., 1990). Follow-up studies of preschoolers with speech and language problems consistently demonstrate persisting communication impairments in a substantial proportion of children, and a high incidence of learning disabilities (Howlin & Rutter, 1987). Early intervention may prevent or decrease the severity of language delays in preschoolers, enhance school readiness, and increase later academic success in school.
Cumulative Effects of Poverty and Environmental Risk. Research on young children raised in poverty demonstrates the dramatic detrimental impact that impoverished environments can have on a child's capacity to learn to talk. Strong correlations exist among the amount that parents talk to their children, socioeconomic status, children's vocabulary, and children's IQ (Hart & Risley, 1992; Walker, Greenwood, Hart, & Carta, 1994). As documented by Hart and Risley (1992), children's capacity for learning language is solidified by age 3, and the cumulative effects of the environment are evident. By school age, children in poverty are more likely to have developmental disabilities and behavior problems, and to require special education services than other children (Brooks-Gunn & Duncan, 1997; US DOE, 2000). Educational programs beginning at 3 or 4 years of age could not hope to overcome such vast differences in cumulative experience. The challenge that we face is how to intervene very early in children's lives to effectively enhance child development and impact on school readiness.

16. Key points
Early experiences and early environment are responsible for brain development.
Early identification and intervention makes the difference!
We are at minute 1 – it starts now.

17. SECTION 2
SETTING THE TRAJECTORY EARLY FOR LANGUAGE ! Talk the talk! So children can talk by 2!

18. High risk social communication indicators are key to early ID
High risk social-communication indicators can be used to:
Identify children earlier,
Identify more accurately the later language development
McCathren, Warren, & Yoder, 1996;
Wetherby & Prizant, 1993; 1996
CHILDREN SHOULD TALK BY 2!
High risk indicators are being used in Ontario physicians documentation such as Improving the Odds

19. Language : risk factors or not!
Tongue-tied
Laziness
Birth order
Being a twin (except if there were prenatal or post-natal risk factors)
Learning two languages
Hearing Loss
Family history
Medical conditions
Weak muscles
ENVIRONMENT
Demographics point to the importance of social determinants of health
Risk factors
Not a cause!

20. What are the high risk social communicative predictors in Early Identification?
Emotion and Use of Eye Gaze
Use of Communication
Use of Gestures
Use of Sounds
Use of Words
Understanding of Words
Use of Objects
Difficulties with these skills are high risk
indicators for persisting speech and language
disabilities in young children

21. Look at WHY and HOW a child communicate?
                        
                        
Video ML child
What do you see
First signs video

22. 1- EMOTION & USE OF EYE GAZE: the root to early communication
Sharing emotion through facial expressions and sounds and sharing attention through eye gaze are critical milestones in learning to talk.
Key elements to look for :
Eye-gaze
Joint attention
Proximity
Positive affect sharing
Following an adult’s point
Importance of eye gaze: child get lots of information about the world through the eye gaze with adult
Eye contact and eye gaze leads to joint attention
First indication of intention
Eye contact (to check) is different from eye gaze (which involves alternating)
Alternating eye gaze: a “cognitive” skills and part of coordinating attention; includes joint attention
Eye contact is key to be ENGAGED and facilitates RESPONDING to others – leads to JOINT ATTENTION
Eye cona
Early communication is rooted in Joint Attention
What is it?
Capacity of infants and toddlers to coordinate their attention to an object/event with a social partner and to communicate about their focus of attention
Responding to joint attention: being able to follow the attention direction of their partner
Initiating joint attention: spontaneously initiating coordinated or shared attention with a social partner
Why is it important?
Important for language development
Basis for turn-taking skills, imitation and communication
May contribute to symbolic play, language dev, and general social- cognitive processes

23. Milestones: emotions, facial expressions and positive affect sharing
Between 4-6 months: intentional use of emotions and facial expressions emerge
Between 4-6 months, child attempts to positive affect sharing
Starts to show positive interest in others
Responds to smiles with smiles
Initiates smiles with expectations of smiles
Between 6-18 months: we should prompt for attention shifts
By 9 months, positive affect sharing should be well established
Parent response is key: when an adult reacts with positive affect sharing to a child’s behavior , higher % of reoccurrence by the child (to reproduce that behavior, action)

24. Early social skills checklist : 9-12 months
Joint Attention :
If a toy, book, or food item is presented, will the child look at it along with an adult?
Proximity:
Will the child like/seek closeness to an adult or another child?
Eye-gaze
• Is the child drawn to looking at adults’ faces?
• Does the child look at someone who is trying to engage him/her?
Emotions, facial expressions and body Language
Does the child’s body posture/position communicate his state of mind?
Does the child show interest, joy, fatigue, or irritability with his demeanor?
Positive affect sharing
Is the child interested in others? Is the child happy to be with people?
Reciprocity
Does the child engage in back and forth actions or play?
Does the child give and take food or a toy?
Does the child try to continue a simple game like peek-a-boo?
Follow the “Point”
Will the child direct his/her attention to something an adult points to in a book (close by) or in the distance?
Is the child aware that the adult wants him/her to look?
Imitation
Does the child imitate actions, gestures, or sounds? Gesture
• Will the child use a gesture to indicate a desire or need?
• Will the child raise his/her hands to indicate “up”?

25. Emotions and Eye Gaze: Red flags
By age 1 :
Limited ability to share attention and/or emotions with eye gaze and facial expressions.
Limited use of eye gaze shifts between people and objects.
Delayed ability to understand and follow others’ eye gaze and finger pointing
Limited positive affect sharing

26. 2 - USING COMMUNICATION before learning to talk
Children learn the power of communication before they learn to talk. Using communication involves many other skills (eye gaze and eye contact, joint attention, acquiring gestures, sounds, words)
Function of communication: calling, greeting, requesting an action, protesting an action, repeating and practicing (Dore, 1974, McLaughlin, 1998)
By 12 months – children should communicate for the same reasons adults do (the WHY). But the way they communicate will be different (they might use eye gaze, gestures, sounds vs words and sentences)
Late onset of these social communication functions are predictor of a disorder (A. Wetherby,2000
Children will communicate to get others to do things and to draw others attention to things
Regulatory “ Do it” (to control behaviors of others)
Instrumental “I want” (to meet their needs)
Interactional, personal, imaginative, etc..

27. Milestones for social communication skills
Look for these important milestones:
Between 4-6 months: communication becomes more intentional (less reflexive)
By 9 months, children will let us know that he/she needs help or wants an object out of reach
By 12 months, children will get adults to notice interesting objects
By 12 months, infants will communicate for the same reasons adults do (important milestone)

28. Using communication: red flags
By age 1
Limited use of gestures and/or vocalizations to communicate.
Low rate of communication using gestures and/or vocalization.
Limited number of reasons for communication (e.g. child only communicates to protest and request food, but not to greet, label objects, etc).
Limited use of communication to share interest/attention with another

29. 3 - GESTURES: learning words by hand
Children use gestures before they use words
The number of different gestures predicts later spoken vocabulary size (Rowe, Özçalişkan & Goldin-Meadow, 2008)
Gestures are actions produced:
with the intent to communicate
typically expressed using fingers, hand, arms
may include facial features (i.e. lip smacking for “eating”) and body motions (i.e. bouncing for “horsie”) – Iverson and Thal (1998)

30. Milestones for early gestures
Contact gestures emerge by 9 months:
Requires a contact between child and object/adult
Emerge as early as 7months – up to 9 months
ex: child gives objects, shows objects , pushes away an adult’s hand
Look for Showing gestures
Distal gestures emerge around 11 months:
Requires no contact with object/adult
Considered later gestures: months
Ex: child points to objects, open-hand reaching, waving
Child should be using at least 6 conventional gestures by 12 months
Look for pointing and following point
Nearly 88% of the gestures used by toddlers and infants are deictic gestures 30

31. Milestones for Later gestures: when gestures= words
A “symbolic” gestures representing an action, a
concept, an object, some feature of an object
(i.e. cupped hand to represent “drinking”; “sniffing” a flower, waving bye-bye, quiet sound wfinger on lips)
Emerge around 12 months – after contact and distal gestures
By 20 months: Child nods head to indicate yes
Between months:
Child uses gesture + sounds before using words
Child uses combination of gesture + word before word combinations (word combinations = 24 months)
Often appear around 12 months (Acredolo & Goodwyn, 1988; Bates, Benigni, Bretherton, Camanioni, & Volterra, 1979) 31

32. Gestures: red flags By 12 months, lack or less pointing or showing
Difficulty of following the adult’s pointing
Slow emergence of gestures
Limited number of gestures
Red flags - Gestures

33. 4 - USE OF SOUNDS: linked to number of words used later
The ability to use sounds is the strongest predictor of language skills a year later
More specifically, two early sound milestones can be targeted:
Around 6 months: canonical stage babbling
onset of canonical stage babbling starts; it is the reduplicated sequences, e.g. baba (Oller et al. 1999)
should be well established by 12 months
Number of sounds by age 1

34. Milestones for SOUND USE
Skills observed:
By 8-9 months: child uses sounds to get attention/help
by 9 months: child uses 1 or 2 consonants and sometimes strings consonant sounds together (canonical babbling)
By 9-11: canonical babbling established
By 12 months: uses at least 3-5 consonant sounds and vowels
By 20 months: child uses at least 6 sounds

35. Using sounds: red flags
By 12 months
Limited number of sounds or only vowels used by age 1 (look at variety of sounds and consonant + vowel combination)
Limited vocalizations, sound play, limited or no imitative skills and limited babbling by age 1
Late onset of canonical babbling (bada) at age 1 is a predictor of disorder
e.g. smaller production of vocabulary at 18 months, 24 months and 36 months. (Oller, Eilers, Neal and Schwartz, 1999)
By 16 months:
no single words, limited imitative skills and/or limited consonants in speech
Limited number of sounds by age 1 can be an indicator of disorder 35

36. 5 - USE OF WORDS
Children usually use their first words around their first birthday.
Number of words is a good predictor of later vocabulary and word combinations
Vocabulary growth is linked to word combination – snowball effect (the more words they know, the more words they have to combine)
Milestones .. A child will usually
By age 12 : uses 3 to 5 words
By 18 months: uses at least 20 words consistently
By 24 months: has words and starts to combine 2-4 words together

37. Vocabulary gap: lasting effects
Children who do not reach WORD milestones (number of words) at 12 months (less than 3-5 words) don’t catch up. (continue to have less words at 18 months, 24 months and even at age 3 - Oller, Eilers, Neal and Schwartz, 1999)
Vocabulary and IQ : Vocabulary size is a good measure of verbal intelligence - at age 3, there is a high correlation between vocabulary size and intelligence (Rossetti. 2001). 
Hart and Riley
Summary Statement: While children from different backgrounds typically develop language skills around the same age, the subsequent rate of vocabulary growth is strongly influenced by how much parents talk to their children. Children from professional families (who were found to talk to their children more) gain vocabulary at a quicker rate than their peers in working class and welfare-recipient families. 37

38. Refer late talking toddlers!
About half of the children identified as late talkers at age 2 received a diagnosis of specific impairment at age 3 (children with less than words and not combining two words).
Toddlers who are either slow to say their first words
or slow to combine words should receive the services
of a speech-language pathologist

39. Using words: red flags No babbling at 12 months
No gesturing (pointing, waving bye-bye) by 12 months
No single words by 16 months
No 2 word combination spontaneous phrases by 24 months
Any loss of ANY language or social skills at ANY age

40. Children usually understand more words than they can say.
6 - UNDERSTANDING WORDS
Children usually understand more words than they can say.
By 6 months: turns to source of sounds
By 9 months:
turns to his name,
understands being told “no”
recognizes the names of familiar objects
By 12 months:
follows simple one step directions - “sit down”
understands many words
By 18 months:
understands the concepts of “off, on, in, out”;
points to several body parts when asked,
responds with words or gestures to simple questions (i.e. “where’s teddy? What’s that?)
identifies a picture in a book when you name it
By 24 months:
Follows two-step directions (i.e. “Go find your teddy and show it to Grandma”)

41. Understanding words: red flags
Refer babies and toddlers when:
By 12 months:
Not responding to their name
Not looking at something when we point to
Don’t seem to understand “no”
Difficulty following one step directions
By 18 months:
Not following simple directions
Not understanding names of familiar objects when you name them,
Not understanding and responding appropriately with words or gestures to simple questions – e.g. “Where’s teddy”, “What’s that?”
By 24 months:
Not following 2 step directions
Receptive Language Exercise (optional):
Imagine you are in a country where you only understand a bit of the language that is spoken there. You need to ask someone for directions to get to your hotel. You stop at an information booth, and the person gives you directions using long complex sentences in the foreign language. Will you be able to understand the instructions?
Probably not. There is more likelihood that you will be able to understand the instructions if the person uses shorter sentences, single words, and perhaps compliments the explanation with a map or other visual information (i.e., gestures…).
Children who have difficulty understanding language will often have difficulty following along, and might seem confused, or appear like they are not paying attention. You can imagine how difficult it is to follow along, and respond appropriately when you do not understand what is being said. Children with receptive language difficulties often rely on visual information to help them better understand. 41

42. 7 - USE OF OBJECTS/PLAY SKILLS
Play skills and knowing how to use and object are important cognitive developmental skills.
Knowing how to use objects helps children learn the names of objects.
Many of the most common first words are names for objects that the child uses.
Observations reported:
Child can use 1 object by 9 months,
Child can use3 objects by 12 months,
Child can use 7 objects by 16 months,
Child can use 9 objects by 22 months, from a list of 10common objects
Child can stack 2 blocks by 16 months, 3-4 blocks by 22 months
Child can pretend with toys by 18 months

43. Milestones: Object use and play skills
By 12 months:
imitates actions such as talking on the phone, sweeping, pushing a shopping cart, etc
By 15 months:
starts to treat objects in appropriate ways
(i.e. cuddles teddy bears and presses the button on his jack- in-the-box)
By 18 months:
Child demonstrates some pretend play with toys
(i.e. gives teddy a drink, pretends bowl is a hat)
Between months:
Child pretends with you with more than one action
(i.e. feeding the doll and then putting the doll to sleep)

44. Play: red flags
Refer if - at any age, play is not use to engage with others or changes. Play for children should be fundamentally based on interaction and socialization.
At 12 months - Refer if child shows limited enjoyment during social games with adults (eek-a-boo, patty cake, social games)
Between months: refer if child shows limited ability to interact and imitate actions with objects
At 18 Months – if child shows:
Limited simple pretend play, like feeding a doll/stuffed animal
Limited use of symbolic play (use of toy object to represent real object – phone, feed baby).
Delayed spontaneous use of actions on objects in symbolic play.
At any time – repetitive play like stacking blocks, lining up cars, spinning objects
Receptive Language Exercise (optional):
Imagine you are in a country where you only understand a bit of the language that is spoken there. You need to ask someone for directions to get to your hotel. You stop at an information booth, and the person gives you directions using long complex sentences in the foreign language. Will you be able to understand the instructions?
Probably not. There is more likelihood that you will be able to understand the instructions if the person uses shorter sentences, single words, and perhaps compliments the explanation with a map or other visual information (i.e., gestures…).
Children who have difficulty understanding language will often have difficulty following along, and might seem confused, or appear like they are not paying attention. You can imagine how difficult it is to follow along, and respond appropriately when you do not understand what is being said. Children with receptive language difficulties often rely on visual information to help them better understand. 44

45. SUMMARY OF RED FLAGS- 0 to 24 months signs for immediate further attention and referral
No babbling at 12 months
No gesturing (pointing, waving bye-bye) by
12 months
No single words by 16 months
No 2 word combination spontaneous phrases by 24 months
Any loss of ANY language or social skills
at ANY age
Child Neurology Society and American Academy of Neurology (Filipek, Accardo, Baranek, et al., 1999) 45

46. These skills will help you identify children
IN SUMMARY …
Use the early social communicative predictors to
IDENTIFY and REFER
Emotion and Use of Eye Gaze
Use of Communication
Use of Gestures
Use of Sounds
Use of Words
Understanding of Words
Use of Objects
These skills will help you identify children
who are at-risk for global developmental delays, hearing impairments and/or speech and language delays

47. For communication, speech and/or language delay
SECTION 3
REFERRAL
For communication, speech and/or language delay
When?
Why?
How?
Where?

48. Act Early. Know the signs
Studies demonstrated that early identification and intervention can help children
Children presenting with high-risk indicators for communication are at risk.
NO to “wait and see” approach: early identification starts with knowing and evaluating the child’s early language predictors

49. Waiting list are not
a valid reason
NOT to refer!
Nor is the child’s age!

50. REFERRING CHILDREN: WHY and WHEN?
When a child is talking very little, others may communicate less with that child.
The interaction of ‘less talk – less input’ has long term negative effects
When a child does NOT meet developmental milestones
When a child presents with high risk indicators
When a parent is concerned
When there is a positive family history of speech or language delays
WHY?
WHEN?

51. Know the signs. Use tools specific to LANGUAGE:
First Words milestones brochures
FW Physician Speech and Language Checklist
Use your professional tools – which assesses overall development including LANGUAGE:
Nipissing District Developmental Scale – is being updated; available in 2011

52. First Words tools
Brochures
First Words Physician checklist

53. Act Early!
A SINGLE “NO” response on the First Words tools can trigger a referral to First Words or other community agencies as these milestones are set AFTER the time of normal milestone acquisition. 

54. First Words new and improved website with a domain specific ECEs, parents and health professionals
Look for the online screening to help
identify children

55. WHERE TO REFER A CHILD: for speech and language?
First Words Speech and Language Program of Ottawa
Speech-Language Delay ONLY
Child 0 to eligibility for senior kindergarten
Direct families to First Words Community Screening clinics (613) ext
OR fax direct request to the First Words Intake office at (613)
Ottawa Children’s Treatment Centre (OCTC)
Speech–Language delay AND developmental concerns (i.e. play, socialization, motor skills, global delay, ASD)
Direct parent to call Intake (613) x4425
OR Fax request to Intake (613)
For children presenting with SPEECH AND/OR LANGUAGE DELAY AND DEVELOPMENTAL CONCERNS (i.e. play, socializing, motor skills) : 55

56. Ottawa Public Health Information Line
Refer to First Words
FREE screening clinics
NO appointments needed
available to all parents of children throughout Ottawa
produced every 3 month
Families and professionals can call the OPHI line at (613)
Ottawa Public Health Information Line
Screening Clinics 56

57. Refer to OCTC
Intake Services: call x or fax
OCTC intake package
Clinical Coordinators determine acceptance to Early Childhood Program (ECP)
Referral for diagnostic/develop’tal assessment
“Getting Started” Services
OCTC Primary Catchment area:
Ottawa
Stormont/Dundas/ Glengary
Renfrew County
Prescott/Russell
North Leeds, Lanark and Grenville
Services also provided to some clients from Baffin Island
Intake Services
Catchment

58. “Getting Started” services
Purpose to offer consultative services to
children and their families waiting for diagnostic
assessment in ECP
First appointment within 3-4 wks of being accepted to ECP
First visit (2 parts) –
i) Early Childhood Consultant and Social Work identify child and family’s needs
ii) Speech-Language Pathologist and Occupational Therapist consult with family and give strategies
Second visit (if required) –
Behaviour Consultant and/or Dietician consultation

59. … From there …
SW continues involvement with family if needs are identified
SLP invites appropriate parents to next Hanen parent training (ITTTT/MTW)
OT/SLP collaborate to support families with any material or resource needs such as visual aids, communication books, sensory supports
Behaviour Consultant and Dietician remain available as needed

60. “Getting Started” Consultation groups
At the initial consultation, families are
invited to attend 3 consultation groups
… for further consultation with SLP, OT and Behaviour Consultation/Dietician
… for further observation of child in group setting
Offered weekly, rotating between disciplines
Lead by an ECC and a Communication Disorders Assistant (CDA)
IDS home visits/other groups if child
not in daycare
Groups: Play and Learn, Mother Goose,
Social Play Group

61. WHERE TO REFER A CHILD:HEARING ?
EASTERN ONTARIO INFANT HEARING PROGRAM (IHP):
Child up to 2 years of age with a hearing impairment or concern (except otitis media)
Screening at birth – in hospital or in community (until 3months of age)
Direct parent to call (613)
OR fax request to (613)
CHEO AUDIOLOGY:
Child (over 2 years of age) with a hearing impairment or concern
Fax request to (613)
COMMUNITY ENT CLINICS WITH AUDIOLOGY
For children presenting with SPEECH AND/OR LANGUAGE DELAY AND DEVELOPMENTAL CONCERNS (i.e. play, socializing, motor skills) : 61

62. Children do TALK BY 2!
Early identification and intervention make the difference.
Use the “TALK BY 2” approach instead of the “wait and see”:
Know the signs of early indicators of language development.
Act early: Refer to First Words or appropriate services
Support families in accessing community resources
Parent education and early intervention can help prevent a cumulative deficit in development 62

63. Know the signs. Act Early and Refer. Children talk by 2!
Take home messages
Know the signs.
Act Early and Refer.
Children talk by 2!

64. Invite FIRST WORDS into your office, to your meetings !
On similar topics – bilinguism and multiple language families; specific topics, etc..
Invite us into smaller working groups/teams.
Invite us during May month – “National Communication, Speech and Language month”
Invite to a general meeting

65. Questions and discussion65