One in seven two-year-olds in England arrives at their health check without the language skills they need, and in disadvantaged areas that figure rises to four in ten. The problem is that a national screening programme called ELIM-I—designed to catch these delays early—is being patchily adopted across the country. Health visitor shortages and pandemic disruption have left some families getting the support and others not, widening existing inequalities. This project will find out whether ELIM-I actually works, how much it costs, and why some local authorities deliver it well while others struggle. If the evidence shows ELIM-I is effective, the team will produce practical guidance for health services on how to implement it properly and equitably. They will also build a data dashboard that lets local authorities track outcomes in real time, turning a fragmented system into one that can be continuously improved. For the families currently falling through the gaps, that could mean the difference between a child starting school ready to speak and one who is already behind.
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Research questions Is the Early Language Identification Measure and Intervention (ELIM-I) being delivered as intended? Is ELIM-I impacting the delivery of services and experiences of the workforce and families? Is ELIM-I impacting children s outcomes and disparities in these outcomes? Background In England, 14% of 2–2½-year-olds lack expected language and communication skills, disproportionately affecting disadvantaged communities where approximately 40% face poor language development. The Healthy Child Programme introduced ELIM-I to address these challenges. However, ELIM-I adoption varies, exacerbated by low Health Visitor (HV) numbers and the COVID-19 pandemic's impact on services. Aims To evaluate the implementation, impact, effectiveness and cost-effectiveness of ELIM-I adoption. To inform policy, service delivery and commissioning decisions regarding the adoption of ELIM-I. Objectives Map diversity in ELIM-I implementation and delivery across HV services and reasons for diversity Understand the experiences of the workforce and families where ELIM-I is and is not implemented Describe models of implementation and their differential effects on experiences and outcomes Evaluate the impact on services, families and children from differing ELIM-I delivery approaches Estimate the costs and consequences of ELIM-I delivery approaches Identify optimal ELIM-I delivery within the current context and approaches to achieve this Develop guidance for local and national data dashboards enabling prospective evaluation of early SLC support Methods Mixed methods examining outcomes across England and detailed exploration of implementation in six local authority sites. Mapping diversity in ELIM-I implementation and data availability: National survey of HV leads examining ELIM-I implementation and mapping geographically. Rapid qualitative exploration of practice in diverse sites. Data mapping to identify relevant permissions and validity to evaluate the feasibility of measuring ELIM-I outcomes with available data. Create recommendations for a data dashboard to enable future prospective service evaluation. Evaluation of ELIM-I implementation, impact and costs: Qualitative deep dive in 6 sites maximally varying in demographics and ELIM-I implementation practices and reach to examine implementation processes, barriers and facilitators and experiences and consequences of ELIM-I adoption in-depth and over time. Quantitative analysis of outcomes before and after implementation of ELIM-I and between LAs where ELIM-I has and has not been implemented. Outcomes compared include children s Early Years Foundation Stage Profile results, rates of identification of children with language and communication needs, and referrals to Speech and Language Therapy. Micro-costing of different approaches to ELIM-I implementation and of reaching families with varying demographics. Synthesis: Findings will be synthesised with stakeholders. If evidence of (cost) effectiveness, we will develop resources to guide services on optimal implementation and delivery of ELIM-I. Timelines for delivery Months 1–11 Set up, survey, rapid qualitative exploration, data feasibility. Months 8–26 qualitative deep dive and analysis, local data access and analysis. Months 18–24 quantitative analysis. Months 25–30 Evaluation Synthesis. Anticipated impact and dissemination. Synthesis of qualitative, quantitative and economic evaluation will indicate if and how ELIM-I affects language and communication child outcomes and service provision. If effective, we will map ELIM-I implementation to generate recommendations to enable ELIM-I adoption and future roll-out and will develop methods for prospective service evaluation.
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