Children as Partners in Speech and Language Therapy: A Systematic Review and Qualitative Study of Service Delivery and Home Practice

Abstract

Introduction: Speech, language, and communication needs (SLCN) are prevalent in young children, impacting educational, social, and emotional outcomes. Speech and language therapy (SLT) can improve long-term outcomes for these children, highlighting the importance of early access. Despite children�s right to express their views, their perspectives remain under-represented in SLT research. Home practice is considered a core component of SLT, yet little is known about children�s views of this feature. This study therefore aimed to understand children�s perspectives of SLT, particularly home practice. Methods: A qualitative convergent design was employed, using two separate study components. First, a systematic review synthesised existing research on children�s views of service delivery more broadly, to contextualise experiences of home practice. Using qualitative evidence synthesis, studies were rigorously obtained, screened, and analysed. Second, a qualitative interview study explored children�s views of home practice in greater depth. Semi-structured interviews were conducted with five children aged 7�12 using accessible, multi-method techniques inspired by the Mosaic approach. Interview data was analysed using thematic analysis. Findings from both components were synthesised and interpreted together. Results: The review, comprised of fourteen studies, summarised findings across four themes, exploring expectations and goal-setting, service delivery preferences, valued intervention elements, and the importance of supportive relationships. The interview study also identified four main themes, including experiences of therapy sessions, home practice descriptions, motivational factors, and improvement ideas. Engagement in home practice was influenced by how children understood their goals, their enjoyment, inclusion of games, and perceived diTiculty. Children reported greater motivation when activities were tailored, enjoyable, and supported by parents, therapists, and teachers. Discussion: Home practice is currently viewed as a useful way to help children generalise skills and increase practice dosage. However, eTorts to increase dosage in under-resourced services may not always align with families� needs and can reduce engagement. Children are frequently excluded from goal-setting discussions, limiting their understanding of therapy and readiness to engage in home practice. Supporting motivation requires greater attention to autonomy, feelings of success, enjoyment, and supportive relationships. Service delivery changes such as utilising a coaching model may help facilitate more child-centred approaches. Reframing home practice as a long- term investment in families� confidence and self-management may strengthen engagement and overall outcomes.