Acceptability of a Digital Early Years Language Support Service for Caregivers of Children Who Have SLCN and/or Are...

Parent-child interaction (PCI) interventions have the potential to mitigate early-identified risks of Speech, Language and Communication Needs (SLCN). PCI interventions can be delivered at Universal, Targeted and Specialist levels, but evidence for effectiveness at the Universal level is lacking, especially for some populations. We examine the acceptability of a universal PCI intervention for two underserved groups: children who have SLCN and/or are multilingual. For the former group we also explore acceptability of a supplementary, targeted intervention.

This study aimed to: (a) evaluate the acceptability of a digital early years PCI support service-comprising a universal text-message service delivering BBC Tiny Happy People videos and targeted speech and language therapy following the Early Language Identification Measure & Intervention (ELIM-I); (b) establish the interest of families with children who have, or are at risk of, SLCN (N = 61) and/or are multilingual (N = 26) in utilising the service, and explore their perceptions regarding merits and drawbacks of the service, and elicit recommendations for improvements.

We employed a mixed-methods approach. Quantitative data were collected via questionnaires based on the Theoretical Framework of Acceptability. Qualitative data were gathered through semi-structured online interviews. Families of children with SLCN provided prospective acceptability data after reviewing three videos, indicating their view of receiving similar weekly video content via text message. Those who then opted to try the text service for a month provided retrospective acceptability data, with additional questions for participants who received the targeted online ELIM-I intervention. Multilingual families received the service for three months before providing retrospective acceptability data.

Quantitative analyses revealed that all acceptability ratings were high on average, though there was individual variability. Reflexive thematic analysis of caregivers' qualitative data identified three central themes: (a) demand for trustworthy guidance to address uncertainty; (b) positives including service suitability for busy family life, personalisation, human connection and reassurance, enjoyment and perceived efficacy; (c) a need for inclusive content, especially for children with complex SLCN.

There is a clear desire for early digital services to help caregivers support their children's language development. Acceptability was generally high. Caregivers wanted to see their family represented in video content. This was largely successful for the multilingual group with content celebrating home languages. Caregivers of children with SLCN sometimes felt under-represented and recommended demonstrating support strategies appropriate for their child's age and stage of development.

What is already known on this subject PCI interventions have the potential to mitigate the risk of SLCN from the early years. There has been interest in creating digital interventions that can reach families universally at low cost and BBC Tiny Happy People have developed video content along these lines. However, previous evaluations of digital services using BBC Tiny Happy People materials, have excluded multilingual families and families who have children with/at risk of SLCN. What this paper adds to existing knowledge This study highlights that a digital support service comprising universal weekly text messages sharing BBC Tiny Happy People video content and targeted online ELIM-I intervention is acceptable and desirable to families whose children have SLCN and/or are multilingual. Caregivers highlighted necessary changes to cater for diversity, particularly the need for appropriate content for families whose children have SLCN. What are the potential or actual clinical implications of this study? Findings support the use of a public health framework to provide families with accessible and evidence-based support (in this case, a universal digital service to promote PCI in the early years with an additional, targeted ELIM-I intervention for those with SLCN). This could remove pressure from in-person services by preventing need, supporting triaging, enabling families to support their child whilst waiting for speech and language therapy and to be more ready for specialist intervention if this is needed. Selecting content that best matches families' characteristics increases acceptability.

1. Digital Services are Acceptable as an Initial Layer of Intervention Caregivers rated the digital language support service highly. They felt that it addressed their curiosity and concern about their child's development and that its benefits persisted regardless of whether caregivers were accessing other support. This indicates that a digital, universal service can function as an effective initial layer of intervention, providing support to individuals on waiting lists and contributing to the management of speech and language therapy caseloads. 2. Inclusive and Diverse Content is Essential to Avoid Caregiver Distress and Harm Content that is representative of family diversity is essential in universal digital language support services. Caregiver feedback highlighted the profound impact of representation: a multilingual family articulated feeling 'connected with the people' when presented with relevant content. Conversely, a perceived lack of content reflective of complex needs was associated with participant distress and reduced engagement or withdrawal from the service. These experiences highlight an ethical responsibility to develop inclusive and representative content that reflects a wide range of developmental trajectories, family structures and cultures. 3. The Speech and Language Therapist's Pivotal Role in Personalising Universal Digital Services The study demonstrated that the human element of the service, such as personalised messages and text message and phone or video call interaction, was highly valued by caregivers. This human connection helped offset the limitations of a universal digital service, providing the opportunity to clarify misunderstandings and a sense of being listened to and understood. This finding indicates that a successful digital service is not about replacing human interaction; it is about using digital platforms to complement and extend the reach of their professional role.