12th December 2025

Speech, language, and communication supporting future lives: The Institute of Health Visiting (iHV) collaborates on NIHR-funded study

The Institute of Health Visiting (iHV) is delighted to be collaborating with The University of Oxford, Newcastle University, and Northumbria University on an exciting NIHR-funded study that will inform health visiting policy and practice to support children’s speech, language and communication.

What does the study aim to do?

The ESCALATER study (Evaluating Speech Communication and Language Support at the 2-2½ year Health and Development Review) aims to understand how health visiting (HV) teams across England currently assess and support speech, language and communication at the 2-2½ year Health and Development Review, and whether teams are using the Early Language Identification Measure and Intervention (ELIM-I), or other approaches. It also aims to learn how assessment and support affect services, practitioner and family experiences of the 2–2½ year Review, and child and service outcomes. Results of the study will be shared widely with health visiting teams, commissioners, and local authority and NHS leaders to help them make decisions about the implementation of the ELIM-I, or other approaches, and how to improve their delivery.

What is the ELIM-I?

The ELIM-I is a measurement tool and intervention, launched in 2021, which is designed to support the identification of children’s speech, language, and communication needs, and provide tailored support to families. ELIM-I is a universal offer, designed for use with all children attending their 2-2½ year Health and Development Review. The ELIM-I website was launched in March 2024 and may be accessed at https://research.ncl.ac.uk/elim-i. Not all local authorities use ELIM-I. Other approaches include WELLCOMM and SOGS.

Why is the study important?

In England, 14% of 2–2½-year-olds do not have the language and communication skills expected for their age (GOV.UK 2025). Research has clearly demonstrated that preschool children with low language levels are at risk of poorer outcomes across the life course in educational attainment, employment, mental health, and general wellbeing (McKean & Reilly 2023; Reilly & McKean 2023). This risk is substantially higher in disadvantaged communities where up to 40% of preschool children have poor language development (Law et al 2011).

In 2018, Public Health England (now DHSC) began an ambitious programme to give all children the best start in speech, language, and communication through the Healthy Child Programme (HCP). The ELIM-I was developed to be used as part of a holistic assessment, alongside the appropriate Ages and Stages Questionnaire, with all children at the 2-2½ year Health and Development Review to identify and support speech, language and communication needs. However, ELIM-I adoption was not mandated, and its adoption and use vary widely across England. Since the launch of ELIM-I, policy and service contexts have also changed dramatically; health visiting services are stretched in capacity, whilst speech language and communication needs of children and wider challenges for family mental health and wellbeing have grown. We must now understand how ELIM-I and other approaches are being implemented, what is needed to support successful adoption of early language assessment and intervention approaches, and what the benefits are to services, families and children.

What does the ESCALATER study involve?

The study began in May 2025 and will run until Autumn 2027. It is led by Cristina McKean, Professor of Child Language Development and Disorders at The University of Oxford, and Lindsay Pennington, Professor of Childhood Neurodisability at Newcastle University. They are working with a team of researchers from the University of Oxford, Newcastle University and Northumbria University, and senior research leads from the iHV.

Over the next 3 years, the study will conduct a national survey and interviews with HVs to understand where and how ELIM-I and other approaches, such as WELLCOMM and SOGS, are being used across health visiting services in England. Practitioners and families will be interviewed about their experiences of different approaches, and data from the Early Years Foundation Stage Profile and referrals to specialist services will be used to understand the effects of different approaches to health visitors’ speech, language and communication support on children’s development. The costs of different approaches will also be investigated.

Between January and March 2026, the study team will be inviting all Health Visiting Provider Leads/Managers to complete a survey to understand how health visiting teams assess and support Speech, Language and Communication at the 2-2½year review. Survey invitations will be sent out via a phased approach throughout January-March.

To find out more, please visit the ESCALATER study website https://tinyurl.com/4ppk793w or the ELIM-I website https://research.ncl.ac.uk/elim-i. Or contact Cristina McKean ([email protected]).

This study is funded by the NIHR (NIHR207059). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Cristina McKean, Professor of Child Language Development and Disorders at The University of Oxford, and Vicky Gilroy, Director of Innovation and Research at iHV

References

GOV.UK (2025) Child development outcomes: data for 2024 to 2025. www.gov.uk/government/statistics/child-development-outcomes-data-for-2024-to-2025
Law, J., McBean, K., & Rush, R. (2011). Communication skills in a population of primary school‐aged children raised in an area of pronounced social disadvantage. International Journal of Language and Communication Disorders, 46(6), 657-664.
McKean, C., & Reilly, S. (2023). Creating the conditions for robust early language development for all: Part two: Evidence informed public health framework for child language in the early years. International Journal of Language & Communication Disorders, 58(6), 2242-2264.
Reilly, S., & McKean, C. (2023). Creating the conditions for robust early language development for all: Part 1: Evidence informed child language surveillance in the early years. International Journal of Language and Communication Disorders.