{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T11:34:48Z","timestamp":1770896088858,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2010,12,31]],"date-time":"2010-12-31T00:00:00Z","timestamp":1293753600000},"content-version":"vor","delay-in-days":604,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2009,5,6]]},"abstract":"<jats:p><jats:italic>Background:<\/jats:italic>The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech\u2010and\u2010language therapy for children with primary language impairment.<\/jats:p><jats:p><jats:italic>Aims:<\/jats:italic>To compare the short\u2010run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a test of expressive and receptive language.<\/jats:p><jats:p><jats:italic>Methods &amp; Procedures:<\/jats:italic>The study design was a cost analysis integrated within a randomized controlled trial using a 2\u00d72 factorial design (direct\/indirect versus individual\/group therapy) together with a control group that received usual levels of community\u2010based speech\u2010and\u2010language therapy. Research interventions were delivered in school settings in Scotland, UK. Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF\u2010III<jats:sup>UK<\/jats:sup>) of less than \u22121.25 standard deviation (SD) (receptive and\/or expressive) and non\u2010verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate\/severe articulation\/phonology\/dysfluency problems or otherwise requiring individual work with a speech\u2010and\u2010language therapist. The intervention involved speech\u2010and\u2010language therapists and speech\u2010and\u2010language therapy assistants working with individual children or small groups of children. A therapy manual was constructed to assist the choice of procedures and activities for intervention. The cost analysis focused on the salary and travel costs associated with each mode of intervention. The cumulative distribution of total costs arising from the time of randomization to post\u2010intervention assessment was estimated. Arithmetic mean costs were compared and reported with their 95% confidence intervals.<\/jats:p><jats:p><jats:italic>Outcomes &amp; Results:<\/jats:italic>The results of the intention\u2010to\u2010treat analysis revealed that there were no significant post\u2010intervention differences between direct and indirect modes of therapy, or between individual and group modes on any of the primary language outcome measures. The cost analysis identified indirect therapy, particularly indirect group therapy, as the least costly of the intervention modes with direct individual therapy as the most costly option. The programme cost of providing therapy in practice over 30 weeks for children could represent between 30% and 75% of the total gross revenue spend in primary school per pupil, depending on the choice of assistant led group therapy or therapist\u2010led individual therapy.<\/jats:p><jats:p><jats:italic>Conclusions &amp; Implications:<\/jats:italic>This study suggests that speech\u2010and\u2010language therapy assistants can act as effective surrogates for speech\u2010and\u2010language therapists in delivering cost\u2010effective services to children with primary language impairment. The resource gains from adopting a group\u2010based approach may ensure that effective therapy is provided to more children in a more efficient way.<\/jats:p>","DOI":"10.1080\/13682820802137041","type":"journal-article","created":{"date-parts":[[2008,9,27]],"date-time":"2008-09-27T00:39:59Z","timestamp":1222475999000},"page":"369-381","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Cost analysis of direct versus indirect and individual versus group modes of manual\u2010based speech\u2010and\u2010language therapy for primary school\u2010age children with primary language impairment"],"prefix":"10.1111","volume":"44","author":[{"given":"Kirstin","family":"Dickson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjorie","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Boyle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elspeth","family":"McCartney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"O'Hare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,12,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1177\/105381518801200401","article-title":"Parent and clinic early intervention for children with language handicaps: a cost\u2010effectiveness analysis","volume":"12","author":"Barnett W. 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