# Co-design to consensus: Identifying the core elements of a novel intervention for pre-school children with co-occurring phonological speech sound disorder (SSD) and developmental language disorder (DLD) using a modified e-Delphi approach

## TL;DR

This study identifies key elements for a new intervention to help preschool children with speech and language disorders through a collaborative design and expert consensus process.

## Contribution

A novel intervention framework for preschool children with co-occurring speech and language disorders, developed via co-design and e-Delphi consensus.

## Key findings

- Consensus was achieved on 44 core intervention elements through a two-round e-Delphi process.
- Amendments and clarifications were necessary to reach agreement on some elements.
- The process highlighted the importance of flexibility in intervention design for stakeholder consensus.

## Abstract

Although frequently seen in clinical services, there are few interventions which have been developed specifically to meet the needs of pre-school children with co-occurring features of a phonological speech sound disorder (P-SSD) and developmental language disorder (DLD). This study aims to achieve consensus on the core elements of a novel intervention for pre-school children with co-occurring features of P-SSD and DLD (“SWanS”- Supporting Words and Sounds), where expressive vocabulary and speech comprehensibility are joint outcomes of interest.

Forty-seven potential core intervention elements, based on a priori findings and the wider literature, were generated by a diverse steering group of professionals and people with lived experience within a systematic co-design process. This was followed by a modified, two round, e-Delphi with expert Speech and Language Therapists (SLTs) to achieve consensus on the elements. Consensus was defined as over 75% of participants (minimum 30 SLTs) rating the elements as either appropriate or very appropriate on a Likert of 1–5, with an inter-quartile range of one or below. If consensus was not achieved in round 1, free text comments were used to generate amended statements for the second round.

Consensus was achieved on 42/47 statements in round 1. During the revision process, one statement was discarded; six statements which did not achieve consensus were re-worded; two statements which required further clarity had examples added; four statements were merged into two statements. Consensus was reached on 8/8 statements presented in round 2, resulting in 44 final statements achieving consensus in total.

Core elements of a novel intervention have been identified through co-design with a diverse group of stakeholders followed by consensus with expert SLTs. Additional flexibility was required within some core elements in order to achieve consensus. Implications for future implementation are discussed.