articleThis content is more than 5 years old.

Why so few teenage referrals?

Alex Ford | 01.03.2014

Speech and Language Therapist Alex Ford explains how low referral numbers have prompted The Fluency Trust to re-think referral procedures. 

Fluency Trust logoThe Swindon-based charity The Fluency Trust was created out of a desire by people who stammer and Speech and Language Therapists (SLTs) to provide intensive residential courses for young people who stammer. Since 1995, its unique courses combine speech therapy with outdoor pursuits. The combination of challenging activities and therapy is highly effective in developing confidence and the ability to manage stammering positively.

Every year The Fluency Trust run two courses: the ‘Blockbuster’, aimed at 10-13 year-olds, and the ‘Teens Challenge’, aimed at 13-17 year-olds. Funding for the residential aspect of the course (e.g., outdoor activities, food, transport and board) is funded by The Fluency Charity and therapy time funded by the young person’s local service provider.


In recent years we have noticed a reduction in referrals to our specialist courses, which prompted us to investigate why this might be happening. We wanted to know: are local services running their own groups and therefore don’t need to refer to The Fluency Trust?; are there any barriers for local services running groups?; are SLTs aware of our courses?; is there an issue that funding is no longer available from the young person’s local service provider or that SLTs are not aware of how to access funding?

We sent out a questionnaire focusing on services for teenagers (13-17) to SLTs throughout the UK, in return sending their department a copy of our ‘SPEAK!’ DVD (see below). A total of 86 responses were received. The following results were noted:

  • On average, services reported around three referrals per year for teenagers requiring support for stammering;
  • Of the 86 responses, 58% reported to have a specialist stammering service for teenagers;
  • 60% of respondents said they were able to provide group therapy, with 71% saying they could provide group therapy specifically for teenagers.


Despite the ability to run local groups, these are not always run due to certain barriers. When examining why group therapy is not offered, the following themes emerged.

The most significant barrier to running local groups appears to be low numbers of teenagers on the caseload, with other factors such as geography/travel times and staffing being other reasons why groups are not run. This data is interesting as The Fluency Trust courses were specially set up for this reason. My colleague, Claire McNeil, gives her thoughts on why that might be: “I think it may be, in part, due to a lack of specialist services available at times suitable for teenagers; also they may not want to have therapy at this time. If children have received effective therapy, by their teenage years they may be managing well and not need more. If they haven’t benefitted from therapy they may not want more, thinking it will be more of the same. Also, teenagers tend to have other demands on their time and may not want to focus on their speech. I do not have evidence for this other than comments from young people I have worked with.”

For the young people that do seek therapy, another barrier was that they did not want to attend a group. However, in our experience this age group may initially decline group therapy but as individual therapy progresses they want to take up this opportunity. A common comment from young people attending our courses is how valuable it is to meet others who stammer. If there are low numbers of teenagers in a local area, the course is an ideal way for them to meet others, receive therapy and help manage stammering.

Barriers to running teens fluency groups

Lack of funding awareness 

Over 60% of SLTs reported they could make referrals out of their local area including to The Fluency Trust (some from services local to London chose to refer to other specialist centres). Despite this, 73% reported they are unaware how to access the funds to send a young person on one of the courses. 

In summary, the main findings appear to show that numbers are the main barrier for trusts running local groups, which supports The Fluency Trust’s residential courses, bringing young people together from all over the country. Over 60% of SLTs reported they were able to refer to us, however 73% were unaware how to access funding. In addition to this, it appears some local services are unable to provide therapy for this age group at all. It certainly appears there is a need for our courses, but our challenge now is how we support therapists to access funding for them. One action we have taken is to encourage parents to refer their child to us directly, especially targeting those young people who are unable to access a local SLT. A referral form for parents has now been added for download on our website and we hope this will increase referrals. The challenge will then be to find support and follow-up for the young people after they have completed the course. We hope to continue to raise awareness of stammering and The Fluency Trust to ensure the support continues for those young people who need it.

Ability to access funding for external referrals

For further details on The Fluency Trust’s courses and referral forms, visit . Watch ‘SPEAK!’, a short film for, and made by, young people:

From Speaking Out Spring 2014, p.18