Background
The marginalization of young people has been identified as one of the major challenges facing society, and a delinquency record has been identified as one of the main indicators of exclusion. More than 60% of young people in prisons in numerous Western countries demonstrate significant speech, language and communication difficulties to such an extent that they can be considered as developmental language disorder (DLD; for a review, see Anderson et al., 2016; Chow et al., 2022), the general prevalence of which is about 7% (Tomblin et al., 1997). DLD is a permanent neurodevelopmental disorder caused by complex interactions between genes and the environment, and it cannot be explained by developmental or sensory disability, neurological illnesses, autism, or anomalies in environmental factors (Bishop et al., 2017). Young people in prison who have DLD are at least twice as likely to reoffend compared to those peers without DLD; language difficulties thus are a significant predictor of recidivism (Winstanley et al., 2021).
Speech, language and communication (SLC) needs, including DLD, manifest themselves in a myriad of ways involving difficulties in expressing oneself, understanding spoken and written language, as well as challenges in social interaction (Bishop et al, 2017; Iverson & Williams, 2025). They are often hidden, but they have a significant impact on the mental health and operational abilities of an individual thus creating barriers to education and employment and challenges to equal participation and inclusion in society. They also make it difficult to participate in all stages of the criminal justice process where interaction and discussion are at the center of activities (Snow, 2019). In prison, this includes, for instance, substance abuse rehabilitation and recidivism reduction programs.
These issues are closely connected to principles of non-discrimination, equal access to services, and effective participation in legal and correctional proceedings (Learoyd & Bryan, 2024; Snow, 2019). Ensuring communication-accessible assessment and intervention supports procedural fairness in prison systems and treatment engagement. At the system level, unrecognized communication difficulties may reduce treatment, weaken implementation fidelity, increase the disciplinary risk and limit the overall cost-effectiveness of correctional rehabilitation.
The assessment of the need for speech-language rehabilitation should be extended to young people acting out through criminal behavior, and speech-language therapy services should be provided to young people in prison (Gregory & Bryan, 2011; Pekkala et al., 2024; Snow & Woodward, 2017). Supporting communication skills allows people in prison to benefit more from programs during incarceration and cope better in interactive situations both in prison and after release (Snow, 2019; Winstanley et al., 2021). As the effectiveness of speech-language therapy is also based on sharing information about communication disorders and environmental guidance, correctional staff should be provided with training on communication difficulties and how to support them (Pekkala et al., 2024).
Supporting equal inclusion of young people in prison through the identification and treatment of language disorders
SLC needs of individuals and their support have so far not been addressed at any stage of the criminal justice process in Finland, unlike in, e.g., Australia (Snow & Woodward, 2017; Swain et al., 2020), New Zealand (Howard et al., 2020), and the UK (Gregory & Bryan, 2011; Learoyd & Bryan, 2024). The project Supporting equal inclusion of young offenders through the identification and treatment of language disorders has been developed to answer those needs. It is a 3-year project run by the University of Helsinki (Department of Speech-Language Pathology, Faculty of Medicine), Helsinki Brain & Mind, and Humak University of Applied Sciences, and co-funded by the European Social Fund (ESF) for the years 2024–2027. The project will develop new solutions for the criminal justice sector in the Southern Finland (the regions of Uusimaa and Kanta-Häme) to support the empowerment and inclusion of young people in prison with SLC needs by rehabilitating the communication skills of this most vulnerable social group. Improved communication skills will contribute to social equality, progression towards education and/or employment, and help combat inequality, exclusion and re-offending.
This project aims to identify, implement, and evaluate research-based social innovations aligned with its themes. Social innovation refers to the development of new solutions that meet social needs and are more effective and sustainable than existing solutions (Mulgan et al., 2007). These include
- identification and support pathway for communication needs in prisons
- an e-learning program to strengthen staff proficiency in supporting communication
- a service pathway to support rehabilitation continuity. Collectively, these initiatives aim to mitigate structural obstacles to substantive equality of participation in rehabilitation and support services.
Assessing the speech, language and communication skills of young people in prison
In order to meet the project aims to report on the nature and severity of the linguistic difficulties of young people in prison, the project provides speech-language therapy services in 8 prisons in Southern Finland by identifying SLC challenges of young people under 30 years of age. To respond to these challenges, the project produces a more detailed assessment of SLC skills based first on an initial assessment administered by the prison staff (mainly special instructors) in which pragmatic and social skills of an individual are evaluated, followed by a referral to the speech-language pathologist working in the project. The speech-language pathologist then administers a more thorough assessment of the SLC skills of the individual using standardized tests and other well-established methods. The assessment covers a wide range of different areas of speech and language production, spoken and written language comprehension, use of grammar, as well as pragmatic skills and social interaction. Consequently, a short period of speech-language therapy is directed to those whose test scores fall below -1 SD in at least one subtest. To see the gains in therapy, a post-assessment of the language skills is administered after the intervention.
So far, 34 individuals have been administered with the pre-assessment and 24 of them have been referred to the speech-language pathologist for a more detailed evaluation. According to the tentative observations, SLC needs are very prominent among the participants. They are displayed as, e.g., a very narrow vocabulary, challenges in formulating grammatically correct sentences, impaired reasoning skills and poor comprehension of abstract language. The participants also show poor executive functions, which appear as poor concentration, weak impulse control, difficulties in sustaining attention, lack of motivation and poor commitment. Furthermore, the young people in prison tend to have low skills in literacy and numeracy, and most of them have reported poor school achievement, absence from school and school dropout. These findings are in line with previous research (Anderson et al., 2016; Chow et al., 2022).
Speech-language therapy for young people in prison
Following the assessment of their SLC skills, speech-language therapy with the maximum of 20 sessions (45–60 minutes each) is offered for those young people who performed poorly on the tests. Ten participants have so far attended speech-language therapy, and five of them have been re-assessed to see a possible change in their language skills. Consequently, the findings reported here are preliminary and based on small sample size.
The speech-language therapy sessions are constructed on each participant’s personal needs. In most cases, the focus of the intervention has been on expanding vocabulary, learning grammar to sentence structure and sentence formation, story-telling and social interaction. According to the comments made by the young people who have participated in the project, they have found the time spent very useful and worthwhile. For example, they have learnt to use new words, to tell the time, to identify months, and to better understand the Finnish grammar.
At the beginning of speech-language therapy, participants require considerable guidance and support in task engagement, including initiating tasks, understanding instructions, and progressing through the tasks. As the speech-language therapy proceeds, these skills gradually improve, and task performance becomes more fluent and independent. Participants also develop their ability to reflect and analyze their personal speech, language and communication skills, that in turn enables their own participation in goal setting for speech-language therapy.
The language performance of those who participated in the post-assessments improved compared to the initial evaluation. The participants reported to be satisfied with the opportunity to practice their SLC skills in a calm, one-to-one setting, and appreciated that their own perspectives were taken into account.
Online training program for prison staff
The project will develop an online training program for the prison sector to support the integration of interactional and communicative tools for young people with SLC needs into the prison environment. The online training program will raise both awareness of SLC needs, with an emphasis on DLD, and the interpersonal skills of prison staff.
By increasing staff competences, the criminal path of young people can be interrupted by addressing interaction challenges and supporting young people’s communication skills at different stages of the criminal justice process. The effectiveness of the work also improves staff retention and commitment to working with young people. The e-learning program can also be used by young people with a criminal background and their families and by organizations working with them, educational institutions, prison health services, prisoners’ work activities and community services.
Towards the end of the project, a survey of prison staff and inmates participating in the project will be conducted to assess the effectiveness of the sub-projects in staff-inmate interaction where language impairment causes communication difficulties and to assess how the project activities have contributed to prisoners’ engagement in education, employment and other rehabilitation programs to support social integration.
Speech-language therapy as part of Health Care Services of Prisons
The administrational aim of the project is to integrate speech-language therapy services as part of the Health Care Services of Prisoners in Finland with the purpose to meet and support those young people who come into contact with the judicial process and who show signs of SLC needs. Unlike physical and occupational therapy services, speech-language therapy has so far not been part of the Health Care Services of Prisoners, but an initiative has been taken to advance the goal.
It would be important to make all the staff working in all stages of the judicial process aware of the signs and importance of SLC needs so that a young person entering the process with such needs can be recognized and a referral given to speech-language therapy services. Incase employing a speech-language pathologist(s) is not an option for the Health Care Services of Prisoners, it may be possible to use the public health care services or purchase external services. Arranging speech-language therapy intervention in a prison depends on the available resources, such as availability of a workspace and workload of the staff, which are currently decreasing in the prisons in Finland. In addition to, or complementary to, on-site visits to the prisons, a speech-language pathologist can also provide online services.
Additionally, a treatment path needs to be created for young people who are about to be released from prison and who require speech-language therapy, for which a partnership-based approach needs to be developed among the Prison and Probation Service of Finland, the Health Care Services of Prisoners and the Social Insurance Institution in Finland, which, by law, provides intensive
medical rehabilitation for the people under 65 years. Therefore, as being part of medical and healthcare treatment, the speech-language therapy services should be provided by the Social Insurance Institution in Finland, with the aim to promote the ability of these young people to function and progress towards education and/or working life after imprisonment.
Why speech-language services are needed in the legal process and prison setting
According to our observation and earlier research, young people in prison show significant SLC needs, and they have a clear need for speech-language therapy. Speech-language therapy can support not only the SLC skills of the young people with a criminal background, it can also support their self-efficacy in different stages of the legal process. Strengthening the language skills improves the benefit of and participation in rehabilitation and support measures by enhancing their abilities to receive and respond to different types of treatments, e.g., substance abuse rehabilitation and recidivism programs, where interaction and discussion are the main means of delivering treatment. Consequently, better language abilities may increase the cost-effectiveness of the imprisonment period (Learoyd & Bryan, 2024). Speech-language therapy also increases participation and integration into society after release from prison. Lastly, improved speech, language and communication skills can also contribute to a reduction of recidivism.
In sum, the project will support the prevention of exclusion and linguistic marginalization, strengthening the active participation, access to training and transition to the labor market of young people in prison who are in the most vulnerable situation on the labor market and at greatest risk of poverty and exclusion.
Seija Pekkala1, Hanna Markkanen1, Anni Kinnari1 & Mika Rautanen2
1 Department of Speech-Language Pathology, Faculty of Medicine, University of Helsinki
2 Finnish Institute for Health and Welfare
References
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