INT J LANG COMMUN DISORD, SEPTEMBER–OCTOBER 2013, VOL. 48, NO. 5, 486–496 Discussion Child speech, language and communication need re-examined in a public health context: a new direction for the speech and language therapy profession James Law†, Sheena Reilly‡§ and Pamela C. Snow¶ †Speech and Language Sciences, Newcastle University, Newcastle upon Tyne, UK ‡University of Melbourne, Melbourne, VIC, Australia §Murdoch Children’s Research Institute, Australia ¶School of Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia (Received April 2012; accepted April 2013) Abstract Background: Historically speech and language therapy services for children have been framed within a rehabilitative framework with explicit assumptions made about providing therapy to individuals. While this is clearly important in many cases, we argue that this model needs revisiting for a number of reasons. First, our understanding of the nature of disability, and therefore communication disabilities, has changed over the past century. Second, there is an increasing understanding of the impact that the social gradient has on early communication difficulties. Finally, understanding how these factors interact with one other and have an impact across the life course remains poorly understood. Aims: To describe the public health paradigm and explore its implications for speech and language therapy with children. Methods & Procedures: We test the application of public health methodologies to speech and language therapy services by looking at four dimensions of service delivery: (1) the uptake of services and whether those children who need services receive them; (2) the development of universal prevention services in relation to social disadvantage; (3) the risk of over-interpreting co-morbidity from clinical samples; and (4) the overlap between communicative competence and mental health. Outcomes & Conclusions: It is concluded that there is a strong case for speech and language therapy services to be reconceptualized to respond to the needs of the whole population and according to socially determined needs, focusing on primary prevention. This is not to disregard individual need, but to highlight the needs of the population as a whole. Although the socio-political context is different between countries, we maintain that this is relevant wherever speech and language therapists have a responsibility for covering whole populations. Finally, we recommend that speech and language therapy services be conceptualized within the framework laid down in The Ottawa Charter for Health Promotion. Keywords: speech and language therapy, child, public health. What this paper adds? What is already known on the subject? Historically speech and language therapists working with children have tended to adopt a ‘clinical’ approach to case management with children referred and diagnosed with speech and/or language disorders. Initiatives such as Sure Start in the UK, which have emphasized the need to adopt a population approach, have led some therapists to change their practice, but as Sure Start is rolled back, there is a danger that population-based approaches may not be sustainable without a public health framework around them. Address correspondence to: James Law, Institute of Health and Society and School of Education, Communication and Language Sciences, Newcastle University, Victoria Road, Newcastle upon Tyne, NE1 7RU, UK; e-mail: j.law@ncl.ac.uk International Journal of Language & Communication Disorders ISSN 1368-2822 print/ISSN 1460-6984 online C  2013 Royal College of Speech and Language Therapists DOI: 10.1111/1460-6984.12027