Finding a speech-language pathologist

Making the decision to consult a speech-language pathologist about your child can be stressful and emotionally draining. I keep a good supply of tissues in my office, not just for the children's runny noses, but also for parents' tears after I've diagnosed their child with a communication disorder.

For a lot of parents, just picking up the phone to ask for speech and language testing takes a great deal of strength; but now that the phone is in your hand, the next question is: "Who do I call?" Finding a speech-language pathologist can be a challenge, especially if you are new to the wonderful world of speech impairments.

How you do it depends on a number of things, including where you live, how old your child is, and whether she attends school. In most places, you don't just open the Yellow Pages, find a speech-language pathologist, and make an appointment as you would for a dentist. You can do it that way if you're going to be paying out-of-pocket, but if you want services to be paid for by insurance or the government, there are a few more hoops to jump through.

Advances in internet communication in recent years have resulted in the growth of individuals and companies providing

online speech therapy, or telepractice. With a high-speed internet connection, a webcam, and a headset with a microphone, a speech-language pathologist in New Zealand can provide speech therapy for a child in Canada, or Thailand, or Botswana, or anywhere in the world. Telepractice is not appropriate for everyone, but there are many children and adults who can benefit from it, and if they live in an area where speech and language therapy services are not locally available, it can be a godsend.

In all fifty states of the U.S., services for school children (kindergarten through grade 12) are provided by the public schools. In most states, the schools also provide services for preschool-age kids (age 3-5). In some states, the schools also provide early intervention services from birth to age three, but in many states early intervention is handled by a separate agency.

If services are provided by the local school district, your first call should be to their administrative offices. Ask for the person in charge of special services. Here are a couple of resources on the web for parents working with the public schools:

The Public School Parent's Network: "A site designed and maintained by parents of public school children to serve as an information source and reference guide for all parents of school age students."

Frequently Used Educational Terms: "Cut through confusion by becoming familiar with the medical, psychological, legal and educational terms often used in educational settings."

If your child is under age 3 and you are in a state where the schools do not provide early intervention services, the family doctor or your child's pediatrician is a good starting point. Keep in mind, however, that physicians are not experts on speech and language development. When you approach a doctor regarding a speech or language concern, make sure you are making it clear that you are seeking a referral, not the doctor's opinion on whether or not you need a referral. Here are examples of the wrong way, and the right way, to request a referral:

Wrong way: "Do you think maybe I should get her speech tested, since she doesn't talk much yet?"

Right way: "I'm concerned about her speech development, and I'd like to get a referral from you for an evaluation to rule out a possible communication disorder."

The first (wrong) way, since it is phrased as a yes-no question, may give the doctor the impression that you want reassurance rather than assistance in getting services. And in fairness to the doctor, some people do ask questions like that and want the answer to be 'no'. Most doctors, as smart and competent as they are, are not mind-readers. The second (right) way makes it clear that you have thought it through and want an evaluation for your child, and that you are requesting a referral. The doctor is within her rights to probe a bit with some questions about your concerns, but if she tries to talk you out of it, politely explain that if your child does not have a disorder, the testing should confirm this, and then you'll have peace of mind, which is certainly worth something. On the other hand, if she does need speech therapy, you can get right on it, which is also good. Most doctors will not refuse a referral if you really want one. If yours does, get a second opinion.

In addition to public school systems and early intervention agencies, possibilities for services may also include hospitals, outpatient clinics, private practices, and university training clinics.

Most hospitals and outpatient clinics will accept payment from insurance policies and (in the U.S.) Medicaid. If you are hoping to use your health insurance, first check to be sure that your policy will cover speech-language pathology services. Many policies will not cover speech-language therapy for disorders that are considered 'developmental' in nature. Most child speech and language disorders come under this category unless they result from an illness or injury.

You may be able to find a speech-language pathologist who operates a private practice. In larger urban areas, some such operations are fairly large and advertise their services. There are also a lot of small-time operators who see private clients in their dens or basement offices. These single-person practices often do not advertise, relying instead on word of mouth. They may or may not be equipped to handle insurance or Medicaid claims. The American Speech-Language and Hearing Association (ASHA) has a listing of SLPs in private practice, sorted by state.

Another option to look into, if you live anywhere near a university with a graduate program in speech-language pathology, is a training clinic attached to one of these departments. At a training clinic, therapy is provided by graduate students completing clinical practicum requirements to become SLPs. Experienced, certified SLPs supervise the students and provide guidance for goals and intervention techniques. The quality of therapy is usually very high at these clinics, since the students working with your child are working hard to make a good impression on their supervisors so that they can get good grades and references once they are ready to join the work force.

Regardless where you turn for speech therapy services, you are likely to have a bit of a wait before speech therapy begins.

Schools and early intervention systems have paperwork and bureaucratic procedures to go through in qualifying children for therapy. When I was in the public schools, I had 60 school days from the time the request was made to get the eval done and meet with the parents to decide whether or not the child qualified for services. That's a long time when you consider that the school year is 180 days! I'm happy to say I never took the maximum amount of time, but I would have been in compliance with the law if I had.

Hospitals, clinics, private practices, and university training programs often have waiting lists, because the demand for speech therapy is almost always greater than the supply of speech-language pathologists.

So we're back to the theme I hammer on so often: start the process sooner rather than later! If your child needs speech therapy, it's never too late to start. But, because of the young brain's plasticity, starting now is better than starting later.

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