Lost for words at speech therapy delays

Parents are worried that the time lost in getting help with their children’s speech and language difficulties could risk making them worse, writes JOHN CRADDEN

ACCESS TO speech therapy clearly wasn’t an issue for King George VI, whose story about how he overcame a serious stammer through a close working relationship with a speech therapist has been turned into a film tipped to sweep the Oscars at the weekend.

The King’s Speech shows speech therapists in a hugely positive light, and few would argue about how important their services are to thousands of children and adults around the country.

But, as of December last year, there were an estimated 23,000 children on the waiting list for public speech and language therapy (SLT) services, according to the HSE’s own figures. This includes those waiting for initial assessments as well as treatment.

Furthermore, nearly 4,000 of the children have been queuing for between one and two years.

The reasons for the long waiting times to see public speech therapists have been the subject of much debate, while a separate row about how public services are delivered has formed the backdrop to a recent High Court case between the HSE and Release, a voluntary speech therapy organisation.

While long waiting lists exist for all kinds of public health services, parents worry that excessive delays in seeing about their children’s speech and language issues could risk making them permanent or untreatable.

One obvious option is to seek out private therapists, but the cost can be prohibitive for many families, particularly if you want an initial assessment.

A typical one-hour therapy session can cost up to €100, while a full assessment with written report can set you back €300-€400.

Mixing public and private SLT services is one cost-effective option, but some parents have reportedly claimed that the HSE will boot children off the waiting lists if they pay for private treatment.

“Sometimes there is a misunderstanding in that most HSE services won’t see a child at the same time that they are seeing another service,” says Celine Lenihan of the Irish Association of Speech and Language Therapists in Private Practice (IASLTPP).

She says doing this could be potentially confusing and disruptive for the child, but the HSE would have no problem with the child attending a private service outside of the times that they are attending the HSE one.

“It does vary, however, and there have been cases where parents report being told that if they go privately, they won’t be able to avail of the HSE service,” says Lenihan.

When asked about this, a spokesman for the HSE confirmed that clients are entitled to use both public and private services and that, far from adversely affecting their progression through HSE services, “it can complement it”.

HSE therapy is usually offered in blocks of six to eight sessions, but parents may be advised not to attend two different services simultaneously to avoid potential confusion or conflict in treatment approaches.

“In practice, availing of private services in between HSE blocks of therapy is often more conducive to therapy gains,” the spokesman said.

Therapists involved in “dual service provision” are advised by IASLT (Irish Association of Speech and Language Therapists) to make sure that they work together with other therapists to provide the best service to the child – something that it acknowledges doesn’t always happen.

It is tempting to believe that you could avoid the high cost of a private assessment by just asking the private therapist to work on the basis of one conducted by a public one.

But, according to Lenihan, most public and private therapists will usually insist on doing their own assessment before treating a client. This is regarded as best practice, but there is also a legal rationale, she says.

“If, as the second therapist, you worked your treatment programme off another therapist’s assessment and some aspect of diagnosis had been missed, you could be open to litigation for not treating the difficulty appropriately.”

You can seek out a private therapist through the IASLTPP’s website, which lists its members throughout the State. Waiting times for private therapy are usually no more than a few weeks, although that may be longer if you are looking for a particular specialty.

According to Lenihan, the cost of each therapist may depend on their training and expertise and the types of therapy techniques that they can offer.

“Therapy is not always required on a weekly basis,” she says. “Some families attend once a fortnight or once every three weeks depending on the nature of the difficulty, while other children may come more often depending on need.”

She adds that most therapists will offer 30-minute or 45-minute sessions as well as hour-long ones, while some clinics offer a discount if you book a block of sessions in advance.

If you have health insurance, you might assume that your plan would offer some level of cover, but the reality is that it’s very limited, according to broker Dermot Goode, of health insurancesavings.ie.

“Basically, the only real cover that’s provided by the insurers is part of your day-to-day cover on either the lifestyle or corporate plans, where they will allow you include a certain amount of expenses for speech therapy along with your other expenses for GP, physio, etc.”

He cites one such corporate plan that includes up to eight visits per year per person insured and which covers half the cost up to maximum of €30 per visit, while other plans will cover an initial assessment to a maximum refund of €60.

You would need to have specific level of cover for a child, which would typically cost between €230 and €262 per annum depending on the plan, says Goode.

You can claim back the tax on SLT for children under the MED1 medical expenses scheme. But while you don’t need a doctor’s referral to use private SLT, the tax office will require one to accompany the claim.

The outgoing Government pledged that any child under five waiting more than three months for speech therapy would be dealt with by the National Treatment Purchase Fund.

However, a spokeswoman for the Department of Health said that it had not been possible to extend the remit of the fund to include speech therapy during the lifetime of the Government.

iaslt.ie (Irish Association of Speech and Language Therapists)

iasltpp.com (Irish Association of Speech and Language Therapists in Private Practice)

TIPS FOR PARENTS

If you are concerned about your childs speech and language skills, the Irish Association of Speech and Language Therapists (iaslt.ie) has a factsheet on what helps children in the home environment, such as:

Use daily routines as a way of teaching new vocabulary, for example, talk to your child while dressing them and name all the clothes. Kids learn through repetition and daily routines such as bath time and meal times, which are repeated over and over.

Limit the amount of time your child spends watching TV, and increase the amount of time spent playing together.

Introduce books at an early age and have daily reading opportunities.

If your child is developing a stammer, it is a good idea to NOT correct their speech or to ask your child to slow down. Instead give them lots of time in conversations, with no pressure.

This article first appeared in the Irish Times.