Schools Serving Students with Telepractice Deserve Parity in Medicaid Reimbursement

United

Aesop coined the phrase “United we stand, divided we fall.” But what do we do when we cannot find partners to stand with?

Nationally, a shortage of speech-language pathologists often prevents children from receiving services they desperately need.

The State of Telepractice

Spurred by ASHA’s 2005 recognition of telepractice, thousands of SLPs have participated in telepractice so far. Telepractice is thriving; more than 10,000 SLPs have applied to PresenceLearning alone and many more are interested in telepractice considering the many other providers like Visual Speech Therapy and Vocovision.

The fast adoption of telepractice was driven by the well known shortage of SLPs, offering clinicians new work/life and professional choices. However, as accumulated research–40 peer reviewed studies at last count–has shown that telepractice is just as, if not more, effective than traditional, onsite therapy, the uses of telepractice have broadened.

Telepractice is now used to bring children together for social pragmatic groups, connect kids with bilingual therapists, strategically alter the frequency and intensity of therapy, improve SLPs’ schedules, bring in specialists, and re-engage students in middle and high school.

The Problem With Medicaid

One obstacle remains in many states that prevents SLPs from working via telepractice: Medicaid reimbursement. This is a critical issue, as schools can receive reimbursement for up to 50 percent of costs from Medicaid and are often unable or unwilling to adopt telepractice services without this reimbursement. ASHA, to its credit, has been a leader in advocating for school-based Medicaid reimbursement.

State policies preventing Medicaid reimbursement are oversights rather than outright bans. Policy has simply not kept pace with advancements in our field. In fact, most state policies don’t even comment on telepractice.

Many states, including California, Colorado, Virginia, Minnesota, Ohio, have updated their regulations, creating a precedent for other states to follow. These states handle Current Procedural Terminology (CPT) coding in the same way as before, but with a modifier indicating tele-delivery.

In the remaining states, the impact is large and negative:

  • SLPs wanting to work via telepractice, many of them retirees or recent parents seeking flexible work, effectively cannot do so within their state.
  • Hundreds of thousands of students not receiving services because of the SLP shortage will continue without the care of a SLP and fall further behind in critical areas like reading, writing and communicating.
  • Schools struggling to fill their share of the 5,000+ unfilled SLP openings will remain at significant legal risk from non-compliance.

Unfortunately, underserved districts and their students in rural areas and the urban core will continue to be hit the hardest until this blind spot in Medicaid policy is remedied.

What Must Happen

Medicaid reimbursement inequality must be resolved in all 50 states. There are important issues of equity for rural and urban core students, as well as the viability of access to telepractice for SLPs and students alike.

How can you help?

The only way to help is, in the words of Aesop and others, stand together for this cause. Here’s how we can stand together:

  • Review your state’s current policies for Medicaid reimbursement regarding telepractice.
  • Contact your state administrator of Medicaid for education to express your concern on this issue.
  • Cite specific examples of how tele-therapy reimbursement would benefit students in your district and similar districts in your  state.

With a cohesive message and ample support from fellow educators, gaining Medicaid reimbursement for tele-therapy for school-based speech-language therapy services can be a reality sooner than you think.

 

Melissa Jakubowitz, MA, CCC-SLP, is the Vice President of SLP Clinical Services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than with more than 20 years of clinical and managerial experience. She is the past-president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.

Five Ways to Empower Your Client

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For the past two years, I have shared an article with my graduate AAC class that a close colleague gave me. The article, titled Empowering Nonvocal Populations: An Emerging Concept was written by Sandy Damico in 1994. Although this article is now almost 20 years old, there are certain concepts that are timeless and empowerment is one of them. According to Ashcroft (1987), an “empowered individual is one who believes in her or his ability to act, accomplish some objective, or control his or her situation.”

Each time I read this article, it empowers me to do a better job as a speech-language pathologist and continue to empower the people around me. It also always gives me perspective on why certain clients are more successful than others. It also helps me reflect on how to empower not just my clients, but my own children. At a recent lunch with a friend who has two children with special needs, we started discussing goals for our children. She shared with me that she does not have high hopes for her children because they have special needs.  I talked to her about empowering her own children because if she didn’t believe in their ability, how can she expect them to believe in themselves?

Here are five ways that you can empower your clients:

  1. Complete a comprehensive assessment to create goals that are appropriate and attainable. If a proper assessment is not done, then the goals may not be appropriate. For example, we need to think about “What are my client’s strengths?”, “What goals will be most functional for him/her?” On the other hand, focusing on goals that have already been attained previously will not empower a person.  If a child or adult feels that a person doesn’t expect anything from them, then why try? We need to challenge our clients but in a way that is attainable with appropriate and functional goals.
  2. Tell your client, “You can do it,” and believe it yourself. This is a simple tip but has worked for me time and time again. There are two parts to this statement. Saying “You can do it,” and not believing it in yourself will not empower your client. We need to tell your client this statement, but in our hearts know they can do it. There have been many evaluation and therapy sessions where others have told me “He can’t do anything,” “He is very low functioning and doesn’t communicate,” etc. I strongly believe that everyone communicates in their own way and it’s our job to find that way and expand on it.
  3. Empower your client’s family. This is a very important tip. Some families may feel defeated or have given up on your client’s ability to communicate. They may have been told time and time again that their child can’t do this, can’t do that, etc. After awhile, a person can start believing it. Empowering families and giving them positive feedback and suggestions about their loved ones is key.
  4. Teach your client a new skill that will change their life (e.g. cooking, etc). Teaching a child or adult a new skill that can positively affect their life can be extremely empowering. I currently see a client who is independent in many aspects of his life as far as hygiene, transportation, etc. However, one skill he was lacking was his ability to prepare food for himself. He was limited to microwaving unhealthy foods because he did not know how to cook simple dishes.  To empower him, we decided to use cooking as an activity to meet his speech and language goals. I am a true believer in increasing independence because with independence comes empowerment.
  5. Don’t give up. Reach out to supervisors, colleagues, etc. It is important to reach out to others if you feel that your strategies and/or techniques are not working for an individual. If you feel defeated with a client, he or she will sense that and in turn feel disempowered. It may just take one or two sessions with some help from a supervisor or colleague to change your entire perspective of your client. If you still feel that you cannot meet their needs, it may be appropriate to refer your client.  Also, use outside resources. I find many excellent posts written on one of my favorite websites (written by Carol Zangari and Robin Parker).

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

NIMTR: Not In My Treatment Room!

poison

You’ve heard of NIMBY, “not-in-my-backyard” haven’t you?  Well there’s a new acronym, NIMTR or “not-in-my-therapy-treatment-room!”  Speech-language pathologists are inundated by catalogs filled with wonderful colorful, fragrant, pliable toys as treatment materials.  We use these every day with our students, our clients in clinics, our bedside patients.  But how much do we really know about the safety and makeup of those therapy materials your shrinking budget dollars are purchasing every year?

Some interesting facts about toys.

Toys are BIG business. Just visit any mall in America or website such as Amazon.com.  Worldwide, over 80 billion dollars were spent on toys in 2009, with more than a quarter of that money consumed in the United States. The latest figures by the Toy Industry Association Inc., places the annual U.S. domestic toy market at $22 billion in 2012.  Of this, $6.63 billion covers toys and articles for infants and toddlers, puzzles and games, and arts and crafts.  I mention these specific categories because they are materials most likely to be used by SLPs working with young children in early intervention, preschool, or school settings.

So many toys … but are they safe?

The United States imports many more toys from foreign countries compared to its exports. China, Japan, Mexico, Canada and Denmark lead the way in toy imports.  Since other countries do not implement the same environmental protections in manufacturing as we do in the states, the question of safety looms large.  The Consumer Product Safety Commission (CPSC) is the main body responsible for overseeing the safety and recall of unsafe toys and products manufactured in or imported into the United States.  In 2012, the CPSC released a new risk assessment tool to help improve the screening of imported products. About 5 percent of the total number of these screenings identified children’s products.  One example: a shipment of 28,000 baby bottles imported by Dollar Tree was seized after determining they were defective and unsafe using the new risk assessment tool. You can read more about the successes of CPSC online.

The Consumer Product Safety Improvement Act of 2008 made it mandatory for all toys aimed at children under the age of 14 to meet new federal safety standards.  Some of these include testing lead content and concentration of phthalates (DEHP, DBP and BBP* in particular). Here is a video to see how CPSC works collaboratively with other government agencies to seize toy imports that are unsafe for children.

Even though we have protections, toys of questionable safety continue to enter the consumer market.  Recently DNAinfo in New York released this alarming report, which shows many toys in stores tested positive for elevated levels of toxic substances, including phthalates, which have been found to be associated with asthma, birth defects and hormone disruption, among other health problems. One item on the list, a Teenage Mutant Ninja Turtles pencil case manufactured by Innovative Design was found to contain 150 times the legal phthalate limit for toys. But alas, currently, it does not qualify as a toy under federal regulations.

What if it is not a toy?

And that’s a good point: Sometimes SLPs use materials in their practice that are not toys. Like the pencil case mentioned above or what about commonly used rubber tubing that a speech-language pathologist may use during treatment for oral exercises?  Would such rubber tubing be considered a toy, a medical device, or something else?  Who oversees the safety of products such as these?

Two organizations responsible for developing standards of safety are the International Organization for Standardization (ISO) in Switzerland and the American Society for Testing and Materials International  based in Pennsylvania.  Both provide standards to industries that produce just about everything, from iron bolts to bathmats.  Each provides standards for purchase to companies, who in turn use the standards to manufacture and distribute their product to specification.  I contacted both these organizations to find what standards exist for the rubber tubing example.  As of this writing, no responses to my request have been received.

What is an SLP to do?

So what can you do to ensure that the materials you use with your students and clients are safe?  Here are a few suggestions:

  1. If you are purchasing from a distributor online, check their website for more information. For example, SuperDuper Publications places a Product Safety statement on their website and invites customers to email them for more information.  Companies who openly provide statements such as these make it easier for the consumer to trust the safety of their purchases.  If you cannot find information on product safety or product testing, email the company and ask for it.
  2. Check the CPSC’s website for toy and product recalls. You can find the latest recalls, search for recalls by product name or by country of manufacture, and also report an unsafe product.
  3. Read the manual! Electronics such as iPads and tablets come with a manual that will often provide the ISO or ASTM Int’l standard used to insure safety and will list potential hazards.
  4. Contact the manufacturer of the product and ask for the MSDS – materials safety data sheet.  This would be a good choice if the product you have or consider purchasing lacks a manual or an information sheet on standards testing.  You also can look up a product by name and manufacturer on the MSDS website. On this site a search for “rubber tube” gave me 34 hits.  While searches can be daunting and time consuming, the insurance of safety provides peace of mind to you and the clients on your caseload.
  5. Avoid buying inexpensive toys or materials from questionable sources such as street vendors.

Informed SLPs can now approach their materials purchases with a new savvy.  Next time you are tempted to buy inexpensive therapy materials composed of questionable ingredients, just say “NIMTR”!!!!

 

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools.

Aphasia: How a Video IS Worth a Thousand Words

 

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I have been a practicing speech-language pathologist for the past 40 years. My last position prior to my retirement in September of this year was as an out-patient SLP at Virginia Commonwealth University Health System (VCUHS) rehab clinic working primarily with stroke and head injury patients. Ours is a rewarding profession but during the past year and a half my involvement in a community aphasia support group has been one of the most gratifying experiences of my career.

Approximately two years ago, the daughter of a stroke survivor contacted VCUHS Speech/Language Pathology Department asking for volunteers to help her start an aphasia support group in Richmond, Va. She indicated that she wanted to form the support group to provide her mother and others living with aphasia the opportunity to exchange information, opinions, and feelings about this communication disorder.

The first group meeting was held in February 2012. The discussions during the monthly meetings often focused on how little the general public knew about aphasia. Other recurring topics included: loss of insurance coverage for out-patient speech treatment due to “plateau in skills” or insurance caps; false assumption that loss of language means loss of intellect; family members and others lacking appreciation of what it is like to have a head full of thoughts and ideas but not be able to communicate these thoughts to others. One of the group members, a corporate trainer prior to his stroke and subsequent aphasia, had an idea about how to address these problems/misconceptions: He proposed making a video that recorded the personal narratives of group members to educate healthcare professionals as well as their own families and friends on the daily challenges of living with aphasia and strategies for being a good communication partner. He and other group members felt that who best to advocate for aphasia patients than those living with aphasia themselves?

This past year, Marcia Robbins and Kate Schmick (two other SLPs who volunteer with the group), Jan Thomas (support group member who has taken a leadership role in the group), and I applied for and received funding through the VCUHS Speech/Language Pathology Department to produce a documentary style video on living with aphasia. Eric Futterman, a Richmond-based videographer, filmed and narrated scenes of aphasia support group members going through their daily routines and one member interacting with SLP. The 18-minute video highlighted the fact that those living with aphasia were not a homogenous group but rather individuals with unique needs and challenges as they faced the difficult road to recovery from their stroke. The video also showed support group members getting on with living and finding new talents. Our group had a community premier of the video entitled “Patience, Listening and Communicating with Aphasia Patients” during our September, 2013 monthly support group meeting. 90 people from the community attended. Attendees remarked on the powerful and informative message of the film.

In an effort to spread the word about aphasia, we have contacted the National Stroke Association and the National Aphasia Association about posting this video on their websites. NSA already has posted the video on their website.

Susan Hapala, M.Ed.,CCC-SLP, is a retired speech-language pathologist who volunteers with the Richmond, Virginia Aphasia Support Group. She can be reached at rva.aphasia@gmail.com.

Kid Confidential-Behavior Disorders and Language Impairment in School-Age Children

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In January, I read an article published in ASHA’s SIG 16 Perspectives December 2012 issue by Alexandra Hollo from the Department of Special Education, at Vanderbilt University in Nashville, Tenn., titled “Language and Behavior Disorders in School-Age Children: Comorbidity and Communication in the Classroom.”  She brought up some really good points that I think we, as SLPs, need to keep in mind when discussing, assessing and treating children who are labeled with behavior disorders.

Hollo discusses how often times children labeled with EBD (emotional and behavioral disorders) also have undiagnosed LI (language impairment).  According to this article, “Four out of five students with EBD are likely to have an unidentified language deficit,” which may result in children resorting to physical communication rather than effective use of expressive language to resolve issues.  In fact, it is estimated that 80.6 percent of students with EBD also have LI however, more than 50 percent of those LI diagnoses remain unidentified.  If staff members fail to recognize the child’s inability to functionally communicate, negative feelings and interactions between the student and staff members may result, which in turn negatively affects academic achievement. What is known about children with EBD is that they “have the most negative short- and long-term outcomes” (Hollo, 2012).

So what does EBD look like in children?  Well Hollo explains the two subcategories of EBD according to the DSM-IV, difficulties with internalizing and externalizing.  Deficits in internalizing include emotional withdrawal behaviors such as depression, anxiety or mood disorders.  Academic trends for these students with internalizing problems include high rates of absenteeism and low academic achievement.  Deficits in externalizing include disruptive behavior as in ADHD, ODD or conduct disorder.  Students with externalizing deficits tend to be more easily identified and receive services possibly due to the fact that their behavior is disruptive in the academic setting and can more easily be determined to interfere with learning.  Academic trends for students with externalizing issues:  disruptive behavior tends to interrupt and/or terminate instruction and therefore affect learning.  More importantly, it was stated that although students with EBD do perform similarly to those with other disorders on standardized tests, their academic performance tends to be BELOW that of other students with disabilities.

In addition to academic deficits, children with EBD also demonstrate deficits in language and social skills.  These children more often exhibit expressive language deficits rather than deficits in receptive language, and they tend to use simplified language within the classroom environment resulting in teachers grossly overestimating the student’s expressive language abilities.  It is important to note that based on Hollo’s research, the CELF and TOLD were the only two language tests that were able to consistently identify LI in children already diagnosed with EBD.

 

Socially, children with EBD tend to have negative teacher interactions, are often times rejected or victimized by peers, and struggle with use of effective conversational skills due to difficulties in initiating and maintaining friendships, problem solving deficits, and difficulties cooperating and collaborating with peers and adults.  In addition, students with EBD tend to be impulsive and struggle with the use of “inner dialogue” to effectively reason prior to responding to their emotions within various situations.  Their ability to control their emotions, follow directions, and transition between activities, classes and subjects is also affected.

Why is this information important for us as SLPs to know?  Well we must first be educated on the comorbidity between EBD and LI to effectively screen, assess, and treat these students.  We also have the responsibility to train staff members on the child’s communication and social skills deficits so as their behaviors may not be misconstrued.  We as SLPs can be instrumental in implementing linguistic supports for these children which include direct (i.e. teaching emotional language, using self-talk for regulation and problem solving skills, provide opportunities to practice negotiations with peers, etc.) and indirect instruction (i.e. collaborate with staff, train teachers on effective communication styles, teach use of slow rate of speech, etc.).  In addition, we can work with behavioral specialists to follow and enforce the behavioral supports that are deemed necessary to help students with EBD be successful in their daily environments.

So the next time you are in your weekly RTI meeting discussing a “problem child” or a “shy, quiet student,” pay attention, and keep in mind that EBD does not look the same in every child. Some behaviors may in fact be linked to language deficits.  Only we, as SLPs will be able to make that determination effectively in order to ensure students receive the services and support they require.

Note:  This entire article was not discussed in detail here.  I discussed the information I felt was important based on my personal clinical experiences.  I refer you to Hollo’s complete article in the December 2012 SIG 16 issue for further information and details.

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

ASHA’s Listen To Your Buds Campaign Brings Safe Listening Message to The 2013 International Consumer Electronics Show

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Annette Gorey, ASHA’s Public Relations Specialist, works to get ASHA’s booth ready for the show.

More than 150,000 people may hear more about ASHA’s Listen to Your Buds campaign at this week’s 2013 International Consumer Electronics Show (CES) in Las Vegas. This marks ASHA’s fifth consecutive year as a CES exhibitor, and the ASHA Public Relations team couldn’t be more excited to spread the word about listening safely and preventing noise-induced hearing loss.

The Listen to Your Buds exhibit will be in the heart of the CES Digital Health Summit. And new this year, ASHA joins the show’s MommyTech Summit to connect with influencers, mommy bloggers, key children’s health and technology media and more. We’ll convey how Listen to Your Buds can help parents help young people use personal audio technology safely. As you probably well know, the parent blogosphere is more powerful than ever and growing fast. This is an increasingly important audience for our Listen to Your Buds campaign and outreach efforts.

The time has never been riper for a safe listening message. Spend a day with a toddler, elementary school student, tween or teen – or just walk around the mall, stand in line at Starbucks or stroll down the street – and you can’t help but see how kids are more connected to personal audio devices than ever before. Headphones have become a fashion item. The latest color iPod is in the hands of a six-year-old. Teens are at the gym listening to music. And this past holiday season, personal audio technology items were among the hottest gifts around. Now, in the wake of technology gift-giving and increased daily technology time, parents should monitor their child’s usage and volume levels and model safe listening behaviors – and the tips at www.listentoyourbuds.org can help.

We know even minimal hearing loss can affect children’s social interaction, communication skills, behavior, emotional development, and academic performance. Some parents are now realizing this, too. Eighty-four percent of parents are concerned that misuse of personal audio technology damages the hearing of children, according to the results of an online poll commissioned by ASHA last May. Parents also show overwhelming support for hearing screenings for tweens and teens—71% for 10- to 11-year-olds and 67% for 16- to 17-year-olds—according to a University of Michigan Mott Children’s Hospital National Poll on Children’s Health released just last month.

ASHA’s exhibit booth in the Living in Digital Times area has information about hearing loss prevention, warning signs of hearing damage, and how to find a local ASHA-certified audiologist using ASHA’s ProSearch. ASHA member and Las Vegas audiologist Dr. Daniel Fesler, CCC-A and Buds Coalition Musician Oran Etkin will be on hand to talk with attendees.

The Consumer Electronics Association (CEA), who puts on the CES each year, is among the Buds’ dozen dedicated sponsors; we joined forces in 2007. Recently, CEA President and CEO Gary Shapiro highlighted just how important the Buds message is. “As a longtime supporter of the Listen To Your Buds youth campaign, CEA represents companies that create audio technologies for listeners of all ages,” says Gary Shapiro, president and CEO of CEA. “We promote products, like noise-canceling and sound-isolating headphones, that help minimize outside sounds, and volume-controlled headphones that give control to parents of young children. New innovations are still to come that will help us practice and teach safe listening so that we can all listen for a lifetime.’”

Erin Mantz is a Public Relations Manager for ASHA.

Don’t Procrastinate, Advocate!

Rotunda at the U.S. Capitol, Washington DC

Photo by Tadson

The typical student in Communication Sciences and Disorders wears many hats. These may include student, clinician, graduate assistant, and about a million others that vary from person to programs, alike. One hat, which should be worn by all CSD students, is that of an advocate for our profession.  Sometimes, as students, it may feel as if our voices get lost in the cacophony of noise in the professional world.  There are over 12,000 members of NSSLHA. If we come together, our voice can be heard and we can make an impact on the future of our profession. It is never too early to begin advocating for the careers and the clients we will spend a significant portion of our lives helping.

TODAY, September 19, is NSSLHA’s 2nd Annual Virtual Advocacy Day! Virtual Advocacy Day provides a mechanism for students to learn just how easy it is to become an advocate. Through this event, and others, we are establishing a way for all NSSLHA members to learn how to correspond with their elected representatives at both the state and national level. Coming together, our message will become loud, and make our voices heard. This will benefit the profession at large and the patients whose lives we impact. Imagine the impact of senators and representatives receiving hundreds of e-mails all on the same topic during the same day. This will certainly peak the curiosity of a legislative assistant whose grandmother recently had a stroke, or nephew was just diagnosed with autism. During the Executive Council’s “hill visits” in the spring, we have seen firsthand the impact of educating the members of congress.

This year, there are three key national issues we are stressing: IDEA Funding, Medicare Therapy Caps, and the Hearing Aid Tax Credit Bill. More information is available about each of these bills at the ASHA Advocacy Center. You can also search for local legislative issues relevant for an individual state. Professionals, we encourage you to join with us for this day of advocacy. Collaboration between students and professionals is critical. You serve as our role models and mentors and we will one day join you as peers in professional careers. We encourage you to stand with us and write your elected officials as well!

You can participate in 5 simple steps:

  1. Visit the ASHA Take Action Center.
  2. Select the “Students Take Action” link to view additional information on key issues.
  3. Edit the letter to your liking. The more personalized information and stories you provide the more effective the communication.
  4. Enter your contact information in the fields to the right of the letter. Based on your address, the system will automatically identify your members of Congress. Make sure to identify yourself as a student and insert your school name.
  5. Select “Send Message” and you’re done!

 

Caleb McNiece is 3rd year doctoral student in Audiology at the University of Memphis. He received his B.A. in Communication Sciences & Disorders and Spanish from Harding University. He is a trainee on the US Department of Education funded project, “Working with Interpreters,” at the University of Memphis. Caleb serves as the Region 3 representative to the NSSLHA Executive Council chairing the Social Media Committee and as President of the University of Memphis NSSLHA Chapter.


Rene Utianski is a Doctoral Candidate in Speech and Hearing Science at Arizona State University and a Research Collaborator at Mayo Clinic-Arizona. She received her B.A. in Speech and Hearing Science and Psychology from The George Washington University and her M.S. in Communication Sciences and Disorders from Arizona State University. Rene serves as the Region 9 Regional Councilor on the NSSLHA Executive Council and is the 2012-2013 Council President.

ASHA/NSSLHA Student Hill Day 2012

ASHA/NSSLHA Student Hill Day 2012 was a success!  On April 2nd 2012, the NSSLHA Board, along with over 100 fellow speech-language pathology and audiology students had the opportunity to meet with our state representatives and senators on Capitol Hill to discuss legislature important for the future of our profession.  With the help of the ASHA Federal Advocacy team, over 250 visits were conducted to bring audiology and speech-language pathology issues to the offices of those who represent us.  This means that students are impacting how these offices think about our services.  We were able to talk about what we do, the individuals who makes our jobs so special, and what legislation would truly allow us to help others more efficiently and effectively.  Even as students, we can impact federal legislation, which affects the future of our profession.

ASHA provides an abundance of information regarding current legislation and how each of us can get involved at the state and federal level. Even if a visit to Capitol Hill is not an option, a letter, email, or phone call is a great opportunity to let your Members of Congress know what’s important to his/her constituents.  You can visit the ASHA Take Action Center for more information.  It is never too early to begin advocating for our chosen professions.  Even as students, we are also voting members and we can have an impact on how services are rendered.  If you are interested in participating in future Student Hill Day visits, please contact Caroline Goncalves with the Federal Advocacy Team at ASHA at cgoncalves@asha.org .

Imagine the impact we can have if the Student Hill Day gets bigger and bigger each year?  Speak out and be heard by those who represent you and take charge of our professional future!

 

Ellen Crowell Poland, AuD/PhD Student, East Carolina University NSSLHA Executive Board Member-at-Large and Caleb McNiece, AuD Student, University of Memphis NSSLHA Executive Board Region 3 Councilor, wrote this piece for ASHAsphere. 

 

Habilitation – What it is And Why it Matters to You

Most of us are familiar with the term rehabilitation and are comfortable with our role in providing “rehab” services.  Habilitation, on the other hand, may be less common. I don’t know of many SLPs who consider themselves “habilitation providers.” Audiologists may be somewhat more comfortable with the term as providers of aural habilitation, but not in other contexts.

So, what is habilitation? Basically, we are talking about services that help a person learn, keep, or improve skills and functional abilities that they may not be developing normally. Still not clear? Contrast that with services that help a person improve skills that have been lost after a stroke, head injury, illness, or other cause. The latter is rehabilitation – regaining lost skills or functioning. Habilitation refers to services for those who may not have ever developed the skill, such as a child who is not talking as expected for his or her age.  Adults can also benefit from habilitative services, particularly those with intellectual disabilities or disorders such as cerebral palsy who may benefit from services at different points in their life to address functional abilities.

Why the focus on distinguishing habilitation from rehabilitation? Anyone who has dealt with private insurance for a person needing habilitative services likely knows the answer. If you look closely at coverage descriptions for many insurance plans, you’ll likely see language specifying that services like physical therapy or speech-language pathology will be provided when skills have been lost due to illness or injury. This language automatically restricts payment for services to those who haven’t had a stroke or suffered an illness, including most children who don’t have a specific diagnosis underlying their speech, language, swallowing, or hearing problems.

Habilitation is getting national attention right now due to the implementation of the health care reform law. Part of the law stipulates that insurance plans offered through the state exchanges and Medicaid programs must provide services in 10 categories of essential health benefits (EHBs), including the category of rehabilitation and habilitation services and devices. ASHA has been anxiously awaiting the regulations regarding the EHBs and has been working particularly hard on ensuring adequate coverage for habilitative services through the Habilitation Benefits Coalition. The concern centers primarily on the fact that habilitative services are not common in “typical” employer plans, upon which the EHBs are to be based, and this lack of clarity around what habilitative services are and how they should be covered could result in continued difficulty with reimbursement for these services.

Recently, the Department of Health and Human Services (HHS) issued the Essential Health Benefits Bulletin in lieu of regulations. This bulletin is offered as guidance, but does not have the power of a regulation. Essentially, the bulletin gives the states the responsibility of determining EHBs, allowing for greater flexibility and customization to each state’s unique needs. Some highlights from this bulletin include:

  • States will have flexibility in choosing their benchmark plan and will have to supplement that plan with any of the EHB categories that are lacking
  • Plans cannot discriminate based on age, disability or life expectancy, but no specific guidance on this is offered
  • If a state doesn’t choose a plan, the default plan will be the largest small group plan based on enrollment
  • States will have to submit their choices to HHS for approval
  • Self-insured group health plans, large group plans, and grandfathered plans will not be required to cover essential health benefits at this time
  • Comments on the pre-rule bulletin are being accepted until January 31, 2012

When addressing habilitation specifically in the bulletin, HHS acknowledges that these services are less well-defined and that confusion exists over what exactly is covered by such a benefit. They have proposed two options for situations where the state chosen benchmark plan does not include habilitation. These include:

  1. Habilitative services would be offered at parity with rehabilitative services — a plan covering services such as PT, OT, and ST for rehabilitation must also cover those services in similar scope, amount, and duration for habilitation; or
  2. As a transitional approach, plans would decide which habilitative services to cover, and would report on that coverage to HHS. HHS would evaluate those decisions, and further define habilitative services in the future (p. 11)

As one can see, the issue of appropriate coverage for both rehabilitation and habilitation services is going to come down to state-level debates and decisions. ASHA will continue to monitor developments and take action, when appropriate, but the burden of the work will likely fall to the state associations and members within each state. If this issue resonates with you, we encourage you to contact your State Advocate for Reimbursement (STAR) and state association to assist in any advocacy efforts. Individuals requiring speech and hearing services, regardless of etiology, have a right to services to help them function as independently as possible. We have a tremendous opportunity now to ensure appropriate coverage for habilitative services as an essential health benefit. This is your chance to have a real impact on the future of health care.

Amy Hasselkus, M.A., CCC-SLP, is associate director of health care services in speech-language pathology at ASHA. She is also currently enrolled in a Masters degree program in communication at George Mason University, with an emphasis on health communication.

Get involved! Why? Because I say so!

I’ve been struggling to write my last post about the 2011 ASHA Convention. What could I possibly have to say that would sum up my experience? Should I be funny? Light hearted? Should I try to send a message? Reach out?

ALL OF THE ABOVE?

That’s the one!

I discovered something about myself while I was at the ASHA Convention. I really like the administrative side of things. It’s been sneaking up on me – an interest in policies, positions, procedures, politics (whew – what an alliteration!) But there it is. Can’t be denied. I just really enjoy knowing what is going on, how it affects me, how it affects my clients – and you’d think this would be the case with everyone.

However, I discovered something else at ASHA as well – a sort of apathetic, passive, bystander effect among CSD professionals when it comes to legislative and regulatory issues. Obviously this isn’t necessarily the rule, and I truly hope it is the exception. But there seems to be this sense that issues which go outside of our clients and our place of business, go beyond us overall.

I attended a lecture entitled Advocacy 101: Add Your Voice, which was presented by ASHA’s Government Relations and Public Policy Board (Regina Grimmett and Shelley Victor.) The description was as follows:

  • This session is proposed by the Governmental Relations Public Policy Board (GRPP) to promote advocacy as related to legislative, regulatory, and other public policy activities affecting the professions. Presenters will explain strategies for self-advocacy, illustrate data use for advocating issues, and demonstrate strategies for meeting legislators/government officials.

After the lecture, learners would be able to:

  • describe their role in professional grassroots advocacy at the local, state, and/or national levels.
  • define advocacy–its goals, types, and benefits of grassroots advocacy efforts
  • advocate for specific federal and/or state issues that affect the professions of speech-language pathology and audiology.

To me, this sounds like pretty important stuff. At the undergraduate and graduate level we are taught that advocacy is within our scope and is our responsibility. Usually we think of that in terms of advocacy for our clients, but this was quite obviously in regards to US. We like our jobs, yes? We like funding and support, yes?

There were probably 15 people present at this lecture. 10,000+ attendees at the ASHA Convention. Fifteen people who wanted to learn more about how to protect our jobs, advocate for ourselves, and interact with people who can make or break us.

Now, I get it. We go to ASHA to learn how to best support our clients (oh, and to see our best CSD buddies). Holding the client paramount – this is our duty. But how can we hold our clients paramount if we don’t have the IDEA/ESEA/Medicare/Medicaid funding to do it? How can we hold our clients paramount when our professions are being threatened by a poor economy and an administration that doesn’t acknowledge our existence? How can we hold our clients paramount when our credentials aren’t universally recognized as a benchmark for licensing and other professional standards? This presentation was two hours. Two hours out of your three day ASHA schedule could have been dedicated to learning how to stand up for yourself and your colleagues.

We have to help ourselves, to help our clients (kind of that whole “Put your oxygen mask on first” thing.) And I would guess that 15 people can’t do it all. We cannot continue to assume that someone else will get to it. We cannot continue to run our professional lives with a “want something done – give it to a busy person” philosophy. We are ALL busy but, we are ALL accountable.

Want to know more about advocacy, for you and your clients? Contact ASHA-PAC. Contact your state association. Go to the ASHA website.  Contact your SEAL.  Contact your State Liaison. Become a Grassroots Captain. Start early by encouraging students, interns, CFs, and newbies to get involved! There are a million resources and you can get to them while you sit in your office chair.

Listen, I’m not saying run for president or Occupy ASHA – just don’t stand by. Do what you can, or at the least support people who are trying. While you’re thinking that someone else may do it, someone else may be thinking that YOU will do it.

I loved every second of the ASHA Convention, and I hope when I attend in the future that I see more presentations about government relations – and I hope to see more of you there.

NP: The Zombies – Time of the Season

 

(Samantha is one of the official ASHA Convention bloggers! Stay tuned for more insights from her and the other bloggers before, during and after convention.)

 

Samantha Weatherford, B.A., is a second-year, speech-language pathology graduate student at Missouri State University in Springfield, MO.  She writes about speech-path and grad school on her blog, so to Speak. Does she think it is a coincidence that the first ever ASHA Convention was in St. Louis, MO, her beautiful hometown, and she chose to be an SLP? NOPE. FATE.