Call for Advocacy to Garner Government Support for Evidence-Based Treatments

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Editor’s Note: This post is another viewpoint on the Speech Pathology Australia’s recent proposal and does not necessarily reflect the views or position of ASHA. 

Evidence-based practice encompasses evidence from high-level research, expert opinion, patient needs and values, along with the context within which the treatment is conducted. In the field of stuttering, we are fortunate to have strong evidence that the Lidcombe Program is effective. If we have clear evidence that a treatment approach works, it should be made available to the people who need it.

Speech Pathology Australia has made a submission to our [Australia’s] federal government to fund stuttering treatment. I’m sure it will be the first of many submissions, which aim to bridge the evidence-practice gap. However, there appears to have been a misunderstanding about the announcement, so SPA published a clarification on its website stating that “SPA’s submission relates only to the formation of the 2015-2016 federal budget. SPA is not supporting legislation or a policy change to promote one program, service or form of treatment over any other.”

As a founder of the speechBITE evidence-based practice website, I thought long and hard about the effect EBP has on clinical practice, funding sources and, most importantly, the clinical outcomes of the people we serve. There are three key aspects to making EBP a central component of clinical decision-making:

  • Firstly, clinicians need to know about the latest treatment advances.
  • Secondly, patients and clients need to be informed about current best practice options, and be satisfied with their treatment decision.
  • Thirdly, funding agencies need to be confident that they are funding treatments that are based on strong evidence.

How can funding agencies be aware of current best practice and confident in their funding decisions? As a profession we need to be proactive by giving this information to funding agencies and lobbying the government. This is precisely what SPA is doing with its proposal. I applaud SPA for taking this step and promoting evidence-based speech pathology practice at the highest level.

 

Leanne Togher, PhD, SLP, is a professor of communication disorders following traumatic brain injury at The University of Sydney and is Senior National Health and Medical Research Council Fellow of Australia. Togher is the director of the speechBITE evidence-based practice website. She is also an international affiliate of ASHA and Fellow of Speech Pathology Australia. She can be reached at Leanne.togher@sydney.edu.au.

New Global Campaign Takes on Noisy Leisure Activities

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Worldwide, the statistics are sobering:

  • 360 million people have disabling hearing loss.
  • 43 million people between the ages of 12–35 years live with disabling hearing loss.
  • Half of all cases of hearing loss are avoidable through primary prevention.

Of course, none of this likely comes as a surprise to ASHA members, particularly audiologists, who are on the front lines of care for people with hearing loss. The good news is that we are going to hear a lot more about this serious health issue with the help of a high-profile group.

Today, on International Ear Care Day, the World Health Organization is elevating the profile of hearing loss—specifically noise-induced hearing loss—by launching a new campaign called Make Listening Safe.

The campaign educates the public about hearing dangers posed by noisy leisure activities and promotes simple prevention strategies. Young people are the focus because an increasing number are experiencing hearing loss. As the creator of the highly successful Listen to Your Buds campaign, WHO asked ASHA experts to advise on Make Listening Safe. A role the association enthusiastically embraced.

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ASHA used Listen to Your Buds to provide an early warning on potential hearing dangers from misuse of personal music players and the need for safe listening. Today, as this technology is nearly ubiquitous, the campaign is going strong on a variety of fronts.

One of ASHA’s most successful ventures is its safe listening concert series. The series educates young children about protecting their ears in a fun, interactive way by bringing innovative musicians and performances to U.S. schools. A new video showcases the most recent concert series, which took place in six Orlando-area schools in conjunction with ASHA’s 2014 convention.

Misuse of personal audio devices is also a key area of focus for Make Listening Safe. According to WHO, among teenagers and young adults aged 12 to 35 years in middle- and high-income countries, nearly 50 percent are exposed to unsafe levels of sound from the use of these devices.

This is one of the new global estimates being released with the launch of Make Listening Safe. In addition to a high-profile unveiling in Geneva, WHO is issuing a variety of materials featuring statistics on the problem’s scope, the hearing loss consequences and action steps that parents, teachers, physicians, managers of noisy venues, manufacturers and governments can take to make listening leisure activities safer.

ASHA asks members to take up the campaign. Here are just a few ideas on how you can get involved:

  • Utilize the WHO’s eye-catching public education materials—including posters, a fact sheet, and an infographic—with peers, patients, friends and loved ones.
  • Engage in grassroots public education, such as sharing statistics and prevention tips on social media or holding a free hearing screening.
  • Approach local media to pitch a story. The campaign’s launch with accompanying statistics is a great news hook. You can tie the story to your local community by highlighting an event your practice is hosting or offer tips for safe listening at local noisy venues (e.g., stadiums, concert venues/clubs). This is also an excellent consumer health story for a television station, particularly because it offers “news you can use” such as easy prevention tips.

The focus on noise-induced hearing loss in young people is not limited to March. While the WHO campaign will be ongoing, ASHA will also poll the public about safe listening practices. Our results will provide more opportunity for outreach during Better Hearing & Speech Month in May and beyond. Stay tuned!

Click here for more information. Questions may be directed to pr@asha.org.

 

Judith L. Page, PhD, CCC-SLP, is ASHA’s new president. She served as program director for Communication Sciences and Disorders at the University of Kentucky for 17 years and as chair of the Department of Rehabilitation Sciences for 10 years. 

Our Profession’s Biggest Open Secret

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What’s the biggest open secret in our field? Each of us might have slightly different answers. Here’s mine: the reason so many students are blocked from receiving needed services is because their home states have not updated their Medicaid telepractice policies.

Children who qualify for Medicaid coverage, by definition, are from low-income families. My experience is that these children are disproportionately affected by the shortage of SLPs and could therefore benefit a great deal from access to treatments delivered via telepractice.

In addition, many schools, when faced with tight budgets, simply do not have the money to hire additional SLPs–telepractice or not–without Medicaid funds.

This places an unfair burden on the rural and urban schools that need telepractice the most. They struggle more than their affluent peers to find qualified SLPs. One reason is that those wealthier districts can pay substantially more for treatment delivered via telepractice if state Medicaid policies haven’t been updated to reimburse for online services.

This isn’t the most surprising part of the secret, however. That honor goes to how easily states can make the change. Consider this:

  • The federal government, which partners with each state on its Medicaid plan, has already approved billing for telepractice. That’s right, the Centers for Medicare & Medicaid Services already has an approved billing treatment for treatment delivered via telepractice.
  • All reimbursements for telepractice are paid for entirely by the federal government. This means that states don’t pay for additional reimbursements out of pocket. Let me repeat that one more time: allowing reimbursement for telepractice increases access to services without requiring additional funds from your state’s Medicaid program.
  • For all states that PresenceLearning has researched—aside from Indiana—allowing reimbursement for telepractice is as simple as publishing a clarifying policy memo. The memo should say that online services can be billed with the same codes as traditional sessions as long as a “GT” telepractice modifier is included for tracking purposes.

It is important to keep in mind that telepractice is just a different delivery method for services already approved by CMS and reimbursed by Medicaid in schools.  SLPs provide online services using the same approaches and materials they would use if they were physically at the school site. 

What can you do to help students get the treatment they need by motivating your state to write that memo?

  • Speak to stakeholders to build a consensus. Stakeholders include: ASHA, state licensing boards, special education directors, state departments of special education and directors of child health programs for your schools.
  • Consult state-level billing agents on the best way to document services to ensure program integrity.
  • Network with colleagues using telepractice to find out which states currently approve Medicaid funding for telepractice.

There are eight states that reimburse for telepractice services. They include: Colorado, Maine, Minnesota, North Dakota, New Mexico, Ohio, Oregon and Virginia. In addition, reimbursement for telepractice services are pending in California and Michigan.[Note from ASHA editors: This list was published in July 2013, so it may have changed. Our December issue focused on telepractice and has a slightly different list of states offering reimbursement.] 

Contact state speech and hearing associations or state-level Medicaid directors to find out how you can assist in getting Medicaid reimbursement for telepractice services. Let’s work together to ensure students who need our services receive them and schools receive the appropriate funding from Medicaid.

Melissa Jakubowitz M.A. CCC-SLP, vice president of clinical services at PresenceLearning, is an SLP with more than 20 years of clinical and managerial experience, Melissa is a Board Recognized Specialist in Child Language. She is a past-president of the California Speech-Language-Hearing Association and is also active in ASHA, serving as a Legislative Counselor for 12 years. Melissa began her career working in the public schools and can be reached at melissa@presencelearning.com

Be an Advocate for Your Clients

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This summer I had an interesting experience with a major insurance provider. The company initially approved treatment for a 3-year-old client, who I evaluated and diagnosed with severe apraxia of speech. This little guy had maybe five words in his lexicon, all unintelligible to an unfamiliar listener. He could not even consistently attempt to imitate monosyllabic words. His receptive language skills were at least at age level with cognition the same.

After several months of treating him with a motor-planning and sound-sequencing approach, his parents received notification from the insurance company that his treatment was denied because “it was not medically necessary” and his apraxia was deemed “developmental.” The communications stated that my client would “outgrow” his issue in time.

I have been in private practice for almost 28 years and ardently disagree with the insurance company’s reasoning. I consulted with Janet McCarty, at ASHA headquarters, and she provided me with excellent professional advice plus solid evidence to fight for my client. I organized my information then consulted with the family to get their green light to proceed. I went all in to fight this decision with the big insurance company’s medical director.

It became a step by step process to help this medical director understand that apraxia is NOT a developmental disorder, but rather a neurologically based disorder that results in disruptions to a child’s ability to sequence the necessary motor movements to produce speech sounds. My favorite part of this story is when I asked the director how much time I had to discuss my client with him during our peer-to-peer scheduled review, he informed me that “he did not want to be lectured about apraxia because he had Googled it and saw the word ‘developmental’ tossed sporadically around the literature and that was all he needed to see to be convinced that apraxia was not a medical condition with neurological basis.”

I quickly lifted my jaw off my desk, hit my reset button and proceeded to help this “medical expert” understand more about apraxia from this expert in the field of speech and language. While our exchange made some positive impact, he still felt the need to take this case to the next level by calling in a third party pediatric neurologist. I knew that this was going to be a medical professional in my corner. The neurologist and I spoke about my client and I was able to answer specific questions about his treatment and progress. Sure enough, her recommendation was absolutely in favor of this severe speech disorder being neurologically based and treatment medically necessary. She agreed that my client would not outgrow it in time or improve through weekly sessions in small groups.

My point for sharing this story is to say that while it is often frustrating to deal with insurance companies, you have to fight for your clients. When you meet, evaluate, work with a child and their family and you know a child needs treatment, you must advocate and spend the time to fight for this child, no matter how BIG these insurance companies are or how much they try to shut you down.

I need to correct my earlier statement when I referred to my “favorite” part of the story…in fact, my favorite part of this story is that my client, who is now 3.6 years old, was approved for intensive therapy to treat his motor planning disorder. He is making remarkable progress and I am quite confident he can tell Santa what he wants in a complete sentence. Maybe with Mom’s help interpreting, but still excited and able to convey his message!

 

Lorraine Salter, MS, CCC-SLP, has been in private practice in Reading MA since 1986. She studied and earned both degrees from Emerson College in Boston, after deciding that a career in performing arts was not going to pay the bills.  She enjoys the ability to create a strong team for the children she serves through interaction with her clients’ families. You may contact her at lorraine@northshorespeechandlanguageservices.com.

Are You Ready for Better Speech and Hearing Month?

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Better Hearing and Speech Month is a mere week away, and ASHA is gearing up for an exciting month! By now, we hope you’ve seen some of the resources we developed specifically for members—press release and media advisory templates, our 2014 poster, a Facebook cover photo, a letter to parents, our 2014 product line, and much more. We also encourage members to utilize the Identify the Signs member toolkit during May, as the campaign will be front and center for this year’s BHSM. The campaign’s message of early detection is a great tie-in to the 2014 BHSM theme of “Communication disorders are treatable.”

If you’re still looking for ideas on ways to celebrate, it’s not too late to plan something. We’ve got a list of suggestions here, and you can check out our new interactive map featuring stories of how your fellow ASHA members have recognized the month.

If you do have a fabulous event or activity in store, we want to see it! Take a photo and post to Instagram with the hashtag #BHSM. One winner will be randomly selected to receive a package of 2014 BHSM products. More details can be found on the BHSM member resource page. The contest will run from May 1st – 12th.

In addition to member resources and contests, ASHA will be conducting a lot of public outreach during the month to raise the profile of communication disorders and the role of ASHA members in treating them. Some highlights this May include:

  • Google Hangout—A live, online Google Hangout to mark BHSM will be held on May 6th from 1:30 – 2:30 p.m. ET. Moderated by ASHA CEO Arlene Pietranton, the event will convene experts from a wide range of backgrounds to discuss the critical role that communication plays in daily life—and the importance of early detection of any speech, language, or hearing difficulties in children to allow them to reach their full potential academically and socially. Guests will include Elizabeth McCrea, ASHA’s 2014 President; Libby Doggett, deputy assistant secretary for policy and early learning at the U.S. Department of Education; Sara Weinkauf, an autism expert from Easter Seals North Texas; Patti Martin, an ASHA-certified audiologist from Arkansas Children Hospital; and Perry Flynn, an ASHA-certified speech-language pathologist at the University of North Carolina – Greensboro. The panel will take questions from the public, and members are encouraged to participate. Questions can be posted to ASHA’s Google+ page, or use the hashtag #BHSM on Twitter. You can RSVP for the event here.
  • Twitter Party—A Twitter party hosted by lifestyle technology and parenting blogger Michele McGraw (@scrappinmichele), and co-hosted by five other leading parenting bloggers, will be held on May 20th from 12 – 1 p.m. ET. During the party, parents and other interested parties will have the opportunity to learn, and ask and answer questions, about speech, language, and hearing disorders. No RSVP is required; members who are interested in joining in should just follow the hashtag #BHSMChat at that time.
  • New Infographic—A new infographic illustrating the prevalence and cost of communication disorders, as well as the benefits of early intervention, will be posted online at www.asha.org/bhsm and http://IdentifytheSigns.org, and distributed widely to traditional and new media.
  • Podcast Series—Four new topical podcasts featuring ASHA members will be rolled out weekly during the month. These are: Newborn Hearing Screening—In the Hospital and Beyond (May 1); Noise-Induced Hearing Loss in Children: A Preventable Problem (May 12); Autism Diagnosis and Treatment of Today and Tomorrow (May 19); and Building Language and Literacy Skills During the Lazy Days of Summer (May 27). These will be available at http://IdentifytheSigns.org.
  • International Communication Project 2014—During May, ASHA is going to be disseminating digital messaging that relates to the International Communication Project 2014 that was launched earlier this year—and promoting signatories to the Universal Declaration of Communication Rights. Members are encouraged to sign the Declaration and invite others to do so to show their support for people with communication disorders. Watch the February Google Hangout to learn more and hear from the participating countries.

 

Many of these resources won’t be available until May 1 or later, when they are debuted to the public. We encourage you to visit our member resource page www.asha.org/bhsm frequently to see the latest, and hope you can share the information with your networks. These resources will also be posted to http://ldentifytheSigns.org, the home of the Identify the Signs campaign and a site designed for consumers to easily find information tailored to them.

We hope this year’s BHSM will be one of the best yet, and look forward to hearing how you’re celebrating the month. Send us any stories, questions, or comments to bhsm@asha.org.

 

Francine Pierson is the public relations manager at ASHA. She can be reached at fpierson@asha.org.

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!

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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.

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.

What Has ASHA Done for Us Audiologists Lately?

hearing aid shutterstockRecently, I was asked by a friend (another audiologist) why I belong to ASHA and what do they do for me? After all, they were the organization for speech-language pathology and really didn’t care about audiology except for the CCC-A, as believed by some. This led me to reflect on why I feel ASHA’s membership benefits me as an audiologist, focusing on the past few years.

Just in the last year, ASHA has provided me with a wealth of information related to reimbursement issues, which was developed in collaboration with the Academy of Doctors of Audiology, the Directors of Speech and Hearing Programs in State, Health and Welfare Agencies, Academy of Rehabilitative Audiology, the Educational Audiology Association, and the American Academy of Audiology.

For me, the guidance for audiologists on reviewing third party payer provider contracts was a very timely and helpful reminder because—at that time—my practice was being approached by a number of entities to provide hearing aid services.

Another helpful resource was the question and answer document about the new Otoacoustic CPT Codes that gave me information on how to bill these codes appropriately. There was also information on new requirements for the Physician Quality Reporting System, which helped me too. Aside from these useful and helpful resources, I appreciate that the information was developed jointly and shared within the audiology community.

When I think about advocacy being a member benefit, I’m thankful for quite a few things that ASHA’s advocacy team has pushed for, including:

  • A comprehensive audiology benefit. This will allow me to provide the necessary rehabilitative/habilitative services to the people I serve. This proposal will recognize that audiologists are the best providers of these services. As health care moves toward prevention of health problems and a new payment system, this will allow me to provide therapy services as part of a team!
  • Legislation related to early detection of hearing loss. The outcome of that work has benefited so many of the children and families we serve.
  • Legislation that averted the proposed 20 percent cut in Medicare payments. These have been scheduled to take place every year for the last several years, but keep getting extended. I can’t help but think that ASHA’s lobbyists have been instrumental in helping in that effort.

ASHA’s ongoing advocacy for the profession of audiology has benefited me in so many ways. Recently, ASHA was very helpful working out the “kinks” in the federal employee health benefits hearing aid plan. ASHA is also developing and implementing plans to help us navigate through the new accountable care organizations.  And, they are working diligently to see that we have a voice in the implementation of the Affordable Care Act.

As I continued to think of all of the benefits from ASHA membership—as an audiologist—I realized there has been great value in continuing to be a member of ASHA!  I want to thank my friend for asking me why I still belong.


Stuart Trembath, MA, CCC-A, is chair of ASHA’s Health Care Economics Committee and co-owner of Hearing Associates in Mason City, Iowa.

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.