Home Advocacy A Controversial Proposal on Stuttering Treatment from Speech Pathology of Australia: What It Means and What Happens Next

A Controversial Proposal on Stuttering Treatment from Speech Pathology of Australia: What It Means and What Happens Next

by Craig Coleman
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Editor’s note: This blog post was submitted by ASHA member Craig Coleman and does not necessarily reflect the views or position of ASHA. Here is the original release from Speech Pathology Australia that spurred Coleman to submit this post. It was published in the February 2015 issue of SPA’s publication Speak Out:

Speech Pathology Australia recently submitted a proposal to the Australian Government Department of Treasury for the federal budget 2015-2016. Given the difficult political and budgetary climate, and in anticipation of a government response to the recommendations made from the Senate inquiry—the budget proposal focused on a single budget initiative.

We argue that Medicare should be targeted towards health interventions that are evidence-based, effective, safe and minimise future health treatment needs. Our proposal focused on an internationally recognised intervention, developed in Australia and based on the most robust scientific evidence of effectiveness—the Lidcombe Program—to treat stuttering in young Australian children.

Tomorrow, we will run a post on this proposal from two of the originators of the Lidcombe approach, Mark Onslow and Ann Packman, along with a statement from the president of SPA, Deborah Theodoros. We encourage your comments on this issue, which you can post below this post from Coleman.

Recently, Speech Pathology Australia (the national speech-language pathology association of Australia) submitted a proposal to the Australian Government Department of Treasury that would require Medicare rebates be made available for children who stutter, but only if they are treated using the Lidcombe Program.

I feel this action gravely limits the scope of treatment for stuttering. Many interventions for preschool stuttering have shown to be effective. What happens when a child receives treatment with the Lidcombe program and doesn’t make progress? Does the child have other treatment options? From this proposal, it would appear that is not the case.

How are new (and perhaps more effective) treatment approaches expected to emerge when only treatment with an existing evidence-base is funded? Imagine if all infections were still treated using penicillin because it was an early treatment option. Would the government and medical associations support such a position? Perhaps a clearer question is would pharmaceutical industry lobbyists allow legislators to even remotely consider the idea? Do we think less of ourselves as a profession to allow this to happen?

This proposal also highlights a concerning trend of what constitutes “evidence.” While certain treatments might have more data than others it doesn’t always mean that treatment is more effective. Evidence-based practice includes current scientific evidence, clinician experience and client /family values. What if the clinician is not properly trained in the treatment approach? What if the personality of the client, family or clinician is not a good fit for one particular approach? Surely, the best “evidence” comes not from group data, but the individualized outcome of each client we serve. While group data certainly present scientific evidence, individual outcomes present actual evidence-based practice. That type of data takes into account all aspects of the evidence-based practice triangle.

After this precedent has been established, we would be naïve to think this could not happen with other disorders in all parts of the world. This is not an issue for the stuttering community of Australia to deal with. It is an issue for the speech-language-hearing community of the world to deal with.

So, where do we go from here? Here is a potential plan I would like to suggest:

  1. Advocate for reimbursement for stuttering. The state of reimbursement for stuttering treatment in the United States can best be described as dire. One of our missions as SLPs should be to work with insurance providers and demand that they pay for stuttering treatment. Somewhere along the way, we have allowed insurance companies to dictate that stuttering treatment should not be reimbursed. We must reverse that trend.
  2. Create a consortium of professionals. This would allow a database of treatment outcomes to be collected from clinicians in the field. Not only would this help with reimbursement, but it would also allow publication of data collected from individualized treatment approaches. We are professionals, not technicians. Our clients deserve better than “follow-the-manual” based programs and protocols.
  3. We need to educate our professionals and the public about stuttering. Stuttering is not merely a disruption in the flow of speech. It is much more than that.

As concerning as this proposal is, it can be a positive if we choose to act with reason, courage and passion.

In order to provide both sides of the discussion, I am including a recent statement from Speech Pathology Australia. While this statement seeks to clarify that this is not an endorsement of one approach, advocating for reimbursement for only one approach certainly seems to send the opposite message. Many insurance companies will not pay for stuttering treatment here in the United States. But responding to that by supporting a policy that would cover only one approach would be very dangerous and erroneous.

It is also important to understand that once Medicare programs establish a policy, private payers soon follow suit. It’s very naive to believe this policy won’t have major negative ramifications in the long run. While it may benefit some children in the short term, there is no doubt in my mind it will not benefit people who stutter or our profession in the long term.

You can read Coleman’s original blog post in full here.

 

Craig E. Coleman, MA, CCC-SLP, is an assistant professor at Marshall University and a board-certified specialist in fluency disorders. Coleman is also an adjunct instructor at Indiana University of Pennsylvania and co-director of the Stuttering U. summer program for children who stutter, their families and SLPs. He is coordinator of ASHA Special Interest Group 4, Fluency and Fluency Disorders. He can be reached at craig.coleman@marshall.edu

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7 comments

Brooke Leiman March 12, 2015 - 11:14 am

Craig- I could not agree more! Although the SPA might have had good intentions when submitting this proposal, the idea that the government and insurance companies could intervene with our clinical decision-making is very concerning!!

Craig Coleman March 12, 2015 - 1:13 pm

Thanks Brooke! I agree completely!

Jill Saunders March 16, 2015 - 1:51 pm

Brooke, I agree! They shouldn’t limit their service to only those who use Lidcome Program treatment. Others who don’t use the program would also benefit from the SPA proposal.

Joseph S. Attanasio March 12, 2015 - 11:25 am

The proposal from Speech Pathology Australia does not ask that Medicare (Australia) stop funding all stuttering treatment programs except LP. It asks that Medicare start the funding, a new undertaking. The LP is the program to begin with because of its research base coupled with budgetary limits that narrow the scope of funding at the present time. Then, should the budget picture improve in the future, Medicare could be asked to fund additional programs with demonstrated efficacy/effectiveness, should they come forth. This model of folding into Medicare new treatments as they become available is not a foreign one. I don’t believe that anyone can expect funding from a governmental agency for treatment programs that do not demonstrate efficacy/effectiveness.

Craig Coleman March 12, 2015 - 1:19 pm

Joseph, thanks for the comment. Your comment restates the problem and that is the advocating for funding for one approach. There are many evidence-based approaches (see below). A much better approach to this problem would have been to advocate for early intervention services for children who stutter through a multitude of evidence-based approaches. Treatment decisions should not be based on budgetary issues.

Franken, M. C. J., Kielstra-Van der Schalk, C. J., & Boelens, H. (2005). Experimental treatment of early stuttering: A preliminary study. Journal of Fluency Disorders, 30 (3), 89-199.

Frymark, T., Venediktov, R., & Wang, B. (2010). Effectiveness interventions for preschool children with fluency disorders: A comparisons of direct versus indirect treatments (ASHA’s National Center for Evidence Based Practice in Communication Disorders – March 2010). Retrieved from http://www.asha.org/uploadedFiles/EBSRFluencyDisorders.pdf

Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, T., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe Programme of early stuttering intervention. British Medical Journal, 331, 659-661

Millard, S.K., Edwards, S., & Cook, F. (2009). Parent-child interaction therapy: Adding to the evidence. International Journal of Speech-Language Pathology 11(1), 61 – 76.

Yaruss, J.S., Coleman, C., & Hammer, D. (2006). Treating preschool children who stutter: Description and preliminary evaluation of a family-focused treatment approach. Language, Speech, and Hearing Services in Schools, 37, 118-136.

Victoria Reynolds March 13, 2015 - 6:49 am

As well as the many issues you have eloquently described, Craig, there is another. Why won’t Speech Pathology Australia release a copy of their original Budget submission? It has been submitted to Treasury and is therefore a public document. I am looking forward to reading the President’s statement and hope she will address this. I do think, as a member, that the Association has a fiscal, if not ethical and legal, obligation to provide us with a copy of what they have advocated to government on our behalf. It’s an issue of transparency – I find it very concerning that our professional association can organise itself in such an opaque manner.

Tom Weidig March 18, 2015 - 2:06 am

I have written a post on this topic on my blog TheStutteringBrain under the link
http://thestutteringbrain.blogspot.com/2015/03/lidcombe-only-effective-treatment.html

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