Home Advocacy Another View on Speech Pathology Australia’s Stuttering Treatment Proposal

Another View on Speech Pathology Australia’s Stuttering Treatment Proposal

by Ann Packman

Editor’s Note: This post is a follow-up to yesterday’s post from Craig Coleman regarding a controversial proposal on stuttering treatment and reimbursement from Speech Pathology Australia. We reached out for responses from Ann Packman and Mark Onlsow, two of the originators of the Lidcombe approach to stuttering treatment—on which the SPA proposal centers. We also reached out to SPA and include a statement here from SPA President Deborah Theodoros.

Response from Ann Packman and Mark Onslow:

During the past two decades the Australian government has invested millions of dollars in research funding to develop an evidence-based treatment for early stuttering. The Lidcombe Program is a result of this funding and is now supported by strong evidence from randomized controlled trials. Those randomized trials include evidence for face-to-face treatment, for treatment using webcam, and for group treatment. The Speech Pathology Australia proposal is for our government to further invest in the health of Australian children who stutter, but in a more direct way by contributing to the cost of their treatment.

We wish to clarify that the Speech Pathology Australia proposal is not for a mandate—a directive—that Australian speech pathologists must use the Lidcombe Program to treat preschool children who stutter. Nor is it a proposal to overturn customary evidence-based reasoning and standardize how Australian preschoolers who stutter in Australia are managed. Nor is there any suggestion that the Australian government would not in the future fund any other evidence-based intervention that is supported by randomized controlled trials. Indeed, if such evidence emerges for the efficacy of another treatment for early stuttering, we would encourage Speech Pathology Australia to approach the Australian government to consider it also for taxpayer-assisted support.

Message from Deborah Theodoros, president, SPA:

Speech Pathology Australia is advocating for public funding (Medicare) rebates for early stuttering intervention at a level which is demonstrated to be highly efficacious and supported by the strongest level of evidence. However, SPA is not suggesting any policy or legislation which would restrict interventions to one program over another or would require a speech pathologist to use a specific treatment, intervention or service. SPA continues to strongly support the principle of practice that speech pathologists remain free, and duty-bound, to exercise their clinical decision-making in relation to the interventions they provide to clients.

 

Ann Packman, PhD, SLP, is associate professor and senior research officer for the Australian Stuttering Research Centre, The University of Sydney. She has more than 30 years’ experience in the area of stuttering as a clinician, teacher and researcher and researches nature and treatment of stuttering. Packman recently served as associate editor for fluency for the American Journal of Speech-Language Pathology and is associate editor for fluency for Language, Speech, and Hearing Services in Schools. Packman is an international affiliate of ASHA. She can be reached at ann.packman@sydney.edu.au.

Mark Onslow, PhD, SLP, is the foundation director of the Australian Stuttering Research Centre, The University of Sydney. He was a principal research fellow of the National Health and Medical Research Council of Australia. Onslow’s research interests are the epidemiology of early stuttering in preschoolers, mental health of those who stutter, measurement of stuttering, and the nature and treatment of stuttering. He is a member of the international Lidcombe Program Trainers Consortium. Onslow is an international affiliate of ASHA. He can be reached at mark.onslow@sydney.edu.au.

Deborah Theodoros, PhD, SLP, national president of Speech Pathology Australia, is also professor and head of the division of speech pathology in the University of Queensland’s School of Health and Rehabilitation Sciences. She is a founder and co-director of the multidisciplinary Telerehabilitation Research Unit in the school and past chair of the Telerehabilitation Special Interest Group of the American Telemedicine Association. She can be reached at president@speechpathologyaustralia.org.au.

 

 

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11 comments

Brooke Leiman March 13, 2015 - 10:49 am

“SPA is not suggesting any policy or legislation which would restrict interventions to one program over another or would require a speech pathologist to use a specific treatment, intervention or service.”

Maybe you’re not banning the use of other programs but you’re certainly making it very difficult to make that choice! Clinicians are left to decide whether to use what is best for the child or to get paid. Yes- we’d like to think all clinicians would do what’s best for the family, but this is also their livelihood and we can’t fault clinicians for wanting to get paid for their services! And what about these vulnerable families? They are being told that this is the “best” program, but what if it doesn’t work? They are left with a) feeling like they did something wrong and b) with footing the bill if they want to even consider trying something that works better for their child and family. Each child has a unique set of abilities and vulnerabilities that play a role in if and how the child’s stuttering persists. These differences demand different approaches to treatment. I am Lidcombe trained and I can assure you this program is not for everyone. I am not saying this to fault the LP because I would say this for any stuttering “program.”

Jill Saunders March 16, 2015 - 2:04 pm

Again, I agree with what you are saying, Brooke. It seems like they are wanting to limit their services while still seeming like they’re helping out.

Ellie S March 17, 2015 - 5:27 pm

While I agree that SPA’s decision may not be ideal, I think that I should clarify the Australian Medicare context. In Australia, we have very limited public funding for early intervention services for communication disorders, with children often receiving only 5-10 intervention sessions after being on a waiting list for 12 months. Often, families are required to attend private services, for which there is an out-of-pocket fee for the family. Medicare, in certain circumstances, provides a rebate to families (which does not always cover the cost of each intervention session). This money is provided to the family, not to the clinician – so, under this proposal by Speech Pathology Australia, it would not be the clinician who gets ‘paid’ for delivering treatment. Rather, the families would be reimbursed a certain amount. The clinician gets paid by the client, who then gets reimbursed by the government.

Katie Gore March 18, 2015 - 5:31 pm

Thank you for clarifying, Ellie! If you wouldn’t mind explaining a couple other Australian context questions…

1. Currently, it sounds like very limited early intervention treatment and rebates are available for a variety of interventions, Lidcombe and others. Is this the case?

2.a Would this proposal potentially INCREASE the amount of sessions and/or rebates that families are able to have?

2.b Depending on answers to 1 and 2a, it sounds like this proposal as is might restrict reimbursable treatment options (ie, Lidcombe-only), but potentially grant more therapy within that single framework. Is that a correct interpretation?

3. Is the current limited reimbursement model in danger of being taken away altogether, unless something with concrete evidence is provided (ie, anything that might explain the motivation for this type of proposal)?

Jill Saunders March 20, 2015 - 12:11 pm

Ellie, thank you for your clarification! I misunderstood that the families will be getting reimbursed instead of the clinics.

Brooke Leiman March 20, 2015 - 12:25 pm

A few more things to consider-

1. Ellie explained that there is already a long wait list. By requiring that SLPs be Lidcombe certified to provide therapy, we are actually reducing the number of service providers, thus increasing the wait list.

2. I was under the impression that there were 2 parts to this proposal, correct me if I’m wrong. The first part of the proposal is requiring that clinicians be lidcombe certified in order to provide services to pre-school aged children who stutter in government health care facilities in Western Australia. The 2nd part of the proposal would extend to how services rendered by private speech-language pathologists are reimbursed. For private clinicians, yes, medicare may be actually reimbursing the families and not the clinician. However, indirectly this will impact the financial situation of private practitioners because families will be much less likely to consider seeing a clinician if they aren’t suggesting Lidcombe (since they won’t be reimbursed).

Corrin Richels March 13, 2015 - 12:00 pm

Would a clinician who exercises his/her clinical decision-making get reimbursed if that decision wasn’t to use the Lidcombe Program?

Katie Gore March 13, 2015 - 6:10 pm

I feel that this statement does not address the main concerns raised by Mr. Coleman’s post yesterday. Reading through this, my understanding is that this new budget proposal will make Lidcombe the ONLY Medicare-approved treatment for preschool stuttering (if this is not true, clarification would be greatly appreciated!). This may not be the same as a “mandate” or “policy”, but this government and regulatory body endorsement of a SINGLE treatment over all others certainly implies a “one-size-fits-all” belief on the part of authorities.

While I applaud SPA for their dedication to proven, efficacious treatment, I find it concerning that published RCTs are cited here as apparently the only qualifier for “efficacious”. This would mean that any future approved treatments would also be programmatic in nature, reducing clinicians to the level of technicians. Does SPA not trust its SLPs to make effective, informed, *individualized* decisions about treatment, outside of a prescribed formula?

Finally, this statement: “Nor is it a proposal to overturn customary evidence-based reasoning and standardize how Australian preschoolers who stutter in Australia are managed,” I feel is exactly what is happening here (even if unintentionally). One, requiring that RCTs and published papers are the only acceptable form of evidence is an extremely limited view of EBP. Two, if the government funds only a SINGLE treatment approach, that treatment WILL become the standard.

Tom Weidig March 18, 2015 - 2:02 am

I have written a comment on this post on my blog TheStutteringBrain under the link
http://thestutteringbrain.blogspot.com/2015/03/deborah-theodoros-has-been-misinformed.html

Tom Weidig March 18, 2015 - 2:12 am

>> Indeed, if such evidence emerges for the efficacy of another treatment for early stuttering, we would encourage Speech Pathology Australia to approach the Australian government to consider it also for taxpayer-assisted support.

Well the Franken study has shown that there is no difference in efficacy between Lidcombe and a second treatment approach Demands And Capacities. So does this constitute enough evidence to say: well we consider Lidcombe effective, and they have shown that D&C is similar, D&C is OK to use??

lexy March 18, 2015 - 4:51 am

I’m aware that the evidence base for LP is strong, especially in context of a young discipline that lacks knowledge (SLP/T, this is my profession and I mean this in a supportively critical way, not as an insult). However, there is some overstatement here. RCTs without a comparison treatment are likely to show successful results. What they show is that stuttering therapy works, not that LP is any more effective than any other therapy choice. The evidence is strong, but can only ever support the hypothesis tested, and so far does not test the hypothesis that LP is the best choice of intervention for preschool children who stutter.

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