Children's speech therapy funding controversy

australiaA decision made last year by the government of Australia with regard to funding speech therapy for pre-school children who stutter has created a controversy world-wide in the global speech pathology community.

Australia’s professional organization for Speech-language Pathologists (SPA) submitted a proposal for the 2015 federal budget “that Medicare rebates be available for early stuttering intervention at a level which is demonstrated to be highly efficacious and supported by the strongest level of evidence.” The rebates would be available only to children who took one treatment in particular, known as the Lidcombe Program.

Successful therapy

The  therapy takes place in the home environment The Lidcombe Program was developed in Australia in the 1980s as a treatment for pre-school aged children who stutter. It has been scientifically researched in Australia, Canada and the United Kingdom with positive results. In the program, parents are trained to administer the technique themselves, which involves gently prompting a child to retry “bumpy” speech, and praising him/her for fluent speech. The success of the therapy is due mainly because it takes place in the home environment and not in a clinician’s office, and because it is performed by the people best situated to monitor the child - parents. Lidcombe practitioners emphasize that the treatment is only successful if the child enjoys the interaction and does not feel hurt or picked on.

Because of the multitude of positive data on its outcomes, the Lidcombe Method has been called the “gold standard” of stuttering treatment for children. Yet the Australian Medicare proposal has been criticized world-wide for limiting the scope of coverable treatment.

Concerns in the community

 the proposal has been criticized for limiting the scope of coverable treatment Brooke Leiman, director of the Stuttering Clinic at National Speech/Language Therapy Center, worries that the decision “has the potential to set a precedent for how all communication disorders are reimbursed by the government and private insurance companies across the world.” Further, such a limiting approach could effect future research and the development of new approaches.

American speech language pathologists have expressed concern that such a practice does not bode well for children who stutter yet do not respond to the Lidcombe method, and may be better suited to other approaches.

Clarification

Because of the mixed response to the proposal, Speech Pathology Australia published a clarification that Lidcombe has the “strongest level of evidence” of all treatment methods for early intervention in stuttering and is therefore the best choice to receive full-funding from Medicare. It is not a mandate for speech pathologists to use only Lidcombe.

Some researchers have pointed out that other methods for early intervention for stuttering do have excellent results according to studies, but that there may not be as much information published about them.

Links

A quick primer on the issue is here.

The podcasting site Stuttertalk has published interesting conversations with people who stutter, SLPs and researchers about this topic:

Is there a best stuttering treatment?

Speech pathology Australia encouraged to clarify Lidcombe-only proposal.

Many in the Stuttering and SLP Communities Speak Out Against Australian Funding Proposal for “One Size Fits All” Treatment (Ep. 502)