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Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
Making Best Use of Speech-Language Therapy: When to Refer and What to Expect
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Making Best Use of Speech-Language Therapy: When to Refer and What to Expect

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In this presentation, we discuss speech and language in school-age youth, identify when referral for Speech-Language Evaluation and Therapy would benefit the patient, and explain utilization of …

In this presentation, we discuss speech and language in school-age youth, identify when referral for Speech-Language Evaluation and Therapy would benefit the patient, and explain utilization of Alternative and Augmentative Communication (AAC).

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  • 1. MAKING BEST USE OF SPEECH-LANGUAGE THERAPY: WHEN TOREFER AND WHAT TO EXPECTCelia Neavel, MD, FSAHMAsst. Prof. UTSW Austin Pediatric Residency ProgramDirector, Center for Adolescent HealthDirector, Goals @ People’s Community ClinicLee Anne Holmberg M.A., CCC-SLPSpeech-Language PathologistEaster Seals of Central Texas
  • 2. OBJECTIVES1. Discuss speech and language in school-ageyouth.2. Identify when referral for Speech-LanguageEvaluation and Therapy would benefit the patient.3. Explain utilization of Alternative andAugmentative Communication (AAC).4. Describe community resources for youth withspeech and language delay and their families.
  • 3. STRUCTURES INVOLVED IN SPEECH ANDVOICE PRODUCTION.
  • 4. PREVALENCE SPEECH PROBLEMSREPORTED BY PARENTS
  • 5. LANGUAGE DISORDERS Language  Shared system for communicating  Involves sounds, signs, gestures, and/or spoken or written words Specific Language Impairment  Absence other developmental problems Other language disorders assoc. with  Hearing impairment  Autism  Mental retardation  Congenital or acquired disorders of brain development  Head injury, brain tumors.
  • 6. MEAN LANGUAGE SCORES AND NON-VERBAL I.Q.SCORES
  • 7. PREVALENCE HAVING READINGDISABILITY
  • 8. NORMAL LANGUAGE DEVELOPMENT IN CHILDRENAND ADOLESCENTS Verbal AND non-verbal; follows predictable course 4-5 y.o.  200-300 words; can describe, define, answer why; tell simple story; understandable to all 5-6 y.o.  Understands > 2000 words, sequencing, rhyming; creates stories; carries out series 3 directions School Years;  Huge demand on skills for school and social acceptance; emerging figurative language
  • 9. WARNING SIGNS SCHOOL-AGED CHILD Phonological awareness problems New inattentive or not well-controlled ADHD Problems reading, writing, understanding social interactions Feelings hurt or gets angry/frustrated Trouble learning second language Parents with language/literacy problems
  • 10. LANGUAGE AND COGNITIVE DEVELOPMENT IN ADOLESCENTS Core language skills established.  Semantics, syntax, language concepts and basic pragmatic skills  Early adolescents more concrete Adult pragmatic and social language skills being refined, including ability to:  Interact with adults and peers in classroom and social activities  Maintain or shift topic of the conversation; participate appropriately in conversation  Take another person’s point of view to know what information is needed during a communication event  Incorporate subtle variations in tone, word usage, rhythm depending on situation
  • 11. IMPLICATIONS OF VOICE, SPEECH, ANDLANGUAGE DISORDERS Need to communicate to function in our society Affect emotional and social life, education and job Substantial cost in life quality and human potential Number will likely increase  Improved survival for medically fragile infants and individuals who sustained injury or acquired disease
  • 12. GOALS FOR INTERVENTIONS Help with developmental trajectory Maintain or improve self-esteem Maximize function Decrease anxiety Educate other important adults so can:  Understand youth’s weaknesses  Make appropriate modifications and contribute further to interventions
  • 13. IDENTIFYING VOICE, SPEECH, AND LANGUAGEDISORDERS Suspected by family, physician, or educator  Consider delayed versus disordered  ASK FUNCTIONING AGE Speech-language pathologists evaluate & diagnose  History, exam, comparison to standardized norms Voice assessment Speech assessment  Motor speech disorders and/or stuttering Language assessment  Formalized questionnaires; direct observation; testing vocabulary, understanding, word and sentence production, language in social situations Must take into account the native language of the speaker.
  • 14. BILINGUAL CHILDRENEllen S. Kester, Ph.DPresident, Bilinguistics Speech and Language Services5766 Balcones Drive, Suite 205Austin, TX 78731(512) 480-9573 Phone (512) 458-9573 Faxwww.bilinguistics.com
  • 15. EXAMPLES FROM BILINGUISTICS 4-year-old Spanish-speaking child with a total of approximately 20 words, who could follow one-step commands with gestures but not without gestures. Intelligibility of 30- 40%. 3-year-old bilingual child who has difficulty following simple directions with gestures. He uses single words and two-word utterances. Intelligibility is 40-50%. Neither of these children had been referred for a speech-language evaluation previously.
  • 16. WHY DO WE GET REFERRALS LIKE THIS? Misconceptions about bilingual development Mobility of population Parents don’t understand “no cost” options Parents not comfortable expressing concerns Parents not aware of developmental differences Parents may be aware of differences, but not know value of early intervention Language barriers may impede referral process
  • 17.  Children code switch between languages because they dont know either language well. Raising children with two languages will confuse them. Children with language impairment should not learn more than one language at a time. Children who use the sentence structure of one language when speaking the other likely have language impairment. We should expect bilingual children to be delayed in developing communication skills
  • 18.  Bilingual children develop early vocabulary at the same rate as monolingual children (Pearson, 1993). Early language milestones are similar (single words, lexical spurt, 2-word phrases, following directions) (Pearson and Fernandez, 2001). Conceptual scores are similar (Pearson, 1998).
  • 19. DETERMINING SPEECH-LANGUAGEIMPAIRMENT IN BILINGUALS English Spanish Normal OK Spanish English Normal OK English Spanish Impaired*
  • 20.  Difficulty learning both languages, even with adult assistance Family history of language/learning disabilities Slower development than siblings Difficulty interacting with peers Inappropriate pragmatic/social language skills (i.e., turn- taking, topic maintenance, considering listener needs, non-verbal communication) Difficulty with language in many routines Idiosyncratic error patterns Language performance unlike others with similar cultural/linguistic experiences
  • 21. LEE ANNE HOLMBERG M.A., CCC-SLPSPEECH-LANGUAGE PATHOLOGISTEASTER SEALS OF CENTRAL TEXAS
  • 22. SPEECH-LANGUAGE PATHOLOGY YOU SHOULDKNOW • Language Disorders: – Receptive Language Disorder – Expressive Language Disorder – Pragmatic Language Disorder • Articulation Disorders: – Oral Apraxia – Stuttering- – Voice Disorder • Feeding Disorder: – Dysphasia
  • 23. A FEW DIAGNOSIS THAT WARRANTREFERRAL TO SPEECH-LANGUAGEPATHOLOGIST Children with ADD or ADHD Hearing Loss or Chronic Ear Infections Cleft Palate or other Craniofacial Anomalies Difficulty Feeding and Swallowing Autism Spectrum Disorders Variety of Syndromes including- Down Syndrome, Fragile X Syndrome, Turner’s Syndrome, etc. Children with Cerebral Palsy
  • 24. REFERRAL TO SPEECH-LANGUAGEPATHOLOGIST Children that schools discharged from speech therapy Learning disabilities or children struggling in school School-aged and cannot identify significant details in story or situation and then sequence them in understandable way 2 – 5 y.o. with very small vocabulary and having difficulty stringing words together in phrases and sentences When parent of a 2 y.o. or older says, “My child is not talking and using words, and does not seem to understand me.” When parent says, “I do not understand what my child says.”Please do not tell a parent who is concerned to wait until child is 4 or 5 y.o. A lot of speech-language development goes on before then!!!!
  • 25. TESTS MOST COMMONLY USED FOREVALUATIONS Language Tests:  Preschool Language Scale 4 (PLS4)  Clinical Evaluation of Language Functioning (CELF)  Clinical Evaluation of Language Functioning-Primary (CELF-P)  Test of Language Disorders (TOLD) Articulation Tests:  Goldman Fristoe Test of Articulation
  • 26. WHAT TO LOOK FOR IN SPEECH-LANGUAGE REPORT Speech-language diagnosis accompanies medical diagnosis, if applicable Chronological age of child included Standard scores from formal testing (average range 85-115) Language age levels in all subtests of formal testing Narrative discusses child’s strengths and weaknesses Specific recommendations Stated goals to be addressed in therapy
  • 27. WHAT A SPEECH-LANGUAGE PATHOLOGISTCAN OFFER• Speech and language Screenings, evaluations, and treatment.• Recommendations for referrals to other therapies i.e. OT, PT• Collaboration with other service providers (doctors, psychologists, other therapists, and schools).• Education on the childs communication issues for parents, and other providers• Parent training on communication and the child’s needs and goals
  • 28. WORKING WITH THE SCHOOLS:WHAT SPEECH-LANGUAGE PATHOLOGISTFOCUSES ON Collaboration with teachers, school speech-language pathologists, and counselors Education and training on specific techniques that are working well in the child’s therapy Opening a dialogue to share progress and difficulties the child is experiencing
  • 29. QUESTIONS TO SCREEN FOR POSSIBLESPEECH-LANGUAGE DELAYSYoung Children: How much is your child talking? How many words is your child using? How many words is your child stringing together? Is your child able to follow directions (Go get your shoes.)? Does your child understand what your are telling him/her? How much are you able to understand your child?
  • 30. QUESTIONS TO SCREEN FOR POSSIBLESPEECH-LANGUAGE DELAYSAdolescents: How is your child functioning in school? How much of what your child tells you are you able to understand? Is your child able to use logical sentence? Is their spoken grammar correct? Is your child able to identify the main details in a story? Then is your child able to sequence these main details to retell the story? Can your child follow multi-step directions? Does your child have pronunciation difficulties?
  • 31. WHAT IS AUGMENTATIVE ALTERNATIVECOMMUNICATION (AAC)? Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.asha.org
  • 32. TYPES OF AAC Unaided AAC: Using body to communicate with others. Includes, gestures, body language, and/or sign language. Aided AAC: Using tools along with the body to communicate with others. Tools can include:  Pencil and paper.  Communication boards or communication books.  Electronic Voice Output Devices (VOD). www.asha.org
  • 33. TOTAL COMMUNICATION APPROACH TOAAC Includes use of combination of speech, gestures, sign, and AAC. Important because it gives person variety of methods to use for successful communicate with others.
  • 34. TYPES OF CLIENTS WITH AN AAC DEVICESEEN AT EASTERS SEALS Clients with Down Syndrome Clients with profound oral apraxia Autistic clients Clients with severe Cerebral Palsy
  • 35. AAC 101Jon YatesAAC SpecialistDynaVox Mayer-Johnson
  • 36. ASSESSMENT AAC Devices recognized as treatment by:  American Medical Association  American Academy of Neurology  American Academy of Physical Medicine & Rehabilitation  American Speech-Language Hearing Association
  • 37. CONDITION SETS THAT BENEFIT FROM THE USE OF A COMMUNICATION DEVICE Child AdultCongenital/ •Cerebral Palsy •Cerebral Palsy Develop- •Down Syndrome •Down Syndrome mental •Mental Retardation •Mental Retardation •Autism •Autism •Muscular Dystrophy •Muscular Dystrophy •Traumatic Brain Injury • TBI (TBI) • Stroke Acute Acquired •Spinal Cord Injury • SCI (SCI) • Amyotrophic Lateral Sclerosis (ALS) • Parkinson’s Disease Degenerative • Huntington’s Disease • Multiple Sclerosis (MS)
  • 38. SOME INTERESTING FACTS 8 out of 1000 people worldwide cannot use speech to communicate.  2-3 million in U.S. could benefit from speech generating devices.  Only 5% of these people have a speech device.  Funding is available.Source: Univ of NebraskaLincoln Website
  • 39. WHAT BENEFITS DOES AAC PROVIDE TO YOUR PATIENTS?  Improves overall quality of life  Supports meaningful personal relationships  Develops functional communication skills  Improves Functional Communication Measures  Reinforces traditional rehabilitation activities  Schedules (appointments and daily activities)  Reminders (medication and appointments)  Videos (physical therapy examples)  Helps patients communicate important medical and personal information to healthcare teams
  • 40. FUNDING: SHOW ME THE MONEY Medical Model  Medicare  Medicaid  Private Insurance  STAP  Other Organizations  ALS  VA School  IEP  Third Party Billing Other  Fund Raising
  • 41. FUNDING: MEDICAL MODELPrivate Insurance  Many insurers follow Medicare guidelines.  Call insurance company and ask questions about benefits. Confirm whether coverage available for Durable Medical Equipment/Speech Generating Devices.  Payment varies by policy.  Ask if met deductible and Out of Pocket Maximum for calendar year.  Any co-payments or deductibles need to be collected before device is shipped. Go through STAP for this!!
  • 42. FUNDING: MEDICAL MODELTexas Medicaid Assistance 100%  Covers approved equipment with no out pocket cost to client  Does require 30-DAY trial period  Process takes about 2 months with trial
  • 43. FUNDING: STAP STAP stands for:  Specialized Telecommunications Assistance Program  Falls under umbrella of DARS Department of Assistive and Rehabilitative Services This is a TAX that we pay for on our phone bills every month
  • 44. FUNDING: STAP Process  Fill out STAP application and provide small report. Application must be accompanied by proof of TX residency.  Everyone in Texas with a dual diagnosis qualifies for STAP.
  • 45. FUNDING: STAP With this funding there is no reason why anyone in Texas should be without a voice.  This is also a great alternative for schools! STAP timeline is about 4 weeks. Times do fluctuate!! Follow up with STAP!!
  • 46. RESOURCES 0-3 y.o. Early Childhood Intervention =/ >3 y.o. Child Find through School/School District or youth’s school if already enrolled Non-Profit Therapy Organization Private Therapy Organization Consider:  Hours  Location – home or center-based; family’s transportation  Type Insurance Accepted  If Youth-focused  Waiting List  Areas of Specialization THANK-YOU DCMCCT speech therapists for sharing list!
  • 47. REFERENCES http://www.nidcd.nih.gov/health/voice/ National Institute on Deafness and Other Communication Disorders, National Institutes of Health asha.org American Speech- Language-Hearing Association Crossed Wires: Identification, Impact, Management and Outcomes of Language Disorders presentation by Lynn Wegner, MD at Texas Scottish Rite March 6, 2010
  • 48. CODING 784.3 Aphasia  784.59 Other speech 784.40 Voice and disturbance,NOS resonance  784.61 Alexia and disorder, unspecified dyslexia 784.42 Dysphonia  783.42 Delayed 784.43 Hypernasality Milestones 784.44 Hyponasality 784.49 Other voice and resonance disorders
  • 49. CODING 315.31 Expressive  315.5 Mixed language disorder developmental disorder 315.32 Mixed  315.8 Other specified expressive-receptive delays in development language disorder  315.9 Unspecified 315.34 Speech and delays in development/ language delay due to learning disorders NOS hearing loss 315.39 Other language disorder (phonologic, articulatio n)
  • 50. VISIT US AT BILINGUISTICS.COM
  • 51. FOR MORE GREAT RESOURCES VISIT OURRESOURCE LIBRARY ATSPEECHPATHOLOGYCEUS.NET
  • 52. Thank you!

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