Having an experienced speech-language pathologist (SLP) who understands hearing loss and the auditory brain working with your newly implanted (or aided) child is essential for optimal progress. The experienced SLP understands the early stages of implantation, the hierarchy of auditory skills, and methods for working on speech and language through audition. In some parts of the United States, and in large cities around the world, provision of speech and language services by a therapist experienced in auditory verbal techniques is a given. In other towns and smaller cities, families are not as lucky.
If you are one of the not so lucky and an experienced therapist is not provided or nearby, what can you do?
No One Will Pay For the Services?
1. Convince the school/early intervention to provide the service
Depending on the age of your child, he/she should be eligible for listening and spoken language therapy through early intervention or the local public school (preschool or K-12). Some schools don’t have an experienced therapist or don’t know any better. It is your job to educate them. Once educated by you, they are often willing to pay for “outside” services, especially when these services are not a duplication of school provided services. Arming yourself with research (the Alexander Graham Bell Association for the Deaf and Hard of Hearing website is a great resource www.agbell.org) as to the benefits for listening and spoken language therapy, you can prove that they are unable to provide what your child really needs. It is also helpful to get a report from you audiologist recommending a therapist with experience working with children with cochlear implants. If you present a report from your audiologist, by law, the district must review the report, formally, in an IEP meeting. It is also sometimes helpful to get the resume of the nearby experienced therapist highlighting the difference in skills and experience.
2. Convince insurance to pay
If, after fighting, you still don’t get the school or early intervention to provide the appropriate service, it has been my experience (especially immediately following implantation), that insurance companies will pay for the services. Often a report/letter from your ENT and/or audiologist will get you approval. Sometimes they also need the research shown to them explicitly. But, usually if they have paid for the implant surgery, they understand the need. Some insurance companies pay for the speech therapy CPT code and not the auditory rehab code, but that is fine, if it is a speech-language pathologist with experience.
3. Pay out of pocket
It is still possible that you will find yourself with no one taking responsibility for providing the appropriate service. If that is the case, you may need to consider paying out of pocket for the services. Remember, this is the time to optimize your child’s benefit from a cochlear implant. If you are lucky enough to live in an area with several experienced listening and language specialists, shop around. Some SLPs offer a sliding scale, which might make some more affordable than others.
I Don’t Live Near Anyone with Experience
What if the problem is not who is going to pay for the services, but rather, that there is NO ONE nearby to provide the service? What can you do then? Here are a few ideas that can be used in conjunction with one another to help get your child the services he/she needs.
1. Have someone experienced help train your therapist
Assuming you have a Teacher of the Deaf and Hard of Hearing (T.O.D.) working with you, use your TOD to help teach the SLP how to work on listening prior to expecting language comprehension, expressive language and appropriate speech production. If your TOD works with your child on listening and spoken language, you can have the TOD work with your child together with the SLP regularly to help the SLP learn the auditory verbal approach. I regularly use this method of co-treating with other therapists and find it invaluable.
2. Find an excellent SLP willing to learn
Sometimes you get lucky and get an SLP who is eager to learn. Take advantage of it.There are many ways for the SLP to get educated about listening and spoken language and the auditory verbal approach. There are online courses through the implant companies, single and multi-day conferences given around the world (use the following link to find courses: http://listeningandspokenlanguage.org/AcademyDocument.aspx?id=742), and The Alexander Graham Bell Association for the Deaf and Hard of hearing holds a convention every other June.
3. Use an experienced therapist as a consultant (monthly).
Rather than traveling weekly (or several times per week) to an experienced therapist far away, consider finding someone who you can meet with less often (i.e. monthly) and is willing to consult with the therapists nearby. Make sure you are a part of those sessions, so that you can also learn what you can be doing at home, since you spend the most time with your child. Having the parent participate in the sessions is one of the hallmarks of Auditory Verbal Therapy. Get homework to do so that you have a plan of what to work on until the next session.
Telepractice is beginning to take hold and insurance companies and schools are starting to pay for the services. These sessions use video conferencing to work together with you and your child to improve listening and language skills. These sessions are used to train you, as the parent, on how to work with your child. The therapist working with you has online interactions with you and your child to help move your child’s listening and
language skills up the auditory continuum. Session goals and homework plans are set up to provide you with an idea of the specific short term goals to be working on. Then the therapist can give you ideas of what activities to do to work towards mastery of these goals.