One Size Does Not Fit All
**UPDATE: May 14, 2015: The Australian Government has turned down SPA's proposal. Thank you to all of the SLPs and parent who have spoken up to educate SPA on the ramifications of their request for program-specific funding. We hope that SPA can work with stuttering specialists to develop a more well-rounded proposal to benefit children who stutter.
By Brooke Leiman MA, CCC-SLP
Speech Pathology Australia (SPA), Australia's professional organization for speech-language pathologists (SLPs), recently submitted a proposal that suggests that SLPs working in clinics run by the Australian government must be trained in the Lidcombe Program in order to treat pre-school aged children who stutter. SPA is also supporting legislation that would extend this mandate to private practitioners and require them to provide the Lidcombe Program in order to be reimbursed by Medicare. Although the SPA's intentions may be to increase access to treatment for young children who stutter, we must not overlook the ramifications of having the government and private insurance companies intervene with clinical decision-making.
The first thing to consider is that there are multiple factors that are known to contribute to the onset of stuttering. Each child has a unique set of abilities and vulnerabilities that determine if and how stuttering is going to persist. Those different circumstances demand different approaches to treatment. A speech pathologist cannot be expected to develop a treatment plan that is specifically tailored to the client when the SPA is using Medicare reimbursement to limit them to one approach. Speech pathologists could be faced with the unfortunate dilemma of deciding whether to use an approach that best fits the child and families' needs or to use the approach that will get reimbursed.
We must also consider that although this mandate is exclusively impacting children who stutter in Australia, it has the potential to set a precedent for how all communication disorders are reimbursed by the government and private insurance companies across the world. Clinicians who focus on disorders, such as Childhood Apraxia of Speech or feeding/swallowing disorders, must think about the ramifications of being limited to one single approach to treating their clients as well. Jane Fraser, the President of the Stuttering Foundation of America, released a statement concerning SPA's proposal to the to the Australian Government. "We can't imagine a policy that limits a cardiologist, an oncologist, or a surgeon by controlling reimbursements to one single approach for all patients -- why limit Speech-Language Pathologists (SLPs)?"
Finally, the decision of the SPA to restrict SLPs to one treatment approach has the potential to negatively impact the future of stuttering research. We must not hinder research or the recognition of new and effective clinical approaches by mandating the use of one existing approach. Organizations such as the SPA and the American Speech Language Hearing Association (ASHA) were developed to ensure that our field matures and moves forward, however a mandate such as this will only hold us back.
If this policy is accepted, its impact has the potential to extend well past the country it is originating in and beyond the disorder it is addressing. Although this is occurring thousands of miles away, it is imperative that we voice our concerns about this issue now to make certain that our field continues to advance our knowledge of communication disorders and to ensure that the families we treat receive individualized and comprehensive care.
Brooke Leiman is director of the Stuttering Clinic at National Speech/Language Therapy Center (http://www.nationalspeech.com/) and also hosts the blog at http://www.stutteringsource.com/.