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Speech and Hearing Perspectives

One Size Does Not Fit All

Published March 11, 2015 11:15 AM by Speech Merion

**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 ( also hosts the blog at 


Here is a quote from the clarification statement that furthers our understanding of this proposal...."The proposal seeks government support of one evidence based practice approach for early stuttering treatment that is underpinned by replicated randomised controlled evidence, as demonstrated by the Lidcombe Program."

I am not underscoring the importance of randomised controlled evidence, however by restricting coverage to ONLY approaches that have this type of evidence undermines the importance of our use of other forms of scientific evidence, our clinical expertise and consideration for the needs and values of our clients.  

I hope this clarifies for you the stance of not only myself but many of my colleagues across the world.  

Brooke Leiman, , The Stuttering Clinic at National Speech/Language Therapy Center April 21, 2015 10:52 AM
Bethesda MD

Out of curiosity Rebecca, what facts need to be checked? I thought the post was well thought out.

Tim April 20, 2015 10:47 PM

I agree it seems preposterous that anyone would advocate for one size for all.  I don't believe that this was the intention of SPA, however it will be the result should this mandate be approved.  Many ASHA and SPA members have asked for SPA to clarify why it appears they are only asking insurance to cover Lidcombe as we hoped we were misinterpreting their press release (Original release can be found here However, even their clarification statement continues to state that although they do not endorse the idea that "one size fits all", the proposal will only be covering this one treatment.  They have ensured us that clinicians are free to provide any approach they see fit, but only one of them will be covered by insurance.  Many clinicians have asked to view the actual proposal in hopes to learn more, however we have all been turned down.  Statements have been made by many organizations, including the International Fluency Association and Stuttering Foundation of America, who have interpreted their release in the same way I have. I urge you to read these releases.  If you can find information that contradicts our understanding of this proposed mandate, please share!  

Brooke Leiman, , Director of the Stuttering Clinic National Speech/Language Therapy Center April 20, 2015 7:08 PM
bethesda MD

Oh, please check further into your facts.  The Lidcombe was mentioned as a particularly well supported intervention, but no one, no matter how impressed with Lidcombe, would truly advocate one size for all.

Rebecca April 20, 2015 4:28 PM

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