Have you noticed your child isn't saying things like his friends on the playground? Does your child continue to point at what she wants, while her friends are able to use a complete sentence? Is your child struggling to follow 1 or 2-step directions like "Go get your shoes and bring them to me"? Do you struggle to understand what your 3 year old is trying to tell you?
Has someone who knows your child, such as his teacher or doctor, recommended private speech therapy?
If you didn't expect this recommendation, you may feel a mix of emotions including concern, disappointment and confusion. Maybe you had a feeling something was off, and so this recommendation was more confirming than off-putting. No matter how you feel, your feelings are valid and it's important to find out what happens next to help you in this process.
Research Your Options
First, research speech-language pathologists in your area. If it's important to use your insurance, contact your insurance company for a list of in-network providers. If your child is recommended for school speech therapy services, this process is much different. I will write about this process at a later date. School therapy services are provided through your public school system, as part of an active IEP plan. Private speech therapy services are your responsibility for payment and place of service may vary based on the company/therapist you choose.
If the therapist has a website, click around and become familiar with it. Many of us post our policies and services online. Review websites such as Google, Yelp and Facebook are becoming popular in our field. Look through these reviews to see what others are saying! A word of caution though, as with your Amazon product reviews, people tend to review services only when they are feeling extremely satisfied or extremely dissatisfied. Be sure to take each review as just one personal account of how the clinic or therapist operates.
Research Your Insurance
If you are planning on using insurance to help you pay for services, call them. Ask what your coverage is and when your annual renewal dates are. Familiarize yourself with your plan to avoid any confusion later. Every plan is different and if your plan changes during the course of treatment, be sure to call the new company and research your coverage again. Always let your provider kn ow as soon as your insurance changes, too!
Interview Your Final Selections
After you've put together a short list of therapists and/or clinics that fit your preliminary expectations, call them. Ask about a wait list and expected wait list time frame. Certain appointment times, such as those after school hours, are in high demand and many therapists will have a waitlist for the times. You can also ask to meet with the therapist beforehand and/or tour their facility. Some clinics may not be able to accommodate these requests, but it's still worth asking.
If you are able to meet your child's prospective therapist before starting therapy, treat it like an informal interview. You want to make sure this person will be a good fit for your child's treatment approach and team. Younger clinicians, while not as experienced, may have more vibrant energy that your child responds better to and fresher research in their mind to brainstorm new solutions. Older clinicians may have the experience to help guide you through difficult decisions and a gentler approach that other children need. The important thing to remember is that this clinician will be working with your child, so think about the personalities your child responds best to. You may or may not have the freedom to "interview" and select a therapist, if you have the selection to do so, I highly recommend it.
Initial Evaluation
You or your doctor may already know what's "wrong", but you still need to go through an evaluation process. If you are filing with insurance, you will need to check with your insurance in regards to a referral and/or prescription from your doctor. Generally, the doctor will write a prescription to "evaluate and/or treat", then your doctor will give this to you or send it to the clinic of your choosing.
Evaluations usually take at least 60 minutes, although they can be longer. There will be intake paperwork with other forms that require your signature (HIPAA, cancellation policy, etc.). If possible, try to have these filled out ahead of time as it will expedite the evaluation process on the day of. Most evaluations start with a caregiver interview so the clinician can get a picture of what brought you into the office along with any background information to get this picture clear. Honesty is best here, we are not judging you! We are here to help you and we cannot do that if we do not know the entire situation.
Following the caregiver interview, the clinician will either begin with a standardized test or informal observation and interaction. Every question we ask, every toy we pull out; these all are part of our attempts to connect and understand your child. Letting your child explore the office, seeing what distracts them and how to bring them back can all be part of the evaluation process.
What is a Standardized Test?
Standardized tests are tools for measuring specific abilities or skills. They have been extensively researched at either a national or international level using specific sampling criteria and statistical analysis. These tests allow clinicians to compare your child to other children of the same age and gender. We use them in order to determine the presence and severity of a disorder, based on statistics. They require a strict administration process, so please try to hold back prompting an answer! We want to see what your child gets wrong, just as much as what they get right.
Informal, or unstandardized, assessments do not give statistical analysis in order to determine the details of a disorder. By definition, they require our clinical judgment and therefore can vary greatly in how they are administered and the interpreted results. Sometimes, I will informally use a standardized test because I know the administration rules would be too difficult for a child to perform under. Other times, I will use an informal checklist or observation with my clinical judgment in order to determine what a child is capable of on evaluation day.
Observation is another key component to our assessment process. This involves actively engaging with your child, but it also involves watching your child interact with you and others that may be around, along with the objects in the assessment room.
Testing is Done!
Towards the end of my evaluations, I like to discuss treatment planning and determine goals for the next 12 months. If the child is older, I like to include his input as well for what he wants to improve on or get better doing. You'd be surprised how young kids have a concept for this!
Together, we formulate and prioritize the areas of need and skills to be targeted. I usually start this conversation with a very big, open-ended question of "So, how would you like to see your child doing in 12 months? What do you want them to be doing more of or less of?" Our treatment plans span 12 months, and then we will complete another re-assessment to measure progress and determine the next 12 months of treatment. By focusing our sight to just these next 12 months, we can break things down into easier chunks.
Not all clinicians will end their evaluation this way. Some like to determine their goals independently based on the assessment results, which is okay. You will still need a treatment plan, with goals and recommendations for the next 3, 6 or 12 months; based on your clinic's and/or your insurance company's requirements.
Following the evaluation, some insurance companies require the evaluation to be reviewed and signed by a doctor prior to starting treatment. This is where it's important to understand your insurance to prevent any large bills accumulating during this timeframe. Other insurances will also require a re-assessment every 12 months in order to continue payment. Again, I cannot stress enough to contact and understand your insurance policy. While we can help you navigate some portions, the insurance companies work better with their clients (customer service), not the providers (annoying people they only speak to when there's a problem). Every policy is different and we simply cannot know the details of each specific policy.
Sometimes an evaluation make take multiple sessions before it is fully completed. We are trained to provide comprehensive, in-depth assessments to get a full awareness of both strengths and challenges for each child. Some children are able to complete testing in one day, some require more rapport building and time to warm up for an accurate picture. Whether the evaluation takes 60 minutes or longer, we just want to make sure we put together a plan that best fits your child and your family.
The evaluation is complete, so now what?
Each clinic or clinician will have a different procedure for when treatment starts and when you will receive the completed report. Knowing your insurance guidelines for signatures and prescription requirements will help for knowing when you can start treatment. A "pre-authorization" refers to your insurance company tentatively approving services until they receive further documentation from the clinician. This does not mean they will cover services entirely or even at all!
Taking away all the variability, once you have an evaluation report in hand with all the necessary signatures, you will begin receiving services on a weekly basis, unless you have scheduled something different with your clinician. It's important to adhere to your therapy schedule and to let the clinician know if scheduling conflicts arise. Consistent attendance is imperative for progress!
Are you ready to schedule your evaluation?
If you're ready to schedule your evaluation with Let's Play Speech Therapy, go ahead and give me a call at 571-310-5953 or email me at susan@letsplayspeechtherapy.com. My evaluations occur in-home and are truly tailored to your needs as I do not participate with any private insurance companies. I am eager to serve your family and guide your child into becoming a social communicator and active community member.