Frequently Asked Questions
Q What is speech and language therapy?
Speech and language therapy provides treatment, support and care for children and adults who have difficulties with communication, or with eating, drinking and swallowing.
Speech and language therapists (SLTs) are allied health professionals. They work with parents, carers and other professionals, such as teachers, nurses, occupational therapists and doctors. There are around 17,000 practising SLTs in the UK working in a wide variety of settings.
SLTs might work to improve how clearly someone talks, how well they can understand what is said to them, or how they put sentences together to talk to other people. They can also help people with conversation and social skills.
A speech and language therapist (SLT) will do assessment, plan and deliver therapy or give advice. They might work directly with a person, individually, or in groups. SLTs can also provide training and strategies for other people to use.
Q Does speech and language therapy work? Is it worth the money?
In the interests of transparency I’m going to say the jury is out on this one. Research has sought to answer this question with mixed results. Some papers have suggested that therapy does not appear to make a difference to outcomes, whereas others have suggested that it definitely does. It also depends on the difficulty that is being treated. Some conditions respond very well to treatment and others don’t. It also depends on the person involved. For example, a person who has had a mild to moderate stroke may respond very well to treatment and make progress, whereas another person presenting with the same difficulties may not.
However, that is what the research says, as a clinician I think it does make a difference. I have witnessed many people improve and make progress after therapeutic intervention. In my opinion it is always worth trying to see if therapy makes a difference. A good therapist will not continue with treatment if it is not yielding any results and should tell you that it is time to take a break or end treatment.
Q Do I have to have an assessment?
It is usual for a therapist to complete an assessment before treatment for several reasons, the most important of which being that it is almost impossible to develop an effective management (treatment) plan for a client and set relevant aims/goals for them without doing a thorough assessment of their strengths and needs.
Q What does an assessment include/involve?
The answer to this question will be different for each person and for each set of circumstances depending on the age of the client, the difficulties they are reported to have and the length of time they may have been experiencing difficulty for. Generally though a speech and language therapy assessment will involve:
- Taking a comprehensive case history
- Observing the person
- Completing activities and tasks (designed to test for specific factors)
- Gaining the views of the client/parent/carer
- Establishing what they are hoping to achieve through therapy
Sometimes it can include the use of a formal assessment designed to compare performance to a set of data based on a typical population. Examples of these are the Comprehensive Aphasia test (CAT) or the Clinical Evaluation of Language Fundamentals (CELF).
For children, assessment almost always involves play, and many times children are not even aware that they are being assessed. When an adolescent or an adult is being assessed the assessment will typically involve doing more formal activities such as answering questions, naming items and/or following specific instructions.
At the end of an assessment a report will be produced that lists the person’s strengths, needs and difficulties. This report will make recommendations about the support the person needs.
Q Do I need a report?
This really depends on a number of factors such as the age of the client, the difficulty they are experiencing and what you are hoping to achieve through therapy. There are some rare times when clients do not need a report and prefer to pay for just the assessment and not an additional report. If this applies to you then please let us know this when you make enquiries. However, a report often provides a vital baseline of where a client is and how they are performing at the beginning of intervention. It can be a useful way to track progress. It is also a valuable tool for informing other professionals/agencies in order to work collaboratively with them and can make an valuable contribution to building up an accurate picture of a person. For example, it can be invaluable source of information for a process such as an Education and Healthcare plan (EHCP).
Q How do I tell if my child’s speech or language is delayed?
There is a page on our website devoted to typical developmental milestones that can help you determine if your child’s communication skills are delayed, but it’s important to remember that children develop at different rates. Every child is different!!! If you think your child might need additional speech and language help then give us a call on 07914 946168 or email us at alisonmann@aqmslt.com. We’ll be happy to help.
Q Why is therapy so expensive?
I know that therapy can seem expensive! Here at AQM Speech & Language Therapy Ltd. we feel strongly about this. Our prices are set to be fair and are commercially competitive. At first glance it can seem as if the hourly rate is a lot of money for one person to come and visit you for 45 minutes, however, it also includes a lot too! You are paying for the professional skills and clinical knowledge of someone who has studied the profession in depth at university for 4 years. Session prices include preparing a plan for the session, doing research so that any therapy delivered is evidenced based, preparing resources, delivering the therapy, writing up case notes (a legal requirement) and other admin tasks. It includes business running costs such as office rental, telephone contracts, internet, equipment, utilities, stationary, accountancy fees, and website costs etc. Also included in the price are professional registrations to organisations such as The Royal College of Speech and Language Therapists and the Health Care Professions Council (essential and a legal requirement), CPD (continuing professional development) and training, subscription to journal databases and professional libraries, specialised resources and the cost of monthly supervision. So, when you look at it in detail it is great value for money.
Q Can I get therapy on the NHS? Yes anyone can be seen by an NHS therapist.
Everyone is eligible for speech and language therapy within their local NHS team. Current RCSLT guidelines say that anyone can refer themselves to the local therapy department.
Clients that are currently receiving therapy from an NHS therapist or are on the waiting list must inform the independent therapist. The NHS therapist should also be informed of any independent therapist involvement to ensure effective treatment. This is because our professional guidelines recommend that we work in harmony together, in order to promote the best interests of the client.
Q What are the benefits of taking my child/loved one to an independent speech and language therapist if I can get therapy on the NHS?
NHS trusts usually have large caseloads and therefore frequently have long waiting lists. Many parents/carers report that even when they get to the top of the waiting list they are only given a limited number of sessions. This is often 30 -45 minutes of six sessions. Once these have finished the patient then goes to the bottom of the waiting list again. Many parents (and therapists) can feel frustrated at this system because just as the person is beginning to make progress they are discharged and may have to wait a long time to be seen again. Independent therapists can often see a person much more quickly. There are usually no waiting lists and no limit on how much therapy can be offered. Independent therapists usually offer far more 1-1 therapy than is typically offered on the NHS too. Many therapists who choose to work in independent practice do so because they want to “do therapy” rather than just assess, make recommendations and then discharge someone, despite knowing that they need more therapy.
Q Can I have private speech and language therapy and get it on the NHS at the same time?
The short answer is YES you can. There is no reason why you should not top up the therapy you receive on the NHS with additional independent speech and language therapy. However, some people worry that if they let the NHS therapist know they are paying for extra therapy then they will lose services. This should not happen. According to our professional body (RCSLT) guidelines both private and NHS therapists should work together for the best interest of the patient. This should involve talking to each other (with the client’s consent) and discussing how to work together for the best interests of the patient. This is a common practice and takes place regularly.
Q Why am I being asked to sign consent forms?
We need your consent for treatment before we can begin to see you for therapy. We also need your consent to store your information securely (in line with the Data Protection Act) in our records. In addition, we also need your consent to contact other professionals such as a GP or Health visitor sometimes, in order to make referrals or liaise with them. We need your consent to be able to do this.
- What if I don’t want to give consent for you to liaise with other professionals?
You do not have to give your consent if you don’t want to. We will not contact other professionals for information, make referrals or liaise with them unless you consent for us to do this. However, it is in your best interests if you do allow us to do so, as we can all work together to ensure better care.
Please note that in situations where there is a concern about well being, child protection or vulnerable adult safety we are able to breach confidentiality, as the law expects us to do so.
Q How long will my child/loved one have speech and language therapy support for?
The answer to this depends on a number of factors and it isn’t easy to give a uniform answer. Usually at the end of an assessment a discussion will take place about whether therapy is needed and how long for? Typically, a discussion will take place and an agreement will be made about how long to treat for. Throughout any therapeutic intervention, it is constantly being reviewed and there should always be an open dialogue between the therapist and the person commissioning the service about how it is going.
Q Why might a speech and language therapist recommend watchful waiting?
Research has given us developmental norms, but we know that children are unique and develop at different rates. Children have different strengths and skills. When a young child appears to have delayed speech and language skills (in the absence of any other obvious difficulties) it could just be that they are slow to develop, so a therapist may recommend a period of watchful waiting.
Q What is watchful waiting?
Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. In the case of speech and language therapy it often refers to a set period of time where the parents and professionals will keep an eye on the child to see how they develop. This can be a worrying and stressful time for parents and they often want to do anything they can to help. So, sometimes, during watchful waiting some indirect intervention is implemented where the therapist will work with the parent to coach them to use specific techniques to encourage communication development. In addition, the therapist is also reviewing the child to see how things are going.
Q Why might a therapist recommend no intervention?
There are rare times when a therapist will assess a patient and based on the observations they have made and the activities they have completed, decide that therapy is not right for that person. This may be for a variety of reasons. For example, a child presents with age appropriate speech difficulties. They have phonological processes (when you have difficulty saying a sound but substitute it for another sound that is easier to pronounce) in place that are common for children of that age and evidence tells us that in a certain number of months’ time they are likely to have grown out of these processes without any intervention at all. Or, alternatively the patient has had a significant stroke and incurred serious irrevocable brain damage and is unlikely to make any progress.
If a therapist tells you that intervention is not recommended it is because they are acting in the best interests of the patient, although we recognise that it can be frustrating to hear this.
Q Why is the therapist working with me and not directly with my child or the client?
Sometimes, it isn’t appropriate to work directly with the client/patient. For example, in the case of a very young child you simply cannot deliver direct therapy to them. However, what you can do is teach their parents/carers specialised strategies that can encourage their communication to develop and improve their communicative environment. Another example is that of an adult with a condition such as dysarthria whereby improving/altering the communication of a partner is a vital part of the therapy approach. Remember we seldom communicate in isolation. It takes two!!!!
Q Why are we being given work to do at home when we are paying for therapy?
Speech and language therapy work is best done in short and regular sessions. Therapy is most effective when it is utilised/engaged in/practiced regularly. Research evidence tells us that clients make most progress when they practice the skills they are being taught in therapy. Parents/carers are often with their loved one 24/7, whereas a therapist is only with them for a short time period. Parents and carers are in the ideal position to practice and utilise the strategies we implement. The work we leave is designed to provide opportunities to practice. It’s not enough to have a therapy session; the lessons from the session must be carried out throughout the week, at home and in the community in order to make the most of them.
Q What happens if we cannot attend an appointment?
If an appointment is missed without any notice e.g. the therapist arrives and no-one is there as expected, then they will be charged in full, at the standard therapy session rate.
If a child’s therapy session is scheduled to take place at nursery or school, it is the parents’ responsibility to inform the therapist directly if their child is not at nursery or school that day.
Similarly, if an adult’s session is scheduled to take place in a setting such as a nursing/residential home, it is the responsibility of the person paying for the therapy to inform the therapist that they are not going to be there. If the therapist is not informed and an appointment is missed as a result, then they will be charged in full at the standard therapy session rate.
Q Why are we being discharged so soon?
All therapeutic intervention will work towards achieving a long term and short term goals. These goals/outcomes vary according to the condition/circumstances. Sometimes a therapeutic goal will focus on a variety of aims depending on the circumstances the patient presents with. For example, a person who has had a significant stroke may never make a full recovery and therefore the aim of therapy is to improve their life, whereas for a child who presents with a language delay or speech problem the aim of therapy is to resolve their difficulty as much as possible. Throughout the therapeutic journey the therapist will be constantly analysing, reviewing and reflecting on the effectiveness of the therapy and the progress that the patient has made. Using their clinical knowledge and skills they may well decide that the patient has made all the progress they are going to, or may need a break.
Q I’m not happy with the service I’m receiving, what should I do?
At AQM Speech & Language Therapy Ltd. we try hard to deliver high quality, person centred, evidence based therapy. However, we recognise that sometimes a client is not happy with the service they are receiving or may have questions about the service they have received. If this is the case then please do not hesitate to contact Alison Mann either by telephone or email and we can discuss your concern and attempt to resolve it together. A copy of AQM Speech and Language Therapy Ltd.’s complaints procedure can be made available to you on request.