Question about choosing a SLP
TriciaJoy
member
I'm mostly on the preemie board, but occasionally post here for help with G tube moms.. hoping someone can help me with a a few questions about speech therapists. Sorry this will get so long, but his history isn't as "simple" as "just" a speech delay, so it might be pertinent.
My son was a 26 weeker with IUGR. Long story, but he was born with some congenital stomach issues which have required a couple of surgeries, ultimately culminating in FTT and a G-tube.
After the G tube was place he almost completely stopped eating. In the last few months, we've made some progress with solids (mainly purees, and finally he'll eat crackers in very small quantities) but he still won't drink. His swallow and motor skills are quite good, but his desire to eat is almost non-existent.
on top of that, he went through a 6 month period of almost constant ear infections. He finally got ear tubes at the beginning of January, and at that time, the ENT noted that he had some ear drum damage in one ear. He has now passed his hear test, though I'm not sure how confident I am in that test.
He's been in EI since he was 4 months old (he gets PT & OT weekly, and sees a developmental therapist twice a month.) for various motor delays (which are almost caught up now, minus feeding issues)
When we were assigned a PT, OT & DT, we had no say in it at all. The EI coordinator just sent someone out to do the evaluations and they did our therapy when it was deemed necessary.
Our DT now thinks he could benefit from some speech therapy. He's 21 months old/18 months adjusted and does have some words. But only 5 or so and a couple of signs, though they are pretty sporadic and are unintelligible to probably any one but us.
This time, the EI coordinator sent us profiles of the SLPs to choose from and I'm sort of bogged down trying to choose one.
Obviously we could use help with feeding, probably more than speech even. I'm not terribly worried about his speech as he's just had a big receptive language jump, so I'm hoping maybe expressive language might follow soon. But I definitely think he could benefit from help in actually speaking correctly. And obviously we could use a lot of help with eating.
But when it comes to the feeding issues- again, it isn't so much an oral-motor skill issue as a lack of desire. I'm not sure how much a SLP can help with that?
And if so.. what sorts of experience should I be looking for? The profiles list their education and diagnostic tools with some experience. One lists 300 hours of continuing education in feeding.. which got my attention.. but that's about as detailed as it's gotten.
Or should I overlook the feeding aspect and focus solely on speech? If so, are there particular therapy models that have worked better for worse for any of you?
I could just use a little push in the right direction. I feel like a little kid who has been given too many choices!
Thanks!
Re: Question about choosing a SLP
Is your OT helping with the feeding stuff too?
an SLP with 300 CE hours in feeding will have a good knowledge regarding feeding and oral motor development (which will be important for speech development) Considering SLPs are required to have 10 CE hours/year, 300 in feeding is a lot.
In my SLP opinion, feeding therapy is more complex than articulation therapy. So if you find a strong feeding therapist, they should be able to adequately address the speech. But I don't think it always works the other way around - you can be a great artic therapy and not know a thing about feeding.
are all of the SLPs on your list in a medical setting/out patient hospital? That environment overall will have more experience with feeding than a PT/OT/ST clinic that may tend to treat from a more educational model.
Although not a lot of info, that 300 hours of CE in feeding would stand out to me too. GL
We went to a feeding clinic... run by ALL SLP's I don't think you should drop ANY concerns & the right speech therapist should be able to help with both. If nothing else, they can do an evaluation and if his issues aren't on their radar, no loss. Do you have any local resource groups or parent groups that might all have similar concerns and be able to recommend anyone by name?
Also, have you talked with your EI Coordinator any further about your concerns with the areas of expertise you need in an SLP? I think both of your concerns are valid and if your coordinator isn't willing to help you find the right/fitting/best professional for your son ---- be aware that you can probably get a new service coordinator. There are limitations to the pool they can choose from (most likely) but just simply helping you find the best fit should be their job.
I had the same experience... where I would just get a list and it was almost like a big huge secret and no one could help me choose. Once my service providers hinted to me that the coordinator I had was not helping ANY of their clients find the therapist in the area of expertise they needed --- I was advised to switch. I did. What a difference. Don't feel pushy.
Thanks for the advice.
My coordinator is really not helpful. I've actually already gone over her head in the past. We used to have a great coordinator who was very helpful in choosing the right person for us (for example, when we started OT, I was still trying to nurse him.. so she found me an OT who is also a lactation consultant. Hello perfect.)
Unfortunately she left EI a little over 6 months ago and I don't care much for her replacement. She's nice enough, but HORRIBLE about returning phone calls and not helpful at all in choosing someone.
At the time of his last IFSP, somehow the state got it in the system that we had double insurance. That has never been the case. THey froze all of our services saying I hadn't provided secondary insurance info. Long story, but I think I yelled at every state employee we have, my son went without services for about TEN WEEKS and I was literally 2 days from staging a sit in at the office until they fixed it.
To answer the question above- yes, our OT does work on feeding as well, but her focus is really more of oral motor skills, which really isn't his problem. Yes, he does have some jaw weakness because he doesn't suck (he chews on a paci but doesn't really suck on it) but by and large, he has surprisingly good oral motor skills considering how little he eats.
I honestly find it a little frustrating because she often comments on his oral defensiveness. Which isn't necessarily incorrect- but he's only defensive with food. He'll put just about anything else in his mouth, is reasonable tolerant of me messing with his mouth.
Anyway, I digress. I'm in kind of a bad mental space with therapists right now. I'll shut up before I start ranting. Our therapists really are mostly great, I'm really just sick of the "system."
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I'm sorry.
Thanks Susan. We've just had a lot of scheduling issues lately, leading to me taking time off work and waiting for people who aren't coming, or them telling daycare they're coming but not telling me. Leaving reports with negative remarks that aren't really pertinent to his development. Our PT made some snotty comments to daycare about how long his hair is the other day.
And I still remain a little unconvinced any of it is doing anything. Don't get me wrong, he's come a LONG way, but he did so very quickly sort of out of the blue (after having been in therapy for more than a year) and I can't help but wonder if the things he did would have happened anyway or if we're really helping him.
Even though our services are through EI, we still pay a good bit of a copay.. and having to hear/read each week about where he still sucks.. it just wears on me.
He'll be 2 in May and they'll stop adjusting his age then. I love that whole "he's two he should magically be up with his peers now" mentality. He's already behind in speech even for his adjusted age, so when he turns 2, it's just going to seem worse (on paper.)
So much for not ranting, right?
Anyway, to answer your question.. it looks like all of the therapists are private and contracted through the state and all therapy is done either in our home or at daycare.
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In my SLP opinion, feeding therapy is more complex than articulation therapy. So if you find a strong feeding therapist, they should be able to adequately address the speech. But I don't think it always works the other way around - you can be a great artic therapy and not know a thing about feeding.
are all of the SLPs on your list in a medical setting/out patient hospital? That environment overall will have more experience with feeding than a PT/OT/ST clinic that may tend to treat from a more educational model.
My thoughts exactly (I'm a SLP too). A SLP that has training and specialization in feeding will be able to help you get to the bottom of why your son isn't more motivated to eat-there are so many factors that can be worked on and adapted to help increase your son's motivation. The 300 hours of CE time spend on feeding is an indicator that the therapist probably specializes in feeding-I'm in the process of getting trained to work with kids with feeding difficulties by the hospital I work for and at this point have only taken 10-15 CE hours worth of feeding courses...300 hours is awesome!
I'm sorry you're so frustrated with your EI experiences thus far...hopefully, by having the opportunity to choose your SLP you'll have a more positive experience!
Thanks guys. I had to choose 3 (numbering my preference) and that one is my #1.
::crossing fingers::
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