Resources are tight in the National Health Service: think one full time therapist with a caseload of around 125 children. So we have to pay close attention during our initial assessments to make sure children meet our criteria for therapy.
For speech sound therapy, children need to have at least 3 processes and reduced intelligibility, as well as age appropriate language and attention skills to qualify. So we give children with lisps, or difficulties with /th/, activities to practise at home, and discharge them. In some cases that’s easier said than done …
I can understand why parents are anxious about lisps; they worry about teasing and bullying. Sometimes I find it hard to reason with them; they’re trying to do the best for their child and I’m trying to manage the needs of a large caseload. We’re in conflict.
I almost want to play them video clips of my pre-verbal child with autism, my dyspraxic child, or my child with a severe stammer and explain that these children are my priority. Not great for confidentiality and probably not effective either!
Empowering parents to support their own child seems like the best strategy. If I can elicit an accurate /s/ in isolation during the session, I can usually convince the parents to agree to discharge. I explain the hierarchy for generalising the sound into conversation and give them written instructions for home practice.
If I can’t prompt the child to produce the correct sound in isolation (I find those lateral lisps tricky!) I tend to go down the ‘your child is not stimulable / ready’ route. I ask the parents to practise discrimination tasks with their child, talk about how the sound is produced and come back in 6 months to a year if the child hasn’t made progress and they’re still concerned.
How do you deal with parents who won’t accept that their child doesn’t meet the criteria for intervention?
If the child has not been seen by a dentist with a lateral lisp..that would be the first place I would start to help ease the parent’s mind. This is hard for me to comment on further because I am in private practice and so I would 1) offer to consult once per month to give home program ideas so they didn’t feel completely slighted. (2)I would suggest that they seek a second opinion which would either calm their concern or allow them to receive treatment from a private therapist who is not bound to the guidelines you are with regard to caseload. 🙂 Good topic.
You bring up an important issue, and I agree with all of your points, which mirror what most school-based SLPs in the states struggle with. My district has a written policy that is similar to yours. If a student has a speech problem that can not be considered a disability, we offer some short term intervention as you do, home practice (I usually facilitate this through a graduate intern), and then recommend they consider private therapy. Yes our training would allow us to address these issues but as you say our caseloads do not allow for it, and we have to triage. In the schools I believe in the mandate that we are there to address the disabilites that affect academic progress, and a lisp does not. Fact is, a parent should not expect the community to pay for, say, braces on their child’s imperfect teeth. It’s a harsh reality but I think a good analogy.
We have support from administration to carry out the law regarding whether or not a child meets the criteria for intervention. That being said, I can’t just leave those families without some support. As you mentioned. I teach the parents how to help their child and ask them to come back in 3 months to see what kind of progress they’ve made and to offer additional suggestions. Many of my families seek private therapy but I know that is not an option for everyone. I’m currently planning on an after school class for next year. The original focus will be the parents of students in therapy. But, my hope is to expand that to any parent who wants suggestions on how to build language and good speech with their children. Getting back to the original question, How do I deal with the parents? I offer support and empathy and do what I’m able to do within the regs of the public school system.
I just found your website. Your ideas and insights are so fun. I am an SLP in Utah. I am just starting a blog of my own to try to compile some of the resources I have found useful. Feel free to visit anytime. I would love some feedback and ideas from other SLPs. the site is slplearningcurve.blogspot.com
I will pick up students with frontal lisps after age 8, and lateral lisps right away, if there is a negative educational impact, such as not being understood when they verbally participate in academic discussions, or if the lisp attracts adverse attention that leads to the student shutting down & withdrawing from participating in discussions. It’s truly an individual case every time. Lisps aren’t that difficult to fix, so Response To Intervention Speech Improvement Classes help too. After 6 weeks, you’ll have documentation to either support putting them on your caseload or not.
I had another thought after posting … About the suggestions to give parents activities & work on it by themselves indefinitely. I think that although our discipline is way understaffed for the demand that’s out there, we risk giving the impression that just anybody can do our job regardless of their educational background or experience. I’ve actually seen this in some schools where they get emergency waivers to allow the music teacher to do speech therapy. It’s a disgrace to our field & something to consider when addressing this issue.