The $204.6 million Budget boost to extend Medicare-subsidised telehealth services until 31 December should be a huge relief for many parents in need speech pathology services. But the situation is not that simple, particularly for parents in rural and regional areas.
Wait lists and wait times to see a speech pathologist, even for a telehealth consult, are continuing to grow. Complicating the issue further is many patients are not suitable for telehealth consults.
The demand for speech pathology services is unlikely to waver anytime soon, with the parents of approximately 25 per cent of children in Australia concerned about their children’s communication development.
Not all of these children will have a communication disorder or need speech pathology services (speech therapy). However, for those that do, the pathway to accessing support services, especially for those in rural and regional Australia, can be particularly difficult. In some cases, it is almost impossible.
Communication difficulties can take many forms and can have a number of consequences. Immediate consequences can be difficulty understanding parents or teachers. Longer-term consequences can include poor self-esteem, leaving school early, and an increased likelihood of involvement in the juvenile justice system.
The good news is that if communication difficulties are identified early, speech pathology can be extremely successful in reducing both immediate and long-term negative impacts. However, the great shortage of speech pathologists nationwide means that parents and children have difficulty accessing these beneficial services.
While speech pathology services are available for free in Australia, many barriers exist to families actually being able to access these services.
First, there are state-by-state differences in how services are provided, with the practicalities boiling down to where children get the service, how much service they are entitled to, and who pays for the service.
For example, in NSW, state-employed speech pathologists work within the health system, working in hospitals and community health centres. In Queensland, they work within both the health and the education systems, meaning that children may receive speech pathology at school. When speech pathology services are not available in schools, like in NSW, families must often seek out services independently. One barrier to this is the lack of availability of these services and this is a particular issue in regional and remote Australia.
A study Dr Verdon was involved in found that the critical maximum distance families were willing and able to travel to access speech pathology services was 50 kilometres, and alarmingly, only 1.4 per cent of localities in non-metropolitan areas had a service available within this distance.
If a family is lucky enough to have a service available within a reasonable distance, the next barrier they face is long waiting lists.
A recent study found that some families wait up to 20 months to receive an assessment of their child’s communication and then may wait a further 20 months to begin speech pathology. Considering how important early intervention is, this wasted time significantly impacts upon the progress and life experiences of children and families waiting for services.
One way that families may overcome these barriers is to pay for private speech pathology. But, at the current rate of more than $190 per hour, this option - if it even is an option for those in rural and regional areas - is out of reach to the vast majority of families whose children need to access these services regularly in order for them to be effective.
These barriers have led to families taking extreme measures to seek support for their children, including moving interstate. They also highlight the equity issue that exists for families in non-metropolitan areas and families who do not have the means to relocate or pay for private services.
The advent of the National Disability Insurance Scheme (NDIS) has provided some reprieve for families by covering the costs of speech pathology for children who qualify for this funding. However, this too is not without its challenges.
First, many communication needs, such as speech sound disorders and developmental language disorders - which affect more than seven per cent of Australian children – are not covered by the NDIS.
Second, the increase in children who have funding for speech pathology services has led to a huge demand for already overrun services. This has resulted in many children with NDIS plans still not receiving services, and their NDIS funds unable to be spent.
So, what can we do to better support children with communication needs and their families?
- Train more speech pathologists, especially with a rural focus to meet shortages
One way to address the shortage of speech pathologists in rural and regional areas is to provide students located in these areas with greater opportunities to study speech pathology. Charles Sturt University offers Australia’s first blended online Master of Speech Pathology. This course provides the opportunity for Australians to study from their home, often in extremely remote areas of the country where university education in speech pathology would not otherwise be possible. Upon graduation, these students are more likely to remain in their communities, working to meet the demand for a workforce that is specifically trained and skilled in rural health practice.
- Investment and use of telepractice – the silver-lining from COVID-19
While COVID-19 has created many challenges, it has caused a very sharp uptake in the use of telepractice. Speech pathologists and families have realised the potential of telepractice in overcoming the tyranny of distance and service shortages. Teletherapy also provides the opportunity for families to access specialist services, such as those for children with cleft palate, which are often centralised in major cities. The evidence base and utility of telehealth is still developing, but this technology certainly presents exciting new opportunities for better supporting children with communication disorders.
- Collaborate with parents and teachers at the coalface
While there continues to be a shortage of speech pathologists, there needs to be a greater focus on providing educators and parents with the knowledge, skills, and resources to ensure greater inclusion of children with communication disorders into mainstream education. This requires children, parents, teachers, specialists (such as speech pathologists), school administrators, and education departments to work together to create an environment where the child can thrive.
One thing that everyone can do is to become more aware of what communication disorders are, and how to advocate for more inclusive communication practices. The following resources are helpful:
- Speech Pathology Australia provides resources explaining communication development and difficulties and Communication Milestone Posters that parents and educators can use to check if a child is on track with their communication development.
- Information about how to communicate in a more inclusive way
- There are podcasts about communication difficulties in children, such as Dr Verdon’s The Talking Children Podcast and The Talking DLD podcast
- Find out more about the most common communication disorders experienced by children Developmental Language Disorder and Speech Sound Disorder
- Learn how to support Multilingual children’s speech and bilingual language development.
Supporting communication is the key to giving children the very best start to life!
To hear more from Dr Verdon and Dr Crowe, listen to episode one of the Charles Sturt alumni podcast series.