Stephanie Landis:

Welcome. We’re so excited on today’s episode on Unbabbled that we have two speech language pathologists here that are near and dear to Meredith and I’s heart as former parish school people. We have Jennifer Rose and Allison Feldman. Thank you so much for being here.

Allison Feldman:

Thank you.

Stephanie Landis:

Thank you for having us. And while you are no longer with us, you guys are out in the world doing a bunch of evaluations, which is what we are talking about here today is getting your child evaluated, what that process looks like, and what parents and family members can expect. To get the ball rolling, will you guys give a brief little intro of who you are.

Jennifer Rose:

Sure. So I am Jennifer Rose and I currently live in Denver, Colorado, but I’m from Houston. I have been practicing for almost 30 years and have been in all different settings, including teaching level one, two at Parish for five years. And now am in private practice and have been for many years.

Allison Feldman:

And I am Allison Feldman. I live in Houston and I have been practicing for about 20 years. And I also worked at the Parish School as an elementary speech language pathologist alongside Meredith and Stephanie. And I have worked in many settings, including public school and private practice as well. And Jennifer and I started the speech garden in 2018.

Stephanie Landis:

Yeah. Well, welcome. We’re so excited to talk to you. So most parents, where they want to start is how do I get an evaluation from my child? So if they’re looking to get a speech language evaluation, how do they even start?

Jennifer Rose:

So we get referrals from all different sources. We get them from pediatricians, we get them from dentists, orthodontists, schools. And when a parent comes to us, a lot of times they ask if they need any type of a prescription or referral from a pediatrician and they do not to come to our practice. In fact, in most private practices, you don’t need a referral unless there’s insurance involved, Medicare, Medicaid, then you would need some type of a pediatrician’s prescription or a referral. And the first place to start would be looking for a practice or a facility that meets your needs as far as scheduling type of therapist, location, and calling a couple places and seeing where you feel like you find a fit.

Stephanie Landis:

So do a lot of the people that come to you, are they referred directly to you from their pediatrician or word of mouth of other parents that have gone through and had somebody at your clinic?

Allison Feldman:

I would say that most of us are from pediatricians, a lot of word of mouth. “My neighbor’s child sees you, ” or, “My son’s second grade teacher said that you come in his classroom to pull another kid.” And I just wanted to say also that, like Jennifer said, you don’t have to have a referral so that the parent can just look up practices or ask around their network of friends and family school. Who have you heard of? Who do you recommend going to and call us directly. But we do get a lot of word of mouth referrals.

Jennifer Rose:

We also get a lot actually from Facebook groups, like parent Facebook groups. People will comment. One thing I would say is that when parents are looking for a practice or looking for a therapist to make sure that they’re certified, that they’re licensed in the state, that they’re looking for the evaluation in. And it’s always a good idea to check referrals. Word

Allison Feldman:

Of mouth- Oh, go ahead. And the other thing is parents will call us sometimes and say, “Do you specialize in X or do you do this as a specialty?” And a lot of times, not a lot of times, but sometimes we’re like, “You know what? Actually, that’s not our specialty. That’s not what we feel most comfortable with. So let me refer you to this speech pathologist who does.” So that’s a big part of our intake as well.

Meredith Krimmel:

Word of mouth referrals are so important because if you do get referred by your pediatrician, they usually give you this list of people and you don’t know anything about them. And as you mentioned, some people are self-referrals. Their pediatrician maybe didn’t say anything, but they’re concerned themselves. And do you see a lot of self-referrals? And what do parents, when they come to you in that way, what does that usually look like?

Jennifer Rose:

We do. We actually get a lot of parents that are self-referrals that come to the practice.

Allison Feldman:

I think a lot of times they’re saying, “My child’s not talking like the other neighborhood kids,” or, “All of my friend’s kids are talking so much more. I can understand everything my friend’s kids say, but I don’t understand what my kid says or my older child at this age was speaking in four word sentences and my kids barely saying one.” And the first thing I say is, “You know what? I really admire you for making this call because Jennifer and I always say speech therapy or an evaluation or a consult never hurt anybody.” And so the worst that we tell you is, “You know what? He’s not quite ready for an evaluation,” or, “It’s not quite time yet for that. ” But it doesn’t hurt to call and get a professional’s opinion.

Jennifer Rose:

And we also get calls of the grandparents can’t understand, or teachers are having trouble understanding, or, “I’m noticing that other kids in the class are making this sound, but my child is not. ” And also, we get kids from public school who didn’t qualify in the public school system, but we know should be producing the sounds that they’re not producing. Oh,

Stephanie Landis:

Sorry, Austin. I think that that kind of is another one of my questions of that other places parents can go for an evaluation would be a hospital or a public school as well, but when they go to the public schools, yes, it is free. It’s a free service, but their qualifying is a little bit different. So how can somebody qualify and not be qualified in a school, but be able to get therapy in a private setting?

Jennifer Rose:

So the threshold for qualifying in a public school is very different than it is in a private practice. Well, in private practice, we can use our clinical judgment. And in public school, they have not quite caught up to where we are as speech language pathologists knowing where sound development and language development should be and the amount of educational impact that they require to qualify a child is vastly different than we would use in private practice. We also have, both in Colorado and in Texas, early childhood that people can go to if before a child is three, they can utilize ECI services. But we strongly believe that by the end of kindergarten, kids should have all of their sounds or be working with a therapist because we know that by five or six, those sounds should all be developing.

Allison Feldman:

And the other thing, Stephanie, is that the process takes a lot longer in the public school, and we’re able to get a kid in often the same week or within the week. That’s something that Jennifer and I really pride ourselves on is not making people wait. But I’ve had parents come in and say, “You know what? We’re going through this process with the public school, but if we don’t hear soon, we’re done, we’re switching over.” And it’s really sad because a lot of families can only do that option, but it does take longer.

Jennifer Rose:

We also have families that do get services through public school and then come to us once a week and then we collaborate with the public school therapist because we believe strongly in collaboration and we’ll take the evaluation from the public school if they have one. Right.

Stephanie Landis:

You mentioned working with a school before too. You can work with private schools and children at private schools and get referrals from there as well.

Allison Feldman:

So specifically, our practice does go to many private schools in the Houston area, and we actually do speech and language screenings at many of them. Some of the screenings, the private school pays for the entire grade or grades to get the screening, and some are parent referrals, so I want my child to have this, or the teacher might say, “I really think you should get this referral.” And then many of those clients turn into evaluations and then therapy, and then clients for us for speech and language therapy, both in the school when we push into the school and also in our office.

Jennifer Rose:

The other thing that is important to mention is that our practice and probably other practices, we also offer free consultations. So if a parent’s not quite ready for an evaluation or they’re not sure if their child needs a full evaluation or an speech evaluation, we are happy to do a consultation with them so we can decide whether or not we should move forward with an eval. And sometimes that’s a softer landing place if a parent is not quite ready for an evaluation, we can bring them in, get to know the child, get to know the parent, and decide what next steps are.

Stephanie Landis:

If a parent’s preparing for an evaluation, is there anything that they need to bring or what would help them prepare? Do they need to bring any paperwork or they just show up ready?

Allison Feldman:

So at our practice, and I’m sure many other practices, we send out a case history form and a bunch of legal forms that the parents have to sign before the evaluation. And those forms must be filled out before the evaluation, just because it really helps guide what we should be doing when the child gets here. And in that case history, it has all the child’s identifying information and their birth history and medications they’re on and surgical history, their current health status, their vision and hearing status, how they’re doing in school, where they go to school, and all of their developmental milestones, and also asks for what are the concerns and where did they come from or who do they come from? So we get a lot of the information from that from our online portal. We also speak to the parent before the evaluation, usually over the phone with the initial phone call.

And then again, we’ve sometimes met the family already if we’ve had a consultation. So we’ve had a lot of interaction with the families before the evaluation so that we have all of the information that we need. As far as what to bring, not much. With our babies, a lot of time the parent, most of the time the parent will come into the evaluation or caregiver will come into the evaluation room and they’ll bring a snack or some familiar toys or something like that. But with our older kids, they don’t need to bring anything.

Jennifer Rose:

The other thing that we do like to have, if they have had an evaluation at another facility, we like to see those. And with another type of therapist, occupational psychology, any type of educational testing, we like to see all of that before testing if possible.

Meredith Krimmel:

You kind of touched on this, Allison, but once a family has done the paperwork and they arrive for their evaluation, what should they expect? You mentioned with your babies, you like the caregivers to come in, but for everyone else, what does that usually look like when they arrive for their evaluation and what can they expect?

Allison Feldman:

So for our speech-only evaluation, so only looking at articulation, the speech sounds or fluency, those evaluations take about 30 minutes. For our language evaluations or full evaluations when we’re looking at speech as well as expressive receptive pragmatic language, those usually take closer to an hour. Sometimes we’ll have to do it in more than one session. And we tell the parents, we’ll come out and get you when you’re ready or when we’re ready, but that’s generally what happens during the session. 

 

Meredith Krimmel:

Would they expect to get any feedback from you immediately following the evaluation or is there usually some delay in getting that information?

Jennifer Rose:

It depends on the information. So yes, we certainly share information with them about what we found during the evaluation in a qualitative way, but not in a quantitative way. 

Jennifer Rose:

So if a child is presenting with different types of sound errors or vocabulary, we will definitely talk about that with the parent after we finish the evaluation. And then we’ll tell them what the next steps are. We’ll tell them we’ll be working on the report. We are happy to start therapy if you feel comfortable before the evaluation report is finished. And we explain to them what comes next in the report, that the report will contain all the information they shared with us. We will often get questionnaires from the teachers so we can have parent-teacher input. And then the report will have our standardized test summary, our findings, our goals, our recommendation, our diagnosis, all of that stuff.

Stephanie Landis:

When you’re testing to gather that information, what do you use?

Allison Feldman:

Good question. So depends on the child. If the child is, I would say under two, usually we will use more of a parent.

Allison Feldman:

Parent interview kind of assessment that does give us a standard score. And our sessions are very play-based with those young babies. For our older kids, we will use standardized tests. We will use parent and teacher interview. We will do speech and language samples. We might do some play depending on the age of the child. We, like I said, would do an all of the birth case history that we get initially. But in the actual evaluation, I would say the standardized assessment or assessments that we use and the speech and language sample and observation is generally what we do.

Stephanie Landis:

Yeah. Some of my favorites are with the younger kids so we can play even more. I mean, I try and make it pretty fun for the older kids too, so that they’re engaged in giving me their best effort, but those play-based ones with the little ones are just my own personal favorites.

Jennifer Rose:

Agreed. And a few minutes of pop the pig and go a long way with-

Allison Feldman:

I was going to say, always have a game there regardless. You can have this after we finish this section.

Stephanie Landis:

Yeah. So typically, I mean, most speech pathologists want to get the best that they can out of kids, so they’re trying to make it fun and interactive and an interactive process for the kids. So hopefully they will find it a fun thing that they’re not like, “Oh no, I got to go do this assessment again.” Especially since so many kids are used to a test being sit down, paper, drilled tests, but it doesn’t feel like that hopefully in the moment.

Allison Feldman:

No, and I’ll often say, because a parent will say, “You’re going to go test.” And I’ll say, “This is a really different kind of test that we have in school. This doesn’t look anything like that test. And I just want to see what you know, and there’s no right or wrong.” And a lot of, “You’re doing great,” and just keeping them going throughout the assessment. The other thing I wanted to touch on is that sometimes I do feel like the consult before the evaluation is really beneficial, especially to this kid that’s more shy. And so you’ve already established a report, they’ve seen where your office is, they see that it’s not scary. So that’s, I think, a really big positive to the consult for certain students.

Jennifer Rose:

What Allison said too is very important that we do talk about there’s no right or wrong answer. There’s no grade on this test. It’s not that kind of a time together that we really just want to listen to their words and we talk about how important their words are to us. And when we write things down, I often say when a kid sees me write something down and they might get anxious because I’m writing, I’ll say, “You know what, Bob? I am so old. I have to write down what you’re saying because if I don’t write it down, I will never remember.” And I’m just busy transcribing however they produce something or whatever they said, just to make it very much not feel like a threatening environment and feel like a fun Captain Good times, this is where we want to hang out and play and get rewarded for talking.

Stephanie Landis:

Yeah. And my kids would have two different responses. My youngest would be like, “Cool, let’s go play, whatever.” And my oldest, even at a young age, would just size you up and spend the first few minutes being like, “Do I even want to talk to this person?” So I’m sure that you are very used to having all different personalities and figuring out how to warm them up. So having that consult and getting background and information on a child before you go into the assessment is probably helpful so that you can navigate like, “Oh, how do I get the best out of this child?”

Jennifer Rose:

Yeah. And we also oftentimes have parents that come in and they’ll come into the session and a child won’t do something that they do at home or they act a certain way that is not typical of that child. And we don’t ever want them to feel apologetic or worried or concerned. There’s a reason we do what we do and we can ask lots of questions, can get lots of information. We can take videos from home. There’s a lot of ways for us to gather the information that we need and we can also start therapy and get more information. We can tell if a child is delayed and we can say we recommend therapy and then as we start therapy, we may have to do more testing if a child isn’t in a place where they are ready to give us the information that we need.

Allison Feldman:

Two things. I always tell a parent that testing I feel is a moment in time. And I feel like especially when I was at parish school and we used to give the self every year to the kids, and sometimes the numbers don’t look as pleasing as you want them to. I’m like, testing is a moment in time. The child is showing this skill functionally in the classroom, but may not be showing it on the assessment. And the other thing I just wanted to touch on was what Jennifer said about doing more testing with a current client is so true. I actually started seeing a child just for articulation maybe two to three months ago, and today I’m testing her for language because those were not the concerns that they came in with initially, but as I’ve gotten to know the child, I believe that there’s more going on.

And I said to the parent, “Look, initially you came in and you said that the school had concerns with her speech. I have more concerns that I’d like to take a closer look at.”

Stephanie Landis:

Yeah, I’m so glad you brought that up because that was something I was thinking about too. Do you ever get into a situation where a parent comes in concerned with one thing and as you get to know the child, whether it’s language or maybe you’re like, “Oh, they might benefit from occupational therapy or this or the other.” How do you navigate and work with parents on that?

Jennifer Rose:

Absolutely. That was such a good point, Stephanie, because we do often, like Allison just said with her client, I had a child yesterday that same thing, I’m going to end up doing language testing, but we are very collaborative at our practice and we make referrals to OT, PT, psychology. After we get to know a child, if we see that there is a need that could be addressed by another type of therapist, we try to talk to the parent about them and give them referrals. And we also really, once they do go see those other therapists, we like to work closely with them so we’re all on the same page.

Stephanie Landis:

So that it can be fairly common?

Allison Feldman:

Very. Yeah.

Stephanie Landis:

Sometimes I joke with parents, especially you see it even more in the public school, but speech seems to be like the foot in the door is that sometimes- You

Allison Feldman:

Always say it’s the soft landing point.

Stephanie Landis:

And sometimes it’s just the most obvious. It’s the most obvious when a child isn’t talking when they’re maybe three and they’re not really saying anything, it’s the most obvious thing. And so you start there and then you get to know a family and you’re like, “Oh, well now we can help support in this way.” And sometimes it’s not. Sometimes it’s just you just need a little trouble, little help with your Rs.

Allison Feldman:

Right, right.

Stephanie Landis:

There seems to be a range. What age groups do you find are most frequently coming through and asking and looking for assessments?

Allison Feldman:

All. All. I mean, literally I have a child that’s 16 months that I saw today, and then on Monday I will see an 18-year-old. So we see the whole gamut. I think there’s a lot of parents that call and say, “My child’s not talking. He understands everything, but he’s not talking and he won’t imitate.” A lot of preschool, “We don’t understand my child.” A lot of elementary, they’re having trouble telling a story in school, a lot of middle school and high school. My student, really, he had speech therapy so many years ago, but he still doesn’t have his R or he still lists. So we see everything.

Meredith Krimmel:

We know how important earlier intervention is, but it’s also important to remember it’s never too late. It’s never too late to seek an evaluation. And like you said earlier, it’s just an evaluation. So get your foot in the door and see the worst they could say is you don’t need speech therapy or you’ll get more information about your child and how they learn or how they speak or how they understand language.

Jennifer Rose:

Absolutely. And we do see kids at all different ages. We have a lot of little kids that we work with, a lot of preschoolers, and as we have spent more time in a variety of schools and we do a lot of education in those schools, the referrals are definitely increasing because teachers are more informed and they know what to look for a little bit more. And they’ve gotten to a place where they will say, “Will you just take a peek because we’re not sure if this is a child that needs an evaluation?” Alice and I, like we’ve said several times, we would always rather say, “Nope, you’re in good shape. You don’t need any more information or we’re good for that one.” Or, “You know what? I really feel like we need some more information. Let’s move forward with some type of a consultation or evaluation.”

Allison Feldman:

I had a preschool teacher today say, “One of my kids, at the end of the word when you’re supposed to say or he says, Oh, and I’m like, too young, come talk to me in two years. And so that was a great question that she asked. And so I appreciate that, but the answer is no, we’re not ready for that yet.

Stephanie Landis:

Yeah. And that is great to know. I think sometimes people get a little worried that if they go and take an evaluation that people will be like, “Yeah, of course we can find something to work on with your child.” But therapists really only want to spend their time doing therapy with people who need therapy. Correct. Absolutely. So they’re not going to take on a child just to fill a spot or going and seeing is not going to be a like, “Sure, of course. Yeah, of course we’ll take your money and do this therapy.” It’s really there to make sure that children are getting the support that they need to really be successful and to continue to grow and thrive.

Allison Feldman:

And meeting their developmental milestones.

Jennifer Rose:

I was going to say, we have developmental norms and we like to follow those. And we’ve certainly recognized that when there’s a gap, the gap is going to widen if we don’t have therapy. So we want to address that at an early age if we can to close the gap as quickly as possible, but there’s ages and stages for a reason and we’re not going to work on something that is not age appropriate with a child just to work.

Stephanie Landis:

Yeah, that makes sense. 

Stephanie Landis:

Meredith kind of touched on this earlier, that sometimes parents are now self-referring because they’ll go to their pediatrician with these concerns and the pediatrician is often like, “Oh no, we’ll wait and see. We’ll wait and see.” What are your thoughts on waiting and see?

Allison Feldman:

Oh gosh. So we hear that a lot. I went to my pediatrician and let me back up and say we love pediatricians. I mean- Agreed. God bless them. They take care of our children. And we are not

Jennifer Rose:

Professionals and we do not pretend to be medical professionals or what a step on the feet of medical professionals. We are speech-language pathologists.

Allison Feldman:

However, we are a speech language pathologist and we do feel that a child should be talking at two years old. And we do feel that at a minimum they should have 50 words, but we like more of the spectrum of 200 words and we do feel that they should be combining words at two years old. So if a parent comes to us and their child at 20 months or 21 months is not doing that, we would evaluate them. And we would say, we think that a little bit of speech therapy is going to go a long way for your child. Your child understands everything, that your child has joint attention, he wants to communicate, he’s trying, but he can’t, and that’s what we’re here to help with.

Jennifer Rose:

And even backing up a little bit, if a parent is concerned that if they’re at a baby playgroup or they’re somewhere and they don’t think their child is exhibiting joint attention or communicative intent or isn’t looking at them or interested in any type of reciprocity and a pediatrician is in a wait and see pattern even at 15 to 18 months, we would rather bring them in and let us make that decision and not let us make that recommendation rather than the wait and see.

Allison Feldman:

And like I said earlier, and I could say it over and over, it’s not going to hurt the child or the parent. If anything, you’re just getting another opinion from someone who is trained in communication.

Stephanie Landis:

Yeah. I was talking to my neighbor and our kids play outside all the time and when they were young and she was like, “My mother-in-law says you should be talking more.” And we’re looking around and she’s like, “And all the other kids are talking more, but the pediatrician said, wait and see, what do you think? ” And I was like, “As your friend or a speech pathologist?”

Meredith Krimmel:

And

Stephanie Landis:

She’s like, “As a speech pathologist.” And I was like, “Go get tested now.” And she was like, “But the pediatrician.” And I was like, “Well, if you were asking a cardiologist and you’re like, well, my pediatrician said, and the cardiologist had said, go get your heart checked.” And she was like, “Okay.” And I was like, “Yeah, the pediatricians are fantastic. I love our pediatrician.” But I always encourage parents, if you feel like something’s there, then it’s worth going and checking out. And hopefully more and more pediatricians are going to say, “Great, I think you could wait and see, but here’s your list, go find out and go do it.

Allison Feldman:

“The other thing I feel like I say a lot is Is I believe in a mother or father’s intuition. And if you have a feeling that something is not right, then you should check it out. We’re all moms. We’ve had those intuitions before, and I say that to parents all the time.

Meredith Krimmel:

Yeah. I think as your friend and as your speech-language pathologist, I think if you thought to ask the question, there’s enough concern or thought about it that it’s worth just putting your mind at ease by getting an evaluation and finding out, are you just overly concerned or is it really something you need to address? If you’re thinking about it and asking people, it’s probably best just to go get an evaluation.

Allison Feldman:

100%. Absolutely. Yeah. Or a consult. Yeah. Not even pay for that evaluation yet. Love this. Until you get confirmation that, yeah, this is the next step.

Meredith Krimmel:

Yes. Love the consult idea. That’s wonderful that you guys offer that. It’s a nice way to start the conversation and figure out your next steps.

Stephanie Landis:

And one of the things that I find myself talking to young parents about is that they get these lists of milestones. And something else we’ve also been talking to teachers about when we also at the school do education events and things, is that a milestone is very different than an average. And I think that first time parents often think that the milestone of the checklist milestones that they get means that that’s the average age. And in reality, it’s like, no, that’s the bare minimum. 90% of kids are doing this well beyond that age. Only 10% of kids, it’s the bare mint. And I think that that’s not always understood by parents, understandable because they’re parents and not in the field. And so they’re just looking and they’re thinking, “Oh, we’re checking it off.” But really they’re just below the milestone, I’m like, I would still be a little wanting to look into it.

Maybe if there’s only one thing that’s just right at the milestone. But if you had a few things where you’re like, “Oh, we’re just barely making those milestones.” It might be a little more of a trend to go check out.

Allison Feldman:

And this is not the same, but it just made me think, for example, we were talking about the difference between a public and a private evaluation. And a lot of times a standard average score is 85 to 115. Well, if a client has a standard score of an 86 with us, we’re going to be like 100%. They’re on the low part of average, but in the public school, they would not qualify for speech. But low average is not average. It’s below their

Jennifer Rose:

Peers. We also look at discrepancies too between their expressive and receptive language. If we have a kid that’s understanding a lot and they’re still, even if they’re in the low 90s, but the receptive is in the high 15s, high teens, then that’s a concern for us that there’s such a discrepancy between their expressive and receptive language.

Stephanie Landis:

No, I think those totally fit in and make sense is that we’re not just looking at one single score. We’re looking at the child as a whole and looking at more of a pattern than just one little snapshot. And thinking about the pediatrician rate and C, just like you said that a standardized test is just a snapshot. When you go to the pediatrician, they see them for three minutes and most of the time, especially for little kids, they’re just talking to the parents and not really … They’ve got a two-minute interaction with the child that sometimes, yeah, maybe they are in that snapshot looking good to the pediatrician. So they’re like, “Of course, wait and see, but you are seeing them as a parent in all these other situations and you’re looking at a pattern instead of that snapshot in that

Jennifer Rose:

Moment.” 100%. Absolutely. My daughter histed the pediatrician for the first, I don’t know, how many years. So never know what you’re going to get when you’re in the office. And I think back to what Allison said, you’ve got to trust your gut as a parent. And if you think that something is just off, get it checked out.

Allison Feldman:

And likewise with a teacher. Teachers see these kids more than the parents sometimes. Just they’re at school all day and they see them in an educational environment, they see them in a social environment. And I just think it is so important that these teachers also share what they see that the parents might not see.

Jennifer Rose:

And when we do an eval too, we’re looking, like you said, the whole child, we can have a child that comes in and actually scores well within the average range, but teachers are super concerned, parents are concerned when we interact with them. So maybe they have what qualifies on a standard score as average because they have the pieces, but they can’t put the pieces together. And that’s really important to us as well. So when we do an evaluation, we aren’t just looking at those standardized scores or just a teacher’s recommendation. We’re going to take in all of that information and put it into our clinical judgment of whether or not we feel like that child needs therapy.

Meredith Krimmel:

This is super helpful because I think it’s confusing to so many parents about what these test scores really mean, what does average really mean. And like you said earlier, a score of an 86 is an average quote unquote average range, but it’s low end of average. Well, nobody wants their kid hovering that line. That means they’re struggling. That means they’re working extra hard just to understand or process or speak the way that their peers are.

Allison Feldman:

I call them the fall through the crack kind of kids. Absolutely. And that on paper, they look okay, especially in the public school, they have these average scores, which are average, but low average. They’re not going to qualify for services, but clearly there’s something going on, like you said, Meredith, that is probably making some sort of difference in their academic career. Or social, yeah. Or social. Social, academic. Exactly.

Stephanie Landis:

Yeah. I think another group that sometimes falls through the crack are those late talkers that they just were a little bit late, just those on the bubble. Can you talk a little bit about late talkers and how you work with them or would evaluate them?

Jennifer Rose:

So with children who are on that cusp of being a late talker and just starting development, one of the things we always talk about is that we want children to be making progress against themselves. So if they have two words one week and they have four words the next week and six words the next week, then that’s a nice development, right? We’re gaining words. But if they get some early intervention, they could, again, close that gap faster. And what we don’t want is that gap to widen. So if we have a late talker, we don’t know if they’re going to catch up and close that gap on their own, or if they’re going to need intervention. And I say to parents all the time, “I would way rather you bring them in and let us do a consultation or an evaluation and see how they respond to us now at two or at 18 months or whatever it is, then for you to come next year and for you to say, well, when he was two, he was a late talker and we just decided to wait and now he’s still not talking, I want that time.

I want that … It’s still not too late, obviously, but I would way rather one of us look at them and say, nope, you’re doing good. We’re making progress. Keep doing what you’re doing. Call us in six months and let’s check in again to see if the progress is continuing and if we’re still on the same track versus not doing anything when we know we can make progress with that child and bring … And decrease frustration. We don’t want to frustrate a two and a half year old or three year old or a child who then becomes physical because they don’t have the expressive communication skills that they could have had or that is commensurate with their receptive language.

Allison Feldman:

And I’ll often say to those parents that come in for a consult and I’m not quite ready to evaluate them, but I’ll say, I literally want you to get a notebook out and I want you to write down every word that he has. And then as he gains words, I want you to see, is he making progress or are we kind of just staying the same? Because that’s a difference. If he’s making this progress on his own, great. If you’re seeing things stay the same, call me back. Let’s do a true evaluation.

Stephanie Landis:

That makes a lot of sense and is really helpful to parents to know when should we really be concerned and when shouldn’t we?

Allison Feldman:

100%.

Stephanie Landis:

This jumps way back, but that’s just the way my brain works. You guys were talking about a report. Your report is usually written reports. Do you also speak with the parents to explain what’s in the written report?

Allison Feldman:

We do. We generally will have a meeting with the parents about, especially a full evaluation about the report. We usually will give them the evaluation written report first and say, look it over. Let us know if you have questions or I think we should meet. Let’s find a time to meet just so I can go over it with you and explain it all to you, but we do both.

Jennifer Rose:

And that brings us something else that Allison was just talking about when it’s a full versus not a full. So we do different types of evaluation in our practice. So we do what we consider speech-only evaluations when we are not concerned about a child’s expressive receptive language, their voice, their fluency. We’ll just do a articulation, language sample, oral motor, and that’s a little bit of a shorter process and a shorter eval. We still comment on their expressive receptive language. We comment on their fluency, we comment on their voice, we comment on their pragmatics because you can’t take the speech pathologist out of the evaluation. Take that

Meredith Krimmel:

Brain off.

Jennifer Rose:

Yeah. Yeah. We want to make sure that all of those systems are in developing as we would want them to for that child’s age. But if we’re going to do a full evaluation, when we say that word, what we’re thinking about is speech, expressive language, receptive language, sometimes pragmatic, sometimes fluency. We don’t do a ton of voice in our practice, so we typically would refer out. So if we do notice that there is something that is concerning about a child’s voice, then we will refer out to a therapist that specializes in voice.

Allison Feldman:

And the other thing is, and I know we haven’t touched on this and isn’t necessarily the answer, but a lot of times if when these late talkers or babies come in, the first, not a lot of times, we will always ask, tell us about ear infections, tell us about their hearing screening at birth. “Have you visited an ENT? Has he been sick a lot? Tell us about allergies. “And a lot of time, the first referral that we’ll make is to the ENT before we’re even ready to do the evaluation.

Jennifer Rose:

And that’s something too that when we talked about back to that case history and back to when we’re hearing about what’s going on with the child, those ear infections. And we also look, we look at their tonsils during our initial evaluation to see if there’s something concerning. And sometimes those referrals come a little bit further down the line. I have a little guy that I’m working with that is always congested whenever I see him. And for a while, the mom just thought it was just a little bit of congested, but the congestion hasn’t cleared in a very long time. And I recommended that she go see an ENT because I just had a gut feeling something was going on. And yesterday she told me that we’re having tonsils and adenoids removed very soon. So again, that auditory component, that ENT, ear, nose and throat is really important to have the information from parents and from outside sources if we need them.

Stephanie Landis:

Yeah. It’s hard to start talking if you can’t hear.

Allison Feldman:

100%. We always say it’s like this child’s been underwater before they get their ear tubes and you can’t hear underwater.

Jennifer Rose:

And pacifiers. Sometimes if a child has had a pacifier for a while, it’s hard to talk with a pacifier in your mouth. So that’s something that comes up as well in our case history.

Allison Feldman:

Yeah. And the other thing to note is that sometimes a child will come in and yes, they have speech and language needs, but there is another need that is more important at that moment, whether it be PT or OT or something psychological. And we’ll say, if you have to choose one or the over the other right now, take care of this first and then come back to us. And we are always here, but maybe getting a little bit of OT first might even help self-regulation in our sessions, for example. So that’s something that we see sometimes as well.

Stephanie Landis:

That makes a lot of sense because having that self-regulation is going to help with that joint attention. And the more you have joint attention, the more you can pick up from the speech and therapy sessions.

Allison Feldman:

Right.

Stephanie Landis:

You guys mentioned before you might need a prescription if you’re going through Medicaid or other insurance. Do a lot of private clinics, hospitals accept other places accept insurance? Is that how most people are paying or are a lot of people also then doing private pay?

Jennifer Rose:

Most private practices are private pay. There are practices that do take insurance. There are larger clinics that will take insurance and hospitals take insurance. It’s sometimes a waiting game though to get into some of those facilities. Our practice is private pay only, but we do provide super bills to parents as needed. My experience is that most of the practices that we know of are private pay. Allison, would you say the same?

Allison Feldman:

Yes. I think most of the smaller private practices are private pay. And for a lot of families that works, for some families it doesn’t. And we are happy to say, try this clinic. We know they take insurance and they’re a reputable clinic, but-

Jennifer Rose:

We do that often. When families call and ask about insurance, we are happy to listen to their concerns and talk about their child, and then we’ll send them a list of practices that we know do take insurance or facilities that do take insurance. Because in the grand scheme of things, if the child is what’s most important to us, and whether they come to us or go to someone else is not important to us, it’s that the child gets the therapy and the help that they need. So if it’s at another facility, that is totally fine with us. We just want to get them to the right place.

Allison Feldman:

I always tell families, I’m like, ” You are not offending me. I understand. I’d rather you go to therapy than not go to therapy. So here’s this number, please call them.

Stephanie Landis:

“And with a super bill, often parents can then, on their own, try and get reimbursed through their insurance?

Allison Feldman:

Correct. So a super bill has all the diagnostic codes and therapy sessions and CPT codes, and then we send it to them at the end of the month, and then they can send it on to their insurance company. Sometimes the insurance company will have questions for us or require more paperwork or therapy notes, and we will take care of that.

Stephanie Landis:

So there’s still possibly a chance that for many of these clinics, it’s private pay that parents can still try and work out a way to get reimbursement.

Jennifer Rose:

Yes. Yes. We have quite some families who get out. It’s out of network, but we have quite a few families who get reimbursement for out of network therapy. And Alison and I say the same thing over and over again when we do new intake calls, because Alison and I handle all of the intake calls for the practice. When parents ask about insurance, that we have many families that get reimbursement. It just depends on your policy. And some policies reimburse, some policies don’t, but we are happy to help support them in getting that reimbursement if their insurance company will take our documents.

Stephanie Landis:

Well, this has been incredibly helpful. Thank you so much for your time. We know that many parents will learn a lot and feel hopefully more confident when they go into the new situation because going into any new evaluation or starting a new therapy can be overwhelming for families at times. So I appreciate this insight and information. Thank you so much.

Allison Feldman:

You really appreciate it. Thank you asking us. Yes, thank you so much.

Stephanie Landis:

Now we do at the end of every episode, ask our guests, and it can be related to the topic or totally different. If you have one piece of advice to give to the listeners, what would you give?

Jennifer Rose:

I would say trust your gut. If you have a concern and you’re not sure about what to do, go see a speech language pathologist. Let someone assist you, help you, use their expertise to help guide you.

Allison Feldman:

I could just say the same thing in different words, but everything I’ve said, I believe in a mother’s intuition. A little speech therapy or evaluation never hurt anybody, and the gap only gets wider. So just do what you feel is right, not what other people are telling you to do.

Jennifer Rose:

And we’re strong believers in early intervention. Strong job, strong

Allison Feldman:

Believers in early intervention.

Stephanie Landis:

Yeah.

Allison Feldman:

Hence why we worked at the parish school.

Stephanie Landis:

Yeah. Agreed. Yes. Well, thank you so much. I really enjoyed this and I enjoyed catching up with you both.

Allison Feldman:

Yes. Thank you, Meredith. Thank you, Stephanie. Thanks guys.

Stephanie Landis:

Thank you.