Thursday morning I meet with our Early Intervention service coordinator and the speech pathologist that conducted Ava’s evaluation in order to write our Individual Family Service Plan (IFSP). Every child younger than three who qualifies for Early Intervention will have one of these plans. It’s mandated by the Individuals with Disabilities Education Act.
The meeting is important. This is where her goals will be set and where her services will be determined. As a speech pathologist and a parent who has recently done a lot of research on Childhood Apraxia of Speech I know that intensive one-on-one therapy is essential. The one-on-one part will not be difficult. In Missouri, at least, your early intervention therapist comes to your home to do therapy with your child. As long as I can find a way to keep her brother occupied elsewhere, the therapy will be one-on-one. It’s the intensive part that might be difficult.
I could be wrong, but I believe that the default amount and frequency of therapy provided is a one hour session once a week. I’m going to request that that one hour per week be broken up into two 30 minute sessions. I think it is more appropriate for a child of her age. Speech therapy for apraxia is supposed to be based on motor learning principles. That means (among other things) trying for as many productions as possible. You want to get the child to produce word after word after word. That is exhausting for a little one. She can’t do that for more than about half an hour. That means that the other half hour would be wasted in terms of directly addressing her apraxia of speech. She needs at least half an hour of therapy twice a week from early intervention in an ideal world. I’d love to increase the half hour twice a week to 45 minutes twice a week. The extra 15 minutes would focus on helping Ava and the whole family learn more signs.
I’ve been on the other side of the table many times. I worked in a public school district and participated as the speech pathologist in many IEP meetings. Usually everyone is interested in what is best for the child. The meeting does not have to be adversarial in manner. It should be a positive meeting where everyone is focused in what is best for the child and family. I am going to assume that my meeting will be like that.
I am also going to be prepared. First I will actually read the Missouri First Steps Parental Rights document. Second I will find and print as many sources as possible to document the need for intensive, frequent treatment. I will make multiple copies of my research and highlight the key phrases. In this way I can show the team members research based reasons for my request.
Although I didn't use either of these documents in their entirety, I copied parts of both of these:
Cherab website - One on One Therapy: A Review of Apraxia Remediation
ASHA’s Technical Report on Childhood Apraxia of Speech
The key quote from the Cherub website's article (I've also seen the same quote on the apraxia-kids website)is as follows:
"Campbell also compared outcomes in relation to the amount of treatment provided for phonologically-disordered children with children with apraxia. The parents of 49 children with moderate to severe phonologic deficits receiving individual speech therapy were administered the same survey. For these children, an average of 29 individual treatment sessions (45 minutes in length) were required for parents to report that about three-fourths of their child’s speech could be understood by an unfamiliar listener. To achieve the same intelligibility level among the parents of children with apraxia, an average of 151 individual treatment sessions were required. "In other words, the children with apraxia of speech required 81% more individual treatment sessions that the children with severe phonological disorders in order to achieve a similar functional outcome" (Campbell, 1999)."
The key quotes from the American Speech Language Hearing Association (ASHA) Technical Report on Childhood Apraxia of Speech are as follows:
"There is emerging research support for the need to provide three to five individual sessions per week for children with apraxia as compared to the traditional, less intensive, one to two sessions per week (Hall et al., 1993; Skinder-Meredith, 2001; Strand & Skinder, 1999)"
"In view of the Committee's information indicating that children are being enrolled for treatment of CAS at increasingly younger ages, careful consideration should be given to the length of the therapy session. If repetitive practice of speech-motor patterns is targeted in a therapy session, many children in the younger age ranges can remain engaged for only a maximum of 30 minutes per session."
I’ll let you know how the meeting goes.