EI SLP Vent & WWYD

[Logan's Mom]

Sorry so long...

Our SLP person is always late. She even said to me on Friday (my DH took my son to the park forgetting they had an appointment ) that he just probably thought that she was late because she always is running 15 minutes behind but this time she happened to be on time. Well no, she was 7 minutes late. She tends to be more like 20 minutes late every time. She never is consistant with her days, times (which effects where she goes, here or to DS's daycare.) Well, I've decided that I don't care for her personally but DS doesn't seem to mind her and DCP shared the other day that she likes his Dev Specialist better then the SLP (I didn't bring it up, so its not just me.)

Anyway, I talked to DH and he said that when she is late she doesn't make up her time. So, if she is like 15 minutes late, she leaves in 45 minutes and takes like 10 minutes to write a 1 page summary. :

Also, she is now an "usborne" consultant and had asked us to her house twice prior (we didn't know she was a consultant at the time) to come to the usborne house party which we declined both times. Now she leaves her book and sales sheet for us here.

She has also mentioned that one of her families gave her $100 gift certificate to "beginng years" or whatever the name of the catalog/web company.

My DS seems to like her. His speech has progressed since she started with us in January. Is that due to her or that he is 2.5? He hasn't caught up when they do the testing. He is 31 months and is testing between 20 - 22 months.

We have had 2 different people (a SLP and a psychologistfrom Children's Hospital in Boston) tell us that he needs speech 2 times a week. She just keeps telling me that its not EIs philosophy and there are very few kids who receive speech 2 times a week, even the most severe (my DS is currently diagnosed with delays and nothing else.)

What should I do? I just finally got some additional services. We have OT 2 times a month (he is behind on gross motor, didn't crawl till 11 months, walk till 22 months, still doesn't jump), speech 1 time a week, toddler group 1 time a week, and now a developmental specialist 1 time a week (this is the new addition as of 2 weeks ago.)

The SLP told me that we should get him in a group daycare setting and take him out of where we have now (2 retired ladies who only have him, but completely love him -- has its upside and downsides.) The OT says we should keep him where he is and explore opportunities for group engagement (swim lessons, the park, playgroups). The OT is his caseworker and has been with us since DS was 10 months.

Help!

[PikkuMyy]

That's not true at all. Every child I worked with who received ST gets at least 30 minutes TWICE a week. Same with OT. And since almost every child I worked with gets both of those, that's a lot of kids. It may depend on where you are, some districts set precedents of more services, and others of less. But ST once a week is simply not enough, IMPO.

I see that she's there for an hour. So that's the same total time, but having one hour once a week and thirty minutes twice a week is two different things, and I would almost always argue for frequency first.

If she does not make up the time, then she is out of compliance with your IFSP or whatever legal document you have, and I would keep track of the times and then have a meeting to discuss it.

[azmomtoone]

I think twice a week probably is a lot to expect from EI; we're pulling teeth over here to get once a month for DS, who was evaluated at 3-6 mos expressive speech and 6-9mos receptive (he's 21 mos old). We started this whole process when he was 19 mos and have yet to have a single day of therapy and probably won't until he's at least 22 mos (which he'll be in two weeks)

If your DS seems to like this lady and is learning from her, I would continue the therapy; I would however file a complaint w/ regards to her being late / giving short sessions (it's one thing if she's running late from a previous appt, then gives you the whole hour, or if it's a one time thing.... but if it's every appt, and noone complains, who's to say she's not stopping for coffee between houses but still billing for the whole hour......) And I would definitely have a problem with her leaving stuff she's trying to sell.... I love Usborne books and their program but no way should she be trying to sell stuff for that while she's at work, nor should she be leaving behind advertisements. If you asked for any of that stuff, or had known her through Usborne parties or other mom's networks BEFORE she was your son's theapist that would be different; but I think her boss should be made aware that she's doing those things, and make sure your clear that you are not happy about it.

If you feel that he needs more speech therapy than that you will probably have to look into private therapy.... which your insurance may or may not cover (ours doesn't) and can be pretty costly if not.

As far as caregivers, only you know what is best for your son.... we had the same debate here, whether or not DS might do better in a daycare setting, and had him on the wait list for like 6 mos for one of the higher-end daycares in town, then when our turn came up and we visited the daycare and saw where he would spend his days, we decided no way did we want him there. He currently goes to our neighbors house, 3 afternoons a week, and while he isn't around other kids his age (she was watching two boys, 8 and 12, when he started, and now her grandbaby who's 2 mos old) he gets lots of love and attention, she's always on the floor playing with him when I go over there, or holding him while he naps, etc.... so in our case I think he's better there than a daycare. But it might not hurt to go visit some daycare centers around you and compare to where he currently is... (even if just for your own peace of mind that you are providing the best care you can in your absence)
Classes, such as gymnastics, swimming, can be lots of fun and a good chance to interact w/ other kids.....

[Literate]

Well, I think writing the report for a more reasonable amount of time (5 minutes?) does count for part of the hour. I would insist on the full hour each time. I would call your EI coordinator about that and regarding going up to 2x a week. Your SLP doesn't have any control over that.

We did qualify for 2x a week even before our apraxia diagnosis, so it's not unheard of.

I would either ignore the annoying comments about her other business, or just flat out tell her you aren't interested.

I'm sure if you told the coordinator about the lateness and the extra business BS the SLP would be spoken to, but pick which battles are most important. Yours may be the 2x a week and full hour ones. That's what would be at the top of my list.

[azmomtoone]

Originally Posted by PikkuMyy

That's not true at all. Every child I worked with who received ST gets at least 30 minutes TWICE a week. Same with OT. And since almost every child I worked with gets both of those, that's a lot of kids. It may depend on where you are, some districts set precedents of more services, and others of less. But ST once a week is simply not enough, IMPO.

I see that she's there for an hour. So that's the same total time, but having one hour once a week and thirty minutes twice a week is two different things, and I would almost always argue for frequency first.

If she does not make up the time, then she is out of compliance with your IFSP or whatever legal document you have, and I would keep track of the times and then have a meeting to discuss it.

30 min twice a week is probably a lot better than an hour once a week, esp w/ toddlers..... even a typical toddler will have a hard time paying attention by the end of an hour. Not the way it's done around here either though.

[Sierra]

I take it you are in MA. Having just moved to MA from WA, I got to compare EI a little between the two states.

I think it is true that it is a big, big fight out here in MA to get to see a SLP two times a week through EI. Back in WA, my ds was seeing a developmental specialist, a SLP, and an OT. The Speech was two times a week if I recall, and OT was at least weekly. The developmental specialist came weekly too. And all this was coordinated by a separate person, a parent consultant (all parent consultants had special needs children themselves, as I understood it).

Then I move to MA, and this same exact kid gets what? Exactly one freaking hour per week with a developmental specialist. No SLP. Eventually I was successfully able to fight to get the OT (once every other week), but I made it no where fighting for the SLP. In MA they say they take a "multidisciplinary approach." What does this mean? Someone here summed it up well when she said, the developmental specialist becomes "jack of all trades and master of none." It is so frustrating, but I wish you loads of luck trying to get more speech because I am amazed you are getting any.

As for the lateness factor, I hear you, though I tend to have a *lot* of compassion for folks who run late because I tend to run late too. Back in WA, our developmental specialist always ran late. I decided just to plan for it. In the end, if she said she was coming at 9am, I'd write down 9:15am in my book. She had my cell phone number, and if she ever came by and we weren't home, she'd call and we'd let her know we were on our way. So if she did happen to be closer to on time by some off chance, and we weren't at home, she wouldn't just leave.

That said, this is a professional, and at the very least, it is reasonable to expect that she extends her time with your kid if another kid (theoretically she is running from appointment to appointment) keeps her late. The next time she starts wrapping up, and you notice she hasn't gotten in the full time specified, I'd look at my watch dramatically if I were you and say in a surprised and shocked voice, "Oh? You are leaving already?" When she says "yes," I would say, "It seems like you and my kids are both done 30 minutes after a session begins. I think we need to speak about dividing our sessions into two half hour sessions so that he still gets the full hour weekly." If she says, "Oh, but our end time is ___," I would point out firmly "But you didn't arrive until ___, and you didn't begin until ___."

I too would argue for shorter, more frequent sessions.

[DandeCobb]

Originally Posted by azmomtoone

30 min twice a week is probably a lot better than an hour once a week, esp w/ toddlers..... even a typical toddler will have a hard time paying attention by the end of an hour. Not the way it's done around here either though.

we get one hour once a week, they say they can't split it due to scheduling conflicts. so what it actually means is DS gets 30-35 minutes once a week because after 30-35 minutes he usually refuses to participate :

i would talk to my caseworker about the chronic lateness and the selling of her private business stuff while doing EI. both of those would really make me angry!

[Aridel]

As Sierra said, the approach in MA is multidisciplinary, with a focus on giving everyone a developmental specialist and training parents to do the intervention during the time between visits. This does also mean less direct time with the professionals. How is she about talking about things for you to do during the week? We had an SLP who would stop working with dd 10 min early for awhile, but would spend some of that time talking me through the at-home goals and activities for the week, which I didn't mind. If she had come late, left early and taken up so much time with the note I would have been furious.

The first thing I would do is talk directly to the SLP the next time she comes. When they know you are flexible, you're much more likely to be called to change times for the week - it's unavoidable for the EI folks at times, but should never be an ongoing issue. Get a set day and time, make it clear you cannot change your schedule easily. And, as Sierra mentioned, comment on when she starts wrapping up, and how he seems done (as does she) after x minutes, and more frequent sessions would work better with that time span. Another option is to ask for time during toddler group - there are some kids who can get a little one-on-one speech work during groups, but it depends on the kid, the program, and staffing.

If you have to, ask for an official IFSP meeting. In MA, they don't always have legal IFSP meetings, meaning sometimes they only have one person there, usually the service coordinator. they need to have more than one team member for it to be official, as well as you and anyone you want there.

To be honest, you may never get 2x a week for speech in your area. I would absolutely push for it, and push for it again when you have your school meeting (I see he's starting transitioning) but I push harder for getting a full hour of intervention each week. What part of MA are you in, if you don't mind me asking? I've heard mixed things depending on what EI agency you have.

[chann96]

Writing the report can be considered part of the time, but 10 minutes to write it does seem long.

Sounds like you have a great set-up for childcare and I think I would be hesitant to change that. As you mentioned there are other ways to get group exposure.

It may be difficult to get more ST through EI. I think in many places their schedules are very full and it is difficult to schedule in more time even if they were to agree it was needed. Charlotte's first SLP in WV was a very nice woman who lived in our subdivision. In the 4-5 months she was Charlotte's SLP she was NEVER less than an hour late. We were getting ST 2x per month I think at that point and she was an hour and a half late once and one time she just didn't show up. Now my house can be hard to find, but she lived less than 5 minutes from me. And she never called to say she would be late either. We discontinued services with her. It annoyed me more though after that because our coordinator had told me that if we discontinued services with her that we would be able to quickly pick up another SLP and that wasn't true. They didn't have enough SLPs in the system and no one had any time in their schedule. We weren't able to get another SLP for over 6 months.

I think if he seems to be progressing with this SLP that I would continue with her and discuss the scheduling issue. Honestly though he will be transitioning out of EI in 5 months so everything will change then. If you try to change SLPs right now my concern is that he may miss out on any ST until that transition if they are short on SLPs. Yes, by law they are required to provide the service, but the unfortunate reality is that they often just don't have the personnel.

[Literate]

Oh! Another thought. I eventually wanted to switch from at-home sessions to sessions at the Easter Seals facility. EI covered those sessions, and I was never late, of course, so that wasn't an issue.

[LowFlyingAnimals]

I'm in MA, too, and dd went through the EI program here.

I actually liked the interdisciplinary approach, but it may depend on what therapist you get. Ours was stellar. But, this way no area of development got left out, especially when something like speech can be affected by and effect other areas of development so easily. If something specific was needed, we always called in an SLP, OT, whatever, and we would come up with a plan together.

I think the reason for once a week for an hour is because it's done at people's homes. Logistically and economically doing all that travel 2x for a half hour would be a nightmare. We were always given ways to work with her during the rest of the week, and it really didn't require an SLP to do these exercises with her.

If you want more time, maybe check in to see if you can get an appt. at the location or 2x/week if you go there. Or look in to private speech therapy. I know a few people who go through colleges and universities where students under supervision do the therapy and it's very economical, which regular speech therapy is definitely not.

Oh, and every therapist dd has ever had come to the home has been late. Every one. Gives me extra time to try to mop up the floor or whatever. But, it really throws me on that one or two occasions they show up on time. However, every single one makes up every second of the time and often ends up doing a little more, probably contributing to why they are always late. She should be making up the time if she's late, and I would just mention when she tries to leave something like, "Oh, didn't you just get here 1/2 hour ago?" You can always address problems like this to the EI office. They should have procedures in place for this.

Also, the Usborne connection, imo, is completely unprofessional and annoying. Some parents might be swayed into getting books because they think she is recommending them as a professional specifically for their child. I would bring this up to her supervisor or whomever as more of a concern than complaint. I really think they need to know and that would eliminate the problem to you as well.

[LoveChild421]

I really think you need to file a complaint with the EI program and/or get a new SLP. An hour a week is so little anyway and when she gets there late and doesn't make up here time she is taking needed services away from your child. That isn't right. You may never get EI to agree to twice a week speech therapy but he should at least have the full hour they have agreed to. She sounds very unprofessional.

Originally Posted by Logan's Mom

The SLP told me that we should get him in a group daycare setting and take him out of where we have now (2 retired ladies who only have him, but completely love him -- has its upside and downsides.) The OT says we should keep him where he is and explore opportunities for group engagement (swim lessons, the park, playgroups). The OT is his caseworker and has been with us since DS was 10 months.

This is probably based more on her personal philosophy than anything else. I agree that children need peer interaction but, having worked at a daycare center in the 2 year old classroom, I think it is a really bad idea to put a speech and developmentally delayed child into a room full of kids with a ratio of 10 two year olds per teacher. They just don't get the personal attention they need. The teachers don't have time to try and figure out what the kids who don't speak clearly are saying and often just brush them aside because something urgent is happening (a child is biting another child or trying to climb on the furniture).

We had a speech therapist suggest this for ds1 too. No way. I agree with the OT- go to the park, playgroups, maybe a mother's morning out or preschool program a couple time a week. Ds1 stayed with my grandma when I was working full-time and will again when I go back to work. IMO there is nothing better than little old ladies for daycare. You just don't get that level of TLC and personalized attention from a daycare setting.