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Address to Senate Inquiry Into Speech Pathology Services 2014

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Address to Senate Inquiry Into Speech Pathology Services 2014 2014 Senate Inquiry into prevalence and implications of different types of speech, language and communication disorders and speech pathology services in Australia 20.2.14 Dear Committee Secretary, Senate Standing Committee on Community Affairs, Gold Coast Speech Pathologists would like Senators to understand their local story. The population on the Gold Coast region is around 514 000. The number of speech pathologists is approximately 50 private and 50 education, health or other agency speech pathologists. The incidence of communication disorders is 14% so that means there are 71 960 people needing speech pathology on the Gold Coast, but with only 100 speech pathologists, that means there is only one speech pathologist to support 719 people. This is an impossible task. Implications for children A full time speech pathologist in a paediatric private practice can comfortably treat around 40 clients each week but the nature of some disorders are such that some clients e.g. those with severe speech sound disorders need treatment weekly for 40 sessions i.e. 12 months. So, having to provide a service for over 700 people would mean an extremely diluted and most probably ineffective service. The Gold Coast region is the worst area in Queensland per 100 000 compared with other regions in the state. With only 19 speech pathologists per 100 000 compared with 27 being the average, this means that many hundreds of children, teenagers and adults are struggling without support. This translates to 12% of primary school children or in more comprehensible terms, 3 children in every classroom in need of speech pathology support. To further illustrate this dire situation, there is a high correlation between communication difficulties and poor mental health. Lastly, children with language impairments are 6 times more likely to have reading problems. Given the shortfall of speech pathologists in the Gold Coast region, the impact on young families is significant. Critical development periods are before 5 years of age, yet wait lists for this age group treated by Community Health speech pathologists, is up to 12 months. For families who can not afford private services, this wait can have devastating effects on a child’s speech development, access to and ability to participate in a prep or pre-prep curriculum, and their ability to interact and form relationships with peers. Even private speech pathology services on the Gold Coast have been placing children on waiting lists for some years now, especially for access to government funding for early intervention autism and disability services. This funding is designed for early intervention up to 7 years of age, yet some children can not access private speech pathology within the time frame due to lack of workforce. A similar situation exists for children attending primary and secondary school. Due to prioritisation procedures, often only the most severe of cases receive direct speech pathology services. Children with mild or moderate speech and / or language disorders usually miss out, and must seek out private services. The general public is generally unaware of this hidden language handicap. In the paediatric sector, research shows that ¼ of Australian parents with 4 year olds have concerns about how their child speaks, yet many do not act on this concern. They think their child is “just a late talker”, then, at 4 years when their child is still unintelligible, parents think the school will help but it is too late at this point. Critical age hypothesis tell us that if children are not intelligible by age 5, their literacy acquisition is likely to be compromised. Even persistent mild speech production difficulties past age 6 are associated with literacy learning difficulties. It is imperative that there is sufficient speech pathology support especially in the early childhood years to prevent negative educational and mental outcomes in later schooling. To prevent unnecessary negative consequences, Gold Coast speech pathologists would like to see rectification i.e. increase in speech pathologists employed in all education, health and disability settings. A speech pathologist employed for every school and its feeder childcare centres would be ideal, not just to treat identified speech and language disorders, but to provide education and training for parents and teachers. As speech pathologists work with feeding disorders, stuttering, voice disorders, social language disorders including autism, all disabilities associated with communication difficulties, and literacy difficulties, the benefits of having a permanent speech pathologist on staff would quickly become apparent to stakeholders. Implications for adults and the elderly Communication can also be significantly compromised through the ageing process due to neurological conditions such as stroke, dementia and progressive neurological disorders. Communication breakdown results in decreased socialisation that affects people’s physical and mental well-being. Given that the number of Australians aged 65 years and over is expected to comprise one-quarter of the population by 2045 (almost twice current levels), we are facing significant challenges in caring for our elderly. Already, this translates to 85 000 Australians requiring speech pathology intervention due to loss of language following a stroke (aphasia). Furthermore, a significant proportion (up to 22%) of Australians over the age of 50 years experience dysphagia i.e. difficulty swallowing, either solids and/or liquids which can be caused by a number of age related health conditions including stroke, Parkinson’s disease, dementia as well as a consequence of ageing. Dysphagia requires timely speech pathology assessment and management, as untreated swallowing problems have serious health consequences including aspiration (food entering the lungs), dehydration and malnutrition. Aspiration may result in pneumonia, which may lead to hospitalisation and in some cases, death. The funding for dysphagia may be deemed as falling under the “Nutrition” care category but funding can only be provided if the resident requires immediate feeding or modification of diet. There is no difference in funding whether one resident takes 10 minutes to feed or an hour to feed, however there is quite obviously a difference in staffing needs as well as the need for regular review by Speech Pathologists to safely monitor swallowing ability. Referrals in many cases are on a “as needs” basis and are usually instigated by choking episodes, hospitalisation with aspiration pneumonia or families who advocate for their family and request reviews. There is very little scope for other vital roles Speech Pathologists could play in educating staff about swallowing and communication difficulties, follow up therapy to try to improve swallowing outcomes, routine screening to try to prevent choking episodes etc. Aside from the swallowing management issues, the current funding tool for Aged Care Facilities ACFI does not include “Communication” as a care need category and thus, there is no funding for assessment and management of communication disorders in aged care facilities unless funded privately by families of the residents who are often on pensions themselves and have little excess funds. This means that if a resident has a stroke resulting in aphasia (communication impairment) they will likely be discharged after a short 2-3 week stint in rehabilitation back to the residential aged care facility with no hopes for any follow through of communication therapy. Research has shown that the first 6-12 months after a stroke is the best time for providing therapy to achieve greatest functional outcomes. Residents who are losing their ability to communicate due to other neurological conditions such as Parkinson’s disease often find themselves “without a voice” and there is no funding available to access Speech Pathology as a means of developing a communication device or tool so that they can communicate even the most basic needs. Even with private health cover or team care arrangements, there are significant out-of-pocket expenses incurred to access what should be fundamental rights – to eat and drink safely without fear of choking, and to communicate effectively for every day needs. Funding for Speech Pathology services in the aged population is in serious need of reform given the ageing population. There is plentiful research showing the positive effect of speech pathology and its effective treatment of most speech, language, swallowing and communication disorders. Therefore, Gold Coast speech pathologists are wishing to add their voices to support the message that communication is a basic human right and every person with a communication disorder should have timely access to appropriate intervention. From Gold Coast Speech Pathologists - Katherine Osborne Amanda Dansky Yvette Dempsey Lyndal Mayhew Karyn Johns Tanya Teitzel Mary Hughes Jane McFie Megan Nevell Karina Waterman Karin Adams .
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