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From: John Tetnowski
Date: 11 Oct 2006
Time: 07:35:40 -0500
Remote Name: 65.1.71.69
Ed, No offense, but notice that, speaking for myself, I have not responded to all questions. I think we respond to the ones that we have something to say about and the ones that we have some knowledge about (not to mention time). I have a "little" experience and knowledge in the area of your question, so I will try to respond. I think that the multidisciplinary approach runs contrary to most training. I agree that we all talk about making appropriate referrals, etc., but may not always do so. I think that there are at least a few reasons why this does not happen. 1) The first one is probably our fault....professional domain. Even though I have worked for PWS with other professionals, it still "ruffles my feathers a little" when clients come to me and tell me that they have been seeing psychologists, counselors, social workers, etc. I say to myself, "what do they know about stuttering?", when the answer may be "just as much as me....maybe even more.... about some aspects". I NEVER discourage them, but I do have those thoughts. I should let you know, however, that I have worked for PWS in conjunction with counselors, physicians, psychiatrists, psychologists, and even in one case a "hypnotherapist". I do think that we need to look at the needs of the PWS. 2) The second reason has to do with a particular sector of SLP, that is, the school SLP. Granted that the role of the school is to meet the "individual needs of the child". Truth is, there are some restrictions due to allocation of resources. I have heard many schools SLPs (and been there myself years ago) say that they are discouraged from making referrals because it puts the school system on the line to pay for that service. I don't think we need a political arguement in this forum, but I am reminded of a bumper sticker taht I see once in a while that reads, "Wouldn't it be wonderful if teachers could buy whatever they need and the Navy had to hold a bake sale in order to buy a new aircraft carrier?" You know what I'm saying; there just isn't enough money these services. However, I do know that in recent years, there is much more emphasis on meeting academic needs. This has forced many SLPs out of their therapy rooms and into the classroom, where they work with teachers, assistants, etc. I think that there is SOME progress on multidisciplinary therapies. 3) In private practices and clinics, it again boils down to cost. It is hard enough to get reimursed for stuttering therapy, period. Making referrals, team approaches, etc, are probably very difficult to get reimbursed for. I am not in private practice any more, but maybe someone who is can talk about the difficulty in getting reimbursed. 4) In my setting (the university), we often make referrals. It is however up to the family to follow-up. We cannot pay for otehr services. Some universities are attched to facilities that can provide multidisciplinary interventions, and probably do so. I know for example, that at one university that I worked, we had a partnership with the school of social work. We had interns in our clinic that provided all sorts of services that social workers provide. It was a wonderful operation. I wish I had looked back and checked to see if there were better outcomes for PWS. Sadly, I let that opportunity get away from me. In summary, some of us do work alone with PWS, but I bet there are a lot more working with other professionals in some fashion. I too would like to hear from others. Thanks Ed, John Tetnowski