34. How Much Does Speech Therapy Cost

Introduction to Speech Therapy Costs in Australia

Heidi Trusler: Welcome to Beyond Words by Pop Family. Today I’m chatting again with Pop, senior speech pathologist and clinical lead for language and Literacy, Monique. Monique is passionate about supporting families to access complex systems and funding schemes. Based in Adelaide, she began her clinical career by working in the mental health, disability and public health sectors. Before joining the Pop team to provide telehealth, speech therapy all over Australia. Mon is really knowledgeable and explains things simply and beautifully to parents. I can’t wait for you to hear what she has to say about how much speech therapy actually costs. Welcome back Monique.

Monique Martino: Thank you so much, Heidi. Thank you for having me.

Heidi Trusler: You’re welcome. It was very easy. Let’s chat broadly today about Aussie families wanting to purchase speech therapy. One of the most frequently asked questions that we get is how much does therapy cost? I love that we’re talking about this because really, it is something that we are going to need to talk about over perhaps a few different episodes to really give parents an in-depth idea of how to best make these decisions together with their speech therapist.

It’s super complex, so I want to start by asking you. Let’s first talk about speech pathology in Australia. In general, there are a lot of different speech therapy services out there, and I want to know how we pay for each of them. So I’ve actually like written a list here and I’ve got if I’m a parent and I can access many different services in Australia, how about community health for my local hospital? How do I pay for that?

Understanding Community Health and Hospital Services

Monique Martino: So that typically is covered by the government. And you generally are able to access like a block of therapy. And the frequency and duration and kind of what span that will be over will be dependent on the community health setting and what they can offer.

Heidi Trusler: Yeah. And and what program they’ve got and what sort of staffing they’ve got. They might be on the staff. They might have a long white list. Generally community health and hospitals work together and they have a category based system. So basically if you’re a cat one, which means that something’s potentially life threatening, you need to be seen early. But if you’re a cat to which actually what a lot of children with speech and language disorders or delays fatal, it means that if they’re understaffed or it’s going to be of a lesser priority, then, for example, someone in the hospital who has just choked on something. So that’s all that’s a little bit about hospital and community health.

Monique Martino: Community health can also vary based on, like whether they do more work around parent training and upskilling, or whether they do more screening for the children, or whether they do some group therapy and some early intervention strategies. So that can also be vastly different across the different community health settings.

Heidi Trusler: Absolutely. So there are different programs in different states around Australia. I have worked for New South Wales Health and Queensland Health, and I have worked in both adult and pediatric settings, and I have experienced different programs to do with their different fundings. There are a lot of really great resources and services out there, so if you’re looking for speech therapy, it is worth calling up your local hospital community health center and seeing if you meet criteria for your community health service. There are there’s criteria. It’s not unlimited for everyone. Of course. There’s criteria. Okay. Now let’s go to schools like school based speech therapy. How do we pay for that?

School-Based Speech Therapy Funding

Monique Martino: So that is also typically funded by the education department or the Catholic Education Department, depending if it’s a private or a public school. Not every school has access to a speech pathologist. So it can be it can vary state by state, school by school, but typically they tend to be funded to do screening or assessment based and then some consultation. And strategies with teachers and supporting them to access the curriculum rather than working 1 to 1 with your child.

Heidi Trusler: Yeah. And it is different in each state. So we work across Australia and you would have clients on your caseload right now who are in every different state in Australia, probably. Largely in Queensland, where we’re rather lucky to have Queensland education funded speech pathologist. But like you said, sometimes those that one speech pathologist has like 200 children on their caseload, so they might see each child once a year for an assessment or a screen on give some classroom recommendations. There are some school based speech pathologists in that public setting that have more funding for some reason. Obviously, I don’t know how all the funding works, but they do get to do one on one intervention, perhaps with your child, but it wouldn’t be for the whole year. It would be for a sort of block of time, because they’ve got to move on to other children in that school.

But most of the and we work quite a lot with rural New South Wales schools in New South Wales doesn’t seem to have any state funding for schools that I well, I mean, I don’t know about metro areas because they don’t work as much in metro areas or their rural schools. They don’t tend to have a speech pathologist position like Queensland does. And other states I’m not so aware of either. So I think it must be a state based thing.

Monique Martino: I think you very much varies state by state and also whether they can actually employ to those positions when they do come up.

Heidi Trusler: Exactly. So then we’re going to come up against the regional and metro changes. It’s obviously a lot easier to employ a speech pathologist in a city than it is in the middle of nowhere. But you do try something about cafod. So we know Cafod does pay for speech pathology services and has speech pathologist around Australia at their schools, and there are other schools. So even obviously schools have, I don’t know what I call buckets of money. You’ve got funding for something, you get to spend it on something. And some schools choose to spend their funding within their guidelines on speech pathology. So we actually partnered with schools to either screen access or see their children long term. And the school is actually paying for that service for the parents. So parents could lobby for that, see if their school has a bucket.

Monique Martino: It’s worth asking. It’s worth asking. You don’t know if you don’t ask. Exactly.

Heidi Trusler: So during Covid, we had some small schools that had no ability to Western schools, no ability to travel, to spend their budget for school camp or something. So they actually chose to spend that on assessments for quite a few children, and especially those early intervention assessments from Prep, Kindi and Prep through to grade one. And so that is one example of how school can use a different bucket of funding for a speech pathology service. All right, NDIS, we won’t talk about that too much. But how do we pay for funding I guess if I’m a parent.

Navigating NDIS for Speech Therapy

Monique Martino: So with NDIS, if you’re eligible under this scheme, whether you’re like under the age of six and you can access early intervention or whether you’re over the age of nine and you’re able to access for an ongoing disability diagnosis, it is all covered by the National Disability Insurance Scheme, and it can be reimbursed in multiple ways out of your child’s NDIS plan.

Heidi Trusler: And it’s generally I mean, it’s almost it’s always bulk billed. Or is can you pay a gap that people pay gaps for NDIS?

Monique Martino: I don’t believe so because generally we are needing to meet that price guide. And so generally it’s regulated across Australia.

Heidi Trusler: So I think on a technicality, if you were a speech pathology service you could charge a gap for self-managed clients. Now that is a nuance of the scheme. We don’t at Pop. I haven’t heard of other clinics doing that, but with the fact that the NDIS haven’t put the price up, for years, I wonder if we will see that, but we haven’t seen it. Generally people charge the NDIS price guide and so if you’re a parent and you have NDIS funding, you’ll be billed. So that’s your experience as a parent. Depending on how the admin happens, you definitely are not out of pocket.

Exploring Non-Profit Organisations and Medicare

Heidi Trusler: Non-for-profit as far as I’ve got. You know, there’s a few wonderful non-for-profit that’s out there. If you’re in rural, rural and remote Australia, you might be accessing a non-for-profit like Royal Far West, for example. How as a parent do I have to pay for that?

Monique Martino: My understanding is no, it is covered, but again, it’s quite limited in terms of what you’re able to access and whether you’re eligible, because how it can look can vary depending on the different profits and what they provide. So it could be providing some general strategies. It could be some screening, it could be some parent coaching. It can really vary.

Heidi Trusler: And so if you’re accessing services through a non-for-profit, I think a lot of not for profits have moved their funding models to be charging NDIS packages as well because non-profits were given more funding for this type of thing before the NDIS came in. So they then had to shift their business model and charge and design plans. But some non for profits are still funded by philanthropists and completely separate private philanthropists who are, for example, paying for the therapy for you or your child. So there are no for profit free bulk billed services. I don’t think that you’re you might receive a gap. I don’t know all of them out there, but it’s worth talking about them.

All right. Now we’re getting down to sort of a little bit more of the privately paid space. So Medicare, we’ve talked about this before.

Monique Martino: Medicare is another big one. I mean, we know that our families who are eligible to access a chronic disease management plan or chronic condition management plan through their GP, they can access up to five sessions per year. And that doesn’t cover the entire cost of the private appointment, but it can help remediate some of those costs and provide a rebate.

Heidi Trusler: Yeah. So Medicare can provide a rebate, but you’re paying a gap. So if I’m a parent, I’m paying a gap. I don’t know. Some clinics, private clinics I have seen in the past do a bulk billed screener, but it’s going to be 20 or 30 minutes and it’s got a cap of the Medicare length of sessions of five sessions. But that doesn’t happen a lot. But it does happen. Private health insurance.

Private Speech Therapy Costs and Billing Practices

Monique Martino: Well, private health insurance, it all depends on the policy that you have with your private health insurer. So it’s worth checking to see what you’re able to access. And again, it works the same way. Generally they would cover like a portion of it, but you still would have a gap and to pay out of pocket expenses.

Heidi Trusler: Yeah. And I think what you do to check that is you go and look at your extras or if you’ve got extras, I know that I don’t know if anyone else is a CV, but a mine for speech therapy is so high I don’t access it for myself. But, I’m often looking at that going, go see VHS. It was like $1,800 or something. It was huge.

Monique Martino: Now you’re prompting me to go have a look at my own private health, just out of curiosity to see what my extras covering Medibank.

Heidi Trusler: I’m thinking of the meerkat.

Monique Martino: Compare the market.

Heidi Trusler: Simple. Okay, go and do that. And so if you’re looking for the most amount of money off the services that you need, especially if it’s speech pathology, comparing the market on private health could be worth it. Private health is expensive. You’re going to be doing making those budgeting decisions for yourself. But if you’ve decided that it’s something for your family, maybe checking out which one’s best for speech therapy could be a good long term plan for you.

Last but not least, the parent. I’m a mom. I want to do speech therapy with you money and I’ve got a hand over my money. How generally am I doing that? And I think that’s what this whole episode is about, really. But I think I’m paying if I’m a parent, I’m answering this myself, but I’m paying either using while the schemes we’ve already talked about.

Monique Martino: Yeah. And if you do, pay out of pocket then it’s generally charge three, you know, your credit card or your bank transfer.

Heidi Trusler: Yeah. And so that’s, that’s going to be really largely where and when we talk about this, this is just generalized across Australia. If you’re looking for speech therapy this is what to expect. And all of the different ways that you could access it or pay for speech therapy okay great. So now that we’ve got a good idea of like how you would pay for speech therapy, how is it billed? So I was thinking about this coming in to most people. It would make sense I think because a lot of services are billed the same. If I need a plumber to change my tap, he’s going to bill me for my time. But he might also bill me for travel and he might bill me for like the utensils that he uses. So as a private speech pathology clinic. Now we’ll talk about private speech pathology practices like up. How do we generally or how to other private practices bill for our time.

Monique Martino: So generally obviously there’s build time for the client service that you’re providing in terms of direct face to face therapy. But then there’s also additional, parts that are, you know, important in the quality care. So your report, like assessment reports, progress report recommendations, which are generally essential for schools, doctors, NDIS, the family themselves. We’ve also got letters and home programs and resource packs. So our time is essentially built in meetings, reports providing all the additional services on top of the appointments that we provide your child.

Heidi Trusler: Yeah. And our administration per se is included in our hourly rate. Correct. So unlike a lawyer, for example, who bills every eight minutes, he said 8 minutes or 5 minutes for every time they write you an email, we would be, you know, including that in the hourly rate that we are charging. So now let’s talk about like the elephant in the room. What is the standard hourly rate for. What am I going to pay? What am I out of pocket for speech therapy for an hour of speech pathology?

Monique Martino: Well, across Australia the standard rate for speech pathology services generally falls between 190 to $250 per hour, and I can depend on the service tort, the location that it’s in, the therapist’s experience, that kind of thing can play into that. At port, we align ourselves with the NDIS price guide, so our hourly rate for our NDIS clients is one, 93, 99 per hour. And that’s the same whether your self-managed plan managed, agency managed.

Heidi Trusler: That’s our NDIS, right? We actually have a slightly different rate for our privately paying families. The reason why we charge slightly less for our privately paying families is because they are paying completely out of their own pocket, and we do take that into account. NDIS families are paying for their service, they are being bulk billed for their service and we find that, that makes a difference. We when the NDIS rate came out, we actually were charging quite a lot less than what they recommended. And over the years we have, with inflation have increased our, privately paying price guide. It’s now pretty much on par. It’s very similar, but at other clinics the same sort of thing happens and at a different private practice that the cost you talked about the lower end, about 195 an hour, up to 220.

Monique Martino: Was it 250, 252. Yeah. So friends, upper end.

Factors Influencing Therapy Duration and Costs

Heidi Trusler: And definitely if you’re paying for a psychologist these days, you’re paying closer to two, 22 to 50 per hour. And so for health professionals, depending on who you are, that’s that’s just a rough guideline of an allied health professional really. But it also depends on where you live in the cost of living, where you are as to generally what the cost of your speech therapy session might be. So if you’re living in a small town out west, you’re hopefully actually you’re not on the NDIS because you get charged that ludicrous rural fee that I don’t like. We’re not talking about that say we are in charge, that we charge the same no matter where you live, because it doesn’t cost us any different. Our model of care, it costs us the same. So we charge the same no matter where you live. But if you live in a rural town, you might have a slightly lower hourly rate because that clinic’s rent might be lower. You know, things are going to be lower if you are in the eastern suburbs in Sydney, you’re going to be looking at a more expensive hour of therapy because renting that building is going to be super expensive. That’s one of the things to keep in mind when you’re paying for speech therapy.

So, I’m I’m a parent. I’m on my journey. I decided I want to pay for speech therapy. I still don’t know how much it costs, really, but I’m thinking, oh, my friend, they sent their kid to the local community health center for speech therapy. They did ten sessions. They’ll fix. Perfect. I’ll be budgeting on ten sessions. Why?

Monique Martino: And I know the short answer. No long answer is, it’s not really a reflection on how long it takes. It’s a reflection on how long the service can actually be offered for that particular client. So the public health system, for example, which is what you were referring to, they do like a block therapy model. So essentially it allows therapists to see families for short bursts and really focuses on, you know, key skills identification, screening before moving people off the caseload to make space for others. So the time frames could be six weeks, ten weeks, 12 weeks. And it’s more about trying to get equity across, providing services to people across different regions. To be able to access that block therapy. So generally it’s more about access and service flow, not really about how long it takes to reach those therapy goals when accessing those therapy blocks through the public health system.

Heidi Trusler: Yeah, you’ve you’ve got a limit. We’re so lucky in Australia to have a community health service that will see our children and provide them with support. I mean, hopefully if your community health service is staffed, I know of plenty, especially in remote Australia and in regional Australia that don’t have staff. But if it’s staffed, it’s generally pretty great. But it’s not the solution to everything, and it’s certainly not the solution to optimal therapy outcomes. So it can be and that’s awesome. Like sometimes that’s exactly what your child need. That language and that exact therapist at that time then perfect. But I mean, I’ve worked in that setting, for a few years. And, I was lucky in my very first job to work within three different departments in the hospital so I.

Monique Martino: Could refer to.

Heidi Trusler: Myself. I just did more work so I could see my clients for a bit longer. My patients were a bit longer. Sorry, but not everybody has that capability and quite a lot of community health health professionals have huge waiting lists, and they really have a lot of people to get through. So we have to move on and make space for somebody else sometimes before you’re ready.

Monique Martino: And it’s not to say that some kids won’t make progress in that time. Like some some children will be able to make progress in that time, especially if they’re goals like really narrowing. They’ve got really strong family involvement. But for many others, many of the families that we see, ten weeks is just the first step in a really long the therapy journey. It might get the ball rolling, help families learn some strategies or gather some data, but really, it’s done and dusted after ten sessions.

Heidi Trusler: Yeah, I would say, on a very, very general and, this is where I’m general, this is not advice for you if you’re a parent listening, but very generally at what we have, you know, 90% pediatrics and 90% kids and 10% adults that we see. And our 90% of kids are the largest cohort of school aged kids. And for what, school aged kids? So that’s for 4 to 5. And to that what they’re coming to us for largely is by our data needs much more than ten sessions. So, by the time you’re calling us and you have a school aged child, that ten sessions might not, might not do it. It might, depending on what they need. But we’ll talk about that. I actually love data. I love the data that we can we can pull now as well to sort of prove this stuff. So let’s talk about why it’s so difficult for us. You know, if I’m a parent and listen to this podcast, I just have clicked on it because I want to know the cost of therapy. And then I’m listening to us talk around it and all of these things like, that’s so annoying, you know, why is it so difficult for us to predict the cost of therapy?

The Role of Family and Support Systems

Monique Martino: Well, no two children are the same. So every client comes with a different mix of strengths, challenges, motivation, attention span, home environment, support. And all of those things are factors that affect progress. So we might see two children, same age with similar speech sound errors one could master in ten weeks, whilst another one might take 12 plus months because they might have an underlying language difficulty or motor planning difficulty. And therapy is not a one size that’s all formula at all. Part of our role is really a process of like learning, generalizing, building independent. And that can really take different amounts of time for everyone.

Heidi Trusler: Exactly. You imagine you’ve got two kids or two adults. Let’s make them have exactly the same diagnosis. Now I want to talk about something that everyone sort of knows about dyslexia. It’s a more longer term one, so I can use a shorter term one in the future to be less biased towards long term therapy. But I’ve got two dyslexic kids. They’re both seven. This one has a leaves in the middle of the city, has full time working parents, has no family support. Oh, is a really fussy eater that has a tutor after school. This kid lives in the outback on a property. His mum does school with him. Grandma lives next door, collects his eggs for breakfast. He does gardening and eats spinach for dinner and doesn’t complain about it. And you know I’m going with two different. They’ve got exactly the same diagnosis, right? But the the environments that these kids are in and I know we talked about might be a good segue into support because this child had a tutor, but this child has mum teaching him, which is a good or bad thing. And, and that mum’s highly motivated and it could be one on 1 or 1 on three, depending on how they’re home schooled, if they live in the middle of nowhere, like my sister and grandma lives next door.

So that is, you know, that support is worth so much also in nutrition like stuff that’s not within our scope. That then affects the right in which your child can grow and learn and develop. All sorts of things can affect how the and now I, I don’t know, I didn’t pick one to do better than the other, but we can make a rough guess, which is what the word prognosis means.

Prognosis and Individualised Therapy Plans

Monique Martino: An educated guess, an educated guess.

Heidi Trusler: That’s better. We can make an educated guess and will generally when we can. When we put a diagnosis like dyslexia, we can get a pretty accurate one. Correct? Because you need six months of intensive, evidence based intervention before you can even get a diagnosis. And intensive means at least weekly. So that we know that from the outset, okay, if we’re looking at this type of thing, we need to do weekly, probably for 45 minutes or 60 minutes, but we know what that looks like. And we know once we get the six month mark, what we’re looking for and which step to take after that, it’s really lovely and clear because the diagnostic criteria is clear.

There are other things and I don’t know, something maybe, for example, like a stuttering presentation which everyone knows about stuttering generally as well, but there are other, presentations like stuttering where you could have the two same kids and we would not be able to give us exact more as accurate a prognosis as we would with a kid like a dyslexic kid, where we know what the criteria generally tends to be.

Monique Martino: Yeah, 100%. And I love that we talked about, you know, family being a really big factor as well.

Heidi Trusler: Yeah. Family. Family or and family being sorry we’re called pop family. But who is your family. So this this kid over here had a tutor and that would be part of their learning family. And their. Yeah. Support system and environment, because that’s a really enriching thing that that child might need to implement their speech therapy. Is it a big sister? Is it you know, so, what what impact does that make on like what? And why do we need, I guess, community or family around us if we’re going to make gains in speech therapy?

Monique Martino: I actually think it’s absolutely one of the biggest because therapy, let’s say you have a child, they’re doing 45 minutes of therapy per week, right? So that’s 45 minutes spent with the speech pathologist. But there are 10,000 minutes between sessions, right. If it’s happening weekly and even more when it’s happening fortnightly. So what happens in those minutes is what truly drives progress. And so if we’re seeing family and again, we’re saying family like your teachers, your grandparents, your people in your in your network, you know, if they’re helping the child to practice regularly using strategies in everyday routines, keeping communication open and sharing those with the therapist, you know, we do see faster, stronger results.

Achieving Quality of Life Goals through Therapy

Heidi Trusler: Absolutely. I mean, I glorify family that like I’m a mum and some things like the amount of things that you have to do when and I’m only going to take it when you’ve got a few kids is a lot. And so sometimes the best person to do that reinforcement might not be you, sometimes it might be that tutor or delegating and making sure. And so that’s what you say our speech therapists are really good at. Like who is the person? Let’s identify them. Let’s make sure we train them up. Because you’re exactly right. Therapy is going to cost less if you implement more practice or just absorb more. Outside of our sessions, we are essentially coaching and guiding you. We are not the ones doing all the heavy lifting.

Monique Martino: We are the coaches. Yeah, we are the coaches. And now we can.

Heidi Trusler: Move into my favorite analogy, which is speech therapy is just a gym workout for the brain that we put together. You come to us or you come to us. We work out which brain muscles need a workout because that’s what we’re doing. When you’re doing speech and sometimes it’s motor, that motor happens in your brain. Everything happens in your brain where working out which pathway where we’re brain retraining. And so we’re making that brain work. So where the personal trainer or the coach making that brain work. But then we’re also coaching you to make some lifestyle changes or like, oh, here’s this is how you should practice.

And so that, that family member or community member or teacher or tutor or big sister grandma, that person who picks up that nuance, they actually learn to be the best therapist for your child. So then you’ve got not only your speech therapist, but you have another therapist. And the way that our telehealth model works actually almost forces that person to be more involved. It doesn’t almost force it does. That’s why it’s such a brilliant it’s a it’s a boundary. It’s a barrier game where that person on the other end needs to do more because of this screen in the middle. And that means that they learn more about how to be a therapist. And that’s a really beautiful way to gain better results and effectively get therapy to cost less. Because if you get more results more quickly, then it won’t cost so much.

Monique Martino: Yeah, in the long run, you won’t be in therapy for as long.

Heidi Trusler: Yeah. I mean, and what’s the goal like what is the goal of therapy? Because when we talk about, you know, for example, that we’ve talked about the community health model and I a goal is largely based on budget. I mean, I see people, but for this period of time, it’s not really their goal and how get the greatest outcomes in that period of time. But it’s not like optimal outcomes. That’s not what the goal of that model is for. That is to see people who need to be saved. Like I explained in the category based type system, what is our outcome like? If you come to therapy with us, what do we actually want to achieve with you?

Monique Martino: I think we want to achieve your quality of life goals, which is what we do in collaboration, and we set those with the families. And so it looks so different from child to child, client to client.

Heidi Trusler: But that’s exactly right. How what a parent is paying for at top at the end of the day is for their child’s life to get better. That seems like a big promise. But like that’s that’s actually what we do. That’s what we’re focusing on. So, you know, I always explain this to a speech pathologist or like someone new who starts a pot by saying, so if you do this self or you do an assessment and then you just create your activities based on that assessment task, oh, that’s just my worst nightmare. Because that’s not like you’re not in corporate. You’re not being holistic. You’re not actually, you know, that’s what we want. We really want you to look at that whole person, that whole child, which is where it gets very difficult with prognosis. The whole child, the whole family. What does actually what do you actually here for? What’s going to provide value to you as a person. And how do we make sure that you find value in what goals where achieving and then once we work that out, then we can go ahead and try and hit them in hopefully the shortest time possible.

Monique Martino: Exactly. Because if they’re functional goals and they’re meaningful to you, you’re more likely going to be motivated to do the steps to support that goal, to do the home practice, to attend sessions regularly, to work closely with your speech pathologist. So and they’re all core parts of what can really affect client outcomes.

Understanding Session Length and Its Importance

Heidi Trusler: Absolutely. I mean, we’re dipping into other topics now, but I mean really this what we’re talking about functional. It really it’s neuro affirming. It’s all of those things wrapped into one. But really what we want is to provide value to the person who’s paying for speech therapy. And we want to get outcomes that you want, not necessarily that we want. So will we identify things and we’ll go, oh, I think this one would be a good one. But, we we work with you. Okay. So prognosis is a big one. We talked about that. And it’s a little bit of a how long is a piece of string situation. But we think of how long the session is. So back to the page. How long am I going to the gym full. You know, how long am I turning up to speech therapy for and at? We have 30, 45 or 60 minute sessions. What factors are important to me as a parent to think about when I’m choosing that session time with my speech therapist?

Monique Martino: Yeah, I think a lot of factors come into play. It really depends on the person they age, their attention. So, for example, 30 minutes can work really beautifully for younger children, children with really poor attention or with if or when. Maybe the therapy focus is really narrow. You know, you’re only focusing on a couple of speech sounds. 45 minute sessions are a nice, sweet spot, I think, for like school aged clients, because it does give enough time for therapy, for coaching and a quick chat. I think 60 minute sessions are really where the magic happens, where we can really delve into multiple areas and do more, deeper coaching, as well as do our assessments and reviews with our with our families.

Heidi Trusler: Yeah. You’ve just got that extra time to be a bit more well-rounded in a one hour session. 45 minutes, is an average at pop. So when if we’re pulling out, our average session length is 45 minutes. And that’s why you say it’s the sweet spot to, I think, across an industry standard. Like I interview hundreds of speech therapists. And I always ask them what the you know, what sort of session length they’re coming from. And an industry standard is that 45 to 50 minutes. So a lot of clinics don’t offer 30 minutes.

And correct the reason why we have thought about cutting it out, but we just don’t feel that that aligns with our core value of being a holistic service, which means that there are some people that desperately need that shorter time period and wouldn’t get value out of the longer one, especially people who might need more sessions. So, for example, two sessions a week and there are some conditions that really need intensity. So they need more sessions per week. And we feel strongly that the 30 minute that it’s cheaper and shorter, but it’s really needed for those. But on average people do a 45 to 60 minutes.

Monique Martino: Yeah, 45 six minutes I would say is probably what I see the most.

Frequency of Therapy Sessions

Heidi Trusler: Let’s talk about frequency because I’ve just talked about that. Oh gosh. What am I using the right the same word here. I’ve got to make sure I’m using the same word. We’ve just talked about length session length.

Monique Martino: Yeah. So duration.

Heidi Trusler: Duration. There we go. That’s my word. Duration. And then what are we going to call the next one frequency. So how often. So I’m coming for 45 minutes because that’s average I’m coming with chosen 45 minutes for my child. But how often do they come? Once a month or three times a week.

Monique Martino: So generally it can be. Well, it really depends on the client and their goals. I think weekly sessions are really ideal for like building momentum, especially when a child is learning something new like a speech, sound or decoding strategy. Fortnightly works when we’re more in the consolidation phase, so families are feeling more confident with home practice and need just a bit more kind of top up support and guidance. Monthly is better for more your long term monitoring and maintenance. For those people who are more at the end of their therapy journey. So we will adjust as we go. But weekly I would say, is best to start with optimal outcomes.

Heidi Trusler: And I find as a clinician, you know, throughout my whole career, when I had a fortnightly client, the accountability would really drop off. And unfortunately, that’s on both ends. Like as a speech therapist, if you don’t see someone for two weeks, you then you then go, oh, you haven’t been forced to think about them like often enough. And so I then struggle to remember what I was doing with them. I have to spend more time planning, I have to. It’s been so long since I’ve seen them that I may see different changes, so it actually makes it harder for me as a therapist to see that frequency. And I never really enjoyed that because weekly and know what I did last week, you’re you’ve got to see me this week. So pressure’s on for you to sort of do a home practice or to be a, you know, I’m going to ask you, how do I read that. So it in and that one week it just seemed to be like, you know, it is a sweet spot. There is research behind it as well.

But one month for example, we’ve got some people who would do monthly therapy, but it’s very small and sometimes we actually say, no, we won’t do monthly therapy. We don’t. If it’s particularly flat, we wouldn’t take someone’s money if we didn’t think it was going to get the, optimal outcomes for that person just because it fitted the budget or something, we’d rather use them, you know, we’d rather optimize a budget for the optimal outcomes, and it might not be the right frequency. There are some clients, some people especially, I’m thinking like a light talker where mums going away and doing heaps of homework, where it could be appropriate on occasion.

Monique Martino: Yeah, I think it’s really just working closely with your therapist around what is it? It’s all really around balancing that clinical need, but also family capacity. And really when you think about it from the, you know, perspective of the child and the family, I think starting weekly, even if you do have the idea, you’d need to drop to four or right, because then you can build rapport with your therapist, your child, and the family starts to build trust with the therapist. And that’s where we really see some wonderful progress happening.

Heidi Trusler: Relationships are where the magic happens. Engagement. That’s where the magic happens.

Monique Martino: Where are we going next? Where are you taking me next on this journey?

The Role of Diagnosis in Therapy Frequency

Heidi Trusler: We’re on the bus for an ice age. But where we’re taking the parents on this ride with us and we’re going, okay, so now I’ve saddled up. I’ve gone right. I might do 45 minutes. We might start with weekly, because that is generally what pop’s going to recommend. You come to us. The diagnosis of calf which is child childhood up a pressure of speech. Correct? I was like, what are the lungs for?

Monique Martino: Baby brain.

Heidi Trusler: But if you come to us with a diagnosis that we really clearly know needs higher frequency, we would say, what’s in your budget? Do you have 2 or 3 times a week because the evidence says that’s best for you? Yes. So there are specific diagnoses where we know higher frequency works better. And then there is other there are other diagnoses like a language disorder, for example, where the evidence says that maybe doing it three times a week is no better than weekly. Which is why, largely as a company, we land on a standard of weekly sessions. It would be in the beginning at least. And that’s our general recommendation, general. We’ll find it on 45.

I’m I’m the mom. I’ve always landed on 45. We’re looking at sodding weekly. I want to know how neuroplasticity maybe plays into this like the law of neuroplasticity. Does that back up any of what we’re saying in terms of frequency and duration?

Neuroplasticity and Its Impact on Therapy

Monique Martino: Oh, 100%, because it’s like one of the principles is if you don’t use it, you lose it. And so if we’re not practicing outside of sessions or we’re not seeing each other very frequently, then we’re not really using those skills. We’re not training those muscles. And then we’re not building and we’re not growing and we’re not developing. And that can really make then progress slower.

Heidi Trusler: Yeah. And and so if you don’t if you’re not familiar with the laws of neuroplasticity, go and have a look. It’s like just brain firing and wiring. And what we’re doing in speech therapy quite a lot of the time is actually building new pathways in the brain. So we do need repetition. We need reps. So that’s why I cut back, get back to the gym. We need reps. I’m not going to give strong arms if I don’t do the actual action, which is what we do in our brains. We need repetitions of those activities in order to build those strong neural pathways, which is just building a new road in your brain so that you can do stuff better.

Monique Martino: Yeah, exactly. And it’s like the electrical signals from your brain can like, jump to that skill faster and actually be able to do it because of that repetition, that ongoing, consistent, practice of it.

Heidi Trusler: If you’ve ever mastered a skill in your life, if you’re a parent listening to this, think about something that you’re good at. Where are you born? Good at it, you know, like, for me, horse riding. Did I come out of the womb a good horse rider? No, no. And hours and hours and hours and hours and half of my life as a child in the saddle of a horse. So I mean, that’s how you get good at it. You get and you fall off plenty of times, but you practice and practice and practice and practice and flex those muscles. And then all of a sudden you get better at it and you get generalization and but you know what? I haven’t done horse riding in a few years. So it’s a good analogy. Or wow, I might need a refresher. My muscles might have lost a bit of muscle memory.

Monique Martino: But then you might find that it won’t take you so long to get back to where you were, because it is because of the laws of neuroplasticity, of course.

Heidi Trusler: So my body does what it’s supposed to do and I get on a horse, but it’s my confidence. So I go all, Oh, okay. Yep, I can do this, I can do this. And maybe a better example is for adults like snow skiing or something. A lot of people have been snow skiing like once or twice in their life. And so you go and you do it once and you get carried it over a week because you do it every day and you do it all the time. But then if you don’t go for, you know, a year, like, how good are you really at snow skiing? So it’s it’s the same premise. And that’s what we’re talking about when we talk about neuroplasticity.

Determining Therapy Duration for Different Diagnoses

Heidi Trusler: Now we’re going to circle back to length like total duration because I’m a parent and I’m pushing for like I’m I am a Type-A parent and I’m putting my annual budget together, and I want to know if I can afford to go on holidays if I choose to do speech therapy. So I will try some 45 minutes. We’re going to do it coming for weekly. So my child does have a diagnosis of dyslexia, you know, how long am I doing therapy for? Is it the ten sessions? Is it two months, 12 months, 14 months, four years? Like how do we know and when? When do we know?

Monique Martino: What’s the million dollar question? And again it really depends on the goal. So like I, I guess let’s take a look at a few examples. Right. So for some speech sound goals let’s say they’ve got some typical speech error patterns. There’s maybe 1 or 2 speech areas and areas that they need to work on. They may need to take 3 to 6 months of consistent therapy to reach that kind of clear, functional speech. But then we look at literacy and we look at dyslexia. The evidence tells us that we need at least six months of structured intervention work before the diagnosis can be made, and then post that diagnosis. The likelihood of your child needing therapy past, you know, 12 months, 24 months is is higher.

Heidi Trusler: Yeah, definitely higher. And yes, you know, I’ve spent the last decade working with dyslexic kids and adults and it is so, so amazingly rewarding. You work in this area today and there is arguably no more functional skill than literacy. Just being able to read and write, you know, to walking that path with people who have not been able to do that is just, you know, it’s shocking because it’s something that I find so easy. So, it’s very humbling and great work. But the long term success that you can see and, and then when you get someone to the point, especially a dyslexic child, when you and I’m going to be careful not to talk about outcomes here, a specific examples but like not allowed to but it when you work with someone long term and you can get especially someone with a dyslexia diagnosis, you can get them to a point where you’ve achieved a lot of wonderful goals.

But what you then need to do, especially for a child who’s developing, is you need to maintain that. So I have a dyslexic child is seven, and you’re trying to teach them how to read because they can’t read yet and their peers can. So they’re down here and their peers are up here. And then over the next 2 or 3 years, you might get them to hear. And then all of a sudden, you know, they’re getting a say in English. Yeah. And their peers are, you know, I mean to say I see like, that’s awesome. I mean, we’re not training rocket scientists here. We will. And probably this dyslexic kid, is that a rocket scientist? But with him it’s just writing. So we’re getting to that point where.

But then if we drop off there, what could happen is the gap could get larger before the end of school. So we’ve got to make sure that we then and that’s where you were saying, like the monthly or there are different bespoke term by term therapies or where children can leave therapy and come back for a refresher when they need a new a new neural pathway to be built. And they’ve got a skill that’s difficult because when you get to high school, for example, there are a lot of tools that you’re allowed to introduce. Kids can use computers more and correct, and dyslexic kids can find things easier because they don’t have to actually just do the pen and paper all the time. So there and depending on your school, depending on the rules, depending on all of those things, depends on what you might need for each different stage and where the how long term that is.

But with the. For example, I have seen professional adults with dyslexia who come back to be relearned and to make their jobs easier, or to help get a promotion because they need a bit of a upskilling. And it’s a wonderful thing to be able to provide, but it’s quite long term compared to if we’re going to fix their sound.

Monique Martino: Exactly. And I think, you know, the key messaging really here is that the goals evolve as the child grows and because they know they don’t stay the same and the therapy needs to remain purposeful, but it also needs to be reviewed really regularly because sometimes, you know, the goal is not age appropriate. Sometimes the goal may be to just try and reduce that widening of that gap between where your child is and what is expected of them at school in that level.

Heidi Trusler: And quite a lot of time, what doing that does. Like, I don’t care about their results at school. I’m going to be very clear to parents. And sorry to teachers listening, but like, I don’t care. It’s so subjective. And what are we testing them on anyway? Subject matter. I mean. Correct. So it’s one way of learning and there’s so many other different ways that our brains work that we could be testing these kids on. But they’re not getting tested on.

So, you know, if it’s that rating element and it’s English class getting doing this and closing that gap a bit, what that does is it builds confidence and it builds that confidence so that when that child can leave school, when when that child is 17 and they’re choosing with me and they’re looking at the, you know, careers advice with them, mum or dad or their teacher that they don’t feel limited by what their basic skills are like. That’s my that’s my quality of life dream. Optimal outcomes for that, for this hypothetical dyslexic child that we’re talking about. So yeah, mean if they’re privately paying they could have spent thousands and thousands of dollars and been in therapy forever. And that would be forever. Not forever that from assess to the point where they have the confidence to choose what they truly want in life and they aren’t restricted by that literacy difficulty.

Monique Martino: Yeah, by that reading difficulty or that spelling difficulty 100%.

Family Support and Financial Considerations

Heidi Trusler: We’re back to how long for a piece of string? But I hope that we’ve explained that really well to parents. Let’s just circle back to family support. If I’ve got all of these things going for me. And do you know what I like to do with parents and speech therapists? I should probably do this too, is I like to say hypothetically, and I use Oprah because Oprah is like this really big, positive energy. You get a car, you get a car, you know, sorry if I was Oprah. I like to do this with the family, if I was Oprah, or if you are if you were Oprah. This is what I tell you you need. So it means if there was no financial barrier as a allergist, what would I recommend? And that’s an interesting exercise because you’re generally not getting go there. Sometimes you can though.

Monique Martino: And so you shouldn’t make the assumption that the parent is not going to prioritize that, especially if they’re paying for it out of pocket. You have no idea what their finances are. They might go, we could do that. Or, I’ve worked with families who I have replaced the English curriculum for their child and I’ve worked with their teacher, and I have become that class in school. They’ve done my homework. And so I’ve become quite a big part of their either homeschooling or working with their traditional school. And that’s a really big help to the teacher to help with that individualized learning plan. And it was a huge investment in, you know, that particular child’s confidence to be able to structure it that way. So you just never know.

And I think it’s really important to to to throw that Oprah scenario out there too, because you can always pare it back and move backwards to what you can afford. So we’ve talked about so many factors today that influence the cost of speech therapy. Essentially arguably the biggest one is your budget. Like we didn’t even talk about that. But like what is your budget? Are you Oprah? You know, you could be that’s great for you, but you need to talk with your speech therapist about what you’ve got to work with. NDIS is really clear on this. Like this is the budget. This is what you’ve got to work with. And so then you can make the best plan for how to best get those quality of life outcomes and how to best gain that confidence for you or your child. Next, I think, is prognosis. It’s come up in every question that I’ve asked you today.

Prognosis and Setting Realistic Expectations

Monique Martino: Yeah, because it’s a big is a big driver of cost.

Heidi Trusler: And so can you just summarize prognosis for parents like to make it really easy.

Monique Martino: I guess prognosis is really just the likely pathway of how much improvement we expect. And, you know, the journey it takes to get there and how long it might take to get there. And we’ve talked about how it’s influenced by lots of different factors, and it’s not about predicting it perfectly. It’s about setting, you know, realistic expectations and tailoring therapy so that it’s really meaningful.

Heidi Trusler: And something we didn’t talk about to do with prognosis is that there are checkpoints along the way that can really, really help with budgeting and prognosis. So at the beginning, on the parent I’ve I’ve come so I pop we do a discovery call. So I’ve called up I’ve talked to the speech therapist for 15 minutes. She’s told me she thinks my child needs speech therapy. So then I book in I make my speech therapist. Time and again I’ve meeting you. We do an initial consultation and then an assessment. Now, depending on whether I’ve already had assessment somewhere else. And I’m bringing that to you or I’ve had no assessment or I’d like not to do assessment. You don’t have to do standardized assessment at pop. You know, have to purchase a report. We can do what we call a dynamic assessment, which means we can just get started and see where you’re at.

And so but that is still an assessment phase. That’s a getting to know you phase getting to know what our goals are. So I would just really broadly, roughly for parents say that that phase takes anywhere from 3 to 6 sessions. That’s where we really see a solid kind of sense of what’s driving the difficulty and how responsive the child is to the therapy. And, and or as an adult. How I mean, if you’re an adult, I might take less because you’re able to communicate for yourself. You’re able to tell us your budget. I like all of these things. But if you’re if you’re bringing your child, it might be 3 to 6 sessions.

So if you’re thinking like initial outlay paid for the 3 to 6 sessions, then there’s a checkpoint and you can sort of say to your therapist, okay, like you’ve got a fair idea of what the picture looks like now. How long until we sort of reach this benchmark or this goal? And we’ve got short term goals, which is like 3 to 6 months. We’ve got long term goals, which is like 12 months, but then we’ve got quality of life goals. We could hit some of those within that 12 months. We don’t know. We could need to reach for longer, but at that point your therapist has a better idea and they are probably going to be able to be able to stretch you out to what they think the next checkpoint is from there. And so I think that that’s maybe an important one for budgeting is to say to a therapist, hey, is this a checkpoint where we can talk about how long this next bit’s going to take, and they should know?

Monique Martino: Yeah, I think it’s really just a point of trying to figure out, like, you know what we know at this point in time and what we kind of could predict could happen over different parts, whether that’s term lay or whether that six month lay, you know, it can vary per child and what kind of goals that we’re trying to achieve with them.

Heidi Trusler: And what I like to say to parents is, okay, so if we haven’t achieved this by this time, this is probably going to be my plan. Yes. But if we have achieved it, this is going to be my plan. And the final piece of the puzzle is and one of the main predictors is. How much you practice. Yes. We’re back here. Neuroplasticity. So it’s going to wrap up on this episode how much this therapy cost. It’s largely impacted by how much work you do I guess.

Monique Martino: Yeah it’s it’s it’s the 10,000 minutes between sessions and how you choose to spend those. And being able to do as much home practice and, and even just embedding some of the strategies into everyday routines, that’s home practice in itself.

Heidi Trusler: Incredible. Thank you so much, Winik. I think that this episode is going to be highly valuable for parents. No pun intended. No pun intended. But, but hopefully I’m not sure if we even need to do when we had examples in here today as well. I think we might need another episode for examples, but we will say it’s just such a complex discussion. But hopefully this gives parents a really good place to start and a springboard to have a really meaningful, winning conversation with their therapist about how much that break achieving those quality of life goals is going to cost for them.

Monique Martino: Yeah, and really, just hopefully we also empower parents to really build those partnerships with the therapist and talk it through.

Heidi Trusler: Yeah, absolutely. Yeah. I hope you enjoyed this episode. Don’t forget to head over to the Shownotes to get your free snapshot of what affects the cost of speech therapy. Plus, follow for more episodes. I really wish that we could have given you a set framework or price guide to answer this big budget question. However, hopefully we explain just how complex and individualized the ongoing costs of speech therapy can be and can vary from person to person. If you have any questions about how much speech therapy costs, you can always book in with a pop speechie for a free discovery call. We’d love to hear what other topics you’d like us to cover. You can reach me by leaving a comment on our podcast app, or sending us a DM on Instagram or Facebook. Our handle is @BeyondWordsbypopfamily. That’s all one word.

I’d also like to take a moment to acknowledge the traditional custodians of the lands in which we are joining this meeting from today. As we connect virtually, we recognize that we gather from many different places across Australia, each with its own unique history, culture and connection to country. We pay our respects to elders past and present. Please also remember if you or your child are facing challenges in the areas we discussed today, please seek an individualized speech pathology assessment or chat to your GP. This is not medical advice. Take care and we’ll catch you in the next episode.