Eli's Rehab Report

Learn easy ways to keep business knocking at your door.

National Stuttering Awareness Week last month may have perked your attention. You might be asking: Could I be doing more with stuttering in my practice? Can stuttering work be profitable? Am I using best practices? Get tips that'll steer you in the direction of a revenuegenerating niche.

Nearly 5 percent of all children go through some period of stuttering, according to a press release from the American Speech-Language Hearing Association.And some children stutter into adulthood. But does your community know what stuttering really is and that you're available to help? Chances are, your community doesn't know enough, so start educating.

First and foremost, "a professional informative website is imperative in this day and age to market your business," says Chamonix Olsen, MS, CCC-SLP, BRS-FD, SRP coordinator for the Specialty Board on Fluency Disorders at the American Institute for Stuttering Treatment & Professional Training, a non profit organization based in New York.

Try this: "Presenting at area preschools is a way to educate more people about stuttering," Olsen says. Plus, you'll develop "a personal connection between your business and those who may end up referring to you."

Share with parents risk factors so they know when to bring a child in for a speech screening. The ASHA press release named the most prevalent:

• Family history. Almost half of all children who stutter have a family member who stutters.

• Age at onset. Children who begin stuttering before age three-and-a-half are likely to outgrow stuttering.

• Time since onset. Between 75 and 80 percent of all children who begin stuttering will stop within one to two years without speech therapy. In most children, stuttering tends to decrease after the first six months.

• Gender. Girls are more likely than boys to outgrow stuttering. In fact, three to four boys continue to stutter for every girl who stutters.

• Other speech and language factors. A child who makes frequent speech errors such as substituting one sound for another or leaving sounds out of words may be at greater risk.

Educate your referral sources, too. "Contact local physicians and let them know that you are interested in serving people who stutter," suggests Jane Fraser, president of the Stuttering Foundation.

Other possibilities: If you have a community college or other higher-education program in your city, see if its  student services have a program for students who stutter, Fraser adds. "You can also participate in local health fairs or other community events where you have an opportunity to market your business."

If you need brochures for community education, you can download Stuttering Foundation materials at www.stutteringhelp.org.

SLPs often don't have enough experience working with people who stutter, so start educating yourself, too. "SLPs have many resources available to them to build their knowledge, skills, and confidence in working with people who stutter, via conferences, self-study programs, and professional networks," Fraser says.

An SLP inexperienced in stuttering therapy misses more than just best practices; they also can miss "important therapy outcomes that extend beyond changes in fluency," Fraser says. A common example she offers is the patient who expects the speech therapy to "cure" their stuttering. When that doesn't happen, the SLP feels he's failed the patient or that the therapy doesn't work.

"Seeing the patient as a whole communicator is critical," Fraser says. "What are they doing well? What should they be doing more of? What other communication needs besides increased fluency will make him or her a better communicator?"

Get a leg up on competition: Construct opportunities for patients to transfer and generalize their newly learned skills and attitudes, Fraser recommends. Many SLPs don't think to do this essential therapy component, she says.

"Include self-advocacy goals, opportunities to involve friends and family members, and real-life communication situations that the client might experience at work, home, or school."

Getting insurance to cover stuttering can be "a real challenge," Olsen admits. "This can vary from total rejection to covering only a few sessions." So take a long, hard look at your business model, and decide if taking insurance for stuttering services is worth it.

If you do file insurance and hit problems, write a letter to your payer to support why it should cover the treatment.To read a copy of a successful letter Olsen wrote, e-mail the editor at rehabreport@gmail.com, with "stuttering letter" in the subject line.

Important: Don't let simple errors jam your reimbursement. Often the SLP documents the person's level of stuttering speech (e.g., percent of stuttered syllables), but fails to mention the functional impact, points out Nan Bernstein Ratner, Ed.D., CCC-SLP, FASHA, professor and chair for the Department of Hearing and Speech Sciences at the University of Maryland.

Tip: Use an evaluation tool, such as the OASES (Overall Assessment of the Speaker's Experience of Stuttering [Yaruss & Quesal]) to document functional impact on everyday function, Ratner suggests. For more information on coding and billing for stuttering, see the next issue of Rehab Report.