The availability and adequacy of
speech pathology services in Australia
The previous chapter provided considerable anecdotal evidence of long
waiting lists for speech pathology services in Australia. The committee
received many accounts of people with speech and language disorders and their
carers wanting to access a speech pathology service but being unable to do so.
The problem appears particularly acute in regional and regions areas of
Australia where in some cases services simply do not exist.
This chapter's key theme is the logical extension of these problems: the
supply of speech pathology services—particularly in the public system—has been
unable to keep pace with demand. A recurrent theme in the submissions from
adults, the parents of children with speech and language disorders, speech
pathologists and peak bodies, has been the lack of adequate speech pathology
services in Australia. In many cases, this has meant long waiting lists to see
a speech pathologist in the public system, long travelling distances for people
living in regional and remote regions, and the expense of private services for
those who can afford it. The cost for a visit to a private speech pathologist
generally exceeds $150 for an hour's consultation.
The chapter looks at the following issues:
data on the number of speech pathologists in Australia;
the gaps in speech pathology services in Australia including;
the waiting lists for children to access services;
the supply shortages in regional and remote areas;
the service delivery model in residential aged-care homes;
the provision and adequacy of private speech pathology services;
the committee's recommendations to investigate these supply
The committee does note that despite widespread concerns with the long
waiting lists for public services and the cost of private clinicians, there was
very little disquiet about the quality of these services. Indeed, many
submitters to this inquiry made a point of commending the quality of the
services that they or their child received.
The number of speech pathologists in Australia
The demand for speech pathology services in Australia clearly outstrips
supply of these services. However, the exact number of practising speech
pathologists in Australia is not known. Speech Pathology Australia (SPA)
explained that the data gathered through the Australian Bureau of Statistics (ABS)
Census groups speech pathologists with audiologists. The Australian Health
Practitioner Regulation Agency (AHPRA) does not gather numbers either because
speech pathology is not a registered profession.
SPA currently has 'just over 6000 members'.
SPA estimates that this is 'approximately 70 percent of the total number of speech
pathologists in Australia as members'. If this is accurate, there are around
8,500 speech pathologists in Australia.
The 2011 ABS Census found that there were 5,295 speech pathologists in
Australia. This number had increased from 2,322 in 1996, 2,984 in 2011 and
3,867 in 2006. The increase in the five years from 2006 to 2011 represented a
37 per cent increase.
Numbers by state and territory
Table 5.1 shows the distribution of speech pathologists by state and
territory and by 100 000 of population. As a proportion of the population,
the two territories have significantly fewer speech pathologists.
Table 5.1: Number of speech pathologists
No. per 100 000 of population
Source: Health Workforce
Australia, 'Australia's Health Workforce Series, Speech Pathologists in focus',
July 2014, p. 14. Data drawn from 2011 Australian Bureau of Statistics National
Sector of employment
SPA found that as of July 2014, 52.5 per cent of its members were in
private practice, 33 per cent were in public practice and the remainder were
employed in a combination of both public and private practice (see Table 5.2).
In NSW, Victoria and Western Australia, more SPA members reported working in
private practice than in public practice.
Interestingly, two-thirds of SPA's New South Wales members were employed only
in private practice. In Queensland, South Australia, Tasmania and the
territories, more SPA members reported being in public practice than in private
Table 5.2: Public and private speech pathologists by state and territory
Private practice only
Public practice only
Public and private practice
Source: Health Workforce
Australia, 'Australia's Health Workforce Series, Speech Pathologists in focus',
July 2014, p. 17. Data drawn from Speech Pathology Australia data.
The 2011 ABS Census found that 43 per cent of speech pathologists worked
in the public sector, and 57 per cent in private practices. In the 2006 Census,
the ratio was 41 per cent public to 59 per cent private. However, in the 1996
and 2001 Censuses, there were more speech pathologists employed in the public
system than in the private sector (see Graph 5.1).
Graph 5.1: Number of speech pathologists—public and private sectors
Source: Health Workforce Australia, 'Australia's Health Workforce
Series, Speech Pathologists in focus',
July 2014, p. 6. Data drawn from 1996, 2001, 2006 and 2011 Australian Bureau of
Statistics National Censuses.
Numbers in remote areas
This chapter presents the committee's evidence on the shortage of speech
pathologists in regional and remote areas of the country. Table 5.3 shows that
the ratio of speech pathologists to population falls in areas with less density
Table 5.3: Speech pathologists in Australia by region
No. per 100 000 of population
Source: Workforce Australia,
'Australia's Health Workforce Series, Speech Pathologists in focus', July 2014,
p. 15. Data drawn from 2011 Australian Bureau of Statistics National Census.
A female-dominated profession
Speech pathology is a female dominated profession. Ninety-eight per cent
of SPA's members are female. There is a relatively high attrition rate for
speech pathologists—13 per cent. The contraction of the full-time workforce
peaks at 10 years post-graduation when many speech pathologists move from
full time to part time work due to family commitments.
Gaps in speech pathology services in Australia
There are significant gaps in speech pathology services that are available
in the Australian community. In its submission, SPA noted the following gaps:
it is not standard to have a speech pathologist within the care
team for special care of infants in nurseries;
New South Wales, the Northern Territory, the ACT and Western Australia
either have no speech pathology services in their public school systems or very
there are very few specialist speech pathology services for
only 4.5 per cent of speech pathology practitioners provide
services to rural communities which constitute 30 per cent of the total
the lack of speech pathologists in the residential aged care
This chapter presents the committee's evidence on the extent, nature and
impact of these gaps. The particular focus is on the evidence of long waiting
lists for children and the need for a more effective system of early
Long waiting lists for children to
access speech pathology services
Chapter 2 of this report noted the importance of early diagnosis and
treatment of speech and language disorders. For young children with speech and
language disorders, early intervention is crucial to the long-term well-being
of the child. The long-term benefits to children from early and effective
diagnosis are significant. Where there is no intervention, or delayed
intervention, the costs to the child and to society can be significant.
Many submitters and witnesses to this inquiry emphasised that long
waiting lists for children to access speech pathology services compromises the
benefits that could be gained from therapy and treatment. Further, some argued
that even when a child does access a service, the pressure on the system often
leads to limits on the service.
In the public system, the basic issue is inadequate resources and too
few speech pathologists to cater for the demand for early intervention
services. This is a problem nationwide. A submission from Associate Professor
Patricia McCabe, Associate Professor Kirrie Ballard and Dr Natalie Munro, reported
on the results of a 2010–11 Australia wide survey of parents of children who
require speech pathology services. The submission stated:
Parents reported being on long waiting lists with 25% waiting
more than 6 months and 15% waiting more than 1 year for assessment and 18%
waiting more than 1 year after assessment for treatment. Qualitative responses
revealed concerns such as; a lack of available, frequent, or local services,
long waiting times, cutoff ages for eligibility, discharge processes, and an inability
to afford private services. Overwhelmingly they were happy with their treating
speech pathologist and unhappy with the frequency, length and total number of treatment
sessions received. Parents in regional centres, and rural and remote locations were
more likely to have difficulty accessing any services including private
Associate Professor Michael McDowell from the Neurodevelopment and
Behavioural Paediatric Society of Australasia emphasised in his submission that
early intervention 'works'. However, their doctors are frustrated because
speech pathology services in the public systems are 'completely inadequate'.
The resources are distributed across multiple government departments (health,
education, disability services) both state and federally. He argued that no
department takes responsibility for the problem at a community level and the
resources devoted to screening, assessment and treatment services are
inadequate. As a consequence, Associate Professor McDowell argued that:
There exists currently a sad 'Catch 22' that results from
this situation. Waiting lists for therapy assessment and particularly therapy
intervention services are so long that by the time children get to the top of
the list, they are no longer eligible as they are too old.
The availability of speech
pathology services for children in Victoria
The committee received several oral and written submissions from Victorian
submitters about the availability of speech pathology services in the state. At
the public hearing in Melbourne on 11 June 2014, Professor Sheena Reilly
from the Murdoch Children's Research Institute at the Royal Children's Hospital
commented on work that the Institute in currently undertaking to map the
location of speech pathologists against areas of socio-economic disadvantage
and developmental vulnerability. Professor Reilly told the committee with
reference to one of these maps:
This is some mapping work we have been doing on services in
Victoria, and this could be repeated over every state in the country. This is
done in collaboration with Megan Harper from the Department of Education and
Early Childhood. What it shows you is services mapped across the Melbourne
area. The blue dots are private speech services, the green dots are public
services and the pink dots are early childhood intervention services. You can
see that there is a chronic inequitable distribution of those services and it
mirrors what Gail [Mulcair from Speech Pathology Australia] was talking about
earlier, the explosion in private services but also where those services are.
They are in our very rich south-east corridor of Melbourne where people can
afford private services. These services have been mapped onto disadvantage
across the Melbourne area. The most disadvantaged areas are the red and orange,
and that is not where our services are...
Professor Reilly referred to a second map (which was also provided in
MCRI's submission and is reproduced as Map 5.1, below) which shows where
children are most developmentally vulnerable according to their language and
their cognitive skills. Professor Reilly explained that:
the red and the orange again are the vulnerable areas and you
can see that that is not necessarily where our services are...
That tells you something about services—and that is something
we have got a lot of information about and should be doing across Australia.
That information about children exists; it is not something that we have to go
out and create.
Map 5.1: Location of speech pathologists, Melbourne:
Source, Submission 161, p. 10
The committee received evidence from other submitters that corroborated
the findings indicated in this analysis. A Melbourne-based speech pathologist employed
in both the not-for-profit and private sectors wrote in his submission:
I believe that there are inadequate speech therapy services
for children up to the ages of 6 that are funded by the Commonwealth, state,
and local governments. This is especially the case in the Western Metropolitan
Region of Melbourne where there are many families who fall within the lower
socio-economic bracket. There are many children who will be waiting on lists
for service for extended periods. By the time it is their turn, they may be
going to school, thus missing out on earlier intervention.
It is important that children are able to access early
intervention- specifically for speech therapy (I am not confusing it with early
intervention where children have multiple areas of delays) as it can impact on
future development. This in turn can also have a negative impact on their
education and self esteem.
The committee asked Professor Reilly whether she had plotted these
services for other Australian cities and regional centres. She responded:
No, we have only done it for Melbourne and parts of Victoria
so far. It could very easily be done; we have geographers across the country
who could do that for us.
The committee believes that as a visual representation and as a guide
for policy-makers, this mapping exercise is very useful and should be conducted
across the country (see recommendation 4, below). It would also be useful to accompany
the location of public speech pathologists with information on the length of waiting
lists for each public speech pathology centre.
The maps show that there is very little by way of public speech
pathology services in the Frankston area in the city's south-east. There is an
Early Childhood Intervention Service in Frankston. The Peninsula Model for
Primary Health Planning—Children's Health Alliance and Frankston–Mornington
Peninsula Medicare Local noted in its submission that Early Childhood
Intervention Services (ECIS) typically have a 6–9 month waitlist. In the Frankston–Mornington
Peninsula catchment, the key ECIS providers are Biala and Noah's Ark. The Peninsula
Model noted that for Biala 'waiting times tend to run at 12 months'.
Peninsula Health (PH) is the public provider of hospital based and
community health Speech Pathology services in the Mornington Peninsula. These
services are delivered through Frankston Hospital and the Frankston, Hastings
and Rosebud Community Health Services.
The Peninsula Model stated that the waiting time for Speech Pathology at
Frankston Hospital is 2 months for an initial screening assessment up to a maximum
wait time of 12 months. It added that two-thirds of children are offered group
therapy while they wait for individual therapy. In terms of Peninsula Community
[T]he waiting times...are...currently running at 14 months. Long
waiting times significantly impact on the ability of families to put measures
in place that will enhance the child’s ability to develop and learn.
Developmental delay is not usually identified until 2-3 years of age offering
only a small window of opportunity to provide early and effective intervention
that will enhance school readiness and improve a child’s learning experience.
The Peninsula Model submission noted a number of other challenges
associated with the lack of speech pathology services in the catchment area.
Many children from vulnerable communities are referred for
therapy mid-way through their preschool year when their delays are identified
by a preschool teacher. They receive some but limited speech pathology support
prior to school entry. Follow up support for these children at school is
essential to assist them to succeed academically. However the service system
for school aged children is different and requires children to transition to a
new system with different eligibility and priority criteria. This can be
difficult for parents and carers to understand and to navigate, and disrupts
continuity of care...
Public services experience long waiting lists for Specialist
and diagnostic services that assist Speech Pathologists plan and deliver
appropriate interventions, such as specialists services that diagnose Autism
Spectrum Disorder or similar...
High demand on public services reduces their capacity to
provide best practice care in the child’s natural environments by outreach.
Centre-based services are the norm; outreach to natural environments is
strictly limited in an effort to stretch resources.
The Peninsula Model's submission also stated that the recommended ratio
of qualified speech pathologists to students in Victoria is one for every 733
students. On this basis, it noted the need for:
...a further 744 Speech Pathologists within Victorian
Government schools (DEECD) alone. In 2012 there were 140 full time positions in
Victorian Government schools, funded by DEECD. This represents a significant
unmet need. By way of example, the current ratio of Speech Pathologists is
1:4512, or six times less than the recommended norm.
The availability of speech pathology services for children
in New South Wales
A submission from NSW Health identified some of the key features of the
availability of speech pathology services in New South Wales. These are as
as at June 2013, 527 full time equivalent Speech Pathologists
were employed in the NSW Public Health workforce representing six per cent of
the total allied health workforce employed;
the average age of Speech Pathologists in NSW Health is 35.4
years and the speech pathology workforce is dominated by female practitioners;
the speech pathology workforce is predominantly part time with
the average number of working hours being 24.7 hours;
speech pathologists are often sole or lone practitioners in a
facility or service (particularly in rural and regional districts). As a result
arranging coverage for leave is often difficult although allied health locum
schemes go some way to assisting with leave relief; and
'due to the large proportion of part-time, temporary and locum
Speech Pathology staff, managers’ report challenges in ensuring there is an appropriately
skilled workforce to cover all clinical areas'.
Interestingly, NSW Health commented that its own modelling indicates
that available supply of speech pathologists:
...is adequate to meet projected demand based on the assumption
that there is no initial workforce shortage, no inward migration, and new
graduates, re-entry and wastage/loss percentages remain constant.
However, the assumption of no initial workforce shortage in the
State is clearly not accurate, as the following evidence attests.
A speech pathologist working in community health in western Sydney made
the following comment on waiting lists in her submission:
At the centre I work all waiting lists are between 8-12
months long. This is an unacceptable time for a child with a communication
impairment to have to wait to receive a service. This is particularly so for
those children who are in the year before school. Research has shown that these
children are at a significantly increased risk of continuing academic, social
and attention difficulties throughout their years of schooling (McCormack et
al, 2009). Our waiting lists mean that even if a child is referred in the year
before they commence school, it is very likely they won’t receive an assessment
appointment until they start Kindergarten. Lengthy waiting lists are also
detrimental to staff job satisfaction. Although working extremely hard and
trialling various strategies to address wait list times, minimal success has
been achieved in this area. As a result there is a constant feeling that
despite working hard, an effective and timely service is not being provided.
Unlike most other Australian States, New South Wales does not have
speech pathologists attached to government schools. This was a source of both
surprise and frustration for many parents of school-aged children in New South
Wales needing speech pathology services. The father of a young son with
developmental delay who is attending a Sydney kindergarten. He wrote in his
I was very disappointed to learn that his current school only
supplies a support teacher, not a speech therapist. His kindergarten teacher
recognised his developmental delay without our mentioning of it.
As school is in the northern beaches Sydney area, I enquired
as to whether we could transfer his public hospital speech therapy from
Sydney’s Eastern suburbs where we live to his Northern Sydney school area so
that there would be less disruption with his school attendance.
The head of speech therapy for the Northern Area Health
kindly returned my call and apologetically explained that they could not
provide public hospital speech therapy services to children whose residence it
outside the Area Health Service despite being schooled within the Area.
She also explained that once children turn five years of age
in her own Area Health jurisdiction and commence school, speech therapy is
discontinued unless desperately needed. The reason for this sudden cut-off, as
she explained, was because of limited funding resources from the State and
Federal Governments. She respectfully declined to offer speech therapy
services. I can’t remember how many times she apologised for declining my
What alarmed and puzzled me was that this head of a
government department informed me that NSW was the only state/territory that
did not have a speech therapist attached to each school.
Professor Mark Onslow from the Australian Stuttering Research Centre
highlighted the inadequacy of services for children with stuttering
difficulties. In many cases, he noted, the pressure of needing to address the
backlog in demand led to shortcuts in treatment. As he wrote in his submission:
Clearly, then, the speech pathology profession is under
resourced to manage the public health problem of early stuttering. At present
there is evidence that speech pathologists and managers of speech pathology
health care services, by necessity, respond to the shortcomings of treatment
services in unproductive ways.
The latter report was a survey of 277 Australian speech
pathologists, around half of whom said that they responded to waiting list
pressures by taking shortcuts with proven, treatments for early stuttering.
Those shortcuts involve providing treatment “blocks” of 12 weeks per child
rather than the complete treatment, treating in groups of children rather than
individually, and giving treatment sessions less regularly than each week. Such
compromises will likely damage the educational, occupational and psychological
wellbeing of children who consequently stutter later in life.
In short, current knowledge is that early stuttering is a
prevalent condition with possible lifetime consequences, with proven treatment
methods but without adequate treatment services. Planning and implementing
reform of public health care speech pathology services for stuttering is
Mr Roger Blackmore, a developmental paediatrician working in the public
system in Sydney, argued that the prioritisation of young children has meant
that waiting lists can be longer for older children:
Whilst local community allied health speech pathologists are
available they have to prioritise younger preschool children for intervention.
Waiting times can be extensive for older children however who may have
presented late or missed intervention when younger due to their vulnerabilities
such as out of home care and social disadvantage.
Ms Kirsten Wright, a speech pathologist at the Mount Druitt Community
Health Centre, also drew the committee's attention to the deleterious effect of
waiting lists on a child's development. As she explained:
...waiting times for publicly funded services are often
compounding the children’s initial speech and language difficulties. If a child
is not referred for an assessment until they begin school, at the age of 5
years, and the waiting list is two years long (which is not uncommon in my
local health district and surrounds), the child may have missed that crucial
period for developing their sounds and language in order to support the
development of their reading skills (a foundational skill for education). Even
if they could be re-referred for another block of therapy sessions, by then
they are likely to be over the age of 8 years and would no longer be eligible
for the service. The one short block of sessions is not an adequate service to
address all the issues that are present for children with moderate or more
severe speech and language disorders, in my experience. There is often only
time for one set of goals, especially where the parents are not able to
adequately engage in providing support for these goals in the home environment
due to the many stressors that are associated with being in a low
socio-economic area (low education overall, single parenting is common,
financial pressures, higher than average numbers of children in the family and
other social pressures). I have observed many of these factors in the client
group I have worked with.
Ms Wendy Yarrow, a Sydney-based speech pathologist, put a similar view
in her submission. She noted the difficulty for school aged children to receive
community-based speech pathology services:
In most hospital and Community Health Centres priority is
allocated to children aged 0 to 5 years, that is prior to school entry. I
fundamentally support providing Speech Pathology services to support Early
Intervention and agree it should be a priority. Unfortunately, due to the limited
funding for Speech Pathology services, early Intervention is provided at the expense
of Speech Pathology service provision for school-age children. In some instances,
school aged children are not offered any Speech Pathology assessment or therapy
services and the most some children are offered an assessment only or an assessment
and one block of 6 to 8 weeks of therapy in total. Consequently, if parents
want their school aged child/children to receive Speech Pathology services they
must be able to pay for services from Private Speech Pathologists or other fee
for service Speech pathology providers, such as, non for profit organisations.
Mr Robert Ieroianna, the principal of Parramatta East Public School in
Sydney, argued that in his experience, delays in treating children for speech
disorders affected their learning development relative to their peers. As he
wrote in his submission:
Currently in our school, which is a medium sized primary
school in metropolitan Sydney, we have a number of students in need of speech
support. Most are waiting on a long public health waiting list for assistance
to obtain speech services. I am told that in Western Sydney, the wait for
speech support through the public health service is approximately one year. For
private speech therapy, costs can be very prohibitive for many families living
in our school community. Without exception, the evidence in our school
indicates that the greater the delay from referral to actually receiving speech
therapy support, the greater the learning gap between that child and others at
the same stage of learning.
Mrs Susan Gardner of the New South Wales Department of Education and
Communities also emphasised the opportunity cost for a child having to wait for
an extended period of time to receive therapy:
Families who are on a low income place their child's name on
a waiting list for Government assisted services. The current wait on these
lists is about eighteen months to two years. This support stops at age eight.
This means that even if a child's name is placed on the list by the parent, GP
or school on day one in Kindergarten, it could take until Year 2 for the child
to come to the top of the list to be offered the services. That means that
there are two years of 'nothing'. Schools and parents are left to do the best
that they can for the child or children. There are six Medicare assisted
sessions that can also be accessed for these children.
The availability of speech pathology services for children
The committee received several submissions from parents and speech
pathologists in Queensland about the state's shortage of speech pathology
services for children. The mother of a five year old boy living in south-west
Brisbane expressed her frustration at the long waiting lists to access the
My son is 5 years old and has childhood apraxia of speech
resulting in significant speech and expressive language difficulties. At the
age of 2 I was aware of his lack of speech, and sought a referral from my GP to
see a Paediatrician. This was followed by several hearing tests to determine if
this was the problem, but all was clear. Then we started Speech Therapy. The
waiting list in my local area for the Child Development Service in suburban Brisbane
was a year, in fact I waited 18 months. I received 6 sessions, and then the
speech therapist contract was not renewed. We were informed it was another 6 month
wait!!! We transferred to another Centre again waiting, and in all received 14
sessions until my son was no longer eligible since he was starting school. So in
the course of 3 years we received 20 free 30 minute sessions with the Child Development
service. During that time both centres always operated below capacity. Numerous
consulting rooms were vacant. No staff appeared to work fulltime. In view of
the fact that the waiting lists showed there is a significant demand for their
services, it is appalling that the Queensland health service operates their
Children’s Developmental centres like this. The amount of therapy received was
inadequate for my son leaving him not equipped to attend Prep. at the age of 5.
The short supply of speech pathology services was also reported in
rapidly growing regional areas of the State. Ms Katherine Osborne from Gold
Coast Speech Pathologists lodged a submission to the inquiry, co-signed with
ten speech pathologists from various Gold Coast practices. In it, she estimated
that there are 71 960 people needing speech pathology on the Gold Coast
(14 per cent of the population) and only 100 or so speech pathologists (50
private and 50 public), leaving 'only one speech pathologist to support 719
people'. She added: 'This is an impossible task'.
The Gold Coast Speech pathologists' submission provided data indicating
that the Gold Coast is the worst region in Queensland in terms of access to
speech pathologists. It has only 19 speech pathologists per 100 000
compared with an average of 27 in other areas of the State. It argued that as a
...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
The committee is interested in whether the Queensland average of 27
speech pathologists per 100 000 people is low on a national basis. Again,
the committee makes a recommendation (below) to map language support services
across Australia in a way that will provide information on the number of speech
pathologists per number of people by region.
The committee received a submission from another Gold Coast based speech
pathologist, which gave the following example of the problem of waiting lists:
This child ‘E’ was first referred to Community Health speech
pathology at the age of 2 ½ years. His own parents had difficulty understanding
more than approx 50% of his speech. This is a very low rate of intelligibility
by any measure. As time wore on without an appointment being offered, they went
to a centre for dyspraxic children (Max’s House) in Brisbane which is at least
an hour from the Coast by car. The fact that he was treated there is an
indication of the severity of his speech difficulties. Eventually, the parents
couldn’t continue to make the journey and they sought local therapy. I was able
to take him on & I treated him over approx 2 years. I discharged him from
therapy late last year after he’d made excellent progress, not just in speech
but in early aspects of literacy which were targeted simultaneously.
As for his referral for a Govt service with Community Health,
his name came to the top of the list 21 months after it had first been placed
there. ‘E’ was already experiencing psychological difficulties when he first
started with me and his parents attributed this mostly to his intense
embarrassment & frustration at not being understood. These difficulties
faded as he made progress with his speech & had disappeared a long time
before his therapy ended but after he became easier to understand.
The Glenleighden School
Despite the many frustrations of parents and clinicians in Queensland
with lengthy waiting lists and the impact that this wait was having on
children's development, there were positive stories. One in particular is the Glenleighden
School in Fig Tree Pocket in Brisbane.
Box 5.1: Parents on the Glenleighden School
I was made redundant at work and I happened to
come across an online job at The Glenleighden School in Fig Tree Pocket,
when I started reading up on the school and that they specialised in
Primary Language disorder I sat there and cried. I was amazed that here was
a school on my doorstep that could help my daughter, I knew instantly, but
why had I not heard about it from my doctor, the speech pathologist, kindy?
...My daughter was accepted and started at Glenleighden in April 2010 and has
come on leaps and bounds since joining this magnificent school. Submission 156, Name withheld
Finding Glenleighden was like finding an oasis in
a desert of confusion, uncertainty and grief. Here at last was a place and
a group of people who "got" her – an organisation which
recognised her hidden disability and was able to offer an adapted,
multidisciplinary program that was tailored to her individual needs. The
absolute key to the improvement we saw in once she started at the school was
that the speech pathologists, occupational therapists, physiotherapists and
special education teachers all worked together implementing a joint plan
based on their combined assessment of requirements. Apart from hands on
therapy, Glenleighden also offered information, care and support for us as
parents – a port in the storm of emotion and fear arising from years of
investigations and hypotheses. We were only just beginning to comprehend
the extent and the complexity of the challenges that lay ahead – not just
for but also her brother as well as my husband and I. I can't tell you the
number of times over the years during which **** has attended Glenleighden
that I have seen the same look of absolute relief on the faces of new
parents when they realise the gem they have found in this unique school.
Their gratitude, like ours, is palpable. Submission 215, Name withheld
We went through the process of applying to The
Glenleighden School and gathered the information required. We will never
forget when the phone rang and the beautiful voice on the other end said
that he was accepted into the school for 2012. Quickly we put our new house
on the market and sold it for peanuts to just offload it in the bid to
start our new life in Brisbane. We said goodbye to our family and friends,
took a deep breath and hoped that our decision was the right one. ****
started school like any other little one on their first day. He seemed
nervous and excited. From the first week we felt reassured that The
Glenleighden School was the best choice for our child. ****'s progress is
exceptionally slow however there is progress.
Despite The Glenleighden School being the best
option for **** it all comes at a cost. School fee’s come in at over
$10,000 a year and additional private therapy has also been required. Most
years’ we spend approximately $20,000 on helping ****. We also lost about
$135,000 between the sale and purchase of our house in Townsville to our
new home in Brisbane. Financially we are starting over however we also feel
fortunate that we were able to make the move in the first place and despite
many sacrifices to keep **** at the school, we are privileged that we can
still manage to pay the fees to keep him there. Submission 14, Name withheld
The Glenleighden School caters specifically for children with severe and
specific childhood language, communication and related disorders. It is the
only facility of its kind in Australia.
It was established in 1979 and is operated by the Association for Childhood
Language and Related Disorders (CHI.L.D). CHI.L.D also operates an outreach
program and a clinic in Woolloongabba in Brisbane.
The committee had the opportunity to visit the Glenleighden School on
27 June 2014. It was impressed by the school's facilities and the
commitment of the staff to their challenging roles. Following a tour of the
school, the committee had the opportunity to discuss issues relating to the
inquiry with a group of parents of children attending Glenleighden. Most of
these parents had made written submissions to the inquiry. The committee
extends its sincere thanks to these parents for giving so generously of their
time. It also thanks the school principal, Ms Cae Ashton, for
facilitating this opportunity.
Parents were clearly impressed with the quality of care and teaching
offered by the Glenleighden School. Box 5.1 (above) provides a sample of
comments made in submissions by the parents of children attending Glenleighden.
The availability of speech pathology services for children
in South Australia
There were also concerns about the availability of speech pathology
services in South Australia, particularly for school-aged children. The South
Australian School Principals' Association stated in its submission:
The hardest thing to face is that unless these students are
from families who are able to access private support these students are simply
not getting the type of support that would make a positive difference to not
just their education outcomes but their life chances. And our regional and
rural school leaders report that even this private option, if affordable to the
family is usually not accessible or available.
The committee received a submission from the South Australian branch of
SPA on some of the gaps in the State's provision of speech pathology services.
waiting times for treatment of stuttering in South Australia can
be up to a year. At about 4 years of age, children with communication disorders
will generally transfer to speech pathologists working in kindergartens and
school. However, speech pathologists working within these settings do not currently
provide specialised assessment and treatment for stuttering;
the South Australian Department for Education and Child
Development (DECD) employs 75.2 full time equivalent speech pathologists to
provide services for students attending government funded preschools and
schools. The Association of Independent Schools of South Australia (AISSA) and
Catholic Education Office (CEO) of South Australia does not employ speech
pathologists directly, but has some capacity to engage with private providers
through sources including the federally funded ‘More Support for Students with
Disabilities’ Initiative; and
the majority of services target preschool aged children and
students in their first few years of schooling. There is limited capacity for
direct speech pathology intervention for children and students from the age of
In 2013, South Australia commenced an integrated single service system
for paediatric speech pathology services. This model is intended to allow equitable
access to speech pathology services, improve service coordination, consistency
in service delivery and continuity of care for children and families.
Specifically, it addresses a gap in services for children aged 3–3½ to 4 years
due to SA Health services often ceasing to provide a service once a child
commences at a state preschool. Due to waiting lists, referrals for children in
this age bracket were not always accepted before they were eligible for a
service through the education system.
Under the single service model, SA Health and the Department of
Education and Child Development are sharing responsibility for services for
children aged three years to school entry.
The availability of speech pathology services for children
in Western Australia
Western Australia is another state that does not employ speech
pathologists within schools. Instead, the State Education Department funds the work
of Language and Development Centres (LDCs) who are also responsible for running
school outreach programs. There are five LDCs: the West Coast, South East
Metropolitan, North East Metropolitan Districts, North West Metropolitan and
Fremantle Language Development Centres. All five Centres:
provide a full time educational placement for children in Kindergarten
and year 1 who have primary language disorders or difficulties. Some Centres provide
placement for children in years 2 and 3;
provide specialised language and academic intervention on an
individual and small group basis;
operate from a number of sites and share facilities with local
primary schools; and
employ speech pathologists who work with parents and teachers to
assess, evaluate and plan appropriate programs for students.
The LDCs all operate an outreach team composed of Support Officers, Speech
and Language. These Support Officers are employed by the State Department of
Education. They may or may not be speech pathologists but they do not take
individual referrals. Rather, the role of these consultants is to provide
high-level advice for teachers in building their oral literacy capacity.
The Western Australian Primary Principals' Association noted in its
submission that for children with speech and language needs, teachers need the
capacity to 'differentially target and cater for' these individual needs. In
contrast, the Association described the current situation in Western Australia
Speech pathology services for school aged children in Western
Australia have mostly been viewed as a separate system of support delivered
externally to individual students (those without traditional disability label
with speech/language needs) through Health or loosely connected to schools for
students with disabilities by Therapy Focus (limited services). Services from
the Department of Health Child Development Centres for students who have
language disorders and difficulties are severely stretched, with up to a 2 year
waiting list at some Government clinics. The wait lists are worst in our most
disadvantaged areas. Getting children into finite speech pathology services
once they have started school is becoming increasingly difficult. This impacts
on our most disadvantaged children as their parents tend not to seek services
in the ‘before school’ age bracket (shorter wait time).
The WA Primary Principals' Association noted that there is inequitable
access to Language Centres and some Education Support Centres. It explained
that students remain on wait lists if their parents cannot afford private
assessments that are required for referral, which advantages those who can
afford to pay. The Association highlighted the rising ratio of students to speech
pathologists under the State's Language Centre model:
Within the 5 Language Centres the Education Department
employs 10 speech pathologists to support the early, intensive direct
service to students placed in the program (full time withdrawal in a school
setting for a maximum of 3 years). The ratio of students to speech pathologists
has risen from 1:70-80 in 2004 to 1:100-130 in 2014. The Outreach Service,
which is focused on building teacher capacity across the broader mainstream
communities, has 17 Support Officers Speech and Language (a mix of teachers and
speech pathologists). These officers are available to provide support to any
number of the 630 schools eligible for the service.
Ms Jodi Lipscombe, the Head of the Speech Pathology Department at the
Princess Margaret Hospital in Perth, also noted that families currently have
very restricted access to government funded speech pathology services. She
observed that for many families, there is a waiting list of 12 months or longer
for services to commence for their preschool children.
Telethon Speech and Hearing is a non-profit organisation that provides a
range of diagnostic, therapy, education and support services for children and
adults with hearing loss and speech and language delays. Its submission noted
Families convey experiencing significant wait times for
speech pathologist services at the Western Australian State Government Child
Development Centres. Some families are waiting up to eight months to see a
speech pathologist. Currently the Child Development Centres provide support for
children in the early years but this does not necessarily extend to ages six,
seven and eight.
Next Challenge is a WA-based organisation that has provided
private speech pathology services to both metropolitan and rural primary
schools in the State over the past decade. As such, the organisation fills a
key service gap, particularly through its support for schools with children
from lower socio-economic backgrounds. Speech pathologists working for Next
Challenge provide screening and assessment for school children,
particularly for those entering kindergarten and pre-primary. This initiates
referrals to government funded services and private services where possible.
Ms Victoria Bishop, a speech pathologist with Next Challenge, noted
...our schools have asked for assistance in supporting those
students with delayed or disordered language, speech and literacy skills. The
schools have requested this because the waitlist for government funded services
are so long, with their children in Kindergarten to Year 2 often waiting 12 to
18 months to receive even one block of therapy services. One block is usually
not sufficient to remediate such difficulties. This wait time is a significant
amount of time in a young child’s development, and these children fall further
behind in school achievement, resulting in poorer long term educational and
socio-emotional outcomes. In addition, families often have significant barriers
preventing access to attending government funded clinic services.
Ms Bishop emphasised that services within the school setting maximises
the child's chances of receiving therapy.
The availability of speech pathology services for children
The committee received little evidence on the availability of speech
pathology services in Tasmania. The Tasmanian Department of Health and Human
Services (DHHS) did note in its submission that the State Government employs
approximately 39.7 full-time equivalent speech pathologists. These employees
work in the following locations:
Tasmanian Health Organisation (THO)
North West—North West Regional Hospital, Mersey Community Hospital and
Devonport Community and Health Services Centre. Outreach services are provided
to King Island, Smithton and the West Coast.
THO North—Launceston General
Hospital, outpatient clinics (paediatric and adult) and outreach.
THO South—Royal Hobart Hospitals,
Transitional Care Unit, Community Rehabilitation Unit, Community Therapy
Services, Specialist clinics (Holman Clinic (cancer), cleft palate, cochlear
implant, paediatric feeding), outpatient clinics (paediatric and adult).
Outreach services are provided to Bruny Island, Clarence Integrated Care
Centre, Dover, Glenorchy, Huonville, Kingston, New Norfolk, Oatlands, Sorell,
Tasman Peninsular and Triabunna.
Services, Child and Parenting Units (north and north west).
DHHS identified the following gaps in the provision of speech pathology
services in Tasmania:
A significant gap is the lack of locally based services to
northern half of the east coast. In areas with limited access to speech
pathology services, video and teleconferencing is utilised to improve timeliness
of access to services.
[S]peech pathologists are not currently employed in public
mental health services in Tasmania.
Once children commence in the education system they become
the responsibility of the Education Department speech pathologists. This may
create a gap in continuity of therapy...
A significant service gap also exists in the area of juvenile
justice. Youth offenders are complex and challenging for policymakers and
practitioners alike and face high risks for long-term disadvantage and social
Aged care is also a significant service gap and as the
population ages, demand for services will increase...
Other service gaps include cancer care, aboriginal services,
and community services in the north...
Tasmania, along with the Northern Territory and ACT, does not
have a tertiary training program for speech pathology. As a result Tasmania
must compete for staff from other jurisdictions.
The availability of speech pathology services for children
in the ACT
Table 5.1 noted the finding of the 2011 Census that the ratio of speech
pathologists to 100 000 of the population was higher in the ACT than in
any other State. Canberra Hospital has 7.15 full-time equivalent speech
pathologists. Rehabilitation, Aged and Community Care employs 4.8
full-time equivalent speech pathologists. Therapy ACT employs 29.3
full-time equivalent speech pathologists across early childhood, school aged
and adult services. There are waiting lists for all these services with Therapy
ACT—as of March 2014, 866 people were on the waiting list. There are approximately
16 private practices, several of which employ tree or four speech pathologists.
The availability of speech pathology services for children
in the Northern Territory
SPA noted in its submission that the Northern Territory has 'a
demonstrably high need for support in relation to communication disorders'
based on AEDI results. It also cited a letter from the then Chief Minister, the
Hon. Paul Henderson to Speech Pathology Australia in August 2012 that 'there is
a high demand for speech pathology, particularly for children aged 4‐7 years'.
SPA stated that there is only one speech pathology position within the Northern
Territory Department of Education. The waiting list for an assessment for a child
of school age in Alice Springs is approximately 12 months and even then, it
will only be provided with indirect support (such as through a teacher).
Supply shortages in regional and
remote areas of Australia
Table 5.2 (above) noted the finding of the 2011 Census that the number
of speech pathologists per 100 000 of population declines as population
density falls. Very remote areas have only six speech pathologists to 100 000
of the population compared with 26 speech pathologists per 100 000 in
major cities. Several submitters and witnesses to this inquiry commented on the
difficulty of accessing speech pathology services in rural and regional
Australia. They also expressed concern that services that were once provided
have now been withdrawn.
The President of SPA, Ms Deborah Theodoros, told the committee that 'access
to speech pathology services is a postcode lottery in Australia'. She added: 'it
is almost impossible to access adequate services if you live in rural and
remote Australia or if you are socioeconomically disadvantaged'.
The National Rural Health Alliance gave examples of the following two
remote regions of the country where there have not been adequate paediatric
For example, until recently there were no paediatric speech
services (and other early intervention services) on Kangaroo Island in South
Australia, until the child reached school age. At that time, he or she would be
placed on a waiting list for up to eight years for a visiting service team, who
only attended twice during a school term. Children with severe difficulties
(such as feeding difficulties) were directed to the mainland. The consequence
of this delay is that problems are not picked up early enough, leading to poor
educational and health outcomes. Similarly, demand for speech therapy in the
midwest of Western Australia is reported to be significant, with a large number
of children missing out altogether or very limited services.
Coolah is a country town in New South Wales with a population of around
1000 residents. It is 100 kilometres north of Mudgee and 136 kilometres
north-east of Dubbo. Ms Kirsty Arnott, a director at the Coolah Preschool and
Kindergarten, wrote in her submission that she is 'devastated and confused' as
to why the speech pathologist from Mudgee Community Health will no longer
travel to service Coolah and the surrounding area. She noted that her son had
used the outreach speech pathology service for eight weeks in 2013. Ms Arnott
described the financial and time benefits of this service for her family as
With the cancellation of this speech pathology service I
wonder who is going to provide this service for our community in the future.
Does this simply mean that our children will not receive this service? Are
rural families expected to incur the expense, both financially and in time, to
travel up to 300km for an hour of private therapy sessions? Who will identify
those children who require speech therapy prior to formal schooling?
The Western Australian and Tasmanian organisations of the Independent
Living Centre (ILC) employ speech pathologists to provide information, advice,
assessment, prescription, implementation and training in augmentative and
alternative communication (AAC) and assistive learning technologies. The organisations'
joint submission noted that:
Many towns experience difficulty recruiting Speech Pathology
and other Allied Health staff, resulting in little and often no services in a
particular town and surrounding areas for lengthy periods of time. The high
turnover of therapy staff in country areas also significantly impacts families
and the individuals progress, as they often start again with new assessments
each time a new therapist commences in that role. ILC WA is able to deliver
some face to face services to country WA clients. Speech Pathologists in
country WA often have large caseloads and a range of client’s (sic) not just
clients with complex communication needs. In an eastern WA town speech
pathologist turnover is extremely high and the department is often
understaffed. In this town school aged children with disability are often on
waitlists with no access to speech pathologists. Some clients with complex
disabilities and with no means of communication had not seen a speech
pathologist in over 4 years. When ILC WA visited this town we received
referrals from the school and private therapists to look at AAC. Often suitable
technologies are identified, however due to lack of Health Department Speech
Pathologists in the town, the clients is unable to access a trial or funding
for the device. This is frustrating for families and decisions for AAC are
often made based on the access to funding rather than the most suitable option
for the clients’ communication. Families often buy their own devices without the
support from a speech pathologist. Without support from a speech pathologist
communication devices are often not used to their full potential or abandoned
leaving the individual with no means of communicating.
The Australian College of Nurses (ACN) stated in its submission that
there is 'a particular paucity of speech pathology services for infants and
children in regional and remote areas'.
It argued there is a 'significant need for improved resourcing of speech
pathology services in these areas particularly to address service gaps in
Aboriginal and Torres Strait Islander communities'. The ACN identified
particular areas of need as:
extreme difficulties in accessing speech pathology services for
children with severe developmental delays in remote Northern Territory
communities that have access to outreach speech pathology
services, but no community-based speech pathology service. As a result, clients
are often unable to access regular and/or ongoing appointments.
Ms Meg Houghton, a speech pathologist with nearly 40 years' experience
in various settings, argued in her submission that the challenge for catering
people in remote areas could be resolved by:
ensuring parents have cost effective access to technology to
enable them to regularly access therapy with their various therapists;
better funding for travel to regional centres/cities to access
services (more than once or twice a year);
the alternative is to fund speech pathologists to service remote
areas (several times a year); and
covering the cost of appropriate web based or computer based
programs suggested by their therapist.
Other proposals, from a speech pathologist in a central Queensland town,
were reproduced in the National Rural Health Alliance's submission. These are:
enticements to establish rural private speech pathology (SP)
internet connection speeds to support Telehealth SP services;
financial assistance to access professional development resources
such as the Speech Pathology Australia lending library in rural areas;
establish network of specialist clinicians from whom rural
clinicians can request advice and clinical guidance (eg. Fluency specialist);
support to purchase clinical resources in rural areas. Generalist
caseloads require a broad resource set that organisations seldom provide;
improve collaboration between existing speech pathology services;
promote community awareness in rural and remote areas.
The service delivery model in aged-care
SPA expressed particular concern with the current model for service
delivery in residential aged-care homes. Its President told the committee:
People in aged-care facilities are screened, obviously, for
communication and swallowing but that is done by nursing staff with a
residential aged-care facility. So we are not formally part of that funding
tool, which we feel is urgently needed in the aged-care sector.
SPA noted that its members consistently report that speech pathologists
are rarely employed by aged care service providers as staff. The preferred
model is to contract private speech pathology services for assessment and/or
management advice for specific residents. However, SPA claimed that:
...private speech pathologists working in the aged care sector
consistently report that referrals for communication assessment or management
are rarely received. This is despite the high prevalence of communication
disorders for this population, and recognition by nursing and care staff that
participation and social interaction are vital. This issue relates to the
current Aged Care Funding Instrument that does not adequately assess
communication or acknowledge the profound impact that communication and sensory
impairments have on the total care needs of residents. Even though untreated
communication difficulties increase the time, complexity and burden of care
there is inadequate provision of funding or resources for care staff to
identify or meet residents’ communication abilities or needs (Potkins et al.,
2005). This fails to comply with aged care Accreditation Standards (e.g.
Standard 2.6 Residents are referred to appropriate health specialists in accordance
with the resident’s needs and preferences) and best‐practice guidelines. Furthermore, this
means that a large number of older Australians with a range of medical
conditions (i.e. stroke, dementia, Parkinson’s disease) are denied access to an
effective mode of communication and provision of best‐practice care that is tailored to meet
their specific communication needs.
Professor Theodoros told the committee that:
It is very important that speech pathology is recognised and
involved in aged-care reform and policy. One way of doing that, of course, is
for us to be a part of the aged care and accreditation standards funding...
The committee is concerned by this evidence, although there it has not
been provided with data to confirm these practices. The committee recommends
that the federal government in collaboration with state governments inquire
into the practices used by residential aged-care centres to screen for speech
and language disorders and employ speech pathologists.
The committee recommends that the federal government, in collaboration
with state and territory governments and other key stakeholders, investigate
the current service delivery model for speech pathology services in aged care
residential homes in Australia. The federal government should seek information
the capacity—in terms of both skills and resources—of nursing
staff within a residential aged-care facility to screen for communication and
the number of speech pathologists directly employed by an aged
care residential centre; and
the number of residential aged care facilities that opt to
contract out private speech pathology services, and of these, the number of
cases—in a calendar or financial year—where a private speech pathologist has
On the basis of this evidence, the committee recommends that the federal
government form a view as to whether these practices are compliant with aged
care Accreditation Standards. The findings should be considered as part of the
federal government's ongoing aged care reforms.
The provision and adequacy of private speech
Those who are unable to access speech pathology services in the public
system often seek private speech pathology services. The committee received
several submissions from speech pathologists operating private clinics and
private patients who have noted that the public system's waiting lists have
forced people to access the private system. Ms Julie Carey, the owner of a
private speech pathology practice in Blacktown in western Sydney, made the
following observations in her submission:
Over the past 24
years I have become increasingly concerned about the lack of quality,
affordable speech pathology services available to the people in western Sydney.
The community health centres in the area are understaffed and currently have
long waiting lists. In addition they are required to limit their service to
specific age groups and offer a very limited number of sessions. These
restrictions force families to seek private therapy. This is an expensive
While some submitters were happy with the quality and the availability
of private speech pathology services, there was criticism of the lack of
appropriate private speech pathology services in regional and remote areas. One
submitter, whose four year old son has Menkes disease, commented:
We live in the regional town of Bowral, located in the
Southern Highlands of NSW. We have found access to many therapies difficult,
and have relied on a few exemplarily young therapists who have gone out of
their way to meet the needs of **** and our family. Until recently there have
been very few options for to participate in speech therapy locally. There is a
private paediatric speech therapy service in the area, but we have found that
the staff are not experienced with the challenges faced by a child with such
severe disabilities as our son. This limited experience has also hampered the
speech therapy services offered at our local hospital. The experience and
expertise of these therapists is generally limited to oral communication, and
they lack knowledge of alternative communication strategies and technologies
The biggest concern with private speech pathology services appears to be
the high out-of-pocket cost for these services. As chapter 1 noted, a patient
can claim the Medicare rebate (currently $52 for a consultation) or claim
through a private health fund (roughly 65 per cent of the cost), but they
cannot do both. The committee has received evidence that a private speech
pathologist charges around $180 per session, leaving the patient around $130
out of pocket.
Patients can only claim once per session through Medicare and private health
funds typically have an annual cap on the dollar amount claimed in a financial
The high cost of private speech pathology services was recognised not
only by patients and the parents of patients who made a submission to this
inquiry, but also by private practitioners themselves. Ms Carey wrote in her
have a university degree and are paid accordingly. Therefore the cost of the
service must be kept at a level sufficient to pay professional wages. Medicare
provides 5 sessions annually under the Chronic Disease Management Plan.
Currently the rebate is about $50 per session. This does not even begin to
cover the cost of an assessment ($180) and barely covers half of the treatment
session ($90). In addition speech pathology intervention is a long term
intervention and clients often require at least 2 years of therapy to achieve
goals. Many families cannot afford expensive private health cover and are
therefore not able to access essential speech pathology services. In addition
many families have more than one child in the family who requires therapy and
are simply unable to afford the cost of ongoing therapy.
Five private treatment sessions through Medicare per year
In terms of claiming a Medicare rebate for a private consultation, the
Department of Health's Chronic Disease Management program allows five treatment
sessions per calendar year. Many submitters to this inquiry have commented that
this number of visits is inadequate to treat disorders such as stuttering, and
the associated Social Anxiety Disorder. The Australian Easy Speak Association
wrote in its submission:
The amount of
financial support required can depend on the type of treatment used and when
the intervention is applied. Appropriate intervention involves regular sessions
with a speech pathologist. Sessions (face to face or telehealth) of 30-60
minutes in duration for 15-50 sessions usually achieve good levels of fluency.
Intensive group treatments of a week in duration, in combination with
attendance at regular maintenance sessions, can also achieve good levels of
Similarly, Ms Carey wrote:
Those families who
are able to avail themselves of the 5 subsidised sessions quickly see the value
of therapy but come to the realisation that in order for therapy to be
effective it must be consistent and long term. Five sessions per year do very
little to address severe speech and language disorders.
The cost of private speech
A recurrent concern of submitters to this inquiry was the cost of
private speech pathology services. Those who did access these services
emphasised the financial burden it had placed on them, while those who did not
use a private therapist highlighted cost as the key prohibiting factor. One
submitter, who asked for her name to be withheld, provided the following
Through our entire
journey with *** the thing that I really wish I could change would be the
financial burden that it has placed on us. The countless hours spent in the car
and in appointments and waiting around, the loss of my career don’t bother me
at all compared to the shame and guilt I feel at not being able to provide him
with the support he needs, simply because we can’t afford it. To a slightly
lesser extent access to services has had an impact as well, as there is simply
not enough therapists or funding to go around. However I really do consider
myself one of the lucky ones due to the amount of services we were able to
access, particularly the wonderful Early Intervention Services provided by
Therapy ACT, The Act Department of Education and The Glenleighden School.
Committee view on the shortage of speech pathology services for children
The committee has gathered considerable evidence in the course of this
inquiry that the supply of speech pathology services has fallen well below
demand, leading to considerable waiting times. These delays for public and
community-based services are evident in all states and territories. There is
some evidence that services are inadequate in socio-economically disadvantaged
areas while in many remote areas, the services are simply not there.
The committee is concerned with the evidence presented in this chapter
indicating significant gaps in the supply of services for children with speech
and language disorders in the various States and Territories. It appears that
many children are missing out on timely services at a cost to their development
and to the community. Governments at all levels have a responsibility to ensure
that these delays are properly identified and avoided.
Mapping the supply of speech
The committee believes that in terms of identifying the need for public
and private speech pathology services by location, there is real value in
conducting nationwide the type of research commenced by the Murdoch Children's
Research Institute in Victoria. Mapping a range of language support services
against the AEDI information about vulnerable communities would identify
potential areas of mismatch between the need for services and their
availability. This exercise could also potentially capture data about the
quality of existing services. The data would:
give service providers with a basis from which to refine existing
services and develop new services; and
help to reduce speech pathology waiting lists.
The committee recommends that the federal Department of Health work with
the most relevant stakeholders to make an assessment of the financial cost,
timeframe and research benefits of a project that maps language support
services across Australia against the Australian Early Development Index
information about vulnerable communities.
Pending an assessment of this proposal, the committee recommends that the
federal government consider funding a project along the lines proposed. The
findings of this research should inform future policy decisions to fund public
speech pathology services in Australia. The findings should also guide private
practitioners as to those locations where their services are most likely to be
An audit of children's speech, language and communication
The committee has gathered considerable evidence about these shortages
from across the country. What it has not done is conduct a thorough and
systematic analysis of the adequacy, strengths and limitations of existing
speech and language services for children. The committee agrees with the
Murdoch Children's Research Institute (MCRI) that there needs to be an audit of
the state of children's speech, language and communication needs in Australia.
A similar project led to important policy changes in the United Kingdom.
MCRI proposed that this audit would perform the following tasks:
- consult extensively with individuals, families and communities from a
variety of demographic subsets that are directly affected by speech, language
and communication needs, including but not limited to culturally and
linguistically diverse and Aboriginal and Torres Strait Islander communities;
- consult extensively with a range of children’s health and education
providers, including but not limited to early childhood education and care
centres, primary schools, secondary schools, speech and language therapists and
special needs coordinators; and
- commission research by leading academics in the field of speech,
language and communication needs into specific areas of interest to ensure that
policies, programs and services are evidence-based and as equitable, effective
and efficient as possible.
The committee recommends that the federal government provide funding and/or
support for an appropriate research institute to conduct a thorough and
systematic audit of the adequacy, strengths and limitations of existing speech
and language services for children in Australia. The audit should consult with
children's health and education providers, including but not limited to early
childhood education and care centres, primary schools, secondary schools,
speech and language therapists and special needs coordinators.
The committee recommends that this research proceed as soon as possible.
The research would provide a foundation for the federal Department of Health to
conduct its work into paediatric speech and language disorders.
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