The Role of Healthcare Professionals in the Opioid Epidemic: Prevention, Intervention and Community Effort
In a nation gripped by the opioid epidemic, Huntington, WV has experienced its share of suffering. Our community, however, is rallying to be the epicenter of change. Numerous efforts are being made to support those dealing with addiction, who are in recovery, and those who experience the tragic effects of addiction second-hand. This past semester, the Department of Communication Disorders at Marshall University decided to contribute to that change by launching a new seminar on professional's involvement in caring for people and communities affected by the opioid crisis.
I had the opportunity to co-facilitate the class with Pam Holland. Together, we learned alongside 6 eager, compassionate graduate students. The course was rooted in conversation about the issue and how we can serve those in need. Students conducted literature reviews, engaged in community awareness events, learned from amazing guest speakers, and even had the opportunity to visit and assist at the local Neonatal Therapeutic Unit (NTU). As a culminating project, they conducted a live webinar on various topics discussed throughout the semester and developed educational materials which can be freely used. The links to those resources are below.
A sincere thank you to all of those who contributed to the course this semester and to those who work every day to help serve those affected by addiction.
By: Courtney Massey, Cassidy Forth, & Cara Stump
What is tele-practice? Why should I care? These are questions you were probably wondering when you read the title of this post. We hope that by explaining what tele-practice is, how it is used in the field of speech-language pathology, and how it could be used in the future, you will see why it is so important for us to advocate for this important service delivery model to be reimbursed by insurance companies so that it can become a widely used tool and help a great deal of people overcome their communication disorders.
Knowing there are people that are not receiving care who could be receiving it through tele-practice is saddening, especially when you realize that it is because insurance companies do not cover tele-practice for speech-language pathology. There are many reasons that tele-practice should be implemented in therapy and covered by insurance companies, and we plan to outline some of these below.
The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status”. The American Speech-Language-Hearing Association, the governing body for the speech-language pathology profession, has defined tele-practice as “the application of telecommunications technology to the delivery of audiology and speech-language pathology professional services at a distance by linking clinician to client/patient or clinician to clinician for assessment, intervention and/or consultation” and is in support of the adoption of this service delivery model. You may hear the term “telemedicine,” “tele-practice”, “telehealth,” “teletherapy”, etc. used in the literature; however, all of these words mean the same thing and are used to reference the act of providing a service in an online format rather than face-to-face interaction. With the evolution of technology that is continuing to grow, we must also evolve and take advantage of this new way of connecting people who may not otherwise be able to meet with various healthcare professionals. Tele-practice is an amazing new way for people to get the care they need in a more convenient way; as patients and healthcare professionals are evolving to accept and embrace this new service model, insurance companies must also realize that it is a valid and effective way of assessing and treating patients and should therefore be reimbursed in the same manner that face-to-face sessions are reimbursed.
There are several benefits to utilizing teletherapy as an SLP. There are many rural areas throughout the United States that do not have access to services. Teletherapy allows everyone to have access to therapeutic services as long as an internet connection and computer are present. Previously, patients had to travel hundreds of miles to see specialists but now they can see specialists from their own home; this is allowing specialists to promote themselves as a professional, their knowledge, and their services to people all over the world. A specialist could also use teletherapy to teach other professionals their skill sets and potentially allow more professionals to develop expertise. Teletherapy could also be cost effective - currently some SLPs travel from home to home over multiple counties to provide services. This is costing companies an abundance of money in mileage fees and reimbursing individual professionals for gas. Being able to provide even half of their sessions via tele-practice instead of driving to each individual home would save companies thousands of dollars per year.
Many states are recognizing the need for speech and language therapy provided by telepractice and are beginning to provide laws and regulations that govern SLPs in this practice. These new laws are allowing SLPs in many states to provide tele-practice, but it is billed to the patient at the full expense because it is not covered by insurance. Many people who may benefit from the speech and language services may not be able to afford the out of pocket costs.
Medicare, a federal program for people who are 65 or older, is a source of insurance that does not currently consider speech-language therapy via tele-practice as reimbursable. Medicaid, a program for low income families, and private insurance have not set up reimbursement standards for speech and language teletherapy services. In other words, insurance has not stepped up to cover tele-practice services, because they don’t believe there is a high enough need and desire by the people who have their plans to actually cover it.
Tele-practice for speech and language therapy should be covered by all insurances (federal, state, and private). In addition to the many benefits listed above, people should have the right to all options for their healthcare needs. With the addition of tele-practice coverage under insurance plans, more people will have options to speech and language services they may not have previously been able to attend or receive due to reasons, such as time, location, availability, and affordability.
The most important thing you can do is to advocate! Advocate for your family, friends, colleagues, neighbors, and anyone else who would benefit from tele-practice! Being silent on a cause/policy or hoping that the issue will arise will not result in change. The best way to advocate for reimbursement of teletherapy is by supporting current efforts and writing to anyone you can! A few potential points in your letters could include: personal experiences with tele-practice, personal experiences of not being able to receive services, a lack of available resources in your area, cost reliefs, and much more! Several states already have policies in place, therefore, research may be required before writing your letters.
American Speech-Language-Hearing Association (2018). Telepractice. Retrieved from: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956§ion=Key_Issues#Reimbursement
American Speech-Language-Hearing Association. (2018). Reimbursement of telepractice services. Retrieved from: https://www.asha.org/Practice/reimbursement/Reimbursement-of-Telepractice-Services/
Dudding, C. (2013). Reimbursement and telepractice. SIG 18 Perspectives on Telep
ractice, Vol. 3, 35-40. doi:10.1044/teles3.2.35
Frailey, C. (2014). A primer on medicaid telepractice reimbursement. The ASHA Leader. 30-31.
By: Kellan Mallory, Erin Dial, Whitney Wright, Kendra Markwell
Stuttering is a speech disorder in which there is an increase of disruptions in a person’s speech. These disfluencies can consist of blocks (no sound coming out), repetitions (repeating the same sound, syllable, or word), prolongations (making sounds longer), and interjections (“uh,” “um”). Additionally, individuals who stutter may also have increased tension in their neck and face as well as secondary behaviors associated with their stuttering (e.g., eye blinking, foot tapping). Most importantly, a person may experience negative thoughts/emotions related to stuttering and a negative impact on social, academic, or vocational interaction. According to the The Stuttering Foundation (2018), the disorder affects 70 million people worldwide and 3 million people in the United States alone.
Though the exact cause of stuttering is unknown for each individual, research heavily indicates neurophysiological and genetic factors. This is supported by the incidence of individuals who stutter with a family history of stuttering. Despite popular belief, stuttering is not caused by emotional instability or parenting style, but rather genetic and neurological predisposition. However, temperament and environment can certainly impact a person’s reactions to stuttering.
Currently, reimbursement for stuttering therapy is largely non-existent. This is likely due to the misconception that stuttering is a psychological disorder rather than a genetic and neurophysiological condition. However, research indicates that stuttering therapy by a speech-language pathologist is effective in providing individuals who stutter with strategies to use in order to decrease disfluencies. Additionally, more recent research discusses the importance of targeting negative reactions in relation to stuttering. This tends to be the most important aspect of stuttering due to the social and emotional impact stuttering can have on individuals. A study by Craig, Blumgart, and Tran (2009) found that stuttering negatively impacts vitality, social, emotional, and mental functioning in adults who stutter, and that the impact on quality of life is comparable to the impact from other medical diagnoses such as TBI or coronary heart disease (2009). Further, these findings have significant therapeutic implications for children who stutter. It is reasonable to assume the negative impact of stuttering may be due to stuttering becoming a chronic condition arising from childhood. Therefore, it is imperative that treatment access continues to improve for children and adults who stutter so that stuttering may have less of an impact on quality of life as children transition to adults.
Studies show that stuttering has a negative impact on daily life activities in adults and children. In the work setting, research has found that adults who stutter have a decreased likelihood of getting a job and being promoted due to the negative perceptions held by many employers. In school settings, children who stutter were associated with lower test scores and an increased likelihood of being held back a grade. However, with speech therapy the negative effects associated with stuttering have been found to decrease significantly. In the workplace, individuals who received speech therapy and experienced a reduction in stuttering as a result were promoted within 10 months after receiving treatment. In the school setting, timely treatment for stuttering was found to improve the academic performance of children. (Conture, 1996).
Speech therapy has been found to improve patient attitudes about their stuttering through counseling techniques. Speech-language pathologists teach their patients how to be more accepting of their stuttering and to limit stuttering's influence on their lives. They also help desensitize patients from their fear of stuttering by having them participate in activities that push them outside of their comfort zone. These activities promote transfer the of their new skills to real life speaking situations (Irani, 2012). In addition to emotional gains, patients who stutter learn various techniques which help them to decrease the amount of disfluencies they experience.
Speech therapy for stuttering must become more accessible and affordable for patients. Insurance reimbursement for speech therapy is important for all individuals, so they can learn to manage their stuttering effectively and not let it interfere with their ability to have a successful and happy life.
American Speech-Language-Hearing Association. (n.d.). Childhood fluency disorders. Retrieved from: https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935336§ion=Causes
Conture, E. (1996). Treatment efficacy: Stuttering. Journal of Speech and Hearing Research, 39(5), 18-26.
Craig, A., Blumgart, E., & Tran, Y. (2009). The impact of stuttering on the quality of life in adults who stutter. Journal of Fluency Disorders, 34, 61-71.
Irani, F., Gabel, R., Daniels, D., & Hughes, F. (2012). The long-term effectiveness of stuttering therapy: A mixed methods study. Journal of Fluency Disorders, 37(3), 164-178.
Onslow, M., Costa, L., Andrews, C., Harrison, E., & Packman, A. (1996). Speech outcomes of a prolonged speech-treatment for stuttering. Journal of Speech, Language, and Hearing Research, 39, 735-749.
The Stuttering Foundation. (n.d.). FAQ. Retrieved from: https://www.stutteringhelp.org/faq
By: Samantha Graffius, Hannah Roy, Christian Boles, & Elaine King
What are Voice Disorders?
For most of us, our voice is a tool we use each and every day; we chat with the ones we love, speak to the clerk at the supermarket, and sing with our friends. For others, it’s an essential part of their career. Teachers, singers, actors, and the like all use their voices constantly. Voice disorders are a problem throughout professions, but the aforementioned few are particularly vulnerable to voice disorders due to their prolonged use of their voice. If a teacher loses his or her voice after a long week, they are unable to perform their job; likewise, a singer who cannot sing due to vocal nodules is ineffective.
But what is a voice disorder?
A voice disorder is when a person’s voice is different than the expected age, gender, cultural background, or geographic location. Voice disorders can occur in any individual but are more prevalent in adult females, elderly adults, and occupational groups such as teachers, manufacturing/factory workers, salespersons, and singers (ASHA, n.d). Studies have shown that voice treatment provided by speech-language pathologists can improve the quality of life of people with voice disorders. The following list of examples demonstrates the effectiveness of voice therapy as seen in the research literature:
Following voice rehabilitation, patients with laryngeal cancer reported positive effects on overall psychological well-being as well as lower ratings of anxiety and depression (Bergstrom, Ward, & Finizia, 2016). “Voice therapy has been demonstrated to be effective for hoarseness across the lifespan from children to older adults” (ASHA, 2018; Ramig & Verdolini, 1998; Thomas & Stemple, 2007). Therapeutic techniques used during voice therapy have shown positive results for individuals diagnosed with muscle tension dysphonia (da Cunha Pereira et al., 2018)
What we are asking?
If Kim has a stroke that severely debilitates her, the insurance company (in this example, Medicare) will provide, at maximum, $3,000 of annual coverage. This amount is static and will not change. If Kim needs additional therapy, Medicare will not allow for reimbursement once that amount is met.
This presents a problem. Kim may begin to show improvement early and have no need for additional therapy. However, in the likely event that additional therapy is required, Kim will be ineligible to receive more until the next year. A break in therapy this large could impact her recovery. Research shows that the amount of therapy given impacts the recovery time of individuals with voice disorders (Fu, Theodoros, & Ward, 2016).
So, what can we do about this?
Insurance companies need to be educated that patients should be covered for the entire time it takes them to improve. It’s important that the insurance companies hear from a large amount of us; they respond to the requests of the many, not the few. Without your help, this limitation forced by insurance companies will continue to affect the lives of those with voice disorders - from stroke and Parkinson’s victims to those with vocal trauma. Speech therapy for those with voice disorders is a necessity by increasing their quality of life.
ASHA, (n.d). Voice Disorders. Retrieved from https://www.asha.org/practice-portal/clinical-topics/voice-disorders/
Bergström, L., Ward, E., & Finizia, C. (2017). Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being. Supportive Care in Cancer, 25(9), 2683–2690. https://doi-org.marshall.idm.oclc.org/10.1007/s00520-017-3676-x
da Cunha Pereira, G., de Oliveira Lemos, I., Dalbosco Gadenz, C., & Cassol, M. (2018). Effects of Voice Therapy on Muscle Tension Dysphonia: A Systematic Literature Review. Journal of Voice, 32(5), 546–552. https://doi-org.marshall.idm.oclc.org/10.1016/j.jvoice.2017.06.015
Fu, S., Theodoros, D., & Ward, E. C. (2016). Long-term effects of an intensive voice treatment for vocal fold nodules. International Journal of Speech-Language Pathology, 18(1), 77-88. doi:10.3109/17549507.2015.1081286