Appropriate and timely speech therapy is vital to children who suffer from language and speech impairments and elderly patients with swallowing and articulation difficulties. The Consumer Council conducted a research on speech therapy services and discovered that the diagnostic and therapy services offered by service providers differed. A considerable discrepancy in charges could also be observed, as the costs of each therapy session ranged from a few hundred dollars to a few thousand dollars. Consumers should also check whether their assigned speech therapists are registered with the ‘Accredited Registers Scheme for Healthcare Professions, Department of Health’ to ensure that they possess professional qualifications. In addition, as not all service providers list out the details of their services and charges on their websites, consumers have to gather information from service providers directly, reflecting considerable room for improvement in the industry’s information transparency. The Council reminds people who are planning to receive speech therapy to first learn about the diagnostic and assessment tools, therapy services, qualifications and experience of therapists, as well as payment methods, in order to choose a suitable treatment plan.
The Council sent questionnaires to 54 speech therapy service providers in recent months to enquire about the costs and information for the diagnosis and treatment of 2 cases: a child suspected to be suffering from language and speech impairments (Case A) and an elderly patient with swallowing difficulties after a stroke (Case B). To the Council’s disappointment, only 25 service providers responded before the closing date. The rest purported to not have time to reply, baulked at disclosing service details or declined to respond. Of the 25 service providers that replied, all provided speech therapy services for children, while only about half of them (11) provided services for elderly people with swallowing difficulties after suffering a stroke. Among these, only 5 could provide enquirers with more detailed service information.
Choose Appropriate Assessment Tools at First Consultation
Speech therapy normally begins with assessments at the first consultation and subsequent treatment plans will then be decided. Different service providers make use of different assessment tools. Many use either standardised or non-standardised assessment tools, or a mix of both. Other assessment areas also differ. For Case A, assessments of social, oral motor, breathing and swallowing abilities, as well as verbal fluency and tone of voice would be provided; while in Case B, clinical swallow tests, as well as assessments of oral function, ingestion and communication would be provided. Individual service providers could offer items at additional charges based on the needs of patients, or further assessments by doctors through referrals.
Consumers must pay heed to the differences between the service details of service providers. Upon the Council’s enquiries, individual service providers were found to use standardised assessment tools, such as the Hong Kong Test of Preschool Oral Language (Cantonese) (TOPOL), Reynell Developmental Language Scales (RDLS), Symbolic Play Test (SPT) and the Hong Kong Cantonese Articulation Test (HKCAT) during their assessments. Their theoretical basis and credibility, as well as comparisons of children’s ability with reference to norm, help to produce objective and reliable diagnostic results. Non-standardised assessment tools, on the other hand, rely on professional clinical observation and tests on children’s performance in different linguistic areas to assess children’s linguistic ability and undertake follow-up studies. Service providers do not have to abide by any industry convention of using non-standardised assessment tools. Even though each child may receive different assessments, the Council advises service providers to include the relevant information on their websites or promotional leaflets for consumers’ reference and comparison. Consumers can also approach service providers directly to enquire about assessment tools in detail so that they can determine whether the tools suit patients’ needs and avoid delaying treatment.
Enquire about Services in Detail
Consumers should check treatment progress and effectiveness regularly after choosing a service provider. The treatment and training received by patients after their first meeting with speech therapists vary among service providers. Some design treatment plans according to individual assessment reports. Taking Case A as an example, some service providers developed children’s linguistic ability systematically through fun activities for individuals or groups. They also provided training to parents and recommended suitable at-home training to improve the quality and quantity of linguistic stimuli at home. Besides, some service providers would design treatment plans based on areas such as pre-speech skills, comprehension, expression and articulation. Others offered household training and guidance to parents or carers, or allowed parents to visit classes and take part in training so that it could be extended into children’s everyday life.
As for Case B, some service providers provided training in swallowing, exercise of mouth muscles, recommendations on food texture, eating posture and techniques, as well as skills in feeding patients. Some service providers even offered neuromuscular electrical stimulation and/or deep pharyngeal neuromuscular stimulation to train patients’ throat muscles, to help them overcome swallowing and articulation difficulties.
Huge Discrepancies in Service Fees; Beware of Surcharges
The survey revealed a considerable discrepancy in the charges of different service providers. The cost of the first non-package consultation session for both Cases A and B ranged from $780 (45 minutes) to $4,000 (120 minutes). As subsequent therapy sessions are long-term services, consumers must carefully consider whether the services meet their needs and budget, so as to make informed choices.
Consumers should also note that the charges varied according to the qualifications of speech therapists, the service dates (weekdays or weekends) as well as the assessment items. In addition, the duration of each session varied, with a range of 30 minutes to 2 hours for the first consultation, and 30 to 90 minutes for each subsequent therapy session. Individual service providers may also adjust their charges on pro rata basis for overtime, as the duration of sessions depended on the age and degree of cooperation of children, as well as the number of questions raised by parents.
Beware of Risks when Making Full Prepayment
To begin a series of treatment, consumers can consider purchasing packages for cheaper services. For example, 1 service provider offered a 5% discount for every 6 sessions and a 10% discount for 12. However, consumers should check whether these packages have a validity period as some service providers imposed a 12-week to 1-year validity period. For example, a university-affiliated teaching clinic offered packages only from January to April and from September to November each year. Although some packages may look like a good deal, consumers should beware of the risks when making full prepayment, e.g. whether outstanding fees would be refunded in case services were suspended.
Refer to the Register to Check Qualifications of Speech Therapists
Currently, the registers scheme for speech therapists in Hong Kong is voluntary in nature. When choosing speech therapy services, consumers should first check whether their assigned speech therapists are registered with the ‘Accredited Registers Scheme for Healthcare Professions, Department of Health’. Of the 25 service providers that replied, all of them admitted that not all their speech therapists possessed relevant qualifications awarded overseas. 21 of them had ‘Members of Register of Speech Therapists accredited by Department of Health’ in attendance, bringing the total number of their speech therapists to 75. 17 of them stated that their speech therapists did not possess any overseas qualifications. The Hong Kong Institute of Speech Therapists adopts high standards of evaluation method and has been granted a full accreditation status under the Pilot Accredited Registers Scheme for Healthcare Professions. The Institute maintains the Register of Speech Therapists and reviews the professional skills of registrants to ensure that they qualify as practitioners. Besides, it is authorised by the Department of Health to use the ‘Accreditation Mark’ on its website and issue Certificates of Registration to its registrants for easy identification by the public. Members of the Institute can have their business cards printed with the title ‘Member of Register of Speech Therapists accredited by Department of Health’.
When choosing speech therapy services, consumers should pay heed to the following:
- Understand the differences between the functions of different assessment tools, namely standardised and non-standardised assessment tools, to determine whether the service providers’ assessment or diagnostic tools are suitable for the patient;
- Compare treatment options and the relevant requirements carefully and consider charges and other factors before making decisions;
- Enquire about the qualifications and experience of the practitioners carefully and check whether they are ‘Members of Register of Speech Therapists accredited by Department of Health’ or possess relevant qualifications;
- If planning to purchase packages, beware of the risks and restrictions of full prepayment.
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