Barriers & Facilitators of Speech and Language Therapy and Solutions: A Quick Overview
- Elizabeth Ulreich-Moran
- Dec 30, 2021
- 5 min read
Updated: Oct 30, 2022
Let's start by defining who we are and where we are in the therapy process: the speech-language pathologist (SLP) or the client?
Are you starting out as an SLP?
Do you consider yourself a veteran In the field?
Are you an SLP who is currently working on checking your implicit bias?
Are you a client wondering if your current program is right for you?
Are you a client who is feeling defeated in the therapy process?
Are you a caregiver who is feeling overwhelmed?
Wherever you are along your journey with speech and language therapy, here is a quick overview of barriers and facilitators that can impact the therapy process.
Note: The terms "patient" and "client" are used interchangeably throughout this post as the terms vary based on the setting of care.
Barriers To Rehabilitation
A barrier to rehabilitation is something that gets in the way of the therapy process. There is a range that stems from our own perception and knowledge of cases to physical and social constraints. It is important to identify the barriers in order to ensure optimal patient care. If barriers are ignored, the therapy process may falter.
Physical and Medical Barriers
Comorbidities: What other diagnoses are playing a part in this process?
Medications: How are the current medication impacting the patient?
Perception and Knowledge
Reduced client engagement and motivation: Find out why this is happening.
Reduced knowledge of the therapy process: Does the client know what to expect?
Lack of preparedness: The client may have gone through a life-altering event and family members may not have been prepared to be the caregiver(s).
Social Barriers
Transportation: How are they getting to therapy? Do you go to the client?
Technology: Does the patient have the means for devices or the option of teletherapy?
Finances: Refer to social work to help with resources related to finance.
Insurance: What does insurance cover? Is there coinsurance?
Culture: Be mindful of the client's culture and understand how that may impact the process. We need to check out bias here.
Facilitators Of Rehabilitation
A facilitator of rehabilitation is something that can help support the therapy process. Similar to barriers, facilitators can stem from the same categories.
Education
We only know what we know. When we equip ourselves with education as a tool we can then pass along that information to our clients and caregivers. The more we know the better we can serve.
Patient-centered care
Putting the patient at the center of care by considering their input and their goals
Peer support
Support from colleagues and managers, especially for case management
Positive caregiver involvement
Involved and engaged caregivers
Resources
Usually related to financial ability, resources that facilities have in order to provide patients with quality care.
Continuity of Care
Communication between professionals as patients transition between levels of care (I.e., hospital to short term rehab to outpatient)
Solutions
You may be thinking: How can I reduce barriers and increase facilitators related to speech therapy? Here are 5 solutions.
Solution #1: Patient-Centered Goals
From the onset of therapy, specifically at the time of the evaluation, the first question that should be asked is: "What brings you here and how can I help?"
This sets the stage for open communication (see Solution #4) and the patient and/or caregiver being an immediate part of the therapy planning process. Without this, therapy can easily become one-sided, with SLPs often losing sight of the patient; the human being that we are trying to help.
Solution #2: Education
Throughout the process, education should be provided in a way that the client and/or caregiver can understand. Ask how they learn best (visual, written, auditory) and provide the information in that way. Provide time throughout therapy to allow for these conversations; ask if they understand, ask if they have questions.
Here, I add in the discussion of realistic expectations. Every case may need this discussion. Specifically, as stated in the ASHA Code of Ethics, we should never make predictive outcomes. We cannot predict the future and therefore should not claim to be able to "fix" a problem. We are guides, navigating our patients towards their goals.
Solution #3: Know When To Refer Out
If you are the SLP and you are not an expert in the case then you need to make that clear to the client. If the client chooses to move forward with you, great! If not, provide the client with SLPs who may better serve them.
If you are the client, when you are reaching out to an SLP, ask them their areas of specialty, if they have any. If you want a specialist, ask them for resources so that you can find someone to best serve you.
Other than specialists, this solution should also be kept in mind for multidisciplinary team members. Anxiety and depression often coincide with speech and language diagnoses, but we are not experts in those areas. While we can help as they relate to the speech and language difference or disorder, when the problem goes beyond that, it is best practice to refer to a mental health professional; similar to what we would do for medical issues. SLPs need to know when to refer to other professionals.
Solution #4: Open Communication and Transparency
Just as important as Solution #1, open communication and transparency are paramount in the therapy process. As the SLP, we should ensure our clients feel comfortable asking questions. We also need to be sure that were are transparent, leading back to the realistic expectation conversation as well as financial disclosures.
This is also an area where we can help problem solve solutions for improving patient engagement and participation. Ask questions such as, "How can we solve this together? What is getting in the way at home?" As a busy parent, I know that time can often be the answer, so by being creative with strategies to use in short snippets throughout the day may be a good solution.
For some, this process is difficult and they need to know that they are welcome to ask any question at any time. Even if that means they want to change providers. That is OK. This is their journey and we are their guides. Sometimes we need to guide them elsewhere.
Solution #5: Resources
Similar to Solutions #3, resources are part of the referral process. SLPs often have resources to provide clients in order to help them improve their quality of life outside of therapy. Some examples include:
Stuttering Support Groups: ex: CT National Stuttering Association Chapter
Community Resources, such as local parent or advocacy groups
Summary
In summary, we encounter barriers and facilitators with every case, despite being the SLP or the client/caregiver. The goal is to support the client. Open communication will never fail. Remember, the therapy process is not set in stone! We can all put the client first to determine the best path, even if that mean switching SLPs.
Remember how I spoke about the many hats of the SLP? Advocate, ally, and educator are the top hats I wear in addition to my SLP hat. Without them, my relationship with my clients and team members would negatively impact the therapy process. The hats matter, but how we wear them matters more.
Questions or Comments?
Do you have questions or comments? Looking for a mentor? Looking for guidance related to a case? Comment below or drop me a line!
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