Acquiring Speech Services

Here's the timeline of our process with acquiring speech services for the trio:

Tue. January 23--18 Month Well Check, pediatrician suggested we seek speech evaluations
At that time, James, Amelia, and Maddie were each saying 2-3 words. Despite recommendations to contact Child Developmental Services Agency, we decided to delay until 21 months. We began the process with Jackson at 18 months, but could not afford the sliding scale fee at that time. Jackson ended up flourishing on his own just a few months later. I secretly hoped the trio would do the same.

Mon. May 4--Made initial contact with CDSA
The 21 month mark came and passed, and the trio had not made any advancements in language development. I called to begin the evaluation process. Unfortunately, living in a county with nearly a million people makes it practically impossible to have direct contact with humans. The phone tag and waiting game began.

Wed. May 13--Completed 50 min intake surveys over the phone
During this phone call, I spent roughly 15 minutes discussing the birth, development, specific strengths, and weaknesses of each child. (Part of this phone call took place in the school pick up line, where I was then scolded by the director. It is literally impossible to have an uninterrupted hour during the day where I can talk on the phone!)

Wed. June 3--Hearing screening with audiologist
The CDSA requires children to have a hearing screening before a speech evaluation is conducted. This was stressful because part of the test required one child to sit on my lap in a booth. Therefore, I was asked to bring a helper with me so someone else could sit with the other two and we could rotate. Unfortunately, this was the same day as End of Grade tests, preschool graduations, and award ceremonies. I did not have any outside help, so the trio's case worker stayed with two in a playroom while I took one individually for the hearing test. The test consisted of three parts:
1. The audiologist placed plugs in the ear to measure the pressure. James, Amelia and Maddie all had negative pressure due to runny noses.
2. The audiologist inserted ear plugs in the ear, played sounds, and measured how the ear reacted to the sounds. The challenge to this test was that the instrument couldn't accurately measure the results if there was any other sound. So if they cried, laughed, or tugged at the ear plugs, the test didn't work.
3. A child and I went inside a very small room with a glass window. The audiologist sat in the adjacent room, played different sounds, and watched so see where James, Amelia, and Maddie looked. According to my research, this test is called a visual reinforcement audiometry. "This is a test where the child is trained to look toward a sound source. When the child gives a correct response, the child is "rewarded" through a visual reinforcement such as a toy that moves or a flashing light."

The problem with the last test was that Amelia was very distracted and would only look in the direction where a drumming bear would appear. Every time the bear lit up from the black box, Amelia clapped and laughed. Even when other sounds were played, she kept pointing and babbling in the direction of the bear.  Amelia did not pass her hearing test. James and Maddie did.

Thu. June 11--Early Intervention evaluation to determine eligibility
A team of 4 individuals (including case manager, OT, PT, and SLP) came to evaluate the trio for Early Intervention services for over two hours.  The toddlers were evaluated in the following developmental areas: cognitive, physical (fine and gross), communication, social-emotional, and adaptive.  Some of the things they had to do included:

• stack six blocks
• point to objects in a book
• draw lines and dots on paper
• role play with play food, baby doll, toy car
• pick up specific objects when asked

They scored within normal range in all areas except communication. Both parts of communication (receptive and expressive) were low enough that all three qualified for services. James scored lower than the girls. He also scored lower (but still within normal range) in cognitive and gross motor skills.

Mon. June 15--Develop Individual Family Service Plan
The EI team returned to develop three IFSP's and determine what services we wanted. This was another meeting that was over two hours long. Each child had to have two goals with strategies for each goal. I honestly don't remember all of the specifics. James' goals were not throwing food and asking for more (using sign language and/or verbally). Amelia's goals were to begin naming body parts and understanding yes vs no. Maddie's goals were something about identifying cups (she gets OCD about straw vs sippy cups) and understanding yes vs no. Some of the strategies given were ridiculous (tie a string on James' cup so he can pick it up himself while still in his high chair). Others were more practical suggestions that we hadn't been doing (physically shake their head up and down and say "yes" to questions that are obviously yes).

The other outcome of this meeting was to determine when to meet. I definitely didn't want to have three different sessions. The main two options were combined therapy for 90 minutes a week or two separate sessions (combined hour for girls and 45 min individual for James). Since they're going to be together no matter what, we're starting with combined services.

Tue. June 23--Begin speech services
The case worker has already found several therapists that could meet our schedule. I selected the only therapist who had experience working with multiples. She will begin next Tuesday at 11 am. I have no clue what to expect, but I'll update after their first session. Let's hope the trio make quick progress!