Water Play: Pool Group Style

Happy Spring Everyone!!  I hope that the temps are rising and the sun is shining in your neck of the woods!  Here in the Midwest, I am enjoying seeing buds on our trees and flowers peeking through the dirt.  

This week, The Frenzied SLPs are posting about water play in speech and language therapy since April Showers bring May flowers.  Please take a moment to peek at all of the posts by following the links at the bottom of this one.

This theme seemed like an appropriate time for me to write a follow-up post about my mission to offer pool speech and language lessons.  I first wrote about my experience here and then was honored to have been featured in the Limelight section of the December 2015 ASHA Leader.  Months later, I am still getting emails filled with excitement and questions about how I researched and orchestrated pool groups.  Some of these messages have come from SLPs from as far as Germany and as close as my home state of Illinois.  In true SLP fashion, many professionals asked poignant questions, so I thought it would be a good idea to blog a FAQ post about speech and language pool groups.  

FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS

Coursework and Training:

1. How did you got started in doing treatment sessions in the pool? Initially, I observed a pool group offered through an Early Intervention at a Jewish Community Center in 2003 in Rhode Island.  Shortly after, I submitted a request to the department that handled insurance and liability coverage at the hospital-based Early Intervention that I worked for in Rhode Island.  It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center.  There were fees involved for pool rental, but I never handled that part of the program. My only responsibilities were to promote the pool group with clients on my caseload, collaborate with a PT for planning, and write weekly service notes to submit with my billing to our office.
2. Do you have any special certifications to help with your sessions in the pool?  All of my training was acquired from experience.  I was VERY fortunate to host my first pool group with an exceptional physical therapist who taught me so much about positioning and working with resistance in the water to help improve stability and attention.  
3. Is there coursework or training for providing aquatic speech therapy services?  One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting  since 1/2002 [California Board of Speech Pathology (PDP#129)].

Securing a Facility:

1. How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then I would start by calling rehabilitation facilities.  Many of these locations have heated pools that they use for physical therapy with clients.
2. How did you secure the pool? I started researching for the pool group session that I wanted to offer through my private practice six months before the services were slated to begin.  First, I called three facilities and ask to speak with the aquatics directors.  Next, I followed-up with meeting those in person that were most receptive to my plan and/or were already renting their pool to other rehabilitative agencies.  In the end, I selected Rush Copley Healthplex because the director returned my calls and had availability that suited my scheduling needs.  
3. Do you think a neighbor's pool with an outside shower and bathroom work?  Personally, I would not feel comfortable using a neighbor's pool as I am not a strong swimmer and I would not want to take on the liability and responsibility that comes with offering this type of group.  I also like being in the community and being able to offer pool group services to up to 10 families.  Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.

Billing, Insurance, and Liability Coverage:

1. Do you bill for it like a normal group speech therapy session?  Yes, I bill my speech and language services using the speech group CPT code 92508.  This code is an "un-timed" one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty. 
2. Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates?  I do a little bit of both depending on the insurance carrier and my network participation.  Some families have a required co-payment that is close to the full reimbursement allowed by the 92508 CPT, so I typically advise these families not to use their coverage, especially if they are also allowed a certain number of speech services per calendar year.  I would rather not take six individual sessions away if the family has a 25 session cap for a 30 minute group session and my clients concur.  Part of my research time was also spent requesting updated reimbursements from each of my in-network insurance companies so I could get a sense of what I should charge for my services. Every state is different, so I would suggest researching your reimbursements and deciding on your charges once you gathered that information.  You can expect to make significantly less for group services than for individual sessions.
3. How did you go about getting liability coverage to work with clients in the pool?  I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees.  You should ask this question while researching pool facilities as this may vary depending on your state.
4. Do you pay pool rental fees?  There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs.  Families are expected to pay a designated amount per group for each of the six weeks of my program prior to the start date and this fee is not prorated should they miss a session.  I can not afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.  

Goals and Session Outline:

1. Do you have specific goals for each child or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions, etc)? Years ago, when I worked alongside an Early Intervention PT during pool group instruction, we created a service rendered form with the most frequently reoccurring tasks in our sessions (i.e., managing steps on a slide, using noodles for belly time, vocalizing to make needs known.)  I edited that note to meet the needs of the pool group that I now offer in my private practice for children aged 2-7 years old.  Many of my private practice clients attend my pool groups in the summer, so I prompt them according to the goals that we are working on in our individual sessions.  If I have a brand new student start the group, then I offer the family a free, 30 minute consultation at my home office before the group initiates to observe, collaborate, and manage paperwork.  I ask families to bring their child's current IEP for my records and review to that consultation meeting.  You can find a copy of my SOAP note at this link.  I designed this note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session.  I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.  
2. Have you ever used pool therapy for middle school and high school students with autism?  And if, what kind of activities did you do?  No, I have only worked with children aged 2-7 in the pool.
3. Would you mind sharing more details about a typical pool therapy session? For more details about my group agenda, you can follow this link.
4. What songs do you use in pool groups?  The most popular songs are: The Wheels on the Bus, If you're Happy and You Know it (I use this tune for a directions game to sing, "Put the duck on your head, on your head"), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.

Other:

1. Did you have an ongoing day/time for a number of weeks?  Yes, my summer groups are weekly at the same day and time for six weeks total.
2. Did you have the parents in the pool too?  A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
3. Were your classes 30 min or one hour?  My water sessions are 30 minutes long, but "therapy" begins in the changing room both before and after water play.  We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
4. Did you co treat with a PT?  I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.  
5. How do you advertise (word of mouth, flyers at your clinic, etc.)?  I bought some ad space in local, neighborhood newsletters, but did not obtain a single client from those ads.  Last summer, four of my participants were seeing me at my private practice, one found me through social media on my speech2me Facebook/Instagram accounts, and another signed up for the session at a parent night meeting that I spoke at regarding summer programs at an ABA home base.  This year, I have already signed up five of my private clients and found another when my district special needs PTA (I was recording secretary in 2014/15) emailed members my pool group flyer.  I also personally emailed the school speech pathologists that I network with for my private clients in an effort to have these school professionals help me spread the word about my summer services.   

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