Allocation and funding of Speech and Language Therapy for children with Developmental Language Disorders across Europe and beyond.
Across Europe, who pays the speech bill decides whether a child gets hands-on therapy or just advice—clinical need takes a back seat.
01Research in Context
What this study did
Søndergaard et al. (2022) sent a short survey to speech-language pathologists across Europe. They asked who pays for therapy for kids with developmental language disorders. Answers came from 25 countries.
The team sorted services into three buckets: direct therapy with the child, indirect work like teacher coaching, and a mix of both. Then they matched each type to its main funding source.
What they found
Private money usually pays for one-on-one therapy sessions. Public money usually pays for indirect or mixed services. In short, funding rules decide the therapy style, not the child's needs.
The survey shows a patchwork. A child in one country may get weekly direct therapy while a similar child next door gets none, simply because of who writes the check.
How this fits with other research
Salomone et al. (2016) asked 1,680 European families of preschoolers with autism the same style of question. They also found that country, not child severity, predicted who got help. The two surveys echo each other across diagnoses.
Pye et al. (2024) looked at Australia after a new national insurance plan started. There, higher family income still predicted more services, even when public funding existed. This extends the Europe finding: money matters even inside a public system.
Shepherd et al. (2018) surveyed New Zealand parents and saw cost as the top reason for skipping therapy. All four studies line up—funding drives access.
Why it matters
If you write treatment plans or fight for hours, know that the pay source may already tilt the table. When you justify direct therapy, pair your data with a funding fix. Push for blended budgets so kids get the model that works, not the model that fits the ledger.
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02At a glance
03Original abstract
BACKGROUND: Children with Developmental Language Disorder (DLD) have a significant deficit in spoken language ability which affects their communication skills, education, mental health, employment and social inclusion. AIM: The present study reports findings from a survey by EU network COST ACTION 1406 and aims to explore differences in service delivery and funding of SLT services for children with DLD across Europe and beyond. METHODS AND PROCEDURES: The survey was completed by 5024 European professionals. COST countries were grouped into Nordic, Anglo-Saxon, Continental, Mediterranean, Central/Eastern and Non-European categories. The use of direct, indirect and mixed interventions, and their relationship to funding available (public, private or mixed) were considered for further analysis. OUTCOMES AND RESULTS: The results revealed that for direct therapy, there were more cases than expected receiving private funding. For indirect therapy, fewer than expected received private and more than expected public funding. For mixed therapy, fewer cases than expected received private funding. CONCLUSIONS AND IMPLICATIONS: The results implies that other factors than evidence-based practices, practitioners experience, and patient preferences, drive choices in therapy. More research is needed to gain a better understanding of factors affecting the choice of therapy.
Research in developmental disabilities, 2022 · doi:10.1016/j.ridd.2021.104139