SPEECH LANGUAGE PATHOLOGISTS
- New York
- NYC (New York City)
- Staten Island
- Long Island including the Hamptons
- New Jersey
- and remote to any location!
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Speech-language pathologists (or speech and language therapists, speech therapists, or simply, SLPs) prevent, assess, diagnose, and treat speech, language, cognitive-communication, social communication, voice, and swallowing disorders. Working with individuals of all ages–from babies to adults–SLPs conduct therapy sessions on a one-on-one basis and provide information for families, support groups, and the general public.
In many cases, SLPs work with other healthcare professionals to provide referrals and assessments. Speech-language pathologists treat a wide range of communication delays and disorders. These include:
- Speech Disorders – These can occur when an individual has difficulty producing speech sounds and putting them together to form intelligible words. Speech disorders include articulation or phonological disorders, apraxia of speech, and dysarthria.
- Language – Difficulties in understanding what was heard or read (receptive language) or using words to share thoughts and feelings (expressive language) may point to a language disorder. This can manifest in either spoken or written expression and may involve form (phonology, morphology, and syntax), content (semantics), and use (pragmatics) of language.
- Voice or Resonance – Voice or resonance disorders refer to problems in how one’s voice sounds. One may sound hoarse, lose voice easily, talk through the nose or too loudly, or be unable to make sounds.
- Social Communication – This refers to the social use of verbal and nonverbal communication. This includes how one communicates socially, how well one follows conversation rules and story-telling (aspect of expressive language called narratives), tells jokes, and how one speaks with different people in varied situations.
- Cognitive-Communication – Someone with a cognitive-communication disorder may exhibit problems with organization, memory, attention, problem-solving, and other thinking skills. This can be a result of traumatic brain injury, a stroke, dementia, and may also be congenital.
- Swallowing Disorders – Also known as dysphagia, swallowing disorders refer to difficulties in chewing, sucking, and swallowing food and liquid as a result of illness, surgery, stroke, or injury.
- Literacy – Individuals with speech and language disorders may also experience difficulties with pre-literacy and literacy skills (phonological awareness, decoding, spelling, reading comprehension, and writing).
Aside from the disorders mentioned above, SLPs may also:
- Provide aural rehabilitation for those who are deaf or hard of hearing.
- Work with individuals with severe expressive or comprehension disorders (such as autism spectrum disorder and progressive neurological disorders) and provide augmentative and alternative communication (AAC) systems.
- Help individuals enhance their communication skills (such as modifying one’s accent) to express themselves more effectively.
Please note that we adhere to HIPPA (health information privacy) standards, and all confidential information can not be shared with anyone without your written consent. We also store all electronic confidential information on our HIPPA compliant encrypted email server.
If you are seeking speech, language, and feeding services, you will need to work with one of our licensed speech-language therapists/pathologists: New York State requires that you work with a licensed therapist skilled in these areas if you or your child needs help with enunciation, expressive (oral) language, receptive (auditory) comprehension, social pragmatic skills, feeding, fluency (stuttering), etc. If the individual does not need help with their oral expressive and receptive language skills or oral expressive language skills, he or she can work with one of our literacy specialists (this is different than working with a licensed therapist) if there are literacy concerns. However, some students have what is called a language disorder (expressive and/or receptive language difficulties) and these students need therapeutic literacy intervention performed by our language therapists. This might be eligible for out-of-network reimbursement. If the literacy intervention is considered language therapy, we will need the right ICD-10 code(s) to justify a language therapy approach to your child's literacy intervention. ICD-10 codes which indicate language therapy include language disorder, expressive/receptive language disorder, phonological disorder, autism spectrum, social pragmatic communication disorder, other developmental disorders of speech and language, developmental disorder of speech and language, and sometimes diagnosis such as a specific learning disorder, a specific reading disorder, or a specific impairment in written expression.
In order to start therapeutic services by our speech-language therapists/pathologists, we need written justification from NY licensed therapists or medical doctors regardless of their affiliation with Brooklyn Letters. This documentation typically includes ICD-10 code(s). We will also need current goals. These goals can come from recent reports or from current professionals working with your child. If you do not have any of these codes, we can help!
For literacy tutoring by our literacy teachers, a non-therapeutic service, we need up-to-date goals. Literacy tutoring performed by our literacy specialists is not eligible for insurance reimbursement.
If the literacy intervention cannot be justified by an ICD-10 code (see above), the literacy intervention is considered educational and can be performed by our literacy teachers. New York State believes the ICD-10 code for dyslexia is educational (learning) and not as a Communicative Disorder, e.g. Language Disorder. One day New York State will update their position on dyslexia. Please note that most neuropsychological evaluations do not include decoding and encoding (spelling goals); they mention the need for decoding and encoding intervention. If literacy goals are not included in the neuropsychological evaluation, our first session(s) will include creating these goals. Also, many schools use their methods or commercialized products for creating literacy goals. Unfortunately, some of these tools are not up-to-date with current scientific standards (it's Corporate America ). Fortunately, we use up-to-date assessment tools to reliably identify where your child needs help. Overall, you are in good hands with us, and we will guide you along the way!
If you have up-to-date evaluations/assessments and goals, you can most likely skip reading the rest of this page.
If you are not interested in our intervention services but just need an assessment/evaluation/consultation, we also offer evaluation services!
If you live in New York City, Long Island, and Westchester, we are here to help! We work with all ages, including babies, adults, and everyone in between!
Please note that we can rent space throughout NYC to accommodate evaluations and assessments since we are not a brick and mortar company.
Consultations, Assessments, & Evaluations:
TIER 1 EVALUATIONS & ASSESSMENTS (Home, School, English, Multilingual) Performed by Licensed Speech-Language Pathologists/Therapists
Evaluations include at least a one-hour in-home or at school visit where we ideally meet you and your child, review previous reports, testing, etc., and within ten business days, a 1.5- to 3-page report with professional impressions, recommendations, and goals (if services are recommended) are produced. This report can be presented to private schools and professionals outside of Brooklyn Letters. It cannot be used for IEPs (see TIER2). It helps establish the need for significant but mild articulation and expressive language therapy and for updating current therapy goals.
Articulation/Enunciation/Speech Sounds (ages 3+ only if the individual exhibits difficulties with a few age-appropriate speech sounds): $175-$250
Mildly Delayed Expressive Language (babies-47 months): $200-$300. Three-year-old children with expressive language delays might qualify for a TIER2 evaluation depending on several factors to be discussed by one of our speech pathologists over the phone (free).
Articulation and Expressive Language Concerns: (one visit, babies-47 months) $300-$450. Three-year-old children with moderate to severe expressive language delays will most likely require a TIER2 evaluation depending on several factors to be discussed by one of our speech pathologists over the phone (free).
Social Skills Assessment (18-47-month-old children): $150-$200 We use a standardized empirically validated parent-report questionnaire to help assess pragmatic language development in 18- to 47-month-old children. This assessment helps identify children with delays in pragmatic language development (i.e. the use of language in a broad variety of everyday settings and in interaction with other people) compared to children of the same sex and age in months; to identify children whose expressive language skills should be further evaluated with a comprehensive speech and language assessment. We mail you the questionnaire, you fill it out, mail it back to us and we score it, provide you with the results, and schedule a 30-minute phone consultation.
Bilingual/Multilingual Assessments TIER1 AND TIER2 Home and Office-Based:
Bilingual/multilingual evaluations are billed at a higher rate than monolingual English evaluations and assessments. Bilingual/multilingual in-home and at-school evaluations/assessments are usually marked up an additional 30 to 50% due to the additional work required to assess more than one language. Office-based bilingual/multilingual evaluations and assessments are an additional cost due to the expenses of renting space.
We can furnish an ICD-10 code for insurance purposes with a TIER1 Evaluation if the child has articulation difficulties that are not normal for his or her age or if the child has a significant expressive language delay or disorder. We are out-of-network providers and do not accept any third-party payments, but you may be entitled to reimbursement under the out-of-network provisions of your insurance policy.
Please note that a TIER2 Evaluation is recommended for the following circumstances:
When there are feeding concerns (any age).
When there are fluency/stuttering concerns (any age).
When there are significant moderate to severe early language and communication delays (0-36 months).
If the articulation concerns involve more than a few age-appropriate speech sound errors (ages 3+).
If your child is 3 years old and has significant moderate to severe expressive language delays.
If your concerns involve receptive language or literacy (any age).
If your child is greater than four years of age and has delayed language development.
Free Phone Consultation
If you are interested in a private evaluation or assessment, you will speak with a licensed speech-language pathologist on the phone for free to help best determine if your child should be considered for a TIER1 or TIER2 evaluation/assessment.
TIER 1 EVALUATIONS & ASSESSMENTS (Home, School) Performed by Literacy Specialists/Teachers
Decoding & Spelling Assessments
$200-$300 Decoding and Spelling (Encoding)
These include at least a one-hour in-home visit where we meet you and your child, a review of previous reports, testing, etc., and within ten business days a 1.5- to 3-page report with professional impressions, recommendations, and goals (if services are recommended). These evaluations are not diagnostic in nature and are best for tutoring purposes for creating decoding and spelling goals. Low test scores will indicate that the parent should follow up with a psychologist for additional testing (we can recommend them to you!).
Our Literacy Teachers cannot produce ICD-10 codes as they are not licensed therapists.
TIER 2 EVALUATIONS & ASSESSMENTS (Home, School, English, Multilingual) Performed by Licensed Speech-Language Pathologists/Therapists.
$250-$1000* TIER2 Evaluations are more comprehensive than TIER1 Evaluations and include literacy evaluations performed by licensed language therapists. TIER2 evaluations are perfect for private CPSE and CSE evaluations. A TIER2 Evaluation is recommended when a child has more than a few speech sound errors that aren t appropriate for his or her age, and there are significant concerns related to understanding and using oral and written language, particularly when the child is 48 months and older.
- $300-$500 for Moderate to Severe Early Language and Communication Skills (0-36 months)
- $300-$500 for Articulation/Enunciation/Speech Sounds (3 years and up) when the individual is having difficulties with more than a few age-appropriate sounds
- $700-$1000 Apraxia Evaluation performed by Dr. Melissa (see below for more information)
- $300-$500 for Fluency/Stuttering (2 years and up)
- $250-$400 for Feeding (any age)
- $300-$500 for Early Literacy Skills (4-6 years and up)
- $300-$600 for Literacy (Written Language – Reading and Writing)
- $300-400 for Expressive Language (3 years and up)
- $400-$800 for Expressive and Receptive Language (3 years and up) for students who need their receptive language evaluated and have significant expressive language delays.
- $400-$500 for Expressive Language and Articulation (3 years and up)
- $500-$800 for Expressive and Receptive Language, Articulation (3 years and up)
- $600-$1000 for Expressive and Receptive Language, Literacy, and Articulation (4 years and up)
All of our TIER 2 Evaluations occur over one visit at a quiet space in your home. If you are interested in office space, see below. These visits are 1-3 hours long, and your child will be given breaks. Occasionally, a child is unable to complete the testing with the appropriate amount of time allowed for assessments. We reserve the right to charge an additional $150 fee to schedule a follow-up appointment to complete the testing when these circumstances arise.TIER2 Evaluations include a 2 to 10-page report (higher costing evaluations result in extended reports and visa versa), including professional impressions, recommendations, and goals. Please allow us up to 10 business days to produce the report. If you need the report in less than ten days, it can be expedited for a fee of $100-$200 depending on how quickly you need the turnaround. For higher costing evaluations ($600 and up), we might require additional time to complete the report (10-15 business days). Results are discussed over the phone or in-person if the data is scored at the time of the assessment. If a parent requests a follow-up meeting to discuss the results in person, this will be billed at the professional’s hourly rate.
We can recommend and start intervention before the report is finished because we will know directly after or soon after the evaluation if intervention is warranted and will be able to establish goals. These two essential pieces can be figured out before the report is submitted to you. With your permission, we can share this information with a 3rd party.
ICD-10 codes are furnished if the individual has a significant delay or a disorder. We produce speech and language disorder ICD-10 codes. For an ICD-10 code related to literacy or a learning disorder, e.g., dyslexia, we recommend that you follow-up with additional testing performed by a licensed NY State neuropsychologist. We have many great recommendations!
Fluency/Stuttering Evaluations (see below for more information)
First, parents are asked to complete a written case history form. A stuttering assessment also involves parent interview and child observation, both of which can be conducted through video-conferencing software. The speech therapist will determine the following:
When did the stuttering begin?
Are there situations in which your child stutters more? Less?
Does stuttering run in your family?
Does your child exhibit any negative reactions toward his or her stuttering?
Does your child display any physical tension or secondary behaviors (e.g., eye blinking, facial grimacing, etc.) when they stutter?
Are there any other speech or language concerns?
Is your child is experiencing negative reactions from peers or family members?
Is your child is having difficulty communicating his or her message in an efficient, effective manner?
You may also be asked more specific questions about your child interests and hobbies: What does your child like to do? What is she or he good at? The evaluator will be interested in the whole child, and not just the stuttering.
The speech therapist will try to learn your child’s feelings and attitudes about his stuttering, and the impact that it has on him in different environments (at school, at home etc.). If speech therapy is warranted, a plan will be laid out for parent education and counseling. If speech therapy is not warranted, the family is educated about how to monitor the child’s speech to determine if and when the child should be reevaluated.
*Office-Based Assessments: Please note that we can rent space throughout NYC for an additional fee. Please note that office-based assessments are billed at higher rates, e.g., $20-40 more per hour to cover our rental expenses.
*Bilingual/Multilingual Assessments: Bilingual/Multilingual evaluations/assessments are usually marked up an additional 30 to 50% due to the additional work required to assess more than one language.
About Childhood Apraxia of Speech Evaluations
($700-$1000 for Manhattan). *Additional fees for areas outside of Manhattan
What is Childhood Apraxia of Speech
Childhood Apraxia of Speech (CSA) is a pediatric speech disorder. In contrast to difficulties with articulation (enunciation), a child with Childhood Apraxia of Speech cannot get their mouth movements to the right place at the right time. This will result in not only speech errors but also disruptions to the flow of speech.
Who might have Childhood Apraxia of Speech
Childhood Apraxia of Speech can occur on its own or in combination with other speech and language disorders. Often children with Childhood Apraxia of Speech have not made progress with traditional speech therapy. Some children with Childhood Apraxia of Speech make inconsistent errors when repeating the same word. Sometimes children with Childhood Apraxia of Speech may speak in a way that sounds slow or choppy.
How is Childhood Apraxia of Speech Diagnosed
Childhood Apraxia of Speech is a misunderstood and often misdiagnosed speech disorder. Childhood Apraxia of Speech is difficult to diagnose because the symptoms can appear very similar to speech-language delays and other speech-language disorders, especially when a child is very young or has a limited vocabulary. There is no gold standard test for Childhood Apraxia of Speech so it must be diagnosed by careful and systematic exclusion of other highly similar speech disorders. Although there is no single test for Childhood Apraxia of Speech, the scientific literature has identified tasks that can differentially diagnose children with high accuracy. Accurate diagnosis depends on a skilled and experienced practitioner to understand and use these science-based methods. Methods for differential diagnosis of CAS from other pediatric speech sound disorders vary by the age and communication abilities of each child. Evaluations of CAS must include an evaluation of the motor speech system, examining in detail both the types and amount of sounds and syllable shapes a child has, in addition to the underlying movement patterns and overall quality of the rate, rhythm, and intonation of speech.
About our Online Remote Early Childhood Speech-Language Evaluations
Online assessments of speech, language, and cognitive-communication abilities of children birth to 5 years of age can be administered by a qualified speech-language pathologist. Telehealth speech and language assessments include standardized tests that assess a child’s receptive, expressive, and social-emotional language, articulation, and phonological skills using an iPad or computer. Family involvement is essential for effective speech and language assessments and therapy. Remote assessments provide a unique opportunity for parents to be directly involved in the process as facilitators, as well as reporters. An informed clinical opinion is used to obtain functional information by detailed observation of the child’s natural environment with the people with whom he or she is most comfortable. The parent becomes the communication partner and facilitates skills such as direction following, identifying, labeling, and eliciting overall language. This type of assessment is proven to reduce anxiety and elicit behaviors that provide a clear picture of the child’s true abilities.
About our Remote Online Feeding Evaluations
Remote feeding evaluations will identify oral-motor dysfunctions related to feeding/chewing, taste/texture transition difficulties, and abnormal mealtime behaviors negatively impacting your child. There may be various reasons for feeding difficulties which are not limited to but include sensory processing deficits that may be associated with diagnoses such as Sensory Processing Disorder, Autism Spectrum Disorder, chewing delays, behavioral issues, dysphagia, Failure to Thrive/lack adequate weight gain, inability to manipulate food (food pocketing) or liquid, food selectivity/limited variety, transition from tube feedings to feeding by mouth, and vomiting (reflux). An evaluation will also determine picky eaters versus problem eaters using the Sequential Oral Sensory Approach to feeding. If your child is a picky eater or problem feeder they will require support to learn how to include more variety in their diets. Further, parents will be taught various strategies based on their child’s difficulties during feeding and/or drinking from a cup/bottle. If your child is presenting with difficulties manipulating food such as but not limited to food pocketing or difficulty chewing, there will be strategies and tools given to train them.
Remote feeding evaluations provide a great way to directly involve parents in the process. Observing how a parent interacts and feeds their child provides invaluable insight regarding the social-emotional aspect of feeding. Remote feeding evaluations, as with in-person feeding evaluations, begin with educating the parents on the process by explaining each step of the evaluation using descriptions or, in some cases videos, so the parent is prepared to effectively participate. It will comprise an initial detailed parental history of the child’s medical/behavioral background information, feeding history, meal experiences, and an observation of your child eating a “preferred meal” to observe their oral mechanisms and behaviors. Prior to the evaluation, parents will understand what foods will be presented and in what manner. Parents will actively facilitate the presentation of these foods, thereby maintaining the natural feeding environment for the child. The evaluator will closely observe each aspect of the feeding process. Since parents have been informed of the process, they are able to take cues from the clinician to manipulate the situation as necessary. During the assessment, your child will be asked to consume preferred foods/liquids as well as more challenging items. During a remote evaluation, parents are to be hands-on and provide intervention following the directives of the clinician. Using this information, our feeding therapists can then make a clinical judgment to determine the cause of the feeding difficulties and formulate strategies to target muscular coordination, sensory processes, and negative social experiences associated with food and eating. The evaluation will determine which skills are intact and functional in comparison to developmental norms and which are abnormal inhibiting feeding/swallowing skills.
Dependent on your child’s underlying issues, our team will devise a plan and recommendations to address strategies to assist in eating age-appropriate meals.