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FAQ: Playing with Water in Speech Pool Groups

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In December 2015, the ASHA Leader honored me in their Limelight section. Months later, emails flooded in with excitement and questions about playing with water in speech pool groups. Messages from SLPs globally, including Germany, and locally, such as Illinois, have been received and appreciated. In true SLP fashion, professionals asked poignant questions, inspiring a FAQ post about speech and language pool groups. This post later turned into a guide book: We Talk on Water (available on Amazon.) For detailed guidance on lesson plans, materials, billing, participant recruitment, documentation, and low-tech AAC, this book is essential!

Nanette Cote holding beach ball and spreading the word about the benefits of playing with water in 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? In 2003, I observed a pool group at a Jewish Community Center in Rhode Island. Soon after, I requested insurance coverage. It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center. My tasks were promoting the pool group, collaborating with a PT, and writing weekly service notes for billing submission.
  2. Do you have any special certifications to help with your sessions in the pool? I acquired all of my training through experience. Hosting my first pool group with an exceptional PT taught me about water positioning and improving 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 for Playing with Water

  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 begin 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? Six months before the services were slated to begin, I actively researched for the pool group session I wanted to offer through my private practice. First, I called three facilities and ask to speak with the aquatics directors. I followed up by meeting receptive individuals who rented their pool to rehabilitative agencies. I chose Rush Copley Healthplex
  3. Do you think a neighbor’s pool with an outside shower and bathroom work? I’m not a strong swimmer, so I’d feel uncomfortable using a neighbor’s pool and taking on liability for the 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. I advise families with high co-payments near reimbursement limits not to use coverage, to avoid taking away sessions. Research insurance reimbursements and set charges accordingly, ensuring rates align with coverage and state regulations. 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. This fee is not prorated if they miss a session.  I cannot 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.

Playing with Water: Goals and Session Outline

  1. Do you have specific goals for each child while playing with water or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions)? Years ago, an EI PT and I devised a service form for pool group tasks, now adapted for my private practice. New students are offered a free consultation to align goals. I designed the SOAP 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.

Two boys (6-11) jumping into pool and enjoying playing with water

Miscellaneous Questions

  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 local ad space but got no clients. Last summer, participants found me on social media, through ABA meetings, and referrals.
 

Successful Group Speech Therapy at the Pool

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Group Speech Therapy at the Pool

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”

(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

Natural Environments and Early Intervention

Grandfather with three grandchildren participating in group speech therapy at the pool

The idea of “Natural Environments” is a concept synonymous with Early Intervention.  As specialists, we provide our services most often in the naturally occurring setting, the family’s home. Early Intervention sites often recommend structured group settings for socialization and peer modeling. Finding a ‘natural’ space for group instruction among typical peers posed a challenge for therapists at Hasbro Hospital. A team of us put our heads together and identified an innovative therapy approach of group speech therapy at the pool, where fun meets effective communication enhancement in a unique setting.

Starting Group Speech Therapy

One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island.  She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist.  Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow!  We watched, listened and took notes.

Clearance was easier than expected. A couple of phone calls to the Risk Management office at Rhode Island Hospital sufficed. Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating.  However, it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children.

Outreach for Group Speech Therapy at the Pool

Finding people to participate was quick and easy.  Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group. We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children.  Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines!  Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)

“Sing, Sing a Song”

Nanette Cote with participants in group speech therapy at the pool

Music was an essential element to our group.   We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner.  Our sequence became predictable since we always started and finished with the same songs.   Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.

The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization.  We then noted that music and singing would be encouraged throughout several activities.  Here is a complete description of Developmental targets for pool group.

What’s on the Group Speech Therapy Agenda

Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet.  Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words.  Following this description were summaries discussing target goals for slide and ball play.  Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities.

Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities!  The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels.  Our clients included children with Cerebral Palsy, Down syndrome,   Apraxia, Autism, and Expressive language delays to name just a few.

Starting all over Again

Flash forward to March 2015:  Our family relocated to Illinois and I launched both this blog and my private practice:  Naperville Therapediatrics.  One spring, I transitioned to full-time work from my home office after completing a part-time contract at a Catholic school. Juggling administrative tasks and speech pathology, I’m committed to independent work and collaborating with a nearby OT/PT practice to enhance services for families, inspiring me to explore starting another pool group. For more information on how you can start your own pool group, then read my post about Playing with Water.

We Talk on Water

We Talk On Water author and book

In June 2019, I launched  We Talk on Water, a guide book available on Amazon primarily for speech pathologists, but also useful for occupational/ physical therapists and parents/caregivers wanting to enhance overall communication with a pediatric population at the pool.

If you’re interested in learning more about stimulating your children in a water environment, take a peek at my guide book which is divided into four parts:

  1. Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.
  2. Seventeen lesson plans for 2-5 years old.
  3. Seven lesson plans for 6-9 years old.
  4. Sample documentation (SOAP note, augmentative communication board, list of developmental targets addressed at the pool, registration paperwork)

For more details, you can follow this link to the Table of Contents.

References:
“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995

Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

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