FAQ: Playing with Water in Speech Pool Groups

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!

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

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.

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.

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

Nanette Cote

Nanette Cote is an ASHA certified speech pathologist, published author, and private practice business owner with 30 years experience.