The piece below was written by Julianne Le Quelenec, a speech-language pathologist in the Calgary area. It was published in the September 2020 edition of Alberta Views magazine, and it appears here with permission from the author and Alberta Views.

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"Maybe You Don't Know: An open letter to the provincial government"

In my 12 years as a Speech-Language Pathologist (SLP) serving the Alberta public, I have had the privilege of supporting children who, for a variety of reasons, struggled with their development. For children with autism, Down syndrome, neurological disorders, significant prematurity, genetic conditions, developmental delays and more, I have sat in a room and met with parents and promised to help their child grow. I have advocated for services and supports, I have coached families through difficult times, and I have been trusted to work with, guide and support some truly amazing children at very vulnerable times in their lives. I have heard first words. I have seen children learn to make friends. I have seen children learn to interact with the world around them and adjust to being in school. And I am only one of hundreds… thousands of specialized support staff, in similar programs, who do the same type of work with passion and dedication and skill, all across the province.

And never, ever have I felt that children in Alberta are at greater risk than they are right now.

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The UCP Government’s significant, devastating cuts to Program Unit Funding (PUF) have changed the developmental trajectories of thousands of young, vulnerable Albertans. In an instant. Through the passing of the budget on a Thursday in February, the UCP government upended the supports and services that were allowing children with significant needs to find their voice, learn, grow and develop. Over 70 per cent of the funding that had previously provided educational programming, support staff and therapeutic interventions for children with documented severe delays and disabilities.

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​So, it occurs to me— that maybe you don’t know.

Maybe you don’t know why we had these programs in the first place.

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Maybe you have never seen a 2.5 year old with autism, who is completely overwhelmed with the sensory input from the world around him, and can’t communicate his needs. And as a result, that child persistently hits his own head against the floor until an adult gently restrains him. Can you imagine being so overwhelmed that you hurl your 27-lb body against a hard floor so that you can feel something other than the frustration of having no words? This isn’t an isolated case. This is what can happen to young children who can’t communicate and have a sensory system in need of OT support. It doesn’t last forever, though. With intervention, that child can learn to use pictures or gestures or words to make requests and answer questions. And a year later, that child might say “I want goldfish” at snack time, and smile when you pass them their Toy Story lunchbox. And you’ll marvel at the fact that a year ago, you desperately tried to cushion his forehead as he lunged at the floor, over and over again, when you couldn’t figure out what he wanted. And you’ll feel eternally grateful that you got to be a part of a system that helped that child in real and tangible ways.

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Maybe you have never met a child with apraxia, who knows exactly what they want to say, but whose motor-planning systems don’t allow them to produce sounds with their mouth, lips, tongue and voice. They understand everything. And they can’t say anything at age 2. Maybe you haven’t provided sessions, three times a week for six months to help that child learn to bring his lips together. Those sessions are tough, and he’s so frustrated, but he works so hard. For years. And it’s so worth it. Because that child, who is now nine, can tell you all about his hockey practice and crack jokes and read and write and be all the things a nine year old can be. Because this is what happens when a child can communicate.

Maybe you have never seen a child come to school with bruises on her face. Reflexively, you ask her what happened. And then you cringe inside, because she’s 3.5 and has somewhere between four and six words and answers every question with the word “yeah”. “Where did you go?” –  yeah. “What happened to your forehead?” –  yeah. You wish… so much… that she could tell you what happened. And then she will go home from school, and her mom will ask her what she did during the day, and how she got the bruise on her forehead. She won't be able to answer mom’s questions either. She just says “yeah” and doesn’t understand why mom is upset. Mom thinks that the bruise came from school. School thinks it came from home. Every day this child goes back and forth between home and school, and she can’t tell anyone about either. 

Can you imagine how lonely that is? Not being able to share your thoughts and ideas with a single person? As her SLP, the first thing you work on is helping that child use pictures or real objects to make choices and answer simple questions. It's a goal that can’t happen soon enough. Because you know that the ability to answer questions… or point… or use pictures, not only gives that child a voice but also gives that child some safety. Turns out, the bruise happened on the bus. By accident. When she reached down to pick up her lunch box, she hit her head on the metal wall of the bus. She didn’t tell us that. Another kid from the bus did. The next day. It took mom, teacher, SLP and principal one full day to figure that out. Can you imagine how vulnerable these children are? When they can’t tell anybody about anything? Thirty-one per cent of children with developmental disabilities may face abuse or maltreatment. And it can continue, undetected, when children can’t communicate.

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Maybe you have never met a child with cerebral palsy, who is wheelchair bound and has spastic quadriplegia. That child may never use his voice to speak. But with intervention, he can use his eye gaze to become a proficient user of a computerized voice-output device. That takes years of therapy. It takes such determination and hard work from a little kid, that sometimes during session it brings tears to your eyes because you can just feel the fortitude from this 5-year-old who wants to be heard and find a voice in this world. He is in kindergarten, and his team helps him thrive because he’s learning to use his skills in this new and busy environment. And maybe you have never seen a child like that grow up, and be 15, and use an iPhone with an eye gaze interface and text his friends and surf the internet. This can happen, because he can communicate.

I assume you don’t know this. The struggles, the hardship, the perseverance, the joy, the pride that families experience as their preschooler struggles to communicate and interact… but then grows, and learns, and improves and thrives…. All because they received the right support at the right time.

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If you knew this, you wouldn’t take it away.

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I assume you don’t know the outcomes, either. Because if you did, you wouldn’t have eliminated nearly three-quarters of the funding that underpins early intervention in Alberta, and you wouldn’t have changed the age cut-off from age six, to 4 years 8 months. Here is what the research says:

 

• Early intervention capitalizes on the most critical developmental window that a child will ever pass through. A child’s experiences in their first six years of life will significantly influence their life’s outcome A child’s experiences in the first six years of life will significantly influence their life’s outcome.  This is why PUF needs to continue to age 6, and why PUF in kindergarten should not “align” with services in the remainder of the grades.

 

• Greater access to early intervention supports the most at-risk children. Children from low-income families or minority backgrounds are less likely to receive early intervention services, but for them it can have the greatest impact. Missing out on early intervention further marginalizes children from underprivileged backgrounds.

 

• Up to 42 per cent of children who receive early intervention no longer require special education support in kindergarten and beyond. For children who receive early intervention due to speech/language needs alone, up to 60 per cent no longer require support after kindergarten.

 

Early intervention works. It works for every child who needs it. And the window for this efficacy is birth to 6. 
 

Now, if the human stories didn’t convince you, and the efficacy studies didn’t persuade you, let’s talk numbers. Because, I suppose it’s possible to appreciate the benefits to at-risk children, but still feel reluctant to invest public funds in this domain during tough times. So here are a multitude of reasons why early intervention makes economic sense.

Statistically significant positive effects have been reported over the long term when children receive early intervention. Effects are across the following domains: IQ, behaviour, scholastic achievement, special education requirements, grade repetition, high school completion rates, crime rates, income in adulthood, welfare participation and even-the lifelong number of emergency room visits a person will require.

Providing family centred, early intervention early in life improves academic, behavioural, and health outcomes, and offers long-term health benefits and cost savings. The costs associated with early intervention programs are often fully offset after two years due to a reduction in a child’s need for other services. Most early intervention programs that are evaluated through cost-benefit analysis are found to pay for themselves through benefit to participants, government, and other members of society. Benefit ratios are typically found in the range of $2-4 for every dollar invested in early intervention. Those who participate in early intervention programs will likely require lower public expenditures later in life. They are likely to earn more income and therefore pay more taxes. Early intervention is an effective tool in interrupting the intergenerational transmission of poverty. For every $1 spent on early childhood programs, the economy receives $6 in economic benefits in the long term.

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Our province is hurting. We are in the middle of a pandemic. And every household, from small town Alberta to the legislature, is looking for ways to economize right now.

Cutting PUF funding shouldn’t be one of them.

Let’s be the province who sees the most vulnerable kids, with the most potential, and agrees to invest in them. Let’s be the province who is smart enough to see that investing in early intervention now can pay for itself in as little as two years. Let’s be the province who looks upon a mountain of peer-reviewed research and decides to use it to inform our public service offerings for our youngest, most at-risk Albertans. And let’s be the province that recognizes excellent economic opportunities and makes investments in children based on proven fiscal benefits.

And please, let’s also be a province with a sales tax and pay for these things regardless of the price of oil.

Sincerely,

A Concerned Alberta Speech-Language Pathologist

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Julianne Le Quelenec is a speech-language pathologist in the Calgary area. She designs/delivers early-intervention programs for young children. Sources for this piece are available upon request. 

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