A Harsh Lesson in Access to Care


Every once in awhile you meet a family and are forever changed. That is how I am feeling right now.

I called a mother to coordinate a Spanish-speaking speech evaluation in the family’s home in San Francisco. Mother indicated over the phone that she worked five days a week, sometimes more, and her hours varied, but she could never be home before 6 p.m. So, needing to complete this evaluation no matter what, I agreed to see them at 7 p.m., allowing them time to settle in after their day.

The family story was a rough one, and so was their daily struggle. Mother told me that “Maria” was not talking at almost 3 years old. I noticed that not only were her expressive language skills delayed, but her receptive language skills were as well.

Concluding the assessment, I recommend speech services to Mother. She asked, “Can they come at night like you?” I said, “A therapist who speaks Spanish? Probably not,” I told her. She then explained that her daughter went to a home daycare that was unlicensed and that the owner of the daycare already told her they would not accept any visitors for fear that their being unlicensed would be discovered.

Given that this little girl was at daycare from 7 a.m. to 6 p.m., when and how was she supposed to access these services that were being recommended? I asked myself. And so although I really wanted to explain the importance of early intervention and the difference it could make in her daughter’s communication, I had to hold back. Maria’s Mother’s hands were tied.

She had to work to support her two daughters, being a single mother. She lived in an apartment building in the city where she rented just a room for the three of them. I could see the dilemma in her eyes, trying to help her daughter get the therapy she needed or turning the work away and putting them at risk of not being able to pay their rent. My heart broke for her. I gave her some ideas and suggestions to help her daughter work on imitation of sounds and how to encourage her receptive language in her daily routine, but that was all I could do.

Even though as I left the home I was content with the support that I offered I was also left wondering if mother would find a way to access the services her daughter so desperately needed, or just move on because it would be too risky to give up the work to support them. I left there frustrated, especially because this was just one of many children where this is a dilemma. The need to access the speech therapy services these children need is real. But then again, so is the financial struggle that the so many families that we work with face.

I hope “Maria” gets the help she needs.


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About Author

Jasna Cowan, MS, CCC-SLP

Jasna Cowan, MS, CCC-SLP, is a bilingual speech-language pathologist and the Director and Founder of Speech Goals Speech Therapy, Inc. She is licensed by the state of California and Certified by the American Speech and Hearing Association (ASHA). Her certifications include a Hanen Certification, and Early Start Denver Method. Cowan has been working as a speech language pathologist for 12 years, having received her Bachelor’s and Master’s Degrees from San Francisco State University. In her career, she has gained valuable experience working for the Pacifica School District as an employee and then as a contract consultant for litigious cases. She has also spent a significant portion of her career at the Pine Hill School and the Newton Program for children with high functioning Autism. Her expertise includes speech and language delay and disorders including bilingualism, children with autism spectrum, and articulation and phonological delays and disorders with speech sounds. Her accomplishments include creating the first Mommy and Me sign language class at Kaiser Permanente San Francisco. Cowan currently serves as President of Speech ABCs, a non-profit that assists families in need of speech and language services and related services from her main offices in South San Francisco. Additionally, she consults for the Child Care Coordinating Council (4C’s) of San Mateo. Cowan also sits on a multidisciplinary team at Golden Gate Regional Center (GGRC) in San Mateo, CA for whom she also serves as a therapy provider forGGRC’s Early Intervention Speech Pathologist in Spanish and English. As a trusted GGRC service partner, she provides both bilingual assessments and therapy for young children, ages 0-3. In conjunction with this service, she also conducts parent coaching courses on speech and language facilitation at Good Samaritan Resource Center of the Mission District in San Francisco

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