A Perth centre that provides therapy for hearing-impaired children says it has been forced to start charging families a monthly fee to help make up a $500,000 loss each year.
The Telethon Speech and Hearing Centre in Wembley has sent letters to dozens of parents this week asking them to enter a "funding partnership" that will cost them $167 a month from next year.
Children with normal hearing who use the centre's speech and language program already pay fees but until now those who have a hearing loss and use services such as audiology have been exempt.
The centre says it receives limited State and Commonwealth funding as well as valuable support from Telethon.
But it estimates the annual cost of providing services ranges from $10,000 to $30,000 per child and the most that Government funding provides for a child is $10,000 a year.
Chief executive Peta Monley said there had always been an enrolment fee for hearing-impaired children but the service fee was necessary to keep the centre financially sustainable.
"We're a not-for-profit children's charity and, while we get some funding, not all children have a level of impairment that qualifies for disability funding, even some with a significant hearing loss," she said.
"Unfortunately, when we reviewed our budget this year the board and senior management reluctantly made the decision to introduce these fees.
"We're not saying we're going broke but we can't keep our programs running at a loss and we're already constantly fundraising to try to make up the money we need."
One therapist told The Weekend West some staff were unhappy about how the fees were introduced and the decision to notify families a week before Christmas.
Staff had been asked to nominate needy families who could not afford the fee, and they did not get letters. The therapist said staff felt it was inappropriate because they did not necessarily know each family's circumstances.
Ms Monley said she had spoken to some parents concerned about the fees and encouraged others to come forward.
"The last thing we want is for people to feel they have to leave us because we love our families," she said. "The journey for many of them is hard enough already."