Saturday, December 14, 2013

Shout out to School-Based SLPs! (musings from an 'ordinary speech pathologist')

This post is in no way intended to demean the hard work that talented speech-language pathologists do in a private practice setting.  A long time ago, I was hired by a private practice, and worked difficult cases, drove to remote towns, worked in hospitals, and visited homes and day cares.  It was tough, and at the time, it wasn't exactly lucrative (I was a CFY).  I always worried about where the next payment was coming from. On the flip side, financially strapped parents and caregivers often didn't know where their next dollar was in order to pay me.   Anxiety and stress seemed to be the name of the game from both sides.

I walked away from that setting, and have little desire to return. I prefer public service, which is why I love working in schools.  Billing parents or recruiting clients/contracts is not part of the equation.

During my years as a public school SLP, however, I run into a misperception CONSTANTLY.  Sometimes it's implied subtly; while other times, it's blatant.  For some reason, the word is out that public school speech pathologists are not as qualified as their private practice counterparts. I've been referred to as the 'ordinary speech pathologist', or the one who doesn't know much about (fill in the blank with the disorder).

Although I'm the first to admit that I often don't know answers, I feel my clinical skills (and the skills of my public school speech friends) are on par with SLPs around the country.  I'm in awe of my other public school colleagues, and I often go to them with my questions about children on my caseload.

I would like to eliminate any preconceived notions about the expertise of public school speech pathologists and here is why---

  • In order to practice either in a school or private setting, all NC speech-language pathologists (and most other states) must have a Masters Degree, and have the Certification of Clinical Competence. The training for this is rigorous.  In addition, speech-language pathologists must ALL continue their educations through professional development to maintain certification.
  • Public school speech-language pathologists are often leaders in their field.  Our lead SLP is a past- president of the NC Speech and Hearing Association.  Our SLP group in the Chapel Hill-Carrboro School system has formulated guidelines and protocols for assessment and peer review that SLPs across the state use. 
  • Public school speech-language pathologists independently and as a group read scholarly articles in order to stay current in their field.  We often discuss these at our professional development meetings.
  • Public school speech-language pathologists often publish in scholarly journals and national magazines
  • Public school speech-language pathologists must be well-versed in best practice for a variety of children from all walks of life, and who have various disorders.  There is rarely an opportunity to
    completely specialize, so a public school SLP, when given a new student, must research treatment techniques, attend conferences, or seek expert advice in order to write appropriate goals and objectives.  This scenario happens frequently.
  • Public school speech-language pathologists must also stay reasonably up-to-date with current technologies--both for record keeping and for assistive technology needs of the students.
  •  Public school speech-language pathologists must collaborate effectively with other educators.  Every child is a part of a team of adults, and SLPs often work on many different teams to provide the most appropriate services for the child.  This may not always be the traditional 'pull out' model--often the setting is collaborative; sometimes it involves co-teaching.
  • Public school speech-language pathologists must be well-versed in evaluating and treating children who  speak other languages. 
  • Public school speech-language pathologists must keep detailed records of treatment, and be well versed in special education law.  They need to know how to write measurable goals and monitor progress.
  • Public school speech-language pathologists need to know curriculum for all levels of children, including being well versed on the new Common Core (other other state standards). 

Over the years, I've been involved in interviewing speech pathologists who would like to work for our school system.  It's competitive!   Typically for every job opening, 4 or 5 people were interviewed. Many applicants worked in a private setting at the time of the interview, and often didn't get the job.  Others SLPs interviewed were those with public school experience and also often didn't get hired. There has never been a strong feeling that one group is any more qualified than the other.  Prior work setting doesn't pre-determine clinical skills.

There are, of course, times where a referral to an outside agency for specialized treatment and consultation is necessary.  For example, a child with a cochlear implant needs to be seen by people who really know a LOT about this, and then they can provide direction to the school and parents.  A child with a cleft palate needs the services of a specialized multidisciplinary clinic.
    Parents, of course, may take their children to whomever they choose, and the private SLP may be just the ticket for that child's continued success.  There just is no rule-of-thumb that says that one group is more competent than the other. 

So, why does the misperception still exist? Feel free to comment. 



  1. I don't have the misperception that school SLPs (in general) are any less qualified than those in private practice, so I can't really comment on that. My son has had great school SLP (you) and not great. He has had great private SLPs and not great. School SLPs by their own admission are only required to have educational goals and their only purpose is to help a child access FAPE. I'm not putting that down because it is a very necessary part of special ed, but it certainly is a limitation. So if I take my child to a private SLP, I am free to find someone who is not a generalist but rather is an expert in my child's specific speech-language issues. For example, my son's current SLP is an expert in feeding and swallowing and she almost exclusively works on expanding his severely self-restricted diet, with about 1/4 of her time spent on artic. Not to mention I can hire and fire at will, and I have. That element of choice is pretty much everything- I can find a speech therapist who can offer their expertise but ultimately I, as the parent, drive what the treatment goals are. I'm thankful every day that our health insurance covered my son's early private speech therapy because I was able to find a SLP who had expertise in co-morbid autism and apraxia and was willing to work on the apraxia within the context of rewarding, fun activities to individually teach my child every phoneme as was needed. The school SLP was unwilling to do that. If not for the private SLP, I'm not sure my son would actually have speech. But I'll add that even with the absolute best school SLP, I'd still get private (if available) so that we are free to work on exactly what is needed, not necessarily within the limitations of being "educational".

    1. Thanks for your nice words, and I completely understand why some choose private in addition to school SLPs, especially when handicaps are severe. The blog entry really wasn't about the child's needs, but about misperceptions in general (not yours, though, obviously!)

  2. I work in both school and private settings. I find that most children do better with both private and school therapy-but insurance makes it difficult for some families to receive both. I'm in MN where it is difficult to qualify for school services (2 SD below on 2 separate assessments) I have parents who will ask me to "tell" the school therapist what to do and I always make a point to explain that we can certainly collaborate on goals as professionals but that I can't make blanket recommendations for schools and that educational based therapy can be different from medically based therapy. Also, the school therapist understands the schools culture, teachers and how best to address the students goals within that educational system.

  3. Having been on both sides of the fence, I've certainly seen this in action. I think the point about specialization is a huge one. When I worked in the schools I was lucky enough to be given mostly the children with Autism but still needed to be prepared to treat any child with any communication disorder. When given a voice or fluency kiddo, I needed LOTS of help! In private practice, I can do what I know I do well and focus on that. I think it's really challenging to become an "expert" in every communication disorder and totally respect the efforts of my public school counterparts in their efforts. The best results I've seen with children is when there is a strong collaboration between the private and public school SLPs with each sharing their own expertise.
    The other major issue is funding which also tends to drive trust. I've had to earn the trust of many of my parents, especially when my recommendations are very different from their previous SLP with whom they had already developed that trust. I just think it tends to be easier to develop trust when you know the professional is working for you and not for the school system. I can often say the exact same thing as the school SLP but it's heard differently.
    Just like any other field, there are "good" and "bad" SLPs in both private and public employment. I've met and worked with many excellent school based SLPs!

  4. I think it still exists because up until quite recently there were some states that allowed school therapists to only have a bachelors degree to work in the school setting. I know there are some states where some have been "grandfathered" in to be allowed to continue working with a bachelors. Hopefully as the years go by the requirements for liscensure and certification remain the same for school therapists as clinical/medical therapists that perception will fade.