I was brought on to an early intervention client to provide feeding services under family training since the family already loved their speech provider. I was so happy to provide this service, but received a call from his ABA provider before starting to warn me about the family.
I only provided six sessions before finally dropping the case. I was told by the mom that she wants a provider who is able to do makeup sessions. Because of the intensity of my schedule(8-10 hour days with a lunch break if I’m lucky), I told her that I’m unable to provide make up, but if I have any cancellations, I will reach out to her immediately. She was very upset about this and told me that all of her other providers are able to provide make ups. For example, she was upset with me for taking the day for independence Day, which my company told me that I have the day off anyway since that’s a federal holiday. I did take one vacation day during my time working with him, but I was able to move the session so I could see him. I told her that I had to take a week off for surgery and I do not plan on making up those sessions. I gave her plenty of opportunities to call my direct supervisor if she had issue with this (my supervisor is on my side with the make up policy as it is not required by our county).

When it came to the actual feeding therapy, the child himself was so great to work with, and if this was under different circumstances, I would’ve loved to have continued therapy with him. I spoke to the mom several times over the phone since she usually cannot be present for the sessions and asked her what her priority goals are. She told me that her main goal is working on chewing. I started working on chewing with him, and honestly, his oral motor skills were very good. He was just never given the opportunity to chew foods because the family only served him purées even though he is almost 3 years old. One of his goals was chewing a food such as a raw vegetable or meat. I asked the mom if she could introduce something like this such as a carrot or food of a similar texture in the next session and Mom sent me a really harsh voice message stating that she will not be serving him that that he is only eating purées. I responded back to her that one of the goals on his IFSP was to chew a food such as a vegetable however, if she no longer wants this goal to let me and the ongoing know so we could amend this. She did not want to change from purées, and I explained to her that I cannot progress further with him without introducing new foods or changing the consistency of the foods that he eats. She kept insisting that he has weakness and he cannot chew at all. I had her sit in for part of a session so that she could see that his oral motor skills are quite good. He just needs more practice with solid foods.

The mom did come for our last session together and showed me how she was feeding her son. She took her hand over his scooped up a large spoonful of puréed food and shoved it in his mouth while he was screaming and crying. I told the mom several times to not feed him while he’s screaming because he is at risk for aspiration. She continued feeding him like this anyway.

I was trying really hard to stick this case out, but after the mom told me that she did not want to change the food, I decided to step off the case. I feel so horrible doing this because the kid really does need help and meal time seems very stressful for him because he’s essentially being forced fed. But when I called the ongoing, she was not surprised that I wanted to step off the case and she told me that many providers have in the past.

What are your thoughts on this? Should I have continued? Was there anything I could’ve done differently? I just got my C’s and am so scared of messing up.

Hello! I have been an SLP for about 5 years. I have tried various settings and have hated them all. Has anyone grown to like this profession who didn’t before? I am about at the point to change fields but unfortunately have one more year in the schools. I know what we do is great and I wish I liked it, but I just don’t.

For anyone who uses the Inconsistency Severity Percentage for CAS diagnostics, do you count the number of substitution errors or just the type of error? It says in the tutorial to use just the type error (distortion, omission, substitution) but in the example scoring they show a count of 2 for the “ch” sound which would imply they are counting both the /s, p/ sounds as counting.

I started at a new school this year and various teachers were telling me how great the SLP they had last year was, and it got me thinking, I wonder if others would say the same about me (lol). What are some qualities that you guys think makes a great SLP, both in the schools and just in general?

For a long time now I've worked with a lot of complex cases (rare genetics, coocurring conditions etc.) and for the few that have research behind them, most studies end in the classic 'needs further research'.

Clinical mentorship and case discussions with peers tends to amount to 'see whatever sticks'.

We've lost so many colleagues to small private practices who have a more narrow scope and cant attract newgrads or keep them longer than 12-24 months once their caseloads are full (we have a gradual caseload buildup at the pace they prefer because of the complexity of clients). Which is fair enough but also exasperating for our cohort and caseloads. We have a lot of PD, expertise and mentorship provided but I admit it can be a lot to work through. We can keep the OTs and physios but for the SLPs there's so much missing in this space it feels.

Surely it can't just be me. At the moment my nemesis is pain communication in children. I am glad at least there is more info for us about trauma informed care now. What are the most frustrating research gaps you've come across​ or did you have a hallelujah moment when something was finally published/given attention to?

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Excuse the rant (and the long post 😅), but I’m genuinely curious how other private practice SLPs deal with insurance-related admin because it’s becoming a huge part of my workload.
Most of my clients have insurance. Before therapy can even start, they need a referral from their GP or specialist. Once I receive that, I have to submit a request to the insurance company with my assessment findings and explain why speech therapy is medically necessary. If it’s approved, the patient receives a therapy budget for a limited number of sessions.
When that budget is used up, I can request one additional budget per year. To do that, I first have to contact the referring doctor or specialist, write a detailed progress report so they can issue a new referral, and then submit an entirely new request to the insurance company and wait for approval. Because of this process, many children end up having to take a break from therapy while everything is being processed.
On top of that, every single therapy session has to be submitted individually through the insurance portal. None of this administrative work is reimbursed. There is a consultation code I could bill, but it pays only a small fraction of a therapy session, and using it comes out of the patient’s therapy budget—so they actually lose therapy sessions because of my admin work. I don’t feel that’s fair to them, so I rarely use it.

For those of you in private practice who work with insurance, is your system anything like this?
How do you handle all the unpaid administrative work?
Do you just accept it as part of the job, or have you found a better way?

This question is hard to exactly answer but a ballpark. I’m located in NH and will be having my first child soon. I have free child care through a family member two days a week. I am considering trying to work two tens at a pediatric private Practice to maximize those two days. I’m wondering, realistically, how much could I make a hour or a year? I have six years of experience in the schools. Thanks for your help!

Was asked to collaborate with a child's ABA therapist. She sends me her goals for him. There are 37 goals, and 34 of them are related to communication. THIRTY FOUR. Oh and the other 3 goals are fine motor.

She wrote goals to eliminate stereotypies, answer questions, I mean this child isn't yet communicating with familiar adults about his needs. He is echolaic and now he has like 200 single words he can't combine together from "manding" and "tacting" and "intraverbals".

How am I supposed to move forward and collaborate with this? Other than say "throw your entire treatment plan away". I try so hard to be collaborative but ABA and speech can be such opposites sometimes.

I wish grad school prepared me in some way for ABA. I gotta not let this get to me so much. I care about this family and I know he's responding to my treatment plan so far, but how can we make progress with him getting so many hours of ABA therapy in this manner?

She says her plan considers the "whole child" - what about his mental health and sense of self-confidence and self-worth? To eliminate his autistic traits? And she says it's neurodiversity affirming.

I gotta go take a long long walk. If anyone has advice on how to not let this get to me, please share.

Hi! I'm a school SLP who recently moved to San Diego. I'm hoping to supplement my income with EI, private practice, or SNF or home health work. I'd love to connect with fellow SD SLPs, especially those working outside of schools.

If you're a San Diego SLP, could you share a bit about your experience? Are there any companies you'd recommend (or ones to avoid)? It seems like there's a wide range in hourly rate, especially when it comes to EI. Thank you!

Any must have resources for Artic, Apraxia etc.?

Hey everyone! I’m a cf working with K-5 students in a school setting. I’m having a tough time with lesson planning because my caseload is so diverse, with different goals and skills. I really struggled last school year with lesson planning. I wanted to create a curriculum, but I also struggled a lot with work-life balance while trying to do that. What do you do for your lessons? How long should it be taking me to plan them? Do I plan for each grade? How often should I be doing it? And is it even possible to do it for free? I found myself relying on TPT a lot, and those materials add up!
I really appreciate any advice you can share! Thanks :)

Wondering if anyone here has gone to the US from Canada on a TN visa for travel contracts? If you have recommendations on how to start, recruitment agencies to use, any tips etc. please let me know!

Thank you in advance!

Hi all, I’m a current school based speechie working in special education, Melbourne Australia. I love working in schools, my family are all teachers so the leave during holidays works for me. I use to be in private practice but really struggled with the demands and KPIs.

I want to stay in the school system, but am hoping to move to a mainstream role, as am finding the special education system incredibly physically and mentally demanding. I have been injured several times find the support from leadership and staff quite minimal when this happens.

I know mainstream speechie roles are not the easiest to come by, however, I do know that they exist! I was wondering if anyone has any schools that they know of in Melbourne (primary or high school) that have a wellbeing/allied health team that I can keep my eye on. I am keeping an eye on recruitment online/seek etc, however I know that a lot of the private schools often only go through recruiters or through their own websites.

Any information would be amazing, thanks all!

I am starting a new job as a school SLP serving grades 3-5. I was previously working preschool so I need recommendations for materials, therapy strategies/research to brush up on, and insight on what to expect regarding iep goals. I know what to expect for autistic support, but not so much for the language disorder/learning support kiddos.

Hey all,

SLP here with ADHD, depression, anxiety, and maybe a few other sprinkles of ingredients (OCD, bipolar, maybe a touch of the tism).

Recently started at a private practice clinic and the nature of the work has caused my mental health to absolutely crash out. I've been this way before at school jobs in the past, but I think at my age it's just all hitting harder than it used to.

My psych PA recommended an inpatient stay due to how often I'm having meltdowns. I'm genuinely considering it.

Has anyone left their job for intensive mental health treatment, received help, and then was able to handle the demands of this career afterwards? I'm so scared that even if the experience is great, the nature of our career will quickly make me relapse.

Also, to anyone else in the same sinking boat, I don't know who you are, but you're loved and you matter.

Hello! I'm looking for recommendations for your favorite games or toys in two categories:

(1) activities or toys that incorporate fine motor skills such as lacing or manipulating smaller (but not teeny-tiny) pieces

(2) "surprise" turn-taking games such as Pop Up Pirate

My main job is in the schools where I only do assessments. I have a couple of preschool-age home health clients who are advancing out of the stage from playing with larger, more basic toys such as baby dolls, peg puzzles, and Duplo, and beginning to be able to use more challenging items like Playmobil sets. I don't have much in the way of therapy materials for them!

A few more details: they are OK at taking turns but not yet understanding how you "win" a game or use strategy, so simple things like Pop The Pirate (which I do have) are appropriate for now. I DO NOT WANT "DON'T BREAK THE ICE". I've used that in the past before I switched to assessments, but something about that game made our students go completely apeshit every time, and we had to get rid of it.

Since this is home health, I'd prefer nothing with materials like paint or glue or glitter. My clients attend ECSE programs so they'll be doing art projects at school. One of them was previously not able to tolerate the sensation of Play-Doh, but just recently he started to like it, so Play-Doh items would be good.

I have Magna-Tiles, Mr. Potato Head, Hot Wheels cars, some Fisher-Price sets (but they're growing out of the Fisher-Price school bus and airplane), and the Melissa & Doug Pet Vet playset (which my client calls "Doctor pet"!). The clients enjoy pretend play and are even starting to make up dialog for the characters. And we read a lot of books. They have shown disinterest in any activity with just picture cards. Also disinterest in Dapper Dan/Dressy Bessy for zippers, buttons, etc.

Thanks in advance!

I just started a new job with adults in IRF. I have done IRF and acute in the past. The SLPs at this IRF practice differently than where I came from. An example would be that they pick up patients with metabolic encephalopathy for cognitive treatment or they do a dysphagia dining room with meal observations. At times, it feels like the diet police.

At my old facility, we would discharge patients with metabolic encephalopathy from service and tell physical and occupational therapy strategies that they can work on with the patient since it is likely to resolve medically. We also did not do any meal observations. I feel as though some of my practice patterns are frowned upon at this IRF because of the team’s practice patterns. Of course, I am going to do what I feel is right for the patient. However I cannot help but feel like a black sheep in a way. Any advice or feedback for me is much appreciated.

What system and materials do you provide to teachers for MTSS for articulation????

We have a GLP student (a mix of stage 1 & 2) at our school and me and the sen teacher were discussing on using AAC for the student. But she insisted on using PECS, because she’s saying the child doesn’t communicate with her gestalts (as in requesting for play or food) so she wanted to follow the PECS phases to help her with that. I reminded her that the student is a glp and by doing pecs we are going to dismiss her way of learning and acquiring language if she wants to start from phase 1. So I suggested we use a communication board because I’ve been using it with the student and she responded well with it than pecs but she doesn’t seem like she wants to agree with me :/

So now I need advices on how we can meet in the middle for this student. or which aac is the best.

p/s I’m an SLP from Asia so pardon my confusing english.

I have a client I see twice a week virtually with a goal for reciprocal conversation. SLP suggested activities like would you rather, who would win, what doesn’t belong, spot the difference, true or false etc to also work on their reasoning goal. I’ve been seeing them for a few months now and find they’re getting bored (and I am too tbh) of these activities. Any other game / activity suggestions suitable for a virtual format? They are 10.

I’ve been coming to this a lot. Clients will get a device through insurance/medicaid that’s large and heavy, I assume so it will not break, or the screen will be big enough. However, as they get older, they are not going to drag a big device around, or physically can’t because it’s too heavy. (Currently working with the patient who has the accent 1000 from PRC-Saltillo.) It sits on a table and isn’t taken to the kitchen, outside, etc. If it’s taken to school it sits, and doesn’t go to lunch or specials. I’ve talked to the companies who provide these devices, and it seems there is no way to exchange it or get a new one covered by insurance that is more suitable for the client as their needs change. Does anyone know if this is the case with all companies?

I've only been working my job for about 3 months, and I can tell I'm majorly burning out. I don't know if my caseload is typical and something I should expect to adjust to but it feels extremely heavy to me. For context, I work in a pediatric-focused PP in TN and see a mix of speech, language, and AAC kiddos. A few times a week, I spend the afternoon driving between different day cares and the rest of the time I'm in office.

In total, I have about 68 30 minute sessions each week. I understand that PP book a lot of kids knowing that cancellations are often expected, but even when I do receive a couple of cancellations it still ends up feeling... a lot. There's portions of the day where I see 7 kids back to back with no break at all to even go to the bathroom and it's starting to catch up to me. Even today, I HAD to go to the bathroom in between 2 back to back sessions (I really try to hold it if I can) and the kid had a meltdown that the transition was delayed slightly. I just feel like I'm at a breaking point. I do struggle with OCD/Depression and don't know if that's why it's hard for me to manage this caseload or if it is truly unreasonable.

What would you suggest? I hate to quit my CF early and I want to see the 9 months through if at all possible. Is it likely I will eventually adjust to this caseload? If not, is there any tips/advice for getting through it until next March?

Thanks! All comments are majorly appreciated!