Is the gap widening between School Speech Language Pathologists and Clinical Speech Language Pathologists?

Nov 2, 2014 by

Is the gap widening between School Speech Language Pathologists and Clinical Speech Language Pathologists?

Reading articles and comments on my blog I’ve begun asking myself what I think are a couple of key questions. Is the gap widening between the school speech therapist and the clinical/hospital therapist? Why don’t we function the same way? Actually I’ve been thinking of this for a long time ever since an administrator, in passing at a staff meeting said something like, “They have to realize this is a public school”, in reference to a parent who wanted extra services in the ideal setting. At the time I thought privately to myself, why wouldn’t you want us providing the best services possible on parr with clinical or private therapists.

So do school Speech Language Pathologists and Clinical Speech Language Pathologists function the same way? I know the answer to that would be no. So my next question is why don’t speech language pathologists working with the same types of students all function the same way? School SLPs should be clinicians first and focused on curriculum based services second, after the student has achieved skills at a certain level within the therapy setting.

Why can’t school SLPs provide the same intensive services as a therapist working in a clinic? The first obstacle to this is scheduling. With some creativity and flexibility with administration and teachers I do believe this could be overcome. However, the reality is that test prep and curriculum has almost taken away the ability to be flexible with student’s time. We as therapists would also have to convince schools that intensive services would possible yield a better outcome and hopefully get the students out of therapy sooner. Honestly this is where I fell push in therapy really misses the mark. The second obstacle is staffing. In most (I dare say all) school systems therapists are spread so thin that intensive services are almost impossible to provide. How did school speech language pathologists get to the point where caseloads are so large they can’t be flexible.
When I started thinking about the differences in how school aged children are serviced by the SLP at school and the SLP working in clinical setting I raised more questions than I expected. I think time on task is almost less important of an issue when compared to how goals are written an addressed. However, my one haunting question is why, if our training and purpose is supposed to be the same, why are students serviced so differently in these settings?
SLPs working in the clinical setting have the flexibility to look at speech and language issues from a developmental perspective and address specific needs. Clinical therapists can also write goals that are meaningful and can be measured informally through task performance/observation. While clinical therapists may consider curriculum and homework when designing therapy, they are not asked to focus only on certain threads within a curriculum. School therapists are now being asked to design goals that are related to curriculum rather than looking at the developmental needs of the child. Our training tells us that if children do not develop skills in a prescribed manner, splinter skills are likely to emerge. Given the nature of the students we service, they are already at very high risk of developing splinter skills, why would we support that. School therapists are asked to service students within the classroom setting occasionally taking on the role of co-teacher. In theory, co-teaching might look like a good model on paper but some students may still require intensive services to make progress.

The college curriculum focused on the clinical model as most speech and language programs still do today. SLP’s are trained to have specific understanding of language development, linguistics, overall child development including reading. We’re trained to evaluate and work with students who have different learning styles and disabilities of all types that effect language development and learning. We learn how the brain works. Nowhere in my training was it ever mentioned that I had to water down my role as a language specialist to take on classroom responsibilities. (**In the right setting and with the right population co-teaching/classroom consultation can work but it is not a cure all to manage language disabilities or a large caseload)

So why are we as school SLP’s willing to push aside our clinical training to service students in a manner that focuses on curriculum rather than child development. Water down our therapy and time on task almost forcing (the more astute parent) to look for private services. Letting the private clinical therapist look like they are better trained and know more than we do? Why aren’t we servicing our students in the manner we were trained? These are some questions to ponder as our role in the schools evolves and changes. It’s my opinion that school SLPs need to be more in control of how students are serviced given the limitations of the public school setting rather than being dictated to by administration, common core curriculum and mandated test prep.

So why shouldn’t school SLPs function in a similar manner to clinical or private practice SLP? Sure there are going to be some differences because of the different settings. Have the restrictions become so great on the school SLP that they cannon function in the best possible manner? Has the gap become so large between the school SLP and the clinical SLP that school SLPs do not look or feel as competent? What do you think?

 

This is the second of three articles focusing on the School Speech Language Pathologist and the problems with their changing role.  This really goes against what is trending in education.  My first article “Have School Speech Therapists Lost Their Focus” generated a lot of interest.  As always looking for you feedback.

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16 Comments

  1. Rachel thomas

    I feel that paperwork is spiraling out of control in the school system and making it very difficult to provide the best level of therapy

    • Teresa Sadowski MA/SLP-ccc

      Couldn’t agree more! The teachers are also feeling a good brunt of the paperwork and goal setting too. That’s why I don’t understand why we are all putting up with it. So much wasted time and energy and lots of meetings.

  2. Annabel Ng-Quick

    This article revives an important point and is well-taken on my part. Therapists from these widely-divergent settings develope such amazing strategies to service the populations that they serve. Having clients cross over to both settings helps us learn from each other. Sometimes when we are so immersed in our situations we may miss the forest for the trees and it really helps to gain a fresh perspective. It would behoove our school-based SLPs to have this knowledgeable private practice therapist take over a public school caseload for 30 days. It would totally open her eyes to our multi-faceted dilemmas plus fire up the whole school-based therapy scene.

    • Teresa Sadowski MA/SLP-ccc

      Hello Annabel
      Thanks for taking the time to respond. Therapist Swap…Maybe we could propose a show like that to TLC. I know therapists in both setting do amazing jobs. While the school speech therapist has been asked to water down their therapy for years, Core Curriculum has really put school therapists in some awful situations where we are not allowed to treat students in an appropriate manner. On top of that few of us have the time we use to have be creative. Tons of paperwork and rules.
      Teresa

  3. I agree, completely! I have heard administrators state that we don’t provide “cadillac” services, only “hyundai” services. This is wrong on so many levels. I recently wrote a blogpost bemoaning the fate of the school-based SLP. When did our only function become to help students “access the curriculum?” Despite my best efforts to push-in, it is NOT effective therapy and I am struggling to meet goals. I have just about eliminated all of my push-in and only have a few left on my schedule.

  4. Cathy

    The SLP struggles in my opinion mirror the teacher struggles as well, hence the reason schools are failing in America. When you have creators of curriculum who have no idea of what goes on in a classroom and how a child’s mind develops telling you how to teach, what to teach and when to teach – you have a severe disconnect within the school. It is time for all school personal to standup and push back. In no other setting do you have outsiders coming in telling professionals how to do their job. No one would even suggest a “common” way to treat medical, dental, or legal issues-why because every case is individual as it is with children, i.e. students. Unfortunately in America that is who we have lost sight off. Government and Educational Testing and Textbook companies have made it about politics and profits. Thank You Teresa for having the guts to put something out there that points out the serious disconnects that are going on in the Public Schools of America.

  5. Kathy

    I must be very lucky because while my district encourages us to go into the classroom, we are allowed to do what is right for the student. Our caseloads do not exceed what is suggested in our state. While we need to keep in mind the “common core” we, as therapists,do what is right for our student! There are certain things we don’t do, such as feeding therapy, because we are told that feeding therapy is part of a medical model & not school related, which does not make sense to me. We are even told to look carefully at what each student needs when setting frequency & amount. Our administrator does not want each child to have 2ce a week for 60 minutes. She wants us to put thought into location of services, how much each child gets & wether that child needs 1:1 or small group. I’ve worked in 3 districts over my career & have been fortunate to have this in each district! I have had to remind therapists in the clinical setting that I do have the same training as they do & years of experience with a wide variety of disabilities. Some have been condescending & arrogant! After we exchange information regarding a child for a time they realize that working in a school setting doesn’t make you stupid. Those of us in the school setting need to stand up for ourselves to school administration & clinical therapists. We need to be advocates for the children on our caseloads.

    • Teresa Sadowski MA/SLP-ccc

      Hi Kathy
      You are lucky compared to the majority of therapists I speak with. I also look for positions that work with my philosophy. Sounds like you have a very good administrator that “gets it”. You’ll will be interested in my 3rd article in the series if I can ever get it done. It focuses on outside evals and how unspecialized they’ve become. We may need to advocate for the children on our caseloads but we also need to advocate for ourselves in terms of how much time it take to service our caseloads and appropriate caseload numbers, appropriate referrals and how we can be used in many different ways. I would love to know what state you live in and and read the documents on what your state suggests for numbers. I have not heard of that before. Please email me at theschoolspeechtherapist@gmail.com if you are not comfortable sharing publicly. Thanks for taking the time to read and comment.

  6. Carin

    I am one of those rare SLP’s that work in both the medical and educational setting each week. I can tell you that there are different requirements for evaluations in both settings. In the educational setting, we must satisfy IDEA, Common Core, and the district requirements. In the medical, we must satisfy JACHO, Insurance, etc.

    However, in both settings we need to use evidence-based measures for evaluation. I believe that we must go beyond the ‘scores’ and look deeper to see what the splinter skills are. I like the CELF-5 as it makes that easy to do that right away. I also use the CASL, and the PLS-5. It is important to look at the sensitivity and specificity of our instruments to ensure that what we are measuring is truly what we intended to measure….despite the setting. Articulation testing requires us to actually look at the student/child and not just depend upon what we hear. Are they dentalizing, using appropriate manner and placement, using appropriate horizontal/vertical/anterior-posterior movement? Being a good clinician in either setting requires attention to detail.

    I have had parents come into my clinical setting complaining about the type and frequency of the SLP services that their child receives in the school setting. When I probe a little further, they generally have no idea about the following information on the IEP: classification, frequency/minutes, or goals. The assumption is that school is somehow not as intensive as private. I take the time to educate them on the differences between the two settings and build up the school SLP as the unique Speech and Language provider in their child’s school who can see the impact of the student’s issues on their academics. It often surprises parents when I do this.

    I have been invited to attend IEP’s as a clinical SLP. When I ask the parent what they hope to gain by my attendance, it seems that they want someone to go in and tell the team that they are doing one or more things inappropriately. I will never attend for this reason. I will provide a copy of my evaluation (with a complete summary explaining the strengths and challenge areas), and my plan FOR THE CLINICAL SETTING. That is a major difference. I may give the parent some suggestions as to things to bring up at the IEP to help them better voice their opinions or concerns. Because I am not that student’s educational SLP, I find it highly inappropriate to make specific suggestions to the school outside of findings that testing in either environment would highlight.

    Any Clinical SLP who only does a cursory evaluation is not helpful in either environment. If another SLP had to step in at the clinic, it would be just as hard for them to serve this child as it would be for the educational SLP to follow the recommendations from an outside provider.

    I think we do need to communicate, one with another. I will often tell the parent that my goals may not be the schools goals etc, but that we can try to find common ground. Just an FYI, it is much easier for a clinical SLP to adjust their goals that it is for an educational SLP as it would require the IEP team to meet etc.

    Lastly, we need to support each other. Building up, giving the benefit of the doubt, and contacting (with permission) the other SLP can be a positive thing for the child/student…..who is and should always remain the center our our therapeutic attention.

    We are colleagues, let’s keep that professional relationship, pursuit of best practice, and focus on the needs of our clients despite the setting.

    Thank you for letting me give my two cents here. I appreciate the opportunity..

    • Teresa Sadowski MA/SLP-ccc

      Hi Carin
      Thank you for your thoughtful response and for sharing your personal experiences. You are one of the few SLP who truly can see both sides of the coin. I do believe that we should have more contact with the outside SLP both during the evaluation process and when working on what I hope are common goals. The way we have to write goals in schools saddens me and I often do not feel we target the underlying language needs. With that said it would be nice to know if a private therapist is working on needed foundational skills. You are a rare clinical therapist if you don’t write recommendations for the school setting that are too grand to implement and then cause friction between the parent and school. I thank for you that.
      Thanks for taking the time to read through my articles and respond. I know many will find your response helpful.
      Teresa

    • There is a similar gap of understanding between school psychologists and clinical psychologists who work with kids (plus dealing with the superiority complex of licensed doctoral levels psychs vs. masters level certified school psychs). I don’t think that it is “watering down” – different settings have different requirements. I can’t speak for SLPs, but this is why I have seen clinical psychologists who take on school psych roles struggle with understanding their role within the school and how to use it to their advantage to have a deeper impact.

      As a school psychologist, my focus is often on how a child is being impacted at school, but because home and school blend together, I’m often working on both. More than that, though, I feel that I have more tools to use than I would in a clinical practice. School psychs (and school SLPs) have the ability to see kids more frequently (even if it is just for a moment in the hallway). Plus our ability to provide teacher consultation and coordinate interventions with other related service providers can make us even more effective.

  7. Jess

    I agree with everything you wrote. I’ve worked clinical and have worked in the schools for 7 years now. I have noticed this change over the years and it’s so frustrating because I feel like my hands are tied to be more like a teacher rather than a clinician. This is probably what frustrates me the most, that I’m a “teacher” taking on teacher responsibilities that take away from my duties as a SLP. And don’t even get me started on RtI where untrained teachers, volunteers, assistants or whoever are asked to do my job and provide intervention without training for children who NEED my skilled services. It’s just a hot mess year in, year out that is frustrating. Ultimately children’s needs should be placed first but do much is out of our control that we just roll with the punches, be thankful for having legit workspace (or a classroom for the lucky ones) and do what we can for our babes.

    Love your articles! Blessings to all

  8. Nancy

    I worked in the public schools for 8 years, then in a hospital, a university, and in private practice for 30 years. Then, back to the public schools for 2 years in two separate school districts. One parent from my private practice was hoping I would be in her child’s school district, but honestly the SLP I was in private practice and the SLP I was in the school district were very different. Intensity was a problem in the schools because the therapy services actually provided ended up being about 65% of what was stated on the IEP due to all forms of cancellation. And, they were provided over an 8 mo period at best. Group therapy for articulation was the norm and minimally effective at best. I was able to see one client (after 3 years of group therapy and 3 SLPs: 20 min, 2x a week) for individual therapy 20 min, once a week and she graduated with fully generalized normal speech after 3 months. I was able to direct the therapy to exactly what she needed without the distraction of the group or compromising the goals. I was able to do this because her IEP came due at the beginning of my stint. In private practice, it is 50 min a week individual therapy with rarely a missed session.
    As far as quality of SLPs goes, it takes a lot of initiative to do a private practice and generally attracts a better quality SLP, in spite of having to pay for lost wages and CEUs. There are a lot of reasons people stay in the public schools that have nothing to do with loving the job. Unions allow this to happen. Sadly, the deterioration of insurance coverage for SLP services in insurance plans, will likely relegate private services to the rich, and increase caseloads in the schools.
    Thanks for opening up this discussion. I think there are many reasons SLP’s in the schools don’t feel generally free to be totally honest with themselves or others. And then there is ASHA. I won’t even there!

    • Teresa Sadowski MA/SLP-ccc

      Hi Nancy,
      Thanks so much for taking the time to give us your dual perspective. You and I are very much on the same page and yes we could go on and on about a lot of the issues and groups involved. Not sure schools attract a lower caliber of SLP’s in general. Many of my school colleagues work in other settings after school and on weekends. I believe it is the system, time limitations, lack of understanding of what SLP’s do (and can accomplish given the right conditions), being told how to treat students, scheduling, copious amounts of paperwork……that keep school slps from being as effective as they could be. That was my point in one of the articles. SLPs in all settings should be functioning in the same way and provide the same caliber of services. In the schools we’ve now become more like teachers than therapists and that shouldn’t happen. Thanks Again Teresa

  9. Helen Kinigopoulos

    I found my way here after reading your post on ASHA’s site and have now read your articles and the responses to them. For forty-three years, curiosity has led me to pursue opportunities to work as an SLP in virtually every possible setting, with a wide range of disabilities and with individuals across the age span. I started and ended my career in schools.
    Your articles and the comments of the other readers reflect the incredibly complex working conditions school SLPs encounter in the U.S. and also address intraprofessional conflicts within our profession. What an undertaking! Very sincerely, thank you.

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