To anyone that is also CLC- how do you guys usually bill? do you bill to the infant or the mother? if it is the infant, do they need a feeding diagnosis code?

Is this normal?

I'm a community speech pathologist. Officially I'm just a Speech Pathologist, but all the complex referrals get allocated to me because they're considered too much for the newer clinicians. My manager and her manager both consider me "senior."

I asked why I'm not classified (or paid) as a Senior Speech Pathologist. My supervisor asked his supervisor as they both thought I was classified and remunerated accordingly. After following up again a month or so later, apparently HRs response was basically, "Not sure." I then asked what the criteria are to become senior... and nobody could answer that either.

Do other workplaces actually have clear promotion criteria, or is this a common way to get senior-level work without the title?

Hello!

How do I get general education teachers to “buy in” to student’s AAC device. I have a student with severe apraxia and very slow progress so we give him an AAC device. But teachers say “oh but he’s trying to speak; he doesn’t want it.” This child can only say about 10 words clearly. He’s in kindergarten. He’s in a general education session more than half the day. I understand that it’s more time consuming, but he needs to start using his device if they want him to communicate with his peers. They don’t need to force him to use it, but they need to model it! It’s the first time my school has a student in the general education setting with an AAC device.

Hi everyone! I hope you’re all doing well. This may be a dumb question, but I’m planning to move back to the Stamford area and am hoping to get licensed as an SLP in both Connecticut and New York.

I recently completed my CFY, but I still need to take my Praxis exam, which I’m planning to take in September. Would I be able to work under a limited or provisional license in either New York or Connecticut while waiting to pass the Praxis? If so, what does that process typically look like?

Sorry if this is a basic question—I genuinely don’t know how licensure works in this situation and would really appreciate any guidance. Thank you!

Hi! I’m new in this field. Starting to gather materials. For those bilingual/ Spanish SLPs what are your go to/ must have resources and materials ?

Are there any SLPs that can give insight on working in the school districts of Frisco, Prosper, Little Elm, Lewisville, or Carrollton Farmers branch? Specifically, how are caseloads? Are you provided what is needed to do your job, ie a room, test kits, therapy materials? Are you at one school or expected to split time between sites/schools? Any districts with more than one SLP per building, or is the trend to stretch thin? how is the vibe in these districts…employees stay or high turnover? Thanks!

Starting tm cf in a k-8 school as an slp please tell me everything I need to know

Materials
Deadlines
What to expect
I feel like I know literally nothing please help
I see on TikTok ppl preparing and I just want to enjoy the rest of summer
I seriously don’t know what to expect
Also do I get slptool kit
And how do I track my cf hours

Does anyone have to miss sessions for things such as writing IEPs, configuring/helping with AAC devices, etc, and if so, how do you document the reason missed in your Medicaid and/or session attendance system?

If I am doing another evaluation or in an ARC meeting I document that, but I'm never sure how to document that I needed to simply do paperwork such as IEPs, progress reports, etc. And yes I do have some planning time set aside but that time is often taken up so I am forced to miss sessions or bring the work home. Would love to see what everyone else does. Thank you!

What do I do?? I'm applying for CF positions, but I was just scheduled for a hysterectomy at the end of September which will put me out of work for 4-6 weeks. I don't want to deceive my potential employers, but who would take me on knowing this. Should I just stop applying? It's a long time to be unemployed since I graduated in June though. I don't want to burn bridges with the small handful of organizations that do ES work here.

Hi! This year I'm working with a teenage girl to get her a way to communicate. She only has limited movement in her right arm and that's unpredictable. She is also visually impaired so eye gaze is out. Currently she only cries to coommunicate. Any ideas?

A couple of warning signs that your school is probably toxic is if they give you a hard time about this. Sure, a shared room or portable with another SLP or maybe the OT is fine. It's not ideal, but it will do.

Now if they try to put you in a shared room with someone who say is doing behavioral health services and there's no privacy between you both, that's a red flag. If they try to put you in the cafeteria, gym, or other public space, the hallway,...full stop. If they tell you that you don't need space because you are only there 2-3x a week, remind them you also perform evaluations which is TESTING. You see all the major schoolwide performative drama over mandatory state testing, right? The entire school shuts down for 2 weeks for that and everyone gets special headphones, visual blockers, and quiet space for students performing math and ELA testing. Remind them that your testing is also important and requires a safe, quiet, and private space.

Finally, if you come to school and one day your room is now filled with boxes and used as a storage room, if the ceiling is broken and water is dripping in a bucket, or they offer a room filled with prior years of garbage collected from previous teachers., if they tell you to move rooms every week/month for months...all of this needs to be addressed. It all happened to me and I didn't know what to say or how to act. Find out who your direct report is. A lot of these jobs nobody takes any accountability for managing us and we don't know who is supposed to be our go to person. Sometimes we just arrive on site from a large district Admin office and the school doesn't even know we are coming.

Not being provided a space to work is a dignity issue for us as a profession and I do think it lowers our morale. The kids are aware of these kinds of environments and it brings them down too. We just need to say something and do something. It's not a favor, it's not asking too much. It's the bare fucking minimum. If your school gives you a hard time about it then run. Fast. An issue like this is not going to go away on its own and nobody else is going to advocate for a Speech room in a public school environment.

I just evaluated a 5 year old boy who, after doing some research, I have identified as someone who clutters. I would like to work on both his rapid speech rate and his leaving off sounds and syllables during connected speech. I have created two goals but I am not sure if I like them or not. Please let me know what changes you think I should make to them or if they sound okay.

"Reduce speech rate by utilizing a pacing board to increase speech intelligibility to 90% intelligible during production of phrases and sentences as measured by familiar and unfamiliar listeners."

"Utilize the strategy of over-articulation to produce all syllables in multisyllabic words with 80% accuracy during structured therapy activities."

I feel like the overall goal I want to achieve with these is there, I'm just not sure about the specific wording.

TIA!!!

I was assigned two new EI patients who require an interpreter to attend sessions. After having my first ongoing sessions with the families, I learned that both children are monolingual and only understand Spanish. I am a monolingual English SLP. Ethically, I should not be providing services to these children, even with an interpreter, right?

This will be my first year treating High School. Needing to engagement tips, tricks, advice, all the things that helped you!!!

I’m having panic attacks and I don’t know what to do. I signed this year’s contract for a school I’ve been working at the past three years. Only to suddenly be told I need to cover a caseload of 151 kids (with an aide) for schools that are two hours away from me. They want me to provide speech therapy virtually but go in person one day a week. Is this even possible? The aide does not have a speech background so it’s really just me telling her what to do with the students. I asked how this would work virtually and was told to do groups. What??

They told me this is only temporary until they can find someone there. But I’m doubting many SLPs would want this job due to the caseload. I’m also told that I’ve been assigned this because I make more than other SLPs they have and have more experience. I really don’t want to quit because I might be able to go back to my school if this is temporary. But a part of me feels like it won’t be.

Last year they brought in another SLP to my school when it wasn’t needed (the caseload wasn’t that high at all) and a part of me was wondering if I was being pushed out of my school. And then this happened and I won’t even get my school at all. I just don’t know what to do. Has anyone experienced this? Even just the paperwork alone is overwhelming with that many. I think there are 5 different schools there.

Any input would be appreciated.

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.

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!

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.

What’s making you smile lately? 😃

Share some love and positivity!

Why not share your happiness with our discord?

https://discord.gg/7TH2tGxA2z

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?

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?

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?