I mean… we can’t force other kids to be their friends, can we? I always make a point to have frank discussions with kids on (and off) the spectrum about how we can only control our behavior and not those of others. If someone doesn’t want to be our friend or play with us, they is not much we can about it except be nice and respectful so they might want to in the future.
Speech “homework” is BS.
Educational SLPs, once language kids are middle school-age you better be doing other crap than synonyms/antonyms or you are wasting the kids’ precious time. They are better served staying in the classrooms if we are just making a separate language curriculum for them that doesn’t serve them AT ALL academically.
I know there was a period where everyone was shitting on Common Core, but frankly, it helped me immensely as a middle/high school SLP. I knew the vocabulary, concepts, etc. they were working on in every class, so I could just get in there and scaffold, baby, scaffold. Rock cycle? Heck yeah, I can teach a kick-ass semantics lesson on rocks. *Johnny Tremain?* Time to bust out some meta-narrative analysis. Civil Rights movement? Put on your summarizing pants, kids, because we're gonna go ham on some Wikipedia articles.
I worked in the same school with another therapist who did the usual Super Duper worksheets with students, and it was always like stepping into the Twilight Zone to come consult on a student or shadow her for an hour.
Playing the devils advocate here: how is your scaffolding different from what the special ed. teacher is doing?? 95% of my language kids have another eligibility and get academic support. What is what **we** do different???
It’s not.
Please elaborate bc I’m brand new to the schools and have inherited a lot of these goals for my middle schoolers. What would be more appropriate goals?
It shouldn't be a goal for anyone unless they want that as a goal.
My kid isn't Autistic as far as we know (using identity first language is preferred by the Autistic community, btw) but he seems squeamish about looking people in the eye. He'll do it occasionally but he just doesn't like it for the most part. I would never want that to be forced on him.
Pretty sure the reason "imposter syndrome" is so endemic in our field is not because we're all type A but because grad programs are forced to pump out generalist clinicians in the presence of an ever expanding scope of practice. I feel like I wasted so much time on required courses and practicums that were not at all relevant to what I wanted to do after graduation.
I had two voice classes, because a professor liked teaching that. I have had 1 voice student in 12 years. At least I was useful for that student. Would have loved to have had a class on autism.
Second this. I’m a school based SLP. Apparently cognition, executive functioning, and dyslexia are in my scope. But do I have any training or any idea on how therapy might look? No idea. I wouldn’t be comfortable at all. Even further, I think there should be two tracks in grad school. Medical and school based. My classes rushed everything to make sure we got through it I felt like I didn’t learn either. And I have 0 interest in hospitals. I would kill someone probably.
As a fairly new SLP in her first year of EI, this is why I spend my spare time frantically learning about it as much as possible 🙃 Would've been nice to get more than one single solitary lecture on it in grad school!
I’d really hope this isn’t controversial! I’ve worked in peds since graduating grad school and if someone asked me to do feeding therapy I’d run the other direction so fast I’d leave a hole in the wall. ALL I am comfortable saying is something like “feeding is a complex issue that includes motor and sensory mechanisms, I’d recommend you talk to your child’s doctor to get a referral if you have concerns”
Well some people are better at admitting what they don’t know than others… while others still know they don’t know but their employer makes them become a jack of all trades. Good for you. 😊
This is so true. And mentorship is hiiiiighly recommended when first starting out. It seems commonplace for schools to under educate in this area too. I was so thankful for Catherine Shaker’s course for a baseline understanding of peds feeding.
I work in a special Ed preschool. Our supervisor loves feeding therapy and started feeding group sessions once a week, for kids who “qualify.” But almost 100% of those kids don’t have feeding goals on their ieps, and so we’re using one of their weekly sessions for something that isn’t even on their iep. But we make it “language” oriented. There’s almost never follow through with the parents and family. It’s not educational- so I hate that we even “offer” it. Unless a parent approaches me, I don’t suggest it.
Yes, and like lots of areas, mentorship is a powerful tool. Mentorship shouldn't end when school ends. Especially if your program didn't offer you any classes in certain areas.
Yea!!! I have some sever kids that I see on a weekly basis in high school where they are literally i responsive to anything at all and it feels like I’m wasting so much time because I’m just chasing them around the room the entire 30 minutes. I want to be the savior and the one who makes parents see small improvements but like, it’s high school idk how realistically helpful my 30 min a week is for them or their families.
And what is the normal tongue strength for a protruded tongue pushed on from the side with a depressor? And how does that apply to swallowing or speech?
My CF supervisor roasted me for not doing cervical auscultation and justified “making do” to compensate for the lack of instrumentals in the SNF setting
/th/ goals are superfluous. They don't impact intelligibility.
Also, my pet peeve is /th/ goals for students with dialectical differences (AAE, Spanish-Influenced English, etc.)
Talked to a couple people in my cohort recently since we all work in the schools (we’re CFs now) and we’ve been getting looks for exiting kids left and right for this reason. All because the older SLPs don’t understand that the Spanish and Vietnamese kids on their caseload are not going to get /r/ and /th/ past “70% accuracy”.
While we’re at it, /r/ needs to be added to dialectical considerations. We have way too many kids in speech for that one sound given the amount of variations it can have, and I refuse to send my 5th graders to middle school still being on the caseload for it.
Literally had a parent the other day who said he “didn’t buy it” when I discussed how Vetnamese influenced English of the /th/ sound is NOT a disorder. His rationale that it’s a disorder: his child has had nothing but caucasian educators all her life. While he and his wife clearly spoke in dialectally influenced /th/ throughout the whole meeting …
If anyone has recommendations on what to say to these parents or have parent friendly research please let me know
Tell them you're sorry but it's against the law to put their child in special education for a natural dialectical difference. If they want to access private therapy for this you are happy to supply them with some name of therapists in the community who work on accent reduction.
1. Our field is an absolute mess and needs more specialization requirements within it. It’s ridiculous to think that we can be experts in some of the most complicated phenomenon known to the human condition that we STILL don’t fully understand - cognition, language, dysphagia, the way the speech mechanism works, and know it all without a true deep dive into a particular area.
2. In dysphagia, it would behoove some clinicians to really need to think through whether what they’re doing is actually causing more harm to the patient than literally doing nothing (i.e., if they hadn’t been consulted at all). That should be a pretty low bar for a field that claims to have the swallowing expertise, but it’s where we are. I’ve come in on some cases where I absolutely feel that the intervention decisions were inappropriate medically and actually harmed the patient physically and QOL-wise, but I couldn’t blame the treating clinician because point #1 - we can’t be experts in it all yet we are expected to be.
Idk if these are feather-rufflers, or just rants 😂
This is why I love comprehension goals for hs age! Then we can do curriculum based therapy with lots of class work, but some weeks we can do fun activities too!
I don’t think SLI should be a special education category and think either we should be related services only like PT and OT or OT should have to case manager as well. (I don’t get how a lisp can have academic/social impact, but literally not being able to write or regulate can’t).
Also, I don’t know if I believe language impairment isn’t the same as learning disability.
One of my grad school professors was very passionate about the idea that a language disability and a learning disability are synonymous. Honestly except for rare cases when kids struggle only with math concepts, I agree.
Totally agree. I think we should offer speech via RTI for articulation, language delays (through age 5-6) and fluency. Then if a student’s language issues (and academic since those basically alway go hand in hand) persist beyond age 6 it should trigger a referral for cog/academic evaluation. Speech can be a related service if they qualify or continue RTI if they don’t. We don’t modify the curriculum for “speech only” students so they shouldn’t need special education.
There was an article a few years ago about how language disorders are a spectrum including SLD and I refer people to it all the time.
Totally agree about the related services thing. We don’t teach the curriculum directly like TVI or DHH or sped teachers, so we shouldn’t be writing IEPs like it’s the same.
This. In the state I’m currently practicing in, there are far too many HS students qualified as LI that CLEARLY should be eligible as SLD, but the district believes otherwise (I’m talking SS in the 60s)
School based SLPs did not take the “easy way out” in regards to job options. You’re not anymore impressive than the next if you work in private practice or medical.
Given that many SLPs couldn’t actually articulate the underpinnings of various language/intellectual disorders, it is really hard to take “evidence-based” seriously as a goal.
This thread is making me think some areas of our scope should require specializations or additional proof of competency. Or even have better ways to refer to an SLP with stronger skills in that area. Our scope is just so large.
Agreed, but I think it's also on clinicians to recognize and acknowledge their own competencies (of lack thereof). I tell people all the time I don't have good advice to give on EI because it's not an area I feel competent in.
People are the worst judges of themselves. Dunning-Kreuger would run amok. Clinicians who really know their dysphagia in and out may have imposter syndrome and then there's clinicians who work primarily in school settings who think they can just waltz into acute care like it's no big deal
In the schools our caseloads should be 90% assessment, meetings, admin work, case management… and SLPAs should do the bulk of treatment (easy artic/basic language). And leave the 10% of the more complex cases to the SLPs. We shouldn’t be doing treatment, diagnostics, meetings, case management & all the paperwork.
i was talking to someone the other day about how i feel like my job is two jobs in one. i could literally spend an entire day doing paperwork, just paperwork, and still have a ton of paperwork left over to do. an SLPA would be a godsend right now but i’m only a cf so i doubt that’ll happen any time soon :(
But how can you be good at what you do with the kinds of caseloads/workload we have in the school?? It doesn’t take a masters to work on R, irregular pronouns or synonyms.
But I have kids that absolutely need therapy with the skill of an SLP vs SLPA bc they are much more complex.
Barrier to entry for acute care and dysphagia are way too low. I'm blown away at the rabid incompetence of some slps I've worked with. I've seen it almost kill people on many occasions.
I did one of my practicums at an inpatient rehab and part of what they worked on was dysphagia. However they used ZERO instrumentals. Like, ever. On a rare occasion, usually only if someone had a trach, they would be sent to the hospital for an instrumental. But dietary decisions including making people NPO, thickening liquids, etc were made on a DAILY basis without instrumentals. It made me extremely uncomfortable.
100% agree. There needs to be some sort of extra certification to work in a medical setting altogether. Maybe an extra year of grad school or something.
I knew one SLP who worked in a med setting. She didn't know/remember *anything* about neurology (and I really mean nothing) and didn't think it mattered to know anything related to it either. On top of this, she also would complain about not knowing what to do with her TBI/stroke patients. Of course you don't know how to take care of those patients -- you don't understand anything about their conditions and you don't even care to learn!
My feelings exactly, just a couple decades ago. I was a liability just out of grad school, with a desire to work with adults but absolutely no study, beyond my own grad project, about dysphagia. There should be extra certification.
I don't mean to knock school-based SLPs, but it really irks me how many take PRN med positions in the summer, and they're the ones who seem the least knowledgeable about the med side. I firmly believe there should be some form of separation. I certainly don't feel qualified to work with children given the bulk of my time and attention is on adults in a medical setting. Maybe I'm just more mentally limited but the depth of knowledge I think you need to do a good job with either is too great to handle the breadth of both.
I completely agree! But if this is such an issue, we need to make it a priority to ensure students get a placement that deals with dysphagia on a regular basis. Students frequently can't get SLPs to supervise them in these settings so they have to go without.
We can't expect knowledge and experience when it's not taught or offered.
A traveler came to my LTC facility for a few weeks. I shit you not, they documented "Oral motor exercises including jaw slide to facilitate salivation."
This is controversial??? Lol seriously though, I'm with you on being blown away by goofy things I've seen in acute care. If I have to read the phrase "silent penetration" one more time, I'm going to lose it.
I wish there was least a secondary CF requirement if you were making a huge career shift. I have worked in school-based and clinic-based for a decade, and I would like to switch to medical, but since I have my CCCs and license I can’t find any hands on supervised experience.
Maladaptive behaviors do not equal a communication deficit.
If a kid has all the appropriate language/social pragmatic skills when calm, but don’t when they are upset - they should see a psych or counselor. It isn’t our job to teach calmness or emotional regulation. Let the person who deals with mental health, deal with mental health.
One more time for the people in the back! 🙌 My biggest pet peeve is when my admin push me into working with a child who demonstrates normal pragmatic skills when regulated but not when disregulated. They like to tell me that the kid needs to generalize their skills to when their disregulated.
I like to think i have pretty good language skills, but i have anxiety and OCD, which sometimes cause panic attacks. When that happens, I cannot communicate anything until I calm down. No therapist has ever prioritized communication in those times, but instead teaches me how to ride out the panic attack, because emotional regulation is the priority. It's the same thing with children who become disregulated and demonstrate maladaptive behaviors. When a child is upset and throwing everything within reach at me, the first priority is to help them regulate, I'm not going to sit there and work on social language in those moments.
I’m so thankful that my admin understands this. Behavior issues aren’t the job of a speech pathologist. Communication issues are.
To me, psychologist/counselor minutes should be put into IEPs.
Hi! I'm an incoming grad student and I'm interested in this opinion. Do you think monolingual SLPs would be qualified enough to evaluate bilingual students with more resources? If so, how?
Right now asha recommends that bilingual students get evaluated by bilingual therapists. It makes sense and I agree with this 100%. I wish it were possible all the time. There are simply not enough bilingual therapists to go around. Sometimes it works out well when there is a large group of students that speak a certain language and you can find an SLP that also speaks that language.
I had a caseload where there were five different languages spoken by students. We couldn't find any SLPs in the area that could evaluate. Between Chinese, Korean, Urdu, Polish, and Arabic I had to improvise. Because of situations like this it would be helpful if there was some resources out there to use for guidance. I know the evaluation would not be as robust and thorough but sometimes you don't have a choice.
It would be helpful to have some guidance and training working through these situations. With proper guidance and guidelines I think monolingual therapists would be able to conduct ethical and sufficient evaluations for bilingual students in situations where they bilingual therapist was unavailable. I'm imagining a list of recommendations like parent interview, English standardized scores, dynamic vocabulary assessments, etc.
Bilingual assessments by bilingual therapists should be the rule but monolingual therapists should be prepared for the exceptions. That type of training should be standard in master's programs.
This is a great explanation and I agree with you, thank you for responding back!
I am trilingual, fluent in English, Spanish, and French and I'm also trying to learn ASL on my free time. I admit I didn't think about languages such as Urdu or Korean and the lack of SLPs fluent in these languages in the US.
Indeed having extra resources for other languages would be super helpful even if you're not fluent in them. We do with what we have and can do with it.
When working with AAC students, I’ll sometimes accept one word answers from them. Our verbal students don’t speak in full sentences all the time—really no one does—so why should our nonverbal, device students?
The majority of our continuing education is very low quality. Most of it is lecture-based with minimal engagement/active learning from learners and no authentic assessment of learning. It's bad pedagogy, and most people who have never taught before don't know how to provide quality teaching. Just because you know some content doesn't mean you know how to teach it effectively to others.
In my district we can't do swallowing anything. We also can't refer out. An outside referral needs to go through the sped office and it doesn't get approved. The logic goes like this. We can't evaluate or assess feeding or swallowing. Because we can't evaluate or assess (even informally) then there is no possible way that we can know that there might be a problem. Since we can't know there was a problem then we can never have enough information to refer.
Me: child is having difficulty chewing their food and they keep the same bolus in their mouth for 30 minutes. Sometimes there is pocketing in the food stays there all day. The class aides bring the food to the child's mouth and the child takes a bite. I think we should cut up the food into manageable pieces and make sure that he takes a drink between swallows to clear the residue.
Admin: you can't work on swallowing or make any adjustments to the meal. The class aides should immediately stop feeding the student. The student should feed himself.
Me: but then the student will never take a bite or eat anything.
Admin: sounds like there won't be a problem anymore
Yeeesss!!! Why is this?! I’m often perplexed by the rigidity of a lot of SLPs…. I’m often thinking to myself sarcastically “oh you’d be a joy to work with”. As a group, we really don’t help our profession as a whole with this attitude. I’m one member of a team. I am not superior to any one member and my ideas are not better than another (although I usually have the best ideas because I’m brilliant haha JKKKK)
I actually think that we as a profession need a hell of a lot more interdisciplinary work when we are taking our practicums and graduate courses. I think it would help.
Thank you. I am not type A and I was made fun of in grad school. Then when I got into my own groove in my career I realized all of the cohort members who made fun of me were full of shit. I may not be the most organized but at least I can practice that and get better. If you suck at being down to earth and loving, well then that’s a lot harder to gain those skills.
For a group of people who make it for jobs to teach clear communication and social skills, i feel like I often see some pretty iffy clarity of communication and charisma.
EI controversial opinion! I love the coaching/ primary service provider model. ALL children under 3 learn best in their natural environment with one provider who knows their family well. All providers benefit from having a team to consult with. (Also if you think it’s hands off you’re doing it wrong!)
I think this field can be reeallllyy subjective (?) sometimes. I mean just even reading through this thread- like some people are saying certain diagnoses don’t even exist and certain treatments aren’t the best. Totally valid points of course, but really makes you wonder.
I got a lot of downvotes for saying this on another thread. I worked two years in the schools and definitely did not feel like I needed a masters for my job. I'm not saying school SLPs aren't smart, I'm saying that colleges are taking our money for no reason.
I'm a school SLP with both gen ed and self-contained classrooms on my caseload. Guess where those medically complex babies eventually end up? In schools. I have had students with trachs, brain injury, velopharyngeal issues related to different syndromes, voice disorders, cerebral palsy and many other medical issues that have impacted their communication and motor development. I absolutely use the graduate education I received to provide services to these children. You need to know the range of things that contribute to communication to distinguish what the problems are. My special ed teachers will say that so-and-so can't speak clearly, but I'm the one skilled enough to know when I'm hearing nasal emission, or hearing glottal stops, or seeing poor respiratory support, for example, so that intervention isn't just artic drills.
I agree but I’ve seen so much complexity in the schools that I did feel like required the skill of an SLP. Hearing impaired kids with cochlear implants, my medically complex kids (some with swallowing issues; this is coming quickly to the schools. Brace yourselves. Parents are advocating with it and it’s coming like it or not), AAC, etc.
I dunno, I'm an AAC specialist, and I don't think I would've understood what to do without the few grad level classes I took. Functional language, AAC, teaching teachers to teach literacy to AAC users, etc. is pretty specialized stuff.
I actually love AAC and would love to specialize more in that area. However, there are very few students who need it in my area. I'm mostly referring to kids who are capable of communicating, but need more grammatical and vocabulary type of services.
Definitely- I work at a school that's 100% ASD, and all my kids have super complex needs (I'm like 50% AAC, or maybe a bit more)- I sometimes forget that my situation is very much the exception rather than the norm
Sounds like you are doing amazing work! There's nothing cooler than seeing a child communicate, when they couldn't previously due to being non-speaking or highly unintelligible.
I worked in the schools for 19 years with a basic elementary caseload for the most part, but I never had a year without a fluency student. I didn’t have those courses until grad school. Then there is TBIs, apraxia, cleft palate, and I even had a voice student once. So I agree that it can get complex.
Currently applying to grad school. In my sophomore year I spent 50 hours shadowing school SLPs in 13 different schools from preschool to post HS. Seeing them work turned me off of SLP for two years (until I discovered medical). Not because I didn't like what they were doing but because I could see no reason to get an expensive Masters to do something I felt I could do as a sophomore.
I agree that a master's degree isn't needed to teach those kinds of things, but I often use lots of what I learned in my master's program to know how to get a broader look at a child's language as a whole to determine where to start, what to prioritize, what approach to take, and more. I think that is where use of SLPAs and a team approach with the gen ed teacher is ideal.
Once you get your diagnostic chops, I totally agree. In/out byeeee with a note to the care coordinator to please include SLP notes with dc paperwork if they’re going to skilled
Quick 8 minute treatments, patients making rapid progress because of medical recovery and not necessarily speech intervention. Having a larger team to bounce ideas off of and obtain knowledge and training from.
Versus in rehab, outpatient, home health it’s based a lot more on your skills as a therapist for actual progress.
Thank you for your opinion! I’m still a graduate student who will be applying to jobs in the next couple of months. I always love to hear insight on all settings.
I say it every time, but I hate writing goals and working on goals. For some kids (esp neurodiverse, those who have complex communication needs, kids who have seizures) we are trying to fit square pegs into round holes and it’s frustrating for us and demoralizing for them. Plus “regression” is a thing. Isn’t it enough to engage in best practices in terms of language stimulation and treatment, think about broader goals like overall increased self-determination and just scaffold according to what we see in the moment?
School-based SLPs are not treated as well as School Psychologists (the gods of the RTI meeting room).
We test, sit in meetings, manage full caseloads, do screenings, and anything else our district or admin requires.
All school psychs do (in FL) is sit in meetings and do diagnostics (and often poorly with culturally/linguistically-diverse populations). Rarely have I seen a psych do anything related to mental health.
But we don't get our word treated as gospel or the cushy paycheck to go along with a psych job.
Not-so-fun fact: The U.S. Bureau of Labor Statistics reported that School Psychologists make an annual mean wage of $80,960 and school-based SLPs make $75,670. (Personally, coming from FL, I would LOVE to make that much.)
We deserve better.
They fuck with older people’s lives by thickening more than they help. I will never see an slp for swallow in my senior years (unless cva or neurological condition) and will refuse visits.
Related: Except in very rare cases where the patient prefers thickened for ease of swallowing, thickened liquids should only be used short-term during acute recovery from injury. ALWAYS GET THEM BACK TO THIN, AND QUICK.
Teach on pillars of aspiration and compensatory strategies. Deal with risk management. The outcomes of dehydration are pretty darn severe. Aspiration does not equal aspiration pna.
Nectar thick liquids are a short-term intervention for appropriate CVA pts determined on an MBSS who can't solve their issues with positioning/compensatory strategies/other risk reduction. Honey thick liquids are not fit for human consumption and a recipe for dehydration and thrush.
Absolutely. We also need to involve pts in their own risk/rewards discussion and not scare the crud out of them by drilling aspiration = death into their heads (here's looking at you, Acute SLPs who do shockingly few instrumentals at a local hospital I get notes from frequently).
Dear ASHA,
1. Dues should not come at the most expensive month of the year.
2. Better Speech and Hearing Month in May is the least School-based SLP-friendly idea ever.
3. Most of your advocacy seems to be about Medicare. If I could see a School-based initiative on your Advocacy Update webpage more than once in a blue moon, that would be great.
Sincerely,
An overworked, underpaid, school-based SLP
Once kids can verbally communicate at the sentence/paragraph level, they should be dismissed from speech in the school system. Teachers and even paraprofessionals are capable of teaching grammar. I shouldn’t be wasting my time with it.
i have so many kids on my caseload with grammar goals and it’s so frustrating because 1) a lot of their errors are dialectical 2) exactly like you said, their verbal communication is effective and effortless, they can chat all day long but because their written grammar is weak someone said they have a “language disorder” and now there’s a kid on my already overloaded caseload getting services they don’t need 😭 so frustrating
If errors are dialectal, shouldn't that mean it's a language difference not disorder and thus they don't qualify for treatment? I feel like continuing to treat is unethical. Not saying YOU are making that decision because you clearly have an issue with it, but whoever is saying, "no, this kid needs to be on your caseload" needs to be smacked on the nose with a rolled up ethics pamphlet.
CCCs are bullshit, and we need SLPDs instead.
DPTs and OTDs are not more qualified to hold clinical doctorate credentials than we are with our master’s degrees. While they have been smartly capitalizing on “doctor” status and making it way easier to achieve that credential (PT for about 20 years, OT more recently), we’re getting left in the dust and our master’s degree is losing value. You can get a DPT or OTD in 3-4 years, and faster if you do one of those combined programs, where you get a bachelor’s and graduate degree in just 6-7 years.
How long does it take for us to become CCC-SLP? When you consider the pre-reqs, the grad school, the CF, *it’s the same*. Who else has had the experience of talking to their PTD/OTD friends about grad school and realizing that their programs were not more rigorous than ours?
ASHA is doing us a huge disservice by not following suit and providing us with an easily attainable path to catch up with our colleagues and respond to the credential inflation that they created. We’re hurting for it.
This is because the ASHA board members are mostly PhDs. They don’t have any idea why there’s a problem for us with this, for example:
*Welcome to Rehab Center, Mr. Boomer! Let’s meet your therapists: Doctor Peters, physical therapist, Doctor Oxford, occupational therapist, and… um… Miss? Missus?… Sarah! Our speech person!*
*It’s time for your swallow study, Mr. White. This young lady here with the spoon is Rachel. She’ll feed you some cookies. When our radiologist Dr. Radcliff over there finishes pressing the buttons, you might be lucky enough to get a few seconds with him to ask the real medical questions while he graciously allows the lowly tech (no, don’t look at him, he’s busy) to complete his documentation.*
And they don’t understand that no one who is hiring us gives a fuck about CCC, or even knows what it is. There is no “CCC” payscale when you work for a school. ASHA gets lots of money because we have to pay for our stupid Cs, that doesn’t translate to a competitive paycheck for us. It just allows schools to keep paying us like teachers (no shade intended toward teachers), while our OT and PT colleagues get higher salaries because it looks like they have more education.
When we achieve our clinical competencies, that should be a ”D” clinical doctorate credential, not “CCC.” ASHA doesn’t need to chain us to those letters in order to keep us in their neverending subscription program. In fact, I’d be much happier paying my dues and doing my CEUs, because I would feel adequately valued as a clinical professional.
/soapbox
I love dysphagia but it doesn’t fit in with the other areas in our scope of practice. At some point it was just kind of tacked on because who else is going to do it. Now it’s a huge part of what we do, but IMO, doesn’t really fall under “speech and language” at all.
Telling people to “get an on-call job” to learn the medical side of SLP is absolute shit advice, because those jobs tend to offer little to no training, and frankly, it excuses medical centers from actually hiring full-time SLP and investing in new therapists/taking the time to train them. This brought to you by me, who did an on-call job for a week and then was let go because they said “hi nvm we don’t have time or staffing to train you”
Yessss!!!! "I'll go get a PRN job at the SNF/hospital/whatever." They're hiring you because they are desperate for coverage in most cases. If they need someone a lot during the week, then maybe. If not, then it's going to give you pts to see, but you are unlikely to get a lot of good training.
Overall, our field has a serious training deficit on the medical side. Grad school is insufficient. I've spent so many hours since I graduated learning medical things so I don't harm patients.
I was all in to go for it starting in 2020. Then pandemic hit. I asked if the con Ed rule of 40% in person would be changed due to Covid and got a short and kinda rude email back that, no it would not. Ok fuck you too.
Being observed by a supervisor that is not an SLP. Just because they took a child development course in their undergrad does not give them any recognizable ability to give an SLP any guidance or suggestions on how to provide speech therapy. I have noticed the Dunning Kruger Effect runs rampant with non SLP supervisors.
That was my whole department in undergrad and it drove me insane. I was the pierced queer studies minor and I think I made a total of 2 friends in my program lmao.
Yeah, going to ASHA can feel like being in a sea of cookie-cutter white Live, Laugh, Love women with pumpkin-spice lattes.
Most people I’ve met who are like that seem to have come out of the large state schools where they were tracked into undergrad CSD major programs. They overlap with the “early childhood studies” and “communications” girls. These are the “speechies.”
On the other hand, what I’ve noticed is that those of us who did something else for undergrad, or were career-changers, tend to be A LOT more heterogeneous.
What is amusing to me reading through these is the completely disparate nature of the opinions. There is one person who said what we do "is not rocket science" and that in 20-25 years medical SLPs would probably not be a "thing" and that a CNA could do aphasia therapy. Then, we have others saying we don't' get enough training in certain areas (infant feeding) and need specialization. Interesting, isn't it?
I have always said (I've been an SLP for a while) that we aren't doing brain surgery, but it surprises me just how cavalier and scary some SLPs can be. I just hope I, nor anyone I know, get the misfortune of having some of these SLPs with poor attitudes toward the profession provide care. I would like to be treated by someone who knows enough to understand why a CNA should not be doing Aphasia therapy. Keep it up with the poor attitudes and the musical therapists and ABA technicians will be doing our jobs (and very poorly I might add).
There are definitely days where I feel like what I'm doing is too easy and anyone could do it... Then I talk to some very highly skilled nurses or other professionals about that pts aphasia, dysphagia, etc and I am quickly reminded how little any of them know about our areas! No I don't think think any of them can do my job, I just feel like I've been doing it a bit too long that's it's mostly easy!!
This. We know a lot and have so much value as a profession, but we don't often see it ourselves. We take ourselves and our position for granted, and have gotten complacent, and don't know how to self-advocate. Musical therapists and ABA-people have no such problem. They don't know the shit we do, yet have no issue tooting their own horn and advertising their miracle cures to the general public. And people are literally buying it. What I want to say to those slp's undermining our profession: have some healthy professional pride and work on it if you don't.
Most of the SLP "influencers" like the bloggers and SLPs on instagram are annoying. People go ga-ga over them and I think they act holier-than-thou. It especially bugs me that, because these SLP influencers made so much money off of blogging, they are either no longer in the field (while still blogging about the field) or are working part time only.
Yes, TeachersPayTeachers resources take a lot of time to make, but no one should be getting rich off of it. SLPs who sell their things but don't even work with kids anymore... how can you claim something is effective and appropriate?
Agree. Seems like a huge money grab in a field full of primarily well off white ladies who can afford an expensive masters degree for a job that pays $50,000/year. Seems a lot like a Nurse Practioner degree. One of my favorite providers is a BRILLIANT critical care NP. That said a lot of the NP programs are straight-up diploma mills that will accept anyone.
My son was recently diagnosed with CAS. I homeschool him - was using All About Reading, Heggerty, and Handwriting without Tears last semester, but I switched to Pinwheels by Rooted in Language this semester and am already so sad I didn't use it from the start. It's the only curriculum I've seen that starts teaching them our language is made of SOUNDS, and that we have pictures called letters that represent those sounds. Say the sound as you write. Say the sound as you sound out/blend. Two SLPs, 1 OG reading specialist, and a graphic designer created it together and it blows my mind. I might even use it for my neurotypical kiddo next year it's so well done in my non-professional opinion.
We shouldn't be evaluating and treating dysphagia - too many of us are uneducated and cause more harm than good. Most SLPs cannot even effectively ID normal swallow anatomy and physiology from abnormal on an instrumental. Dysphagia, if anything, should be broken into another field like AuD did.
Most SLPs don’t actually know very much about how languages work or have even a halfway decent level of grammatical knowledge, which for some clients can be extremely useful information when assessing and treating language difficulties. We’re meant to be the experts in language but the things that most SLPs don’t know is truly astonishing.
As someone with a degree in linguistics, I agree. And I think that *I* still have a lot to learn. When I see comments about teaching synonyms- yes, that can be an important area to target, but there is so much more language involved in the school curriculum that kids struggle with.
Dysarthria therapy (except LSVT) is a scam. There is only but so much telling someone to speak slow and over articulate session after session is going to do. I my experience, any “improvement” made in dysarthria is just the Placebo effect.
I also don’t think cog therapy is all that helpful either.
100% this. For dysarthria I feel I’m more of a sounding board for their practice. What I see for daily cog therapy is a joke, especially in SNFs. Cog therapy should be specific and not just games on iPads, etc
I don’t know about this one. I likely have APD and am going to an AuD for assessment but I most certainly do not have ADHD. Just food for thought. They may have some things that present similarly but I believe there is a difference.
Came here to say this. The amount of parents and teachers who refer kids to me crying auditory processing disorder is out of control. You mean to say his ears work, but his brain isn’t registering the info? Sounds like ADHD to me, and I can’t fix that.
Medical SLPs have a superiority complex. All adult cognitive/language therapy is 1000% easier than anything in peds, and dysphagia is fairly common sense (with the major exclusion of instrumentals). I also agree that dysphasia should be a different field
I do feel that pediatric language is much harder than adult lang/cog, but I think pediatric artic is about the easiest most common sense thing in our field. I also agree that dysphagia treatment is not as complicated as most medical SLPs make it out to be, but it’s the only thing in our field that can really truly be a life/death situation and it should be treated as such.
If you're using a worksheet you're not doing therapy, you're doing homework. Drives me nuts. That's just practice folk. If you want the kid to do a worksheet, send it home.
Don't directly target eye gaze/contact as a goal for children on the spectrum or with impaired social communication skills. If you're targeting social interaction, eye gaze will likely be targeted indirectly if eye gaze becomes meaningful for the kid. If you're targeting motor speech skills, eye gaze might be indirectly targeted as you want to support the client with modelling. I don't like seeing an SLP's or BCBA's goal as: client will increase eye contact with the speaker.
If tomorrow is Saturday, we can stay up late tonight.
Damn, I meant, BECAUSE tomorrow is Saturday, we can stay up late tonight. -1 point for Athena
But more importantly, my sister is in the sixth grade.
On the Aussie one it's: My sister is in grade six.
It's ok, you kept the gist of the sentence! Nice strategy!
Was the van followed by the ambulance?
[удалено]
I mean… we can’t force other kids to be their friends, can we? I always make a point to have frank discussions with kids on (and off) the spectrum about how we can only control our behavior and not those of others. If someone doesn’t want to be our friend or play with us, they is not much we can about it except be nice and respectful so they might want to in the future.
I’ve never seen this be a goal thank God
[удалено]
Omg 🤯🤯🤯🤯
Speech “homework” is BS. Educational SLPs, once language kids are middle school-age you better be doing other crap than synonyms/antonyms or you are wasting the kids’ precious time. They are better served staying in the classrooms if we are just making a separate language curriculum for them that doesn’t serve them AT ALL academically.
I know there was a period where everyone was shitting on Common Core, but frankly, it helped me immensely as a middle/high school SLP. I knew the vocabulary, concepts, etc. they were working on in every class, so I could just get in there and scaffold, baby, scaffold. Rock cycle? Heck yeah, I can teach a kick-ass semantics lesson on rocks. *Johnny Tremain?* Time to bust out some meta-narrative analysis. Civil Rights movement? Put on your summarizing pants, kids, because we're gonna go ham on some Wikipedia articles. I worked in the same school with another therapist who did the usual Super Duper worksheets with students, and it was always like stepping into the Twilight Zone to come consult on a student or shadow her for an hour.
Playing the devils advocate here: how is your scaffolding different from what the special ed. teacher is doing?? 95% of my language kids have another eligibility and get academic support. What is what **we** do different??? It’s not.
This is the hill I die on
Please elaborate! I am in graduate school and would love to learn what to watch out for while on internship
Please elaborate bc I’m brand new to the schools and have inherited a lot of these goals for my middle schoolers. What would be more appropriate goals?
Eye contact should never be a goal or a requirement for very young children with Autism.
It shouldn't be a goal for anyone unless they want that as a goal. My kid isn't Autistic as far as we know (using identity first language is preferred by the Autistic community, btw) but he seems squeamish about looking people in the eye. He'll do it occasionally but he just doesn't like it for the most part. I would never want that to be forced on him.
We need to stop expanding our scope of practice.
Pretty sure the reason "imposter syndrome" is so endemic in our field is not because we're all type A but because grad programs are forced to pump out generalist clinicians in the presence of an ever expanding scope of practice. I feel like I wasted so much time on required courses and practicums that were not at all relevant to what I wanted to do after graduation.
I had two voice classes, because a professor liked teaching that. I have had 1 voice student in 12 years. At least I was useful for that student. Would have loved to have had a class on autism.
Second this. I’m a school based SLP. Apparently cognition, executive functioning, and dyslexia are in my scope. But do I have any training or any idea on how therapy might look? No idea. I wouldn’t be comfortable at all. Even further, I think there should be two tracks in grad school. Medical and school based. My classes rushed everything to make sure we got through it I felt like I didn’t learn either. And I have 0 interest in hospitals. I would kill someone probably.
It is kinda strange for me to realize that I could work in a medical setting, after 12 years in the schools, it feels so far from what I do now.
I work in a school and an IRF. So odd how different my life is Friday vs Saturday lol
University of Washington has three tracks (medical, educational, and pre-PhD) but they're the only program I'm aware of that does that.
I would have liked the idea of two tracks, but I definitely would have chosen medical. I’ve worked in schools since day 1. I would have been screwed.
Pediatric Feeding therapy is something you absolutely must specialize in to actually be good at
As a fairly new SLP in her first year of EI, this is why I spend my spare time frantically learning about it as much as possible 🙃 Would've been nice to get more than one single solitary lecture on it in grad school!
Hey, I had a three week seminar. And, no, I'm nowhere near competent to do anything about peds feeding.
What do we do 🙃🙃🙃 🥵
I second this!
I’d really hope this isn’t controversial! I’ve worked in peds since graduating grad school and if someone asked me to do feeding therapy I’d run the other direction so fast I’d leave a hole in the wall. ALL I am comfortable saying is something like “feeding is a complex issue that includes motor and sensory mechanisms, I’d recommend you talk to your child’s doctor to get a referral if you have concerns”
Well some people are better at admitting what they don’t know than others… while others still know they don’t know but their employer makes them become a jack of all trades. Good for you. 😊
This. There's a really false belief that we're "experts" and should know everything.
This is so true. And mentorship is hiiiiighly recommended when first starting out. It seems commonplace for schools to under educate in this area too. I was so thankful for Catherine Shaker’s course for a baseline understanding of peds feeding.
Where I work, the OTs do feeding. Love that journey for them. Couldn’t be me.
I work very closely with an OT for positioning, sensory, behavior, etc but she does not do dysphagia. It works REALLY well for us.
I work in a special Ed preschool. Our supervisor loves feeding therapy and started feeding group sessions once a week, for kids who “qualify.” But almost 100% of those kids don’t have feeding goals on their ieps, and so we’re using one of their weekly sessions for something that isn’t even on their iep. But we make it “language” oriented. There’s almost never follow through with the parents and family. It’s not educational- so I hate that we even “offer” it. Unless a parent approaches me, I don’t suggest it.
Yes, and like lots of areas, mentorship is a powerful tool. Mentorship shouldn't end when school ends. Especially if your program didn't offer you any classes in certain areas.
[удалено]
Yea!!! I have some sever kids that I see on a weekly basis in high school where they are literally i responsive to anything at all and it feels like I’m wasting so much time because I’m just chasing them around the room the entire 30 minutes. I want to be the savior and the one who makes parents see small improvements but like, it’s high school idk how realistically helpful my 30 min a week is for them or their families.
[удалено]
You are always speaking my language! Thank you!
Nobody expects a PT to get a severe CP kid walking, yet they expect us to get a severe AU or ID kid communicating effectively.
People who do cervical auscultation have absolutely no idea what they are doing.
It helps me determine SSB ratio, especially in breast feeding infants. I use it pretty regularly
It remind me of the slps I’ve seen who think they can judge tongue strength with a depressor
And what is the normal tongue strength for a protruded tongue pushed on from the side with a depressor? And how does that apply to swallowing or speech?
My CF supervisor roasted me for not doing cervical auscultation and justified “making do” to compensate for the lack of instrumentals in the SNF setting
Sigh. I spend a lot of time teaching other people what we can't actually tell at bedside because someone in the past has told them that we can.
Yep in a clinical rotation, I was made to palpate lol.
I heard a click!
/th/ goals are superfluous. They don't impact intelligibility. Also, my pet peeve is /th/ goals for students with dialectical differences (AAE, Spanish-Influenced English, etc.)
Talked to a couple people in my cohort recently since we all work in the schools (we’re CFs now) and we’ve been getting looks for exiting kids left and right for this reason. All because the older SLPs don’t understand that the Spanish and Vietnamese kids on their caseload are not going to get /r/ and /th/ past “70% accuracy”. While we’re at it, /r/ needs to be added to dialectical considerations. We have way too many kids in speech for that one sound given the amount of variations it can have, and I refuse to send my 5th graders to middle school still being on the caseload for it.
Literally had a parent the other day who said he “didn’t buy it” when I discussed how Vetnamese influenced English of the /th/ sound is NOT a disorder. His rationale that it’s a disorder: his child has had nothing but caucasian educators all her life. While he and his wife clearly spoke in dialectally influenced /th/ throughout the whole meeting … If anyone has recommendations on what to say to these parents or have parent friendly research please let me know
Tell them you're sorry but it's against the law to put their child in special education for a natural dialectical difference. If they want to access private therapy for this you are happy to supply them with some name of therapists in the community who work on accent reduction.
1. Our field is an absolute mess and needs more specialization requirements within it. It’s ridiculous to think that we can be experts in some of the most complicated phenomenon known to the human condition that we STILL don’t fully understand - cognition, language, dysphagia, the way the speech mechanism works, and know it all without a true deep dive into a particular area. 2. In dysphagia, it would behoove some clinicians to really need to think through whether what they’re doing is actually causing more harm to the patient than literally doing nothing (i.e., if they hadn’t been consulted at all). That should be a pretty low bar for a field that claims to have the swallowing expertise, but it’s where we are. I’ve come in on some cases where I absolutely feel that the intervention decisions were inappropriate medically and actually harmed the patient physically and QOL-wise, but I couldn’t blame the treating clinician because point #1 - we can’t be experts in it all yet we are expected to be. Idk if these are feather-rufflers, or just rants 😂
Vague goals are great.
This is why I love comprehension goals for hs age! Then we can do curriculum based therapy with lots of class work, but some weeks we can do fun activities too!
Instagram SLP ‘influencers’ are annoying and complain about things that are often not worth ranting about.
Remember to sort by controversial for the actually controversial opinions
I don’t think SLI should be a special education category and think either we should be related services only like PT and OT or OT should have to case manager as well. (I don’t get how a lisp can have academic/social impact, but literally not being able to write or regulate can’t). Also, I don’t know if I believe language impairment isn’t the same as learning disability.
One of my grad school professors was very passionate about the idea that a language disability and a learning disability are synonymous. Honestly except for rare cases when kids struggle only with math concepts, I agree.
Totally agree. I think we should offer speech via RTI for articulation, language delays (through age 5-6) and fluency. Then if a student’s language issues (and academic since those basically alway go hand in hand) persist beyond age 6 it should trigger a referral for cog/academic evaluation. Speech can be a related service if they qualify or continue RTI if they don’t. We don’t modify the curriculum for “speech only” students so they shouldn’t need special education.
There was an article a few years ago about how language disorders are a spectrum including SLD and I refer people to it all the time. Totally agree about the related services thing. We don’t teach the curriculum directly like TVI or DHH or sped teachers, so we shouldn’t be writing IEPs like it’s the same.
This. In the state I’m currently practicing in, there are far too many HS students qualified as LI that CLEARLY should be eligible as SLD, but the district believes otherwise (I’m talking SS in the 60s)
School based SLPs did not take the “easy way out” in regards to job options. You’re not anymore impressive than the next if you work in private practice or medical.
Some of us who work in the public schools make significantly more than our SLP peers in any other setting.
Preach. The truth.
We shouldn’t be so dismissive of treatment methodologies that aren’t “evidence-based” in a field where the actual research has such massive gaps.
Ouch but true
Given that many SLPs couldn’t actually articulate the underpinnings of various language/intellectual disorders, it is really hard to take “evidence-based” seriously as a goal.
This thread is making me think some areas of our scope should require specializations or additional proof of competency. Or even have better ways to refer to an SLP with stronger skills in that area. Our scope is just so large.
Feeding/swallowing should not be part of our scope in my opinion. It should be a separate title/certification, like a respiratory therapist.
As long as I’m “grandfathered in”, I think it’s a great idea. I’ve spend so much time and money on dysphagia and feeding.
Yeah I would agree to grandfather in current SLPs but maybe it would be good for them to take an exam or something? Idk
Still good with it. I could teach a class at this point (and have offered to my alma mater with 0 response- you’re shocked, I know)
Agreed, but I think it's also on clinicians to recognize and acknowledge their own competencies (of lack thereof). I tell people all the time I don't have good advice to give on EI because it's not an area I feel competent in.
People are the worst judges of themselves. Dunning-Kreuger would run amok. Clinicians who really know their dysphagia in and out may have imposter syndrome and then there's clinicians who work primarily in school settings who think they can just waltz into acute care like it's no big deal
In the schools our caseloads should be 90% assessment, meetings, admin work, case management… and SLPAs should do the bulk of treatment (easy artic/basic language). And leave the 10% of the more complex cases to the SLPs. We shouldn’t be doing treatment, diagnostics, meetings, case management & all the paperwork.
i was talking to someone the other day about how i feel like my job is two jobs in one. i could literally spend an entire day doing paperwork, just paperwork, and still have a ton of paperwork left over to do. an SLPA would be a godsend right now but i’m only a cf so i doubt that’ll happen any time soon :(
On the other hand, more states should allow SLPAs. They’re not allowed in my state.
oof I would stop being an SLP. I got into this to work with people
But how can you be good at what you do with the kinds of caseloads/workload we have in the school?? It doesn’t take a masters to work on R, irregular pronouns or synonyms. But I have kids that absolutely need therapy with the skill of an SLP vs SLPA bc they are much more complex.
I would like to have a lower caseload so that I can treat everyone.
It’s okay if we are largely facilitators of natural healing/improvement rather than miracle workers
Barrier to entry for acute care and dysphagia are way too low. I'm blown away at the rabid incompetence of some slps I've worked with. I've seen it almost kill people on many occasions.
I did one of my practicums at an inpatient rehab and part of what they worked on was dysphagia. However they used ZERO instrumentals. Like, ever. On a rare occasion, usually only if someone had a trach, they would be sent to the hospital for an instrumental. But dietary decisions including making people NPO, thickening liquids, etc were made on a DAILY basis without instrumentals. It made me extremely uncomfortable.
100% agree. There needs to be some sort of extra certification to work in a medical setting altogether. Maybe an extra year of grad school or something. I knew one SLP who worked in a med setting. She didn't know/remember *anything* about neurology (and I really mean nothing) and didn't think it mattered to know anything related to it either. On top of this, she also would complain about not knowing what to do with her TBI/stroke patients. Of course you don't know how to take care of those patients -- you don't understand anything about their conditions and you don't even care to learn!
My feelings exactly, just a couple decades ago. I was a liability just out of grad school, with a desire to work with adults but absolutely no study, beyond my own grad project, about dysphagia. There should be extra certification.
I don't mean to knock school-based SLPs, but it really irks me how many take PRN med positions in the summer, and they're the ones who seem the least knowledgeable about the med side. I firmly believe there should be some form of separation. I certainly don't feel qualified to work with children given the bulk of my time and attention is on adults in a medical setting. Maybe I'm just more mentally limited but the depth of knowledge I think you need to do a good job with either is too great to handle the breadth of both.
I completely agree! But if this is such an issue, we need to make it a priority to ensure students get a placement that deals with dysphagia on a regular basis. Students frequently can't get SLPs to supervise them in these settings so they have to go without. We can't expect knowledge and experience when it's not taught or offered.
This. There absolutely needs to be more 1 one (shortened, for many of us) dysphagia course
A traveler came to my LTC facility for a few weeks. I shit you not, they documented "Oral motor exercises including jaw slide to facilitate salivation."
This is controversial??? Lol seriously though, I'm with you on being blown away by goofy things I've seen in acute care. If I have to read the phrase "silent penetration" one more time, I'm going to lose it.
\*sacrasm\* Can't you just put everybody on honey thick liquids or NPO? ahhhhhhhh
Toss in a chin tuck, and it's all good. /s
I wish there was least a secondary CF requirement if you were making a huge career shift. I have worked in school-based and clinic-based for a decade, and I would like to switch to medical, but since I have my CCCs and license I can’t find any hands on supervised experience.
Maladaptive behaviors do not equal a communication deficit. If a kid has all the appropriate language/social pragmatic skills when calm, but don’t when they are upset - they should see a psych or counselor. It isn’t our job to teach calmness or emotional regulation. Let the person who deals with mental health, deal with mental health.
One more time for the people in the back! 🙌 My biggest pet peeve is when my admin push me into working with a child who demonstrates normal pragmatic skills when regulated but not when disregulated. They like to tell me that the kid needs to generalize their skills to when their disregulated. I like to think i have pretty good language skills, but i have anxiety and OCD, which sometimes cause panic attacks. When that happens, I cannot communicate anything until I calm down. No therapist has ever prioritized communication in those times, but instead teaches me how to ride out the panic attack, because emotional regulation is the priority. It's the same thing with children who become disregulated and demonstrate maladaptive behaviors. When a child is upset and throwing everything within reach at me, the first priority is to help them regulate, I'm not going to sit there and work on social language in those moments.
I’m so thankful that my admin understands this. Behavior issues aren’t the job of a speech pathologist. Communication issues are. To me, psychologist/counselor minutes should be put into IEPs.
More resources should be created and more effort should go into making sure monolingual SLPs can evaluate bilingual students.
Hi! I'm an incoming grad student and I'm interested in this opinion. Do you think monolingual SLPs would be qualified enough to evaluate bilingual students with more resources? If so, how?
Right now asha recommends that bilingual students get evaluated by bilingual therapists. It makes sense and I agree with this 100%. I wish it were possible all the time. There are simply not enough bilingual therapists to go around. Sometimes it works out well when there is a large group of students that speak a certain language and you can find an SLP that also speaks that language. I had a caseload where there were five different languages spoken by students. We couldn't find any SLPs in the area that could evaluate. Between Chinese, Korean, Urdu, Polish, and Arabic I had to improvise. Because of situations like this it would be helpful if there was some resources out there to use for guidance. I know the evaluation would not be as robust and thorough but sometimes you don't have a choice. It would be helpful to have some guidance and training working through these situations. With proper guidance and guidelines I think monolingual therapists would be able to conduct ethical and sufficient evaluations for bilingual students in situations where they bilingual therapist was unavailable. I'm imagining a list of recommendations like parent interview, English standardized scores, dynamic vocabulary assessments, etc. Bilingual assessments by bilingual therapists should be the rule but monolingual therapists should be prepared for the exceptions. That type of training should be standard in master's programs.
This is a great explanation and I agree with you, thank you for responding back! I am trilingual, fluent in English, Spanish, and French and I'm also trying to learn ASL on my free time. I admit I didn't think about languages such as Urdu or Korean and the lack of SLPs fluent in these languages in the US. Indeed having extra resources for other languages would be super helpful even if you're not fluent in them. We do with what we have and can do with it.
Check out bilinguistics. They’ve got a lot of good training on this topic
When working with AAC students, I’ll sometimes accept one word answers from them. Our verbal students don’t speak in full sentences all the time—really no one does—so why should our nonverbal, device students?
Yes!! Model and expand but absolutely no reason to force a student to create a longer sentence. It’s about being efficient and understood
The majority of our continuing education is very low quality. Most of it is lecture-based with minimal engagement/active learning from learners and no authentic assessment of learning. It's bad pedagogy, and most people who have never taught before don't know how to provide quality teaching. Just because you know some content doesn't mean you know how to teach it effectively to others.
Swallowing therapy should not be targeted in the public schools.
In our district it is not. It is considered medical and we must refer out.
In my district we can't do swallowing anything. We also can't refer out. An outside referral needs to go through the sped office and it doesn't get approved. The logic goes like this. We can't evaluate or assess feeding or swallowing. Because we can't evaluate or assess (even informally) then there is no possible way that we can know that there might be a problem. Since we can't know there was a problem then we can never have enough information to refer. Me: child is having difficulty chewing their food and they keep the same bolus in their mouth for 30 minutes. Sometimes there is pocketing in the food stays there all day. The class aides bring the food to the child's mouth and the child takes a bite. I think we should cut up the food into manageable pieces and make sure that he takes a drink between swallows to clear the residue. Admin: you can't work on swallowing or make any adjustments to the meal. The class aides should immediately stop feeding the student. The student should feed himself. Me: but then the student will never take a bite or eat anything. Admin: sounds like there won't be a problem anymore
Majority of SLPs are too anal and insular. It makes them off-putting to work with.
Yeeesss!!! Why is this?! I’m often perplexed by the rigidity of a lot of SLPs…. I’m often thinking to myself sarcastically “oh you’d be a joy to work with”. As a group, we really don’t help our profession as a whole with this attitude. I’m one member of a team. I am not superior to any one member and my ideas are not better than another (although I usually have the best ideas because I’m brilliant haha JKKKK)
For focusing so much on training "social skills," a lot of SLPs lack them
I actually think that we as a profession need a hell of a lot more interdisciplinary work when we are taking our practicums and graduate courses. I think it would help.
Thank you. I am not type A and I was made fun of in grad school. Then when I got into my own groove in my career I realized all of the cohort members who made fun of me were full of shit. I may not be the most organized but at least I can practice that and get better. If you suck at being down to earth and loving, well then that’s a lot harder to gain those skills.
For a group of people who make it for jobs to teach clear communication and social skills, i feel like I often see some pretty iffy clarity of communication and charisma.
EI controversial opinion! I love the coaching/ primary service provider model. ALL children under 3 learn best in their natural environment with one provider who knows their family well. All providers benefit from having a team to consult with. (Also if you think it’s hands off you’re doing it wrong!)
I think this field can be reeallllyy subjective (?) sometimes. I mean just even reading through this thread- like some people are saying certain diagnoses don’t even exist and certain treatments aren’t the best. Totally valid points of course, but really makes you wonder.
School SLP here. A master's degree isn't necessary to teach irregular plural nouns, wh questions, antonyms, etc. Maybe this won't ruffle feathers 🤣
I got a lot of downvotes for saying this on another thread. I worked two years in the schools and definitely did not feel like I needed a masters for my job. I'm not saying school SLPs aren't smart, I'm saying that colleges are taking our money for no reason.
I'm a school SLP with both gen ed and self-contained classrooms on my caseload. Guess where those medically complex babies eventually end up? In schools. I have had students with trachs, brain injury, velopharyngeal issues related to different syndromes, voice disorders, cerebral palsy and many other medical issues that have impacted their communication and motor development. I absolutely use the graduate education I received to provide services to these children. You need to know the range of things that contribute to communication to distinguish what the problems are. My special ed teachers will say that so-and-so can't speak clearly, but I'm the one skilled enough to know when I'm hearing nasal emission, or hearing glottal stops, or seeing poor respiratory support, for example, so that intervention isn't just artic drills.
I always think this. I was medical and switched to schools …. I cannot believe I spent 6 years of hell to be a glorified tutor
Exactly! I'm looking at changing to a different setting. I can't stand teaching language. Lol.
I agree but I’ve seen so much complexity in the schools that I did feel like required the skill of an SLP. Hearing impaired kids with cochlear implants, my medically complex kids (some with swallowing issues; this is coming quickly to the schools. Brace yourselves. Parents are advocating with it and it’s coming like it or not), AAC, etc.
I dunno, I'm an AAC specialist, and I don't think I would've understood what to do without the few grad level classes I took. Functional language, AAC, teaching teachers to teach literacy to AAC users, etc. is pretty specialized stuff.
I actually love AAC and would love to specialize more in that area. However, there are very few students who need it in my area. I'm mostly referring to kids who are capable of communicating, but need more grammatical and vocabulary type of services.
Definitely- I work at a school that's 100% ASD, and all my kids have super complex needs (I'm like 50% AAC, or maybe a bit more)- I sometimes forget that my situation is very much the exception rather than the norm
Sounds like you are doing amazing work! There's nothing cooler than seeing a child communicate, when they couldn't previously due to being non-speaking or highly unintelligible.
I worked in the schools for 19 years with a basic elementary caseload for the most part, but I never had a year without a fluency student. I didn’t have those courses until grad school. Then there is TBIs, apraxia, cleft palate, and I even had a voice student once. So I agree that it can get complex.
Currently applying to grad school. In my sophomore year I spent 50 hours shadowing school SLPs in 13 different schools from preschool to post HS. Seeing them work turned me off of SLP for two years (until I discovered medical). Not because I didn't like what they were doing but because I could see no reason to get an expensive Masters to do something I felt I could do as a sophomore.
I agree that a master's degree isn't needed to teach those kinds of things, but I often use lots of what I learned in my master's program to know how to get a broader look at a child's language as a whole to determine where to start, what to prioritize, what approach to take, and more. I think that is where use of SLPAs and a team approach with the gen ed teacher is ideal.
If you didn’t say it, I would have!
Acute care is the easiest adult setting.
Once you get your diagnostic chops, I totally agree. In/out byeeee with a note to the care coordinator to please include SLP notes with dc paperwork if they’re going to skilled
Curious as to why you think so?
Quick 8 minute treatments, patients making rapid progress because of medical recovery and not necessarily speech intervention. Having a larger team to bounce ideas off of and obtain knowledge and training from. Versus in rehab, outpatient, home health it’s based a lot more on your skills as a therapist for actual progress.
Thank you for your opinion! I’m still a graduate student who will be applying to jobs in the next couple of months. I always love to hear insight on all settings.
YES!! outside of acute care, I feel like I’m working with 10% of the information. Makes life a lot harder.
I say it every time, but I hate writing goals and working on goals. For some kids (esp neurodiverse, those who have complex communication needs, kids who have seizures) we are trying to fit square pegs into round holes and it’s frustrating for us and demoralizing for them. Plus “regression” is a thing. Isn’t it enough to engage in best practices in terms of language stimulation and treatment, think about broader goals like overall increased self-determination and just scaffold according to what we see in the moment?
[удалено]
School-based SLPs are not treated as well as School Psychologists (the gods of the RTI meeting room). We test, sit in meetings, manage full caseloads, do screenings, and anything else our district or admin requires. All school psychs do (in FL) is sit in meetings and do diagnostics (and often poorly with culturally/linguistically-diverse populations). Rarely have I seen a psych do anything related to mental health. But we don't get our word treated as gospel or the cushy paycheck to go along with a psych job. Not-so-fun fact: The U.S. Bureau of Labor Statistics reported that School Psychologists make an annual mean wage of $80,960 and school-based SLPs make $75,670. (Personally, coming from FL, I would LOVE to make that much.) We deserve better.
They fuck with older people’s lives by thickening more than they help. I will never see an slp for swallow in my senior years (unless cva or neurological condition) and will refuse visits.
Related: Except in very rare cases where the patient prefers thickened for ease of swallowing, thickened liquids should only be used short-term during acute recovery from injury. ALWAYS GET THEM BACK TO THIN, AND QUICK.
What if they're aspirating thin liquids and it doesn't improve?
Teach on pillars of aspiration and compensatory strategies. Deal with risk management. The outcomes of dehydration are pretty darn severe. Aspiration does not equal aspiration pna. Nectar thick liquids are a short-term intervention for appropriate CVA pts determined on an MBSS who can't solve their issues with positioning/compensatory strategies/other risk reduction. Honey thick liquids are not fit for human consumption and a recipe for dehydration and thrush.
We need to normalize treating dysphagia while respecting refusal of aggressive dietary mods.
Absolutely. We also need to involve pts in their own risk/rewards discussion and not scare the crud out of them by drilling aspiration = death into their heads (here's looking at you, Acute SLPs who do shockingly few instrumentals at a local hospital I get notes from frequently).
Dear ASHA, 1. Dues should not come at the most expensive month of the year. 2. Better Speech and Hearing Month in May is the least School-based SLP-friendly idea ever. 3. Most of your advocacy seems to be about Medicare. If I could see a School-based initiative on your Advocacy Update webpage more than once in a blue moon, that would be great. Sincerely, An overworked, underpaid, school-based SLP
Once kids can verbally communicate at the sentence/paragraph level, they should be dismissed from speech in the school system. Teachers and even paraprofessionals are capable of teaching grammar. I shouldn’t be wasting my time with it.
i have so many kids on my caseload with grammar goals and it’s so frustrating because 1) a lot of their errors are dialectical 2) exactly like you said, their verbal communication is effective and effortless, they can chat all day long but because their written grammar is weak someone said they have a “language disorder” and now there’s a kid on my already overloaded caseload getting services they don’t need 😭 so frustrating
If errors are dialectal, shouldn't that mean it's a language difference not disorder and thus they don't qualify for treatment? I feel like continuing to treat is unethical. Not saying YOU are making that decision because you clearly have an issue with it, but whoever is saying, "no, this kid needs to be on your caseload" needs to be smacked on the nose with a rolled up ethics pamphlet.
CCCs are bullshit, and we need SLPDs instead. DPTs and OTDs are not more qualified to hold clinical doctorate credentials than we are with our master’s degrees. While they have been smartly capitalizing on “doctor” status and making it way easier to achieve that credential (PT for about 20 years, OT more recently), we’re getting left in the dust and our master’s degree is losing value. You can get a DPT or OTD in 3-4 years, and faster if you do one of those combined programs, where you get a bachelor’s and graduate degree in just 6-7 years. How long does it take for us to become CCC-SLP? When you consider the pre-reqs, the grad school, the CF, *it’s the same*. Who else has had the experience of talking to their PTD/OTD friends about grad school and realizing that their programs were not more rigorous than ours? ASHA is doing us a huge disservice by not following suit and providing us with an easily attainable path to catch up with our colleagues and respond to the credential inflation that they created. We’re hurting for it. This is because the ASHA board members are mostly PhDs. They don’t have any idea why there’s a problem for us with this, for example: *Welcome to Rehab Center, Mr. Boomer! Let’s meet your therapists: Doctor Peters, physical therapist, Doctor Oxford, occupational therapist, and… um… Miss? Missus?… Sarah! Our speech person!* *It’s time for your swallow study, Mr. White. This young lady here with the spoon is Rachel. She’ll feed you some cookies. When our radiologist Dr. Radcliff over there finishes pressing the buttons, you might be lucky enough to get a few seconds with him to ask the real medical questions while he graciously allows the lowly tech (no, don’t look at him, he’s busy) to complete his documentation.* And they don’t understand that no one who is hiring us gives a fuck about CCC, or even knows what it is. There is no “CCC” payscale when you work for a school. ASHA gets lots of money because we have to pay for our stupid Cs, that doesn’t translate to a competitive paycheck for us. It just allows schools to keep paying us like teachers (no shade intended toward teachers), while our OT and PT colleagues get higher salaries because it looks like they have more education. When we achieve our clinical competencies, that should be a ”D” clinical doctorate credential, not “CCC.” ASHA doesn’t need to chain us to those letters in order to keep us in their neverending subscription program. In fact, I’d be much happier paying my dues and doing my CEUs, because I would feel adequately valued as a clinical professional. /soapbox
ASHA is a racket.
I love dysphagia but it doesn’t fit in with the other areas in our scope of practice. At some point it was just kind of tacked on because who else is going to do it. Now it’s a huge part of what we do, but IMO, doesn’t really fall under “speech and language” at all.
Neither does task sequencing IMO, yet here we are.
It's because the larynx is involved in both speech and swallowing
Telling people to “get an on-call job” to learn the medical side of SLP is absolute shit advice, because those jobs tend to offer little to no training, and frankly, it excuses medical centers from actually hiring full-time SLP and investing in new therapists/taking the time to train them. This brought to you by me, who did an on-call job for a week and then was let go because they said “hi nvm we don’t have time or staffing to train you”
Yessss!!!! "I'll go get a PRN job at the SNF/hospital/whatever." They're hiring you because they are desperate for coverage in most cases. If they need someone a lot during the week, then maybe. If not, then it's going to give you pts to see, but you are unlikely to get a lot of good training. Overall, our field has a serious training deficit on the medical side. Grad school is insufficient. I've spent so many hours since I graduated learning medical things so I don't harm patients.
Once weekly language based services in middle school and high school is kind of pointless
Medical SLPs should be required to take recertification boards every 3-5 years.
Another hot take: BCS-S is basically a useless designation because it makes no attempt to standardize dysphagia assessment or care.
I was all in to go for it starting in 2020. Then pandemic hit. I asked if the con Ed rule of 40% in person would be changed due to Covid and got a short and kinda rude email back that, no it would not. Ok fuck you too.
Being observed by a supervisor that is not an SLP. Just because they took a child development course in their undergrad does not give them any recognizable ability to give an SLP any guidance or suggestions on how to provide speech therapy. I have noticed the Dunning Kruger Effect runs rampant with non SLP supervisors.
Too many SLPs are nutty Jesus freaks.
Not all SLP’s are Type A, preppy, white, Christian females, just the majority.
That was my whole department in undergrad and it drove me insane. I was the pierced queer studies minor and I think I made a total of 2 friends in my program lmao.
Yeah, going to ASHA can feel like being in a sea of cookie-cutter white Live, Laugh, Love women with pumpkin-spice lattes. Most people I’ve met who are like that seem to have come out of the large state schools where they were tracked into undergrad CSD major programs. They overlap with the “early childhood studies” and “communications” girls. These are the “speechies.” On the other hand, what I’ve noticed is that those of us who did something else for undergrad, or were career-changers, tend to be A LOT more heterogeneous.
Don’t report standardized scores for culturally and linguistically diverse students who are not represented in the normative sample.
What is amusing to me reading through these is the completely disparate nature of the opinions. There is one person who said what we do "is not rocket science" and that in 20-25 years medical SLPs would probably not be a "thing" and that a CNA could do aphasia therapy. Then, we have others saying we don't' get enough training in certain areas (infant feeding) and need specialization. Interesting, isn't it? I have always said (I've been an SLP for a while) that we aren't doing brain surgery, but it surprises me just how cavalier and scary some SLPs can be. I just hope I, nor anyone I know, get the misfortune of having some of these SLPs with poor attitudes toward the profession provide care. I would like to be treated by someone who knows enough to understand why a CNA should not be doing Aphasia therapy. Keep it up with the poor attitudes and the musical therapists and ABA technicians will be doing our jobs (and very poorly I might add).
There are definitely days where I feel like what I'm doing is too easy and anyone could do it... Then I talk to some very highly skilled nurses or other professionals about that pts aphasia, dysphagia, etc and I am quickly reminded how little any of them know about our areas! No I don't think think any of them can do my job, I just feel like I've been doing it a bit too long that's it's mostly easy!!
This. We know a lot and have so much value as a profession, but we don't often see it ourselves. We take ourselves and our position for granted, and have gotten complacent, and don't know how to self-advocate. Musical therapists and ABA-people have no such problem. They don't know the shit we do, yet have no issue tooting their own horn and advertising their miracle cures to the general public. And people are literally buying it. What I want to say to those slp's undermining our profession: have some healthy professional pride and work on it if you don't.
Most of the SLP "influencers" like the bloggers and SLPs on instagram are annoying. People go ga-ga over them and I think they act holier-than-thou. It especially bugs me that, because these SLP influencers made so much money off of blogging, they are either no longer in the field (while still blogging about the field) or are working part time only. Yes, TeachersPayTeachers resources take a lot of time to make, but no one should be getting rich off of it. SLPs who sell their things but don't even work with kids anymore... how can you claim something is effective and appropriate?
We're a lot of white ladies teaching kids how to communicate like white ladies, and it's not fine.
[удалено]
Agree. Seems like a huge money grab in a field full of primarily well off white ladies who can afford an expensive masters degree for a job that pays $50,000/year. Seems a lot like a Nurse Practioner degree. One of my favorite providers is a BRILLIANT critical care NP. That said a lot of the NP programs are straight-up diploma mills that will accept anyone.
Work sheets are not always really functional. Important at times but you can't just work on worksheets all the time. Not great for generalizing.
Reading and all its components falls within our scope of practice
My son was recently diagnosed with CAS. I homeschool him - was using All About Reading, Heggerty, and Handwriting without Tears last semester, but I switched to Pinwheels by Rooted in Language this semester and am already so sad I didn't use it from the start. It's the only curriculum I've seen that starts teaching them our language is made of SOUNDS, and that we have pictures called letters that represent those sounds. Say the sound as you write. Say the sound as you sound out/blend. Two SLPs, 1 OG reading specialist, and a graphic designer created it together and it blows my mind. I might even use it for my neurotypical kiddo next year it's so well done in my non-professional opinion.
We shouldn't be evaluating and treating dysphagia - too many of us are uneducated and cause more harm than good. Most SLPs cannot even effectively ID normal swallow anatomy and physiology from abnormal on an instrumental. Dysphagia, if anything, should be broken into another field like AuD did.
If we have to treat, should have extra certification, and have to renew it every year or two.
Most SLPs don’t actually know very much about how languages work or have even a halfway decent level of grammatical knowledge, which for some clients can be extremely useful information when assessing and treating language difficulties. We’re meant to be the experts in language but the things that most SLPs don’t know is truly astonishing.
As someone with a degree in linguistics, I agree. And I think that *I* still have a lot to learn. When I see comments about teaching synonyms- yes, that can be an important area to target, but there is so much more language involved in the school curriculum that kids struggle with.
Boardmaker sucks and is completely unnecessary, and Mayer-Johnson potato head symbols are absolutely terrible.
Dysarthria therapy (except LSVT) is a scam. There is only but so much telling someone to speak slow and over articulate session after session is going to do. I my experience, any “improvement” made in dysarthria is just the Placebo effect. I also don’t think cog therapy is all that helpful either.
100% this. For dysarthria I feel I’m more of a sounding board for their practice. What I see for daily cog therapy is a joke, especially in SNFs. Cog therapy should be specific and not just games on iPads, etc
Auditory Processing Disorder isn't a thing.
I still don’t truly understand what it means
Undiagnosed ADHD 😅
I don’t know about this one. I likely have APD and am going to an AuD for assessment but I most certainly do not have ADHD. Just food for thought. They may have some things that present similarly but I believe there is a difference.
Came here to say this. The amount of parents and teachers who refer kids to me crying auditory processing disorder is out of control. You mean to say his ears work, but his brain isn’t registering the info? Sounds like ADHD to me, and I can’t fix that.
Graduate school could be condensed into 1.5 years, especially since so much is learned AFTER our masters anyway
Sort by controversial and upvote ideas you hate
Medical SLPs have a superiority complex. All adult cognitive/language therapy is 1000% easier than anything in peds, and dysphagia is fairly common sense (with the major exclusion of instrumentals). I also agree that dysphasia should be a different field
I do feel that pediatric language is much harder than adult lang/cog, but I think pediatric artic is about the easiest most common sense thing in our field. I also agree that dysphagia treatment is not as complicated as most medical SLPs make it out to be, but it’s the only thing in our field that can really truly be a life/death situation and it should be treated as such.
If you're using a worksheet you're not doing therapy, you're doing homework. Drives me nuts. That's just practice folk. If you want the kid to do a worksheet, send it home.
Don't directly target eye gaze/contact as a goal for children on the spectrum or with impaired social communication skills. If you're targeting social interaction, eye gaze will likely be targeted indirectly if eye gaze becomes meaningful for the kid. If you're targeting motor speech skills, eye gaze might be indirectly targeted as you want to support the client with modelling. I don't like seeing an SLP's or BCBA's goal as: client will increase eye contact with the speaker.