How to Choose Your Speech Language Pathologist (SLP): Knowledge
Part 5 in our ongoing series How to Choose Your SLP.
And we're back!
So far, you've learned about Setting, Location, Philosophy, and Price -- more than halfway through our six key factors. We hope you are learning everything you need to know about choosing the SLP who will be the best fit for your child. If you haven't read the other posts yet, check out the links above to see our related posts!
Now, we will delve into our fifth factor: KNOWLEDGE
Jack of All Trades
Speech language pathology is an enormous field, spanning the life span from birth to geriatric care and encompassing a wide range of disciplines and disorders.
Before we explain how speech pathologists become skilled in treating specific profiles, let us first start by briefly going through the different types of areas speech pathologists treat.
Speech Production Difficulties with the perception, motor production, or phonological representation of speech sounds. Errors with sounds can be developmentally appropriate at young ages and become delayed later on. Or errors may be caused by acquired injuries (e.g., TBI), a motor speech disorder (e.g., childhood apraxia of speech), structural differences (e.g., cleft palate), or a hearing impairment. Some individuals may also seek out an SLP for elective accent modification services (to reduce or create accents). Speech pathologists are generally trained to treat speech production challenges but may vary in their skill with certain profiles.
Language Difficulties with understanding language (e.g., following directions, understanding vocabulary, making inferences) or producing language (e.g., acquiring words, combining words, grammar, narrative formulation). Language disorders may also include challenges with word-finding/word retrieval and language organization. Some speech therapists may also work with or specialize in Augmentative Alternative Communication devices (AAC). Language is one of the largest areas of speech-language pathology, and many clients have at least some aspect of language affected when they present with communication challenges.
Social Communication Difficulties with verbal or nonverbal language in social situations. This can include navigating social interaction but also includes understanding nonliteral language, multiple meaning words, and emotional vocabulary. Typically these types of challenges occur with neurodiverse individuals, specifically Autistic individuals, who have different ways of interacting socially that can make it hard for them to find social connectedness when desired. This area of speech pathology has been changing rapidly with the growth of the neurodiversity movement. Treatment focusing on masking (e.g., making individuals appear more neurotypical) is being replaced with treatment that supports individuals to interact in a way that is authentic and meaningful.
Fluency/Stuttering Difficulties with the forward flow of speech. Individuals who stutter may wish to reduce their moments of stuttering or may want to work on their self-advocacy skills. Treatment often focuses on speech-enhancing strategies that the client can use when they experience moments of stuttering to increase their confidence and reduce their frustration.
Voice/Resonance When a person's voice quality, pitch, resonance, or loudness differ from the norm for the client's age/gender/culture. This can be physiological, caused by structural changes in the larynx due to aging or structural abnormalities on the vocal folds (e.g., nodules) or in the nasal cavity (e.g., large adenoids). These changes can often be treated by shifting behaviors (e.g., reducing vocal abuse or overuse). Other times, the voice or resonance changes are caused by neurogenic disorders that can cause tremors, paralysis, or spasms in the larynx. Lastly, individuals may seek gender affirmation services to make their voice and/or other aspects of their communication align with their gender identity and/or gender expression. Voice and resonance is a more niche area of speech pathology and is not often seen outside of hospital-based clinics.
Feeding/Swallowing Difficulties with any aspect of eating or drinking, including nursing, latching, sucking, chewing, self-feeding, or swallowing. Infants seen for feeding typically struggle with nursing/latching while pediatric clients may have additional sensory challenges or behavioral challenges around foods. Treatment often focuses on finding ways to keep the child growing while also working through any aversions, behaviors, or physical challenges stopping the child from being able to feed or swallow appropriately. This is a specialized area of speech pathology -- often taking place in hospitals or related clinics -- although feeding therapists are beginning to be more common outside of the hospital settings.
Cognition Difficulties with attention, memory, executive functioning, social cognition, visual perception, or language as a result of acquired injuries (e.g., TBI, concussions) or developmental disabilities that impact cognition. This is a specialized area of speech pathology that is not often treated in typical speech settings.
Literacy Difficulties with phonological awareness (e.g., rhyming, blending sounds), letter-sound correspondences, decoding (e.g., early reading skills), comprehension. Children who have challenges with language may also have challenges with reading and writing, especially when the phonological system is affected. Speech pathologists deal with literacy less in many settings with the rise of trained reading specialists (especially in public schools). In my professional experience, literacy support is slightly divided -- with speech therapists working on phonological awareness and phonological processing skills while decoding skills are tackled by reading specialists. Both professions work on comprehension skills of written language.
Phew. We did it.
As you can see, speech pathology is an enormous field. And even with that overview, there is so much that wasn't covered: bilingualism, selective mutism, picky eating, self-advocacy skills, and more. Speech pathologists see children with complex profiles including those diagnosed with Down Syndrome, Autistic individuals, clients with hearing impairments, and more. Many of these clients have needs that span multiple of the above categories as well as additional needs in areas like sensory integration, mental health, or other health issues related to their profile.
So how do you know if your speech pathologist has the training or expertise to work with your child? Read on to learn more about how to assess a good fit in terms of your clinician's knowledge.
Speech pathologists must go through rigorous coursework in a Masters level program followed by a standardized exam and a 9 month fellowship in order to receive certification by our governing board ASHA (American Speech-
Academics cover all the areas above, but students have the ability to focus on some areas more than others in their clinical placements.
For example, a student interested in working with adults might choose to pursue more hours in their hospital clinical placement to gain experience with aphasia clients post traumatic brain injury as well as in nursing homes to see swallowing and feeding needs.
Another student, however, interested in only working with pediatrics, might focus on an outpatient setting working with Autistic children, an elementary school placement, and a diagnostic hospital setting learning the ins-and-outs of language evaluations. This student might have gathered all of her adult hours working with college students who stutter rather than taking a full adult placement. [Hint: this student is me. I knew I wanted to work with kids from the very beginning and I made sure I got all the hours I could in my areas of interest.]
So while every student learns the basics in school, speech therapists narrow their scope as they begin to build their clinical placements and as they choose their clinical fellowship.
And of course, as soon as a therapist begins working, they grow their clinical expertise with new clients and -- hopefully -- learn from their peers and mentors in their new job.
ASHA does offer specialty certifications beyond general certification. This speciality certification includes a standard exam, a portfolio review, a practical exam, a structured interview, and maintenance requirements to renew the credential.
The options include:
American Audiology Board of Intraoperative Monitoring
American Board of Child Language and Language Disorders
American Board of Fluency and Fluency Disorders
American Board of Swallowing and Swallowing Disorders
These certifications require 100+ hours of intermediate or advanced continuing education in addition to 5 years of full time work in the area and the ability to demonstrate advanced knowledge, skills, and leadership in the field. They are not common certifications, but if you see an SLP with one of them after their name, you know they have some serious knowledge!
More common indicators of knowledge are trainings. These are longer, specialized courses that a speech pathologist can take for continuing education in a specific area.
Some of the popular ones are below:
PROMPT -- training for motor speech (i.e. apraxia of speech)
Meaningful Speech -- training around gestalt language processors and Autism
Sensory-SLP -- training for supporting neurodiverse individuals with sensory needs
Orton-Gillingham -- training for literacy and dyslexia treatment
FEES - training for using a flexible laryngoscope in swallowing assessment
LSVT - training specializing in Parkinson’s and other neurological conditions
As with any job, speech pathologists learn best on the job.
We learn so much from each and every client and also from other speech therapists as we discuss case studies and ask each other questions. We learn from our mentors -- starting in our clinical fellowship -- and then as we find colleagues we respect and admire.
Clinical expertise is one of the best ways to learn what works and how to troubleshoot with real kids who don't necessarily behave exactly as our textbooks or professors made us believe.
I still remember how much I learned in my first year as an SLP when I realized that no one had ever taught be how to actually capture a 3 year old's attention for 45 minutes while also taking data on a clipboard that he desperately wanted more than any of the toys I had out. I also learned how to sit with my chair near the door when I had a very fast 4 year old who really loved to run out of my door midsession!
It's a trial-by-fire sort of learning, but it teaches you how to be flexible, how to adjust, and how to really look at a child's profile and find the ways to reach them and help them succeed.
Clinical expertise will also determine the type of knowledge that a clinician builds. A clinician in a hospital setting might learn a lot about swallowing and feeding but a clinician in a private practice might not have any experience with those types of kids. Similarly, a clinician in a hospital probably doesn't see a lot of speech production kids, while a school-based SLP might see a ton of them.
Here is a general idea of the clinical expertise for speech pathologists in certain settings:
Hospital-Based: Medically-Complex Kids, Feeding/Swallowing, Cognition, Voice/Resonance.
Outpatient Clinic or Private Practice: Autism, AAC, Social Communication, Feeding, Language, Speech Production, Fluency/Stuttering, Phonological Awareness, and sometimes simple Voice cases.
School Based: Autism, Social Communication, Speech Production, Language, Phonological Awareness, and sometimes Fluency.
Early Intervention: Language, Speech Production (early sounds)
And this one goes without saying but of course your speech therapist should be keeping up to date on new data in the field. Continuing education is required by ASHA to renew our licensure.
One of my absolute favorite ways to stay up-to-date on recent research is The Informed SLP -- an organization that provides monthly summaries of journal articles (real science!) and creates easy-to-read research reviews for clinicians who do not have the time or access to read them.
Trainings, as mentioned above, as well as many shorter courses at conferences or online all count for continuing education in the field.
As you search for an SLP, knowledge is perhaps one of the challenging things to assess. We suggest opening up a conversation with your therapist to determine if they will be a good fit for your child's profile. Some examples might include:
Do you have a lot of experience with [your child's profile]?
Do you have any additional trainings that help you better understand this profile?
Are you familiar with the recent information in the field regarding:
Gestalt language processing
Ableism and the medical model of care
Alternatives to whole body listening
Ready, Set, Talk Time
So let's see how Time Boston fits into the Knowledge category.
Talk Time clinicians are speech language pathologists with a Certificate of Clinical Competence (CCC) from the American Speech-Language Hearing Association (ASHA) and are licensed by the Commonwealth of Massachusetts. All of our clinicians are required to complete the Meaningful Speech course in gestalt language processing and the Natural Language Acquisition (NLA) framework.
Alessandra graduated with her A.B. from Princeton University and her M.S. from Boston University in speech pathology. She has worked in both educational settings and in private practices in the Massachusetts area with a wide range of clients. Alessandra is experienced working with children of all ages in the areas of speech production, language, social communication, fluency, and phonological awareness.
Nicole graduated with her B.S. at Emerson College and an M.S. in Speech and Hearing Sciences at the University of Arizona. She spent the last several years working in both school and pediatric outpatient settings. Nicole is PROMPT-trained and proficient in working with motor speech disorders. She is also experienced working with children of all ages in the areas of speech production, language, social communication, fluency, and phonological awareness.
Both Alessandra and Nicole have experience working with medically complex children whose needs span multiple areas of speech and language, including children with Down Syndrome and Autistic individuals. Although neither are specialized in AAC, both have experience supporting children who use AAC as their primary form of communication or to augment their verbal communication.
Talk Time Boston does not currently have clinicians who are skilled in treating feeding/swallowing or cognition. Voice clients may be seen on a case-by-case basis depending on the profile and treatment recommendations. (NOTE: If you are looking for cognitive therapy, check out Arlington-based Jenny Traver at Cognitive SLP)
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