Location, Location, Location
Updated: Dec 3, 2022
How to Choose Your Speech Language Pathologist (SLP): You Guessed it... Location
Part 2 in our ongoing series How to Choose Your SLP.
During the first installment of this series we talked about Setting, where we discussed Early Intervention (EI), school-based therapy, and private practice. For EI and schools, there is typically a predetermined location (e.g., EI will usually come to your home, while school-based therapy takes place, well, at school).
If you are pursuing therapy with a private practice, however, there is a lot more to consider in terms of location.
So, knowing this, let's look at some possibilities. Your child needs help, and you've decided to pursue speech therapy at a private practice. But...
You live outside of the city, an hour or more from the closest speech practice.
You're down the street from your nearest SLP, but getting the kids out of the house on time is impossible.
Your SLP has been traveling to you at your home, but your child is just too distracted and is running amuck every session.
Your child has been receiving speech therapy in the clinic and is doing great, but they aren't generalizing any of their skills to outside of sessions.
Your child communicates great with adults, but is struggling to communicate in school or on the playground with peers.
Finding the right location for speech therapy to take place is hugely important to a child's success. What works for one child might not work for another. A family might have different needs or capabilities based on where they live.
If you have a situation similar to the above, you might feel stuck - what can you do to make things work?
Read on for suggestions from us at Talk Time (based on my experience working across many different locations with patients and their families).
Find Your Fit
Not every SLP is the right fit for every family. And not every family is the right fit for every practice. But the right fit is crucial for your child to make progress in speech therapy.
Let's look at some of the factors to consider when choosing an SLP:
Setting
Location
Philosophy
Price
Knowledge
Communication
This post will walk you through the second of the six factors: LOCATION.
What Are Your Options?
Whether you already have an SLP or you're just starting the conversation with a new private practice, make sure to ask about your options. Every practice's capabilities and level of flexibility will be different. You want to make sure to find someone that is able to provide a good fit for your child and your family.
But in order to start that conversation, you need something to go off of. So let's take a look at some different location options that a private practice could potentially offer:
At the Clinic
Many private practices have a brick-and-mortar office space where you can meet your clinician for sessions. Usually these have a separate waiting room where you might be greeted by a receptionist. At your scheduled appointment time, your SLP will meet you and walk you to a private room where the session will take place.
Basically, it works the same as a pediatrician's office - except the sessions are hopefully more fun for your child!
Going to a clinic may be extra work for you depending on travel time, how difficult it is to get your child into the car, etc. But it can also be helpful for establishing a routine. Your child knows that it is time for speech. They travel to the clinic. They get excited to see their SLP and to pick out toys and games from the game closet. When it's time to leave, your SLP cleans up the mess.
The clinic can be a very peaceful, quiet place to conduct therapy. It is a controlled environment. This might be great for your child, because it allows them to focus on their work without distractions. But sometimes this can make it difficult for children to generalize their learned skills outside of the speech room. Make sure your SLP is working with you on a home program to encourage carryover of skills across environments.
Some clinics will have additional benefits. For example, if the private practice includes occupational therapists (OTs), there may be a shared gym area where sessions could take place. This would also give your SLP the opportunity to consult with OTs about your child's sensory and motor needs. A clinic also has the opportunity to offer group or dual sessions, which are especially handy if your child is working on communicating with peers. Plus, you'll get the chance to meet other parents whose children have needs similar to your own.
One thing to watch out for -- make sure that your clinician is inviting you back into the clinic room to give you regular updates on your child's treatment and progress. If your child is under 3, we would most likely recommend that you're present for the entire session. For older kids, you might be invited back for the last 5 minutes. Otherwise, you might be kept informed via email or phone calls. It can be difficult to have conversations in the waiting room, and this important time to check in with parents is often overlooked in the clinic setting.
Pros
Going to the clinic establishes routine.
There are lots of resources for treatment.
It is a quiet, controlled environment where it may be easier to focus.
Your SLP may have opportunities to consult with other therapists.
There is no clean up for you.
Cons
You have to travel to the clinic, which may or may not be difficult depending on location, travel time, traffic, etcetera.
It may be difficult for your child to generalize skills outside of the clinic environment.
Quality communication with parents can be overlooked.
In Home
A lot of private practices will have an in-home treatment option, where the SLP will travel to you. This is even more common since the pandemic, when many brick-and-mortar offices closed down. If your child has had Early Intervention (EI), you might be familiar with this model.
Here's how it works:
Your clinician will arrive at your home at your scheduled appointment time. Depending on the SLP's treatment style and your child's needs, they may arrive with a bag of treatment materials (e.g., toys, books, games) or they may have nothing but a clipboard. They'll follow you to a quiet room in your home where your child feels comfortable - usually the living room or a playroom. Sometimes sessions even take place outside, on the deck or in the backyard!
In-home sessions can be really beneficial for young children, especially those under 3. They allow the SLP to see the child in their home environment, and to work with the toys and materials that the family has on hand. This can be excellent for carryover of skills outside of treatment sessions. It is also really easy for the parents to be present and involved at each session.
Some children might have more trouble focusing on work in the home environment. They might find it more distracting, or they might be more inclined to run around the house -- it's their domain, after all. But a good SLP will typically find a way to set boundaries and expectations, while also working with the child's interests and using the home environment to their advantage.
Pros
You don't have to travel! The SLP comes to you.
There is more opportunity for carryover of skills outside of the speech session.
The child may feel more comfortable in their home environment.
The parent has more opportunities to be present and involved in the sessions.
Cons
In-home sessions typically cost more or have an extra travel fee.
Some children might be more distracted.
There is less opportunity for your SLP to directly consult with other therapists.
Virtual
For a while in 2020, we all switched to virtual treatment. That means that this modality has grown and improved massively, and SLPs who would never have considered it have since been professionally trained to do it. This is the age of screen sharing and green screens. Of throwing a dinosaur up as your background and pulling some really cool tricks to make it look like you're feeding the dinosaur a banana. Or putting virtual bubbles behind you and getting the child to virtually pop them.
Virtual therapy opens up a world of possibility for those who live in remote areas, too far away to reach a clinic or for an SLP to reach them. All you need is a WiFi connection and a laptop -- or maybe just an iPad.
There are obvious limitations to virtual treatment. Children might have a harder time focusing on work when the SLP is locked into a screen. It's much easier for them to get distracted or walk away, and depending on the child you may need to be present to keep them on track -- even if they're older.
But there are great benefits, too. The SLP essentially gets to visit you in your home without having to travel there, and without you having to pay extra travel fees. They get to see your child in their home environment, which does help with generalization of skills. Some children are more motivated by screens and might find the session more exciting and fun than if they saw their SLP in person. Plus, a virtual option makes it more possible to have some sessions that are entirely focused on parent coaching -- which can make a huge difference for our younger early language learners.
There's more flexibility in regards to session length, as well. Does your child need three 20-minute sessions a week (something that would almost never be feasible in a clinic)? Easy! Even if you live next door to a clinic, you might find that the virtual option works bests for you.
Plus -- goodbye to weather or mild colds affecting your sessions! If you have a WiFi connection, the session is still on. Virtual sessions are a great recourse even if you typically have in-person sessions, but can't get out of the house that day.
Most importantly, virtual treatment can be just as effective as in person treatment. At the end of the day, it all comes down to your SLP and the quality of therapy.
Pros
Most SLPs have had some sort of training and experience with virtual treatment since the 2020 pandemic.
No one needs to travel and treatment is easily accessed.
SLPs can do really amazing things with a little creativity and a green screen.
Some kids are more motivated by screen-based treatment.
There are many similar benefits to in-home treatment regarding generalization of skills.
Parent coaching is much more possible.
There is more flexibility in terms of session frequency and length.
Bad weather or mild colds won't force you to miss valuable treatment time.
Cons
Technical difficulties can arise, which may take up some session time.
Some kids have a hard time sitting in front of a screen for too long and can become distracted.
At School
This one really only works if your child attends a private school or a privately funded daycare, because a public institution will have their own special education and speech personnel on the premises.
Similar to in home therapy, your SLP would travel to your child's school for the session. The SLP may need to go through a background check and fingerprinting, depending on the school's policies, and will communicate with your child's teachers to determine the best time to conduct the sessions.
Keep in mind that treatment at school may mean your child gets pulled out of lesson time. But it also might mean your SLP can conduct sessions directly in the classroom environment, depending on what's best for your child. This gives your SLP an opportunity to observe your child in their classroom. This can be especially useful for working on generalization of skills, social communication, and getting a better idea of what academic supports your child could benefit from. It also allows your SLP to communicate directly with teachers, who are of course a huge part of any child's life.
If you go this route, you'll want to make sure your SLP is setting aside time to keep you updated about treatment and progress -- whether this is done through email, phone calls, or occasional in-person appointments.
Pros
You don't need to travel or schedule time after school for sessions
Your SLP can see your child in their classroom environment, allowing them to suggest academic supports and communicate directly with teachers
It's possible to conduct sessions in the classroom as needed
Cons
Your child may get pulled out of lesson time.
The school may not have a private, quiet area for the session to take place in.
Communication with parents is less frequent and may be overlooked.
Meet in the Middle
Depending on the private practice and the clinician's level of flexibility, you may have the opportunity to meet at a neutral location.
This can be a study room at a public library or at a local park or playground.
This might be a good option for you if...
You live far away from the clinic and/or out of the SLP's travel range for in home visits. Rather than one of you traveling to the other, you could literally meet in the middle.
Your private practice doesn't have a clinic space, but your child is really struggling to focus in the home setting. Your SLP has tried everything and, at the end of the day, your child just really needs a quiet, controlled space.
You don't have room for that extra 'travel' fee that a home visit entails, but it's really hard for you to get all the way to the clinic on time. Maybe you can negotiate a halfway point with your SLP.
This definitely isn't something that all clinics will offer, but if you're encountering one of the above problems (or something similar), it might be worth asking about. A Meetup Spot won't be as equipped for treatment as a clinic, and it won't be as comfortable and generalization-friendly as your home -- but it can provide a happy medium.
Plus, depending on the spot, you might have the opportunity to take part of your sessions into the community, something you can read more about in the next section...
Pros
This is a flexible option that can solve some potential problems
You may not have to drive as far as you would to the clinic -- or, you might find a spot within your SLP's travel range.
Your SLP can still bring toys and materials, just as they might for an in home session.
You may have opportunities to take your session into the community for better generalization of skills.
Cons
There won't be a waiting room, and there may in general be a greater lack of privacy.
You will still have to travel to the Meetup Spot.
It isn't as well equipped as a clinic, and it isn't as comfortable as your home.
The Community
As with the 'Meet in the Middle' option, this totally depends on the private practice and their level of flexibility. You probably won't have sessions that always take place in the community, but going out into the community might be a nice option to have depending on your child's needs.
For example, if your child is working on their "R" sound and is ready to generalize it (meaning they are working to use it all of the time, both in and out of the speech session) it might be helpful to go window shopping in a shopping center and have them practice using "R" out in the world.
Or perhaps your child is doing a great job of self-advocating and asking for what they need with their SLP in a quiet, 1:1 setting, but becomes totally quiet when they're around similarly aged peers. Maybe they could benefit from a speech session at the playground.
For some skills, learning in the speech room isn't enough. For example, if your child uses AAC and is working on ordering food from McDonalds, it might be best to take a field trip. Learning to communicate with real strangers is totally different from speaking to a patient, highly trained SLP -- and it's best to learn to do this with a little support.
I honestly don't think a pro/con list works for this one. Sessions in the Community are something that your SLP might be able to do as needed, depending on flexibility and location. Having this option is always a plus in my mind!
Which locations are possible totally depends on your SLP and/or private practice. Some SLPs may work strictly in the clinic or in home, while others might do a combination of everything (ahem, Talk Time).
The important thing is to know the possibilities and to ask about your options. Consider which locations work best for your child and your family -- logistically, financially, and personally.
Scenarios
These are all fictional scenarios to help you in your decision to understand what setting might be best for your child.
John
John is almost 3 years old. He has been receiving therapy in his home and making excellent progress with his speech therapist. His teachers recently expressed concerns that John wasn't accessing language at daycare. His parents are concerned that progress at home isn't translating to John's other environments.
John's parents discuss their concerns with their speech therapist. They decide as a team to start having therapy sessions in the daycare instead of at home. His speech therapist works to educate and train teachers as well as to generalize John's skills from home therapy over to the classroom environment so he can begin to use more expressive language with his peers.
Amy
Amy is an Autistic teenager who uses high-tech AAC as her primary means of communication. As she has gotten older, she began voicing her dislike of therapy activities during both clinic and home sessions. This is leading to low motivation, task refusal, and occasionally outbursts of frustration.
Amy's speech therapist opens up a conversation with Amy and her parents about how to make speech therapy work for her again. Amy discusses that she doesn't care about the goals they are working on, but mentions several other things she does want to practice -- like going to pick out a toy at a toy store or ordering food at a restaurant by herself. Now, Amy and her therapist have monthly sessions in the community where Amy can build her hands-on, functional communication skills using her AAC device.
Tanya
Tanya is a very busy 8 year old girl with a packed after-school schedule. She does not qualify for public school services, so her family is looked at private practices to help her work on her /r/ and /l/ sounds. Getting therapy is important to her and her family, but logistics seem impossible.
Tanya's family looks for a speech therapist who offers to provide therapy within their daughter's private school. Once a week, she gets pulled out of her classroom and works on her sounds with her therapist in the library. As Tanya improves and begins to generalize her sounds, her therapist decides to conduct therapy within the classroom setting!
Carmen
Carmen is a little 18 month old girl who is not meeting her communication milestones. Her family lives over an hour from the nearest clinic with availability and Early Intervention has not been a good match for their family. Her family want to do more to support Carmen's language but they aren't sure what to do.
Carmen's family finds a speech therapist skilled in virtual therapy and parent coaching. They have weekly 30 minute virtual sessions that are a combination of parent coaching and direct interaction with the child. This includes specific parent skills for the family to implement at home and the use of video modeling to provide concrete feedback on how parents are doing. Carmen's family feels empowered by all of the education they are receiving, and Carmen is beginning to use new words!
Marco
Marco is a five year old boy with a language delay. He lives in the heart of the city where traffic makes travel very difficult, especially during after school hours. Clinics with availability take too much time to get to and therapists with availability are outside of their area. Marco's family is searching for a solution.
Marco's family finds a therapist who offers flexible locations. Working with the therapist, they find a library that is halfway between the speech therapist's office and Marco's home. They use a study room as a Meet-Up Spot each week. And, as an added bonus, Marco sometimes pops out of the study room to work on using language at the library setting!
Wesley
Wesley is a ten year old Autistic boy with ADHD. He has some language delays and is easily distracted. Speech therapy at home has been difficult since Wesley has several siblings around and many distracting toys. Wesley's therapist is concerned that Wesley isn't making progress as fast as he could be.
Wesley's speech therapist has a conversation with his family, and they decide to try two different locations. Wesley has two sessions per week -- one session in the clinic and one session in home. The clinic sessions focus on teaching new, more challenging skills in a focused and quiet environment while the home sessions focus on generalization of learned skills and functional use of language in a more distracting environment.
Ready, Set, Talk Time
So let's see how Time Boston fits into the Location category.
At Talk Time Boston we are passionate about offering flexible options for every individual client's needs. We don't currently have a clinic space, but we do everything else -- I personally see children in all of the other locations each and every week. Further, we are always checking in with families and re-evaluating our clients needs, and are ready to switch up the location at a moment's notice.
Why Talk Time?
We know that there isn't just one solution, or one perfect location, for every family.
We do our best to make treatment accessible to everyone, regardless of distance or financial means.
We intimately know the pros and cons of each of these locations and will work to find the best one(s) for your child's treatment plan.
No matter the location, we make sure there is constant communication with caregivers to ensure carryover of skills outside of sessions.
We believe in making each and every location fun and meaningful for the kids.
WANT TO LEARN MORE?
Check out our services and our intake process on our website here.
And, if you think our private practice is the right fit for your family, please reach out to us:
Email us directly at info@talktimeboston.com
Fill out our quick and easy form here