Setting the Scene
Updated: Dec 3, 2022
How to Choose Your Speech Language Pathologist (SLP): Setting
Part 1 in our ongoing series How to Choose Your SLP.
Let's set the scene:
Allie still can't say their /s/ sound despite several years of therapy.
Nolan isn't meeting milestones at their pediatrician visit.
Tyler just received a formal diagnosis of Autism.
Wenxi is stuttering and feeling very frustrated about their communication.
Pippa is struggling with language-based tasks at school.
As a parent, you want to help. And with some research and guidance, many parents quickly realize that speech therapy is the best way to support their child.
But then comes the hard part: actually finding the SLP.
While SLPs can be found on Google and often pediatricians will provide you a list of practices in your area, the process of finding a good match for your family is actually a bit more complicated than you might think.
Read on to learn our suggestions here at Talk Time (based on my experiences as a parent and as an SLP working in schools and private practice).
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 walk through some of the factors to consider when choosing an SLP:
Setting
Location
Philosophy
Price
Knowledge
Communication
This post will walk you through the first of the six factors: SETTING.
Setting
The field of speech pathology is incredibly large. We work with pediatric and adult populations across many different settings and treat a vast variety of disorders and communication challenges.
If you are a parent looking for an SLP, there are four main choices for outpatient care:
Early Intervention
Early Intervention is a publicly-funded program that provides services for children from birth to three years old with developmental delays and disabilities along with support for their families. This program is free in Massachusetts (and is free or reduced in cost in other states). If a child qualifies for services, the team from the state’s early intervention program creates an Individualized Family Service Plan (IFSP) to define what services the child needs as well as specific goals for them to work towards during therapy. Services may include speech therapy, physical therapy, occupational therapy, social work, feeding support, and more. Early Intervention uses a family-centered model where therapists come to your home to provide services. Therapy focuses on family education and providing functional supports and strategies within the home environment for caregivers to use throughout the week.
Some therapists in Early Interventions are licensed speech pathologists trained to provide speech therapy. However, your therapist may be a developmental specialist or other type of therapist who is not a specialist in communication.
Pros
Free (or low cost) for families
In the home environment, providing a naturalistic environment for your child
Family approach encourages home carryover for faster progress
Cons
Evaluations are limited in detail in the area of communication
Therapists working on communication goals are not always licensed SLPs
Children may not qualify if they do not show enough of a delay
Children age-out at 3 years old and must either transition to the school or private practice for continued services.
Public School-Age Services
Once kids reach their third birthday, they can no longer receive Early Intervention. Instead, they can receive free services from the public school system in their town of residence -- even if the child does not attend school yet or if they attend private school.
The first step to receive special education services is an evaluation. Teachers may request this evaluation but it is also your right as a parent to request an evaluation at any time if you are concerned.
Your child will be assessed in multiple areas of concern including academics, communication, behavior, emotional regulation, social skills, motor skills, and more.
If your child qualifies (i.e. has a disability within the school setting), they will be given supports through an Individualized Education Program (IEP). The IEP will dictate what services your child needs, how frequently they need these services, the goals that your child will work on, and where they will receive the services (i.e. in a separate class, in their classroom, in a specialist's room).
IEPs are reviewed each year and children are reassessed every three years unless requested by a parent. Parents and teachers can also request the IEP be updated or the child be re-assessed if needed.
NOTE: If you do NOT agree with the findings of the school assessment, parents have the right to obtain an Independent Educational Evaluation (IEE). Parents can ask that the school system pay for this IEE, especially if the area of concern was not able to be tested at the school.
Pros
Services are free.
If your child goes to that school, it may help to see them in their natural/social environment
It is easy for the treating SLP to communicate with your child’s classroom teacher – as well as any other school-based providers.
Cons
The process to qualify is long and services in the school are not always sufficient to make progress.
Kids are almost always in small groups for therapy rather than 1:1.
Sessions are often disrupted by vacation weeks and summer.
Kids often miss activities and learning in the classroom when pulled out for therapy. When therapy occurs in the classroom, it may not be as intensive or individualized as in pull-out sessions.
Home carryover and communication with the clinician is often limited.
Therapy goals cannot be altered or adapted easily without changing the IEP in a formal meeting with the school team.
Outpatient Clinic
Many hospitals offer outpatient therapy services for clients. Similar to a private practice model, these are services that the client pays for (either through insurance or private pay) and happen in a clinic environment.
Pros
Outpatient clinics (since they associated with large hospitals) are often in-network with several insurance providers
There are often many different providers at a hospital clinic (e.g., OTs, PTs, psychologists) which allow for your speech pathologist to consult with other professionals and might allow you to receive multiple services within one clinic
Cons
Speech therapists at outpatient clinics may have requirements and restrictions based on their hospital regulations. This can impact their flexibility in scheduling, their policies for qualification of services, and sometimes caseload requirements.
Private Practice
Private practice is the last of the settings for pediatric outpatient therapy.
As expected, these services are provided by licensed SLPs outside of the publicly funded programs like Early Intervention or the public school system.
Private practices vary greatly, which is actually one of the benefits of this setting. Clinicians can tailor their therapy more directly to their clientele, choosing the right locations, frequencies, prices, etc for their business and their families.
Private SLPs may come to your home, provide virtual therapy, or offer clinic-based services. They are often private pay (reimbursed with a superbill) while some practices may take insurance.
Because they are not tied to state restrictions and may not be tied by insurance requirements, private SLPs are able to be more flexible in their treatment and can adapt therapy easily as needed. They also often provide more robust testing and documentation.
Pros
You can choose an SLP that fits your family's values and style
Since they see parents and caregivers at each session, it is easy for your SLP to work closely with the family for home carryover.
Private SLPs tend to have smaller caseloads, meaning that they will have more time to dedicate to each individual patient.
Communication is frequent and thorough. Private SLPs often write more detailed reports, provide progress notes, and talk with families via email/phone communication as needed.
Your SLP can adapt the plan easily whenever the need arises
Cons
Private therapy can be expensive if the practice is out-of-network. It takes time to receive superbill reimbursements (if your plan allows).
If treatment occurs in a clinic, you must spend time driving your child to the appointments. (But some private SLPs offer home-based and virtual options)
As described above, each of these four settings comes with a set of pros and cons. The best setting for your child can and will change based on many factors including age, communication profile, location, finances, etc.
NOTE: Children who experience traumatic brain injuries (TBIs) or have more complex medical disorders may also receive speech therapy in an inpatient (hospital) setting. If you have a child who has experienced a TBI and is looking for outpatient (private) therapy, you should seek out a specialist in the area of pediatric cognitive-linguistic therapy. If you are local, check out Jenny Travers, M.S. CCC-SLP at Cognitive SLP to learn more about this specific field of speech pathology.
Scenarios
These are all fictional scenarios to help you in your decision to understand what setting might be best for your child.
Mattie
Mattie is 17 months old. He has been receiving Early Intervention therapy for three months and his parents haven't seen any improvement in his communication. His therapist is not an SLP, and parents are not receiving education and strategies to help with home carryover of skills. The waitlist for a speech therapist at the Early Intervention program is over 6 months.
Mattie's parents might want to consider a private practice setting (in addition to or instead of Early Intervention services). They can continue to receive in-home services while receiving specialized support and parent education for home carryover. Waiting six months for a child this young is not recommended since research shows that "the earlier services are delivered, the more likely children are to develop effective communication" (Guralnick, 2011 on ASHA website).
Natalya
Natalya is 4.5 years old. She attends public preschool in her town. Her teachers have recently seen that Natalya is struggling with her articulation skills which is causing her to be frustrated with peers. They refer her for an evaluation, and the speech pathologist finds that she qualifies for services. She has been working on some speech sounds for a few months now and making progress nicely.
Natalya's parents are happy with their public school setting. Natalya is making progress in her preschool environment, and no changes are needed in her plan at the moment. If progress seems to be stagnating or if other communication issues arise, they can work with their SLP to update her objectives or seek private therapy if she no longer qualifies in the school setting.
Jackson
Jackson is 10 years old and attends 4th grade. Despite showing vulnerabilities and weaknesses in higher level language skills, he did not qualify for school-based services after his last re-evaluation in his public school. His teacher says Jackson struggles with language arts, especially when he has to explain what he read or tell a story. His parents are also concerned about these higher level language skills at home, too.
Unfortunately, it is common that more nuanced challenges like higher level language may not qualify for services in the public school system, especially if the child is still able to access curriculum. However, Jackson's parents are worried that, as academics become more difficult in later grades, these challenges will make school hard for Jackson. They decide to pursue speech therapy at a private practice to help Jackson feel more confident about these more difficult language-based tasks.
Abdul
Abdul is almost 3 years old. He was just diagnosed with Autism. His parents do not feel that behavioral therapy is the right approach for him, but would like to pursue speech therapy to help him communicate more. Abdul will age out of Early Intervention soon, which means that setting is not a good option for him. They can start the evaluation process with the public school at 3 years old to receive services there where the speech therapist will likely see Abdul once a week in a group setting. But Abdul's parents are unsure that this will be enough.
Abdul's parents might want to consider a private practice setting (instead of or in addition to school services). Private practices can see Abdul sooner than a school setting, which often takes several months to get started. At a private practice, Abdul can also receive therapy multiple times a week in a 1:1 setting to help him make progress faster.
Gale
Gale is 4 years old. He has Down Syndrome and receives multiple weekly services including occupational therapy, speech therapy, and physical therapy. In addition, he has many appointments with doctors and specialists to monitor his medical needs. His parents are currently bringing Gale to lots of different providers in their area.
Gale's parents might consider an outpatient clinic associated with a local hospital. If they can receive all of their services at one location, this could make things easier on them as a family. They also like the idea that the providers can easily talk to each other about Gale's progress, and sometimes even co-treat during sessions.
Mia
Mia is 15 months old. She is a little behind on her communication milestones. Her pediatrician is unconcerned but her parents decide to go with their gut and seek out Early Intervention services. Mia qualifies for speech therapy, and the SLP comes to their house weekly. Mia's parents are learning so much about how to encourage Mia's language in the home environment. By her 18 month check-up, Mia is back on track.
Mia's parents had a great experience in the Early Intervention setting. They had a therapist that helped educate and empower them to support their daughter's communication at home.
Ready, Set, Talk Time
So let's see how Time Boston fits into the Setting category.
Talk Time Boston is a private practice. We see clients in their home, at meet-up locations in the community, and virtually -- all based on what fits the child's communication profile and the family's needs.
Why Talk Time?
We are passionate about working with our clients and their family for home carryover.
We take on a manageable caseload so we know we have time to dedicate to each individual client and their needs.
We value communication about progress. Every three months or so, we analyze our client's progress and write up a detailed progress note with a plan for the next treatment period.
But we also look at our data week to week and adapt our plan sooner if needed.
WANT TO LEARN MORE?
Check out our services and our intake process on our website here.
And, if 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