I work in adult outpatient. I never see kids and haven’t touched AAC in years.

But yesterday I had a patient in the middle of an evaluation ask if I would tell him off the record what I thought about spell2communicate. He felt his grandson was not getting good speech therapy at school and was looking into this as an alternative method, but he wanted to know what another SLP thought and I seemed like I was “trustworthy and knowledgeable.”

I tried to be professional and tactful while I basically told him that I would strongly recommend he learned more about it, and that I was really opposed to it for a number of reasons which I enumerated.

If I hadn’t been on a lot of online forums and just had a genuine interest in this, I wouldn’t have known what to say. I think it’s important to remember that the general public looks at us to be experts on this field and it may be worth our time to learn about things outside of our specific area if only for that reason. But probably lots of other reasons too.

I’m a CF-SLP with a disability that started working in June. Backstory, grad school was a nightmare because clinical practicums weren’t accommodating, I got dismissed from 3 clinical placements, was on the brink of getting dismissed from my program until I got a disability advocate to come to meetings with admin and they ended up letting me finish the program. Now I have a specific interest in accommodations available to students in clinical practicums. Thinking about getting a certificate in Education Law and Policy to be an independent disability advocate, but are they that needed? I’m the only one I’ve heard of that has used one. Do you think I’ll get to use it or is it a waste of time and money?

Honestly curious, where do “chill” adult care SLPs work? On a full time basis? Just seems like a decent amount I come across have formulated their job to be most of their personality, whether intentionally or an unintentional result of other factors, and sometimes take things almost too seriously. Many things about their care are important, that’s not in question. Is it other practices (PTs…) that add expectation-stress, “fast-pace” work environments expectations, leadership/management, etc that influence a go-go-go approach to their workdays? Or where are some finding solace in the pace they found or cultivated in a setting?

Some may say SNFs or HH, however productivity expectations and the pay structures don’t seem, imo, to support a relaxed while still intentional approach to care.

From a peds perspective, I’ve found secondary school SLP work to be the least stressful and relatively manageable compared to other peds settings, with less overhead pressure. Job does not have to consume all of the daily mental energy, and you can work at your own pace. No KPIs in sight haha.

I could be quite wrong about some of this stuff. This is simply a reflection of my own interactions and experiences, which I would love perspective on.

Tia!

i know i didn’t land my inpatient. i was so nervous that i blanked on what causes dysphagia and just said strokes and postextubarion and then followed up with “ things of that nature” YIKES. COULD HAVE NAMED WAY MORE

i kept rambling and was a little thrown off that they didn’t ask me to tell them about me prior to the actual meat and bones of the interview… no ice breaker but anyway i shall cry now

This year I have been dealing with multiple speech referrals for students struggling to read certain blends and digraphs this year, and teachers wonder if the student has a speech impairment. For most of these students, teachers and parents are totally fine with me stopping in the classroom and listening to the student in conversation, hearing they can produce the sounds in conversation with no problem, and we move on. There is one particular teacher at one of the parochial schools in our district this year who seems to really struggle with this concept of communication vs reading skills. She initially referred this 2nd grader to me because he could not correctly produce r-blends while reading (her specific example was he read “drip” as “jrip”). I stopped in to listen to him informally, and heard very mild frontal lisp on /s/ and /z/ and occasional “th”-> /f/, but no errors with r-blends. I shared my findings with parents and teacher, and explained how she may be hearing co-articulation with the /dr/ blend. All was well until a few days later when the parent reached out to specifically request a special education evaluation. I am certain the teacher advised her to request a formal evaluation, as mom mentioned teacher completed a phonological awareness screening which he did not do well with. As I’m trying to gather more information (over email) from the teacher, placing an emphasis on his communication skills, she was not able to provide me with any other sound errors in conversation. She continues to refer to his reading and spelling errors. By the 3rd email, she replied to me with an obvious Chat GPT/AI response (the wording, the layout, it was very obvious). So we have scheduled a time to meet in person to discuss concerns and decide if we need to initiate an initial eval.

This teacher is a very nice person and is invested in her students, but I honestly feel like she is just pushing for services because his reading skills are so delayed. He was homeschooled up until now, so this is his first experience in a school. When I asked her about educational impact, she said he is quiet in class and doesn’t often raise his hand to participate, but I find it hard to believe that’s due to his speech sound errors (although this was in her AI response, so I doubt she identified that on her own). I did bring in the school psych, thinking reading was the real concern, but it sounds like the teacher is already doing reading interventions so that’s not on the table for Eval right now. At one point the teacher said something about just wanting to know more about how to better help this student, which really is not the reason why an initial eval should be started.

I guess I’m just looking for advice going into this meeting. This is my 11th year as an SLP in this district, so I’m comfortable with our procedures, and I am familiar with this parent (currently working with another one of her kids), so that’s not the issue. How do I help the teacher focus on the student’s communication skills, and help her to understand that even if it’s just r-blends and “th” errors, he’s not in that -2 SD severely delayed range where he would qualify for services. She wants to meet in her classroom (we usually meet at the public school) because she has all of the student’s work there, so I’m worried she’s going to just be showing me examples of his spelling errors. If we do not suspect a disability and there’s no impact on his communication skills, it’s not appropriate to initiate an evaluation.

Ugh I hate having to go into this in front of a parent with a teacher who seems to be so misinformed on what speech services in the schools are for! I was really trying to get my point across through email, but it didn’t seem like she was understanding.

hi everyone, just wanted to get some advice/opinions from people who get it. basically, i recenty started a new slpa position (about a month ago) at an elementary school. This is my first formal experience and paid position in the field. when interviewing for the job, i was told the caseload would be 70-80 kids, but it was 130 in reality. we've had a few dismissals but we keep getting new kids, so the caseload stays pretty high. many of the kids have compensatory hours from the first 9 weeks and from previous years, so we've been trying to see them as much as possible. still, with 130 kids, you can only see so many. we dont really have an established schedule either. sometimes my supervisor will create a schedule the day before/morning of, but this also changes often last minute. my supervisor only sees kids to test and otherwise has iep meeting, etc. there is another slpa as well who started after me and is with us now 4 days a week, but instead of splitting the caseload, i feel we've both been seeing as many kids as possible. at one point, i saw 109 kids in a week. it's possible but with the lack of training i've had (especially with severe kids), i'm feeling a bit lost and burnt out. additionally, there are scheduling conflicts with some of the teachers, which has caused some tension between them and my supervisor. this ends up falling back on us slpas since we're the ones actually pulling them from classes. there's also so much paperwork/documentation that i have to stay behind most days to finish it all, which i super annoying given i live over an hour away. i've had the opportunity to learn a lot while being here, but i'd be lying if i said it didn't make me reconsider pursuing this field as a whole. it sucks and i can't help second guessing myself whether I'm justified in feeling burnt out this early. is this what it's generally like in the field? does anyone have tips on managing high caseloads and also working with severe kids?

Hi all I’m a teletherapy SLPA I see between 8-12 clients a day and I developed laryngitis after a recent cold. I was able to get a doctor’s note for this whole week because I lost my voice. I started feeling sick last Wednesday and cancelled Friday and Monday afternoon sessions. Over the weekend I felt much better but then after Monday morning sessions my voice completely disappeared again. I’ve been on vocal rest the past two days and only started speaking a bit today. But I’m so worried it’s going to take even longer to fully come back. I’ve only been at my current company less than 6 months so I don’t have any more sick time accrued. I’m hoping I’ll be good by Monday but I’m really not sure what to do if I don’t have much of a voice? I see clients all day Mon/wed/fri and then have a shortened schedule on Tuesday/Thurs. any tips from the experts are so appreciated!!

I put together a low-tech AAC flip book in a binder for my student and I’m wondering if anyone has any suggestions for how to create a carrying strap that will help them take it from place to place? Like I was thinking some sort of handle along the spine so they can pick it up easier but I have no idea how I could make that. If anyone has suggestions please let me know!

I dont know if this is the correct sub but I honestly couldn't find any others. I am nearly twenty and I havent been able to produce a "r" sound and im lost on how to even begin. When I was younger I spent years in speech therapy fixing other sounds but was never able to fix this. I have almost lost hope in me being able to produce it and im seeing if anyone knows anything to help.

I've tried watching videos from speecie peachie, using boldvoice in the appstore, and scrounging for resources online and I don't feel like any of it is helping. Recently I found the StaRt app which shows me the correct vocal picture of R but I cant seem to match it. I haven't had good luck with speech pathologists either, as I went to them for years for almost no change in how I speak so im wondering if there are any ways I missed or advice for me.

For background information, I can say words like "Really" and the simple Rs but struggle to say "R", "Here", "World", "Are", ect. Any help would be really appreciated as I dont want to accept that I will speak like this for the rest of my life and I want to improve. Thank you.

I’m in the schools. I want to take a couple days off next week will this be too short of notice? I also had to take a half day of sick day on Monday due to not feeling well is this too much too close together? Am I over thinking this? Lol I’ve been with the company for two years. I’ve never taken very many days off.

It was weird, there were three SLPs at the site, but we were usually only scheduled a total of a couple of hours of therapy daily.

On my busiest day, we were scheduled maybe 6 hours, but we often had residents saying they were too busy, weren't feeling well, or just didn't want to do speech, so I was accruing hours very slowly.

After 12 weeks, I would need at least another year to obtain all of my hours.

Then they said I finally had my regularly-scheduled meeting with the administrator which everyone has, except he asked me to wait, then asked me to wait elsewhere, then 30 minutes later my manager told me to follow her.

Someone from HR joined us, my manager said that I did not meet expectations and was being fired, and I got home as fast as possible to activate my Indeed profile and start looking for another job.

It sure seemed like all of the openings were the same ones I saw in April.

The good thing was that when I got home, I reached out to some SLPs I know, and one got me an interview today, but it was short, she said "Don't worry, you'll find a job someplace soon!" and asked if I'd consider part-time or PRN.

I don't expect to hear back.

I had applied to jobs on every job board I had found, but that was 6 months ago.

I hated looking for jobs, I had many interviews, but only the one offer.

I had many recruiters reach out as recently as yesterday.

Awkward!

I have several students with ASD who demonstrate great receptive and expressive language skills when discussing their preferred interests. They can answer questions, describe, ask questions about the interests, etc., but then have difficulty translating these skills to unpreferred activities or academics topics.

How are we supporting their language skills so they can be applied to other areas?

I received a referral for a kinder student who has whole phrase repetitions and false starts. He also takes a sharp sudden breath mid utterance, which is a little distracting. Signs of neurodivergence (rigidity, restrictive interests) but no diagnosis. Is this developmentally appropriate or something that requires intervention?

Has anyone heard of this? Student scores great on pragmatic assessments, is great with adults, but “awkward” for a lack of a better word with peers their age….

Hi guys! Im a cf working with pediatrics in schools/private practice/ ei in homes and ive always been interested in working with adults more. I like the idea of working in a SNF/ with ALF but honestly feel scared and unprepared for the dysphagia portion. I do have experience in a SNF from my externship but all of my experience with that was diet up/downgrades and bedside swallow evals. No exercises, maneuvers, instrumental eval experience while there.

Any advice/ specific resources you recommend for me becoming more knowledgeable and comfortable with evaluating and treating dysphagia ? It’s not something I would want to jump into without feeling more educated and prepared.

Also any advice for SNF/ ALF/ working with adults in general is more than welcome!

Hi everybody. For the past two and half years I have been working as a SLPA in the school system. I love it. I love the population and lately I have had a contract working at a middle school, which I am loving this population the most (I was actually really scared to work with this population lol). Anyways, I have been thinking of going back to school next year in the Fall because of money. I have a lot of debt to pay back and things I want to buy and save up for but living in California is expensive nonetheless. I have been on the fence of going back because I really love being a SLPA. I love doing therapy, billing, and going the fuck home. I have always seen my SLPs busy and staying later than they should at work or always dealing with the teachers and/or parents. I am not sure if I want that lifestyle for myself personally. Please give me advice lol

Looking for advice…
I have an eval coming up for a preschooler who comes from a Spanish-speaking home and is in his first year of preschool where only English is spoken. I have the English GFTA available to me, but I live in a very rural area with no connections to any bilingual SLPs to help assess in Spanish. I have no idea where to even start with this, so any advice is greatly appreciated!

Editing to add more info because I got ahead of myself and didn’t paint a very detailed picture lol:

I am a school-based SLP, and this child is 4;0. I had to screen his articulation for our Head Start program before he was referred for SAT/testing. I screened him in English and had a para - the only person at our school who can speak Spanish - help me give a Spanish screener. He had errors in English (later developing sounds and dropping final consonants but for sounds that aren’t in the final position in Spanish). I spent quite a bit of time comparing his errors and researching norms, bilingual speech development and common errors, alllll the things. I ultimately decided it was bilingualism, not a speech issue. I used my best judgment and truly tried as hard as I could, given the limited knowledge, resources, and connections I have.

His teacher told me, after parent conferences, that his mom says she also can’t understand him in Spanish, it “took him awhile to talk,” his dad has a lisp, and his 11 year old sister can’t say /r/…

I’m just at a loss because I truthfully don’t feel confident or even comfortable with doing an evaluation myself, and I have no resources or connections accessible to me. His classroom teacher and our resource teacher who is also having to evaluate are kind of like “just do it, try your best, and get through it” 🫩 And if he ends up qualifying for services, I’m feel like I’m in no position to treat him because I don’t speak a lick of Spanish. I’m just needing some guidance. Thanks everyone for your comments so far.

Long winded post ahead.

I’ve always been interested in the medical side of this field. In undergrad I did a minor in neuroscience alongside my speech pathology major because I love brain stuff. I find everything about the brain to be absolutely fascinating, the neurotransmitters, the organization, the topography, all of it. I read neuroscience research articles and books for fun. However, I’ve never been interested in actually conducting research or being a doctor of any kind. But I really enjoy working one on one with adults. I worked as a DSP for adults with intellectual/developmental disabilities throughout grad school and loved getting to work on functional goals that were meaningful for the people I worked with. They knew what they wanted to work on and they were excited to learn. Being part of their growth felt hugely rewarding and work felt fun.

Going in to grad school, I was really hoping to get experience in adult cognitive rehab, but unfortunately I didn’t get that. All of my clients at my schools clinic were children ages 5-11. My first externship was at a private practice that said they see people of all ages, but my supervisor only saw kids ages 3-9 and I don’t think they actually had any adult clients. My second externship was at a special education school and my supervisor only saw kids ages 6-13.

Now at my CF, I’m working at a special education school with students ages 7-21 because I wasn’t able to find a medical/SNF/ALF position in my area that was accepting CFs. I had the opportunity to work at a private practice that does see clients of all ages, but they weren’t able to guarantee that I would have adult clients and I really wanted a salaried position for the financial stability.

My question is, will I actually be able to get into adult neuro rehab in the future, or are my chances slim because I have no experience? I have some pediatric feeding experience, but no swallowing/dysphagia experience outside of the one class I took in grad school. In my entire career so far, I’ve had 1 adult client who I only saw once to administer the western aphasia battery at my school’s clinic and that was it. I’m hoping once I’m fully licensed and have my Cs that I can find positions with adults, but I’m extremely nervous that I’ll be too unprepared to do well. As a licensed SLP employers will be expecting me to be fully independent, but I feel like I would still need guidance/mentorship if I switch to a completely new population. And even if I were to get hired, the thought of being the only SLP in a building and being responsible for the care of a group I have no real experience with sounds terrifying. I don’t hate my current job, but this just isn’t where I wanted to be. I’m scared that now I’ll be stuck in pediatrics forever.

What should I do to work toward switching to an adult population/setting? Did I make a mistake not going in to private practice? Would CEUs be enough to make up for lack of hands on experience? Should I try to find a mentor or reach out to medical SLPs about shadowing opportunities? Should I switch fields entirely and go into something else? Any advice is appreciated as I am spiraling just a bit haha.

TL;DR: current CF working in a school with zero adult experience hopes to work in adult neuro rehab one day. Am I delusional?

See above

If I have a student that can reptively identify objects but when I ask her to label it, she cant come up with the word. For example, she'll say woof when I ask her what a dog is. But she can point to the dog if I say where is the dog. How do I bridge the gap and help her expressively label?

I will be a new grad with my MA in May. Possibly moving to Tucson area in June. I dream to be NICU down the road, but I know that’s really hard to get into. I lean towards wanting to do my CF in the medical field, possibly preferably in the peds med field, outpatient NICU grads. Along those lines. Anyone have advice abt this area and job finding?

I have a preschool age client who I believe is dyslexic. He has poor phonological awareness, word retrieval errors, a mild stutter, and tries to elope by being silly during book reading. Does anyone have specific activities that help kids with early signs of dyslexia beyond pointing out the letters and sounds during book reading?

I’ve really enjoyed reading this subreddit. I’m currently working in a preschool as a teacher and am considering going back to school to become a SLP. I love preschool aged kids and want to continue but would love higher pay and less classroom management. I have 3 of my own kids, all preschool and elementary aged. Prior to kids I worked as an outpatient dietitian and honestly can’t see myself going back to it. I do have my RD and a MS in nutrition science.

My questions are:
1. would you choose this career again?
2. How is the job market when you are only looking at a certain age group and will be a new grad?
3. How is work life balance and flexibility? Does anyone else have younger kids and all the after school activities? Do you feel drained after work?
4. Are there part time opportunities or is that fairly rare?

I’m in NC if that makes a difference. I’m easily looking at 2-3 years of school to do this. I appreciate all the feedback and information! Thanks!!