Speech-language pathologists work in a variety of settings. Schools, hospitals, private clinics, rehabilitation centers, long-term residential centers, dementia units, early intervention outreach programs, accent modification businesses, autism-focused centers, mobile swallow study businesses and more. The wide-variety of workplaces for speech therapists is reflective of the large scope of practice outlined by the American Speech-Language-Hearing Association.
Most speech therapists become more specialized in particular areas of practice based on their own interests and professional experience. The scope and variety within the field is part of what made it so attractive to me. The same, however, is why most people have a limited idea of the areas in which speech-language pathologists work.
When considering speech therapy for your child, it can be overwhelming to understand the options.
First of all, speech therapy is a medical service–even in schools. We are professionally trained medical specialists whose area of expertise involves the anatomy from the neck up. We address swallowing & feeding disorders, neurological impairments, oral-motor dysfunction and head & neck injuries, all of which can impact communication skills.
Frequently, parents ask me the difference between receiving speech therapy services at school and receiving it in a clinical setting. I’ve worked in and enjoyed both settings.
Public School Speech Therapy
Public school districts are a wonderful resource. Speech therapy services are available to residents who live within their district boundaries free of charge if a child qualifies based on testing performed during an evaluation.
The most obvious benefit is that there is no financial impact upon the family. In order to qualify for services in public schools, the issue of concern must have a negative impact upon the child’s academic performance. For the youngest of children (those not yet school-aged), qualification is based on whether the child is meeting their developmental milestones for speech and language.
If a student qualifies for services, the second benefit is that therapy happens during the school day. Once an IEP (Individualized Education Plan) is in place, speech therapy is worked into the child’s schedule in conjunction with the rest of their academic rigor. This provides the great convenience of not having to make yet another appointment or commitment beyond school hours each week.
Generally in schools, students are seen in groups for speech therapy. Caseloads vary significantly district-to-district and state-to-state. In Michigan, the recommended limit is 60 students. It is not law but simply a recommendation. This means one speech therapist may have upwards of 60 (or possibly more) students to treat each week based on the goals and time requirements outlined in the IEP.
For some students, groups are very beneficial and allow indirect learning from peers, comfort in knowing they have peers who also receive speech therapy, and informal practice on pragmatics, or the social aspects of communication such as turn-taking, using polite language, etc. For others, working in a group can be highly distracting, demotivating and result in less progress on speech and language goals.
Speech therapy services are also available in clinical settings, such as outpatient services through a hospital provider, or through a private practioner.
Clinical Setting Speech Therapy
Similar to schools, children qualify for services in a clinical setting based on their performance during an evaluation. Often the same or similar tests or battery of tests will be given in both schools and clinical settings. An immediate difference between the two settings involves qualification for services. A child can qualify for services clinically but may not qualify in schools. This touches on that point previously mentioned: the delay/impairment must negatively impact academic performance in schools.
This is one advantage of seeking speech therapy from a clinical provider. A child who does not qualify in schools may still need help and could receive it in a clinical setting.
In a clinical setting, therapy is provided on a one-to-one basis unless the session is specifically outlined as a group session. This means the speech therapist can customize materials and lesson-plans specific to that child. Additionally, this allows the child more opportunities each speech therapy session to practice the target skills.
For example, a child who is working on the /r/ sound. In a school session, which is likely a group, the child might have 10 turns in 30 minutes while two other students also had 10 turns during the same 30 minutes. In a clinical setting, the same child would have 30 opportunities in 30 minutes.
Speech therapists in a clinical setting are able to provide specific feedback to parents immediately after a session and to implement a home practice plan that mimics the strategies being using in therapy. School speech therapists can do this as well, but it is less likely given the caseload volume. When I was in schools, I had the best intentions of sending home carryover work and sometimes I did but not as much as I would have liked.
In a clinical setting, services are paid either by health insurance if any is covered (most plans vary wildly in coverage for this type of therapy) or privately. This obviously has a financial impact upon the family. There is also a reoccurring time commitment for families.
Prevalence & Time in Therapy
Ultimately, the difference between the two settings comes down to how long it will take to resolve the speech and/or language deficit. Generally, in one-on-one therapy, clients are able to make progress more quickly because of the increased practice opportunity, the specificity of lesson plans and therapy methods implemented, and the implementation of home practice/strategies to encourage carryover of the target skill beyond the therapy room. So instead of years of speech therapy, it could be one year or several months.
Additionally, children can be treated in speech therapy both in school and in a clinical setting. This has potential to be beneficial to the child if the team of therapists are collaborating and communicating to share successes and reinforce successful strategies.
In choosing where to seek help for speech and language deficits for a child, it’s important for families to consider all of the factors. Ultimately, the child needs the option that will happen.
Seek out speech therapy services as soon as you suspect there is an issue. According to the National Institute on Deafness and Other Communication Disorders, 1 in 12 children ages 3-17 had disorders related to voice, speech, language or swallowing in 2016. The prevalence of speech sound disorders (articulation and phonology) is 8-9 percent of young children and approximately 5 percent of first graders.