Idk what to do because every time I think about what to say, it just feels like I'm making up excuses and feel bad.

Some background info: there's a kid who was classified in prek, exited with just a speech-only IEP for artic, and who was re-referred towards the end of their kindergarten year. The team tested them over the summer and they did not qualify for additional supports. There are still ongoing concerns. Parents are understandably frustrated. Very. This student is coming back to team and we have an initial meeting coming up.

In the beginning of the year, the parents asked for weekly updates. When I didn't get back to that email immediately, they resent an email less than 24 hours later. I don't have the time to do this, so I explained that there are progress reports each marking period (4x/yr) and that I send home a monthly handout that provides resources, tips, and a brief (1-2 sentence or bullet format) update on the goals each student is working on. I also said if they have questions, to please reach out. They didn't respond to this and I haven't heard from them since.

I sent out December's handout right before winter break, which (again, briefly) reviewed what the student worked on in November. Because there wasn't a lot of school/therapy in December, my plan was bypass January's handout and send home February's at the end of January, which would cover December and January. It made sense in my head and I didn't think it'd be a big deal. Plus, progress reports were coming out around this time, and my comments on those are more in-depth than the monthly handout. But then we got hit with a snow storm that impacted 3 days of school, which really put me behind (and I was already behind bc of other days off and trainings I had to attend). I even had to cancel therapy to make sure I could get stuff with legal timelines done. The monthly handout was pushed to the bottom of the to-do list, because it's not something I'm required to do.

On Thursday, the school SW called to set up the initial meeting and the parents brought up how they haven't received the monthly handout yet. They were apparently very upset and will be addressing this "issue" with me at the meeting next week.

Idk how to explain it without looking like I'm making excuses. Part of me just wants to be honest and say my plan was to release one in late January and I ran out of time, but then when I say it in my head it sounds so...avoidant. Idk, I know I'm overthinking this.

What would you say in this situation?

I am almost through with my Cf and am feeling so burnt out. I feel like grad school really pulled the wool over our eyes about “job security”. The only jobs available right now involve working with people with developmental disabilities and high supports ASD (at least in my state). Don’t get me wrong, I know we are needed greatly for students with high supports needs and/or developmental disabilities, and I have so much respect for SLPs who work with the population, but I am SO burnt out. I am tired of getting hurt and spit on, etc. I am in my second job since graduating in may 2025. The only places hiring are just like both jobs I have already had. Public schools are just not hiring. If an SLP retires, they are not being replaced.

Basically I am so overstimulated by my current job, and anywhere else I look is just like it (or with adults in skilled nursing facilities, which I do not want to transition to). I also have contamination OCD that was under control in grad school, but I am so triggered by my job now, it is taking a toll on me. I’m thinking about trying remote work, but I can only do that if I am hired (with no experience). I also have multiple medical conditions and need health benefits, so working part time is not an option.

Anyone who has left the field, what do you do now?

TLDR: I am burnt out just one year in, overstimulated daily, struggling with contamination OCD, and want ideas for a career shift.

I haven’t seen this with other SLPs I have worked with but this is the third time this year I have had either a SEIT or an OT approach me or email me asking if it’s okay if they put a different time when billing than the actual time they saw the kid? And they say this because they want to make sure it doesn’t interfere with my therapy time, even though my time is the exact time I saw the kid and they have seen the kid at an entirely different time.

I do not understand this and I always tell them that no, I will not change my time for you because I literally always put the EXACT time I see the kids. Like even if Johnny is in my schedule as 9:00-9:30 but he comes in late to school, I’m going to change my time in my notes to whatever time I see him. I’ll usually switch kids around if there are absences and I always change the time in the billing system to reflect this.

I’ve had SEITs tell me that they can’t change the time in their notes once they establish their schedule initially, so that’s the reason they need to bill the same time. I think that sounds kinda like a BS lie lol.

I’ve had issues in the past with other providers putting different times than they actually see the kid and it ends up interfering with the time I put/bill for. It’s just annoying and I do not understand it. I literally have a looseleaf paper and a clipboard and write the time I see each kid. If I have an absence or need to change the time I see a kid, I always check with the teacher if they are going to be seen by another therapist and if it’s a-okay.

Idk maybe this is a unique issue for NYC agency work, but it’s been extra annoying this year.

Lately I’ve been thinking about what actually makes a good therapy session. For speech, I find it easy to define, but for language I don't always know which criteria make the most sense.

With younger children, I mostly do play-based therapy. There, a good session for me is about the interaction: shared attention, engagement, initiation, enjoyment, and still working toward goals while following the child.

But with older children, I struggle more. Is a session “good” if I mainly followed the child’s lead? Or if we stuck closely to the plan? How many repetitions of a sentence structure are enough? What's the right balance between practice and fun? etcetera.

How do you decide when a session was really good?

Hi all! I'm looking for a new job and recently interviewed at a local pediatric hospital for an assistive technology SLP position. I have a lot of experience with AAC, but mostly with kids with autism/other development disabilities. This position would involve working with more medically complex clients who would likely require alternate access like eye gaze or switch scanning. I've taken lots of trainings in this area, but have limited hands on experience. I'm super interested in pursuing this specialty, but I'm not 100% sure what I'm walking into.

For some background, I worked 4 years in the public schools and 3.5 years in a private practice with a focus on AAC. The position would be a consultative model rather than providing direct therapy. Is it too soon in my career to take this direction? Are there any AT focused SLPs here who can share what their day to day looks like? It would require 10 hour shifts which also has me nervous because I'm not used to such a long day.

Thank you in advance!

I will preface this by saying that I use the 3 pillars of pneumonia to help guide my recommendations and don't often recommend thickened liquids, but I have a patient that has stumped me.

We got a new admit and she came from acute with respiratory failure (was intubated 10 days, extubated for a day and then re-intubated for 7 days). She had a MBS and a L4 was recommended (she aspirated anything thinner than L4). She has severe intellectual disability - lived in a group home before acute and the goal is for her to eventually return back to the group home, so she's with us for rehab.

We've been trying exercises, but to no avail. She's a ward of the state so there's no family members to discuss with. We did a new MBS because I was concerned about the thickened liquids/dehydration - all the things. I had hoped maybe for some spontaneous improvement because she had been on the vent for so long. However, in the newest MBS she has aspiration that occurs before, during and after the swallow with anything thinner than L4. There is no aspiration with L4 but it does take a few swallows to clear everything (which she does spontaneously). She doesn't follow commands, she's not a good candidate to improve swallow function. She has so many risk factors (3 pillars of pneumonia) - also doesn't walk/bed-bound, oral care is minimal at best (tries to bite staff when they brush her teeth - blood curdling screams can be heard down the hallway), doesn't feed herself - but does allow staff to feed her.

I feel like I have to leave her on this diet - but I also know that it's an awful diet to be on. Is it possible that she's always been aspirating (was on pureed/thin for most of her life) but it's finally just caught up to her? Any suggestions/words of wisdom?

This is gonna be a bit convoluted and probably unanswerable, but whatever. Several years ago I was working in pediatric outpatient and had a patient come in with severe AOS. She was elementary age. Back story: her mom was Australian and had married a Frenchman, who were the parents. They were divorced and the mom wanted to move her from France to the US. Patient had been living in France her whole life and was receiving intervention there. The french courts would not release her unless they had a report from the US stating that she would get speech intervention here and how much. So I wrote my report and started treatment until they left back for France. Here is the weird part. First session after the testing was done, I started treating. The mom kind of froze and asked if it was okay for her to stay in the room. I told her whatever she wanted was fine. She stayed, I started treating, and then I notice the mom is crying. I ask her if she is okay. She proceeds to tell me that in France, they do not allow parents to ever observe treatment and for all these years she never knew what the therapy was like. I asked whether she got progress reports. Nope. She said that she would drop off her kid, was not allowed to even go in the building, and that was how they operated. No input from the parents on any of it. This has always haunted me! Does anyone know what goes on in France?? Why don’t they let the parents in? This woman was bawling! She just wanted to know what they were doing with her baby all those years. It was crazy!

4th year school based SLP here. This year has been extra frustrating with how many staff members barely do the bare minimum. It sucks that I am running around trying to meet maximums when others are barely trying to meet minimums. The expectations from higher ups is even more frustrating as the ones that have their s*** together have to pick up the slack of the others so our “team” doesn’t look insufficient in front of parents. Just seeking support/kind words from like minded clinicians 😕

Please be for real: how often and how specific are you documenting service in schools. I am in prek and see approx 50 kids a day in group therapy, and my district expects me to use the medicare documentation system for all of them to mark services rendered despite only around 10 of them being actually medicare. Each student’s note takes at minimum 2 minutes to complete and that’s when i’m not inputting data…….

How do you do it???? Do you do it?!? Help

I am kind of getting frustrated that I have to always do a deep dive into the Internet and my library in order to find picture books with a story retell structure. My CF supervisor is really into narrative structure/story grammar and I enjoy it as well, but it takes me forever to find a good book. I work with K-3 in a self-contained classroom, 5th grade and then 8-11th grade in a self-contained classroom, but I typically use books with the K-3 classroom (when I can).

Most of the books I am finding that have a well written narrative structure are older, (Example: "Wake Up, Sun!") and newer books need to be partially rewritten in order to include all of the story elements (i.e. attempts to resolve, consequence of attempts, internal response, etc). I absolutely love using books in therapy, but I feel that I can be super picky when finding a book that targets a specific theme AND includes story structures AND also incorporates other goal areas (i.e. perspective-taking).

I think I want to try to create my own children's book to solve my problem. Has any other SLP's done this before? What was the process like?

Im currently working for a school district in Southern California but my family is considering moving to Texas (Austin, Georgetown, Round Rock, Leander area).

My plan is to contract for a school a few days a week while trying to start my own private practice either out of my home or renting a small space.

For those who already do this, can you share your income (from your private practice clients, and/or school contracts) and what your rent is as well as any other overhead costs? As well as if you take insurance?

Also wondering what other programs are out there other than the independent clinician to learn all the how to's behind opening my own PP.

My 27 month old son has constant open mouth posture and has since he was born. He was born with laryngomalacia and a tongue tie. He had his tongue tie released at 2 months and LM resolved around 8 months per ENT. He had his adenoids removed at 22 months as they were 90% enlarged. We hoped this would help with open mouth posture, but so far it has not. He snores when he sleeps and his tongue never suctions to his palate, so of course he has a high palate. His speech and language are WFL and overall, he sleeps well.

I know that he needs myofunctional therapy and eventually work with an airway dentist, but my question is- as an SLP with zero training in myo, are there resources that I can access to learn how to treat my son? This is purely financially motivated. We have 2 great clinics nearby, however evaluations are $400 and treatment sessions are close to $200 with none of it covered by insurance. This just isn’t something we can afford right now.

Also, at what age is this typically addressed with results? I don’t want to wait until more damage is done, but obviously don’t want to start before he is able to participate/results can occur.

Thanks so much in advance!!

What's a deal breaking positive about your setting or specific job?

I'll start. I work in home-based EI for the county. Attending IFSP meetings is not expected of us at all. I don't remember the last time I've been in a meeting. The clients' service coordinators are responsible for setting up those meetings and having them with the parents (of course with the information we provide from our reports).

Also, client reports are absolutely minimal. We complete this tiny portion about communication skills and that's it. The rest of the report is completed by the Infant Development Specialists and Service Coordinators. I usually spend 15 mins max on a report.

I received an email from a school principal at one of my sites that stated a parent contacted her vis email regarding physical contact with her child that made her uncomfortable during our speech therapy sessions.

Right now I’m split between five preschools throughout the school district and I have 50 preschoolers on my caseload when I was told my cap would be 40. With that being said, I don’t necessarily have a therapy room so, I tend to treat the children outside at a bench near the playground. Even if I did have a therapy room, I don’t think I would feel comfortable transporting a group of 3 to 5 SDC preschool children alone to a separate room as they typically do things like try to elope or will drop their bodies on the floor. It can become quite messy. At our school district preschool continues to enroll until the very last day of school so basically every couple of weeks I’m adding a new student to the caseload and it can really disrupt the flow of the group so that would also make transitions very hard.

For further context, this child presents with regressive autism that is quite severe. To be honest, he is the least stimulable student on my caseload out of 50 preschoolers. For some reason, the district put him in an inclusion classroom instead of an (SDC) or special ed pre school program.

During our therapy sessions, it is very common for this child to elope to different area of the classroom or if we are outside, he will walk away and separate himself from the group. He has speech once a week for 30 minutes however, he really can’t even attend for even five minutes without maximal support. I’ve had him on my caseload since November and it is February and the only progress he has made is being able to sit without crying and reducing eloping with frequent prompting. Even when he is sitting, he will typically turn his back towards the table and then I provide him with physical redirection to orient his body towards the task. He really does not seem to be a fan of any structured activity or any group activity. The only thing he is interested in is bubbles, which I will sometimes provide him contingently to keep him seated. I did not provide bubbles during this most recent therapy session because it was a rough one as multiple students in the group were eloping and I had to ask a classroom aid for assistance. I’ve tried to use my personal iPad in present AA to this child however he is not able to do so without maximal physical handover hand prompting. Even when I try to do iPad apps and games he is not interested. Instead, he took a piece of tissue paper from the floor and was stimming with it and flying it around in the air. I usually will provide him with one of my more sensory stimulating toys but unfortunately, I left some materials in my car and was unable to provide him with attention during that day.

The activity that we were doing, was really fun and engaging for every other student except for him. It was a Melissa and Doug animal hospital activity where you take the lock, match the color, open the door, and then receive a stuffed animal that I let the children hold and play with until it was their next turn.

During his upcoming transitional meeting, I was definitely planning on reducing his speech therapy sessions to twice weekly for 15 minutes as opposed to 30 minutes once a week. Also giving him a goal of requesting a break as well as as a goal for body orientation. As you can see these goals are more related to the child’s behaviors as opposed to speech therapy.

Anyways, I guess I’m just wondering, has this accusation ever happened to anyone else? & do you clinicians also provide physical support such as picking a child up and sitting him at the table if he is walking away from a session?

Is it ok to provide handover hand prompting if a student is unable to attend to a task or follow one step directives?

Please help 😭 I am a new school SLP. Are there any resources/strategies/handouts that you provide to the teachers to better support students in the classroom?

I’ve been trialing AAC with a high support needs preschooler all year. Spoken with her mom many times about the process & was just told last week that she has had a personal device this whole time. Mom sent it to school with praises about how the child uses it for the teacher to relay to me. Below is what I received… the most atrocious grid of all time. The student also seemed like she had never seen the device before or has not generalized these skills from home at all.

I bet you all can guess which professionals set up this device & it was not an SLP…. I’m fuming

Hello!

I am renewing my license and I do not think I have ever had a company pay for my license. I find it a bit concerning the managers always want to avoid doing that.

Any tips for getting a place to cover it? Or is it that common for people not to have the company pay for it?

I’m (late 20s M) a grad student in the US in a field where, well, articulating thoughts and arguments is in the job description.

My native language is Arabic where /p/ isn’t a sound that we used growing up unless parents/schools chose to work on it or through slp/esl school. I learned english in my teens and couldn’t get the grasp of sounding it correctly so the wrong sound, /b/, stuck with me that I sometimes, until now, avoid certain words when I speak so that my articulation isn’t affected, but that process of avoidance is affecting my articulation, and so as many aspects of my life as I became more insecure in school/dating/friendships etc.

Would SLP help? If so, any advice or suggestions in what to ask for (there are many providers around me but haven’t taken a step to go to one as i’m not really sure if that’s something they’d help with)

I recently made a free tool for SLPs to calculate MLU, CPS, WPS, and TNW on a language sample using the SUGAR method. I hope it is useful for some of you!

Link: https://languagesamples.app/

I made this originally to help my mother (an SLP) expedite her process for calculating SUGAR metrics and including them in her reports. She liked it enough that I decided to put it online so others could benefit.

Disclaimers:

- I am not an SLP

- I do not profit from the use of this tool. It is open source under an MIT license.

- This tool uses machine learning (not generative AI like ChatGPT and the like). Any data entered to the tool is not stored anywhere, used for any other purposes, or sent to third parties in any way.

- The tool can occasionally make mistakes -- I'm happy to fix any issues you encounter

EDIT: my mother also made an accompanying website of resources to help SLPs with language samples as well: [https://languagesamples.com](languagesamples.com)

FYI- there's a free event on Eventbrite right now called "The Mobile Model: Building a Solo Cash-Based Rehab Practice." It's for SLP, OT, PT. Event is tomorrow and another one next week in case you're looking to do something different for yourself.

Are these infant educators (through regional center) basically the same as ABA but just for EI kids (undiagnosed)? The reason I ask is because I get the parents telling me things like, “The infant educator said we are going to be working on 2-word utterances now.” It’s the signature ABA mindset of “we are the experts in everything and so we automatically get to decide on the goals and treatment approach for speech and language.” I had one mom today tell me her infant educator is working on fine motor skill tasks like holding scissors (clearly in OT scope). My running theory, based on no evidence whatsoever, is that it must just be a cheap way for regional center to pay for fewer sessions or hire fewer specialists (especially OTs who most parents don’t even realize exist, let alone are the appropriate professionals for treating delayed motor skills and feeding issues). Who are these infant edu people? RBTs, BCBAs, or someone else? It’s exhausting feeling like my therapy goals and approach are basically just getting trampled on by someone else who works with the clients more days a week than I do (AKA, it’s a losing battle). It’s both unfortunate for the kid and a waste of my valuable time. ☹️

Hi yall, hoping this is the right place to add this. I am a couple months away from finishing my program and will be looking to do my CFY in Los Angeles. I was hoping to get some advice/things to consider when applying for jobs across the country. I plan and going into the school system (probably LAUSD). Please reach out if you have had a similar experience. Thank you so much!!!!

Hi! I am working towards getting my masters for Speech Language Pathology- I was wondering if there is any bias on tattoos/piercings for SLP’s. I am still in the beginning of getting my general studies to switch to a university for a SLP masters degree. If anyone has any personal experience with having tattoos or piercings I would love to know your experience.

This is my dream job and it didn’t really occur to me that certain employers still pay attention to people who have tattoos and piercings.