I recently saw a conversation in one of the SLP Facebook groups. Basically, an SLP in a private clinic was going to start seeing a child who was not getting services in the school he/she was attending and the SLP did not understand why. She felt the child’s skills were low enough that they should be getting some support. So what gives?! Why would the student qualify for her but not for school speech therapy? To figure that out, we have to look at some of the major differences that exist between clinics vs school speech therapy.
I have been a school SLP my entire career so far, so I reached out to some of my clinic SLP friends to answer a few questions before I wrote this. Here are some of the differences between services in these two settings that should be kept in mind. I want to preface this post by saying no matter the setting, the child still receives services by a qualified, professional SLP.
Schools are held to entrance and exit criteria set up by their district or state. This means that a school in one state may not ‘qualify’ a student for speech services until they are two standard deviations or more below on two or more assessments, etc. Some districts qualify students at 1.5 standard deviations below the mean and at others it may be one below. So, while there may be two school districts only five miles apart from each other, they may have different criteria. Still with me?
Private clinics are different. They are not regulated by their states or other governing bodies. Clinics assess potential clients and acceptance for services tends to be up to the judgment of the clinician. So a clinic SLP may be able to accept a client for services who receives a score of 84 on an assessment but a school district may not.
Other criteria for the services in the schools is the presence of an academic and/or emotional impact. If a student is struggling with their /r/ but gets good grades, is social with friends, is not afraid to speak up in class, and says it doesn’t really bother them, they would not be considered for testing or services even though their articulation of /r/ is clearly delayed. *There is the potential they could receive RtI/MTSS for /r/ but some districts even have criteria for that. In a clinic setting, they do not have to follow that guideline. If the child has an error or delay they may be tested and receive services at the clinician’s discretion.
This seems to be the area that a lot of families and SLPs take issue with.
It is hard when you see a child struggling and want to help, but according to your criteria they do not meet the standards to see you. Now, the introduction of RtI (now called MTSS in some places) has helped to include some of these more mild‘ students who may have not seen any services in the past. Some, but not all. You can read more about RtI HERE.
Also, there can be criteria in the schools that dictate the amount a service minutes a student qualifies to receive. I know this may seem strict and maybe a bit controlling on the district’s part, but it is done more for consistency among schools and SLPs. Student’s scores, in conjunction with professional judgment and teacher input, may be put into a matrix of some sort to help determine the amount of service minutes the student will receive. In clinics, minutes tend to be allocated by the judgement of the clinician, taking into account the child’s testing results
This is another area that can get a little, shall we say, sticky. In the schools, families do not pay for services. In clinics, services are covered by insurance or families pay out of pocket. This can be pricey depending on the child’s needs. Naturally, if your child could get services at no cost, you would want that first. However, this can cause unfortunate tension between parents and schools. That is another reason for the criteria in schools previously discussed: to ensure that those who have a true disability in communication that impacts their academic and/or social and emotional well-being, not just a weakness, get provided services first.
SLPs have some of the biggest hearts around. We want to help everyone and have a hard time telling someone ‘no’ to services because, depending on the setting, we have to follow certain rules. It doesn’t mean we don’t want to help. It just means our hands are tied. Trust me, it is our least favorite part of the job.
Tip: Now there are some students who, due to their needs, receive both speech at school and in a clinic. This is not uncommon. When students are receiving services in both settings, it is important for both clinicians to be in communication. I like to touch base with my students’ outside clinicians about once a month. I make sure to write these in my schedule each month so I don’t forget.
These are the just some of the big differences in the conversation of clinics vs school speech services. If there are some I didn’t mention, please feel free to politely comment with some that would be helpful for other SLPs to know. 🙂
I can’t thank you enough for writing this. I am often challenged as to delivery frequency. Parents are wanting 3 x’s a week as that relieves them from supplementing. Even the clinics don’t service 3x’s a week! This puts it in perspective!
Thank you, Janis. I am so glad you found this post helpful!
While school SLPs do have guidelines and laws to abide by that differ from clinic and medical SLPs, I think it is important to acknowledge that all SLPs draw conclusions using clinical judgment. As a school SLP, I am using my district’s eligibility guidelines, state & federal laws, as well as clinical judgment to make recommendations to the IEP team. We don’t leave that at the door. Thanks for your post.
Your are 100% correct Karen. Clinical judgement is used in all settings and is a part of the decisions any SLP makes. Thank you for sharing your thoughts!
I am a therapist that has worked in both settings. It is also important to point out the frequency and duration of services in a clinic can also driven by insurance companies. Many insurance companies have stipulations for coverage such as the determination of medical necessity and exclusions for developmental delays. Every policy is different. I hope this helps clarify some things as well.
Thank you so much for sharing your insight! Understanding what can impact frequency and duration of service in different settings is very helpful.
Great article. I have never worked in the schools, always clinics. What I don’t like to hear from parents is that hey think clinic SLP’s have better training than school SLP’s. What? We are extremely well trained! No matter where we are working . I try to pass that info along to the parents ?.
It is greatly appreciated 😉
I work for a private clinic and also work in a school as a contractor. This is why it’s so important to stand up for your title of Speech Language Pathologist. If you’re known as the “Speech Teacher,” people tend to view you as “lesser” qualified.
I know a lot of people feel that the ‘Speech teacher’ title can demean our profession. I always introduce myself at Speech Pathologist at meetings with parents but am totally fine if myself students refer to me as ‘Speech teacher’. I think how people, i.e.: parents and staff, view our qualifications depends on how we act and do our jobs in our buildings. I believe that if others see what we do and how hard we work ( yes, we made need to do some educating or clarify some things from time to time ) that they will respect our positions.
I have worked in both settings and am now a private practice owner with 2 offices in neighboring towns. Our practice also has contracts with 2 neighboring school districts. One thing about private practice clinics or hospital clinics that also needs to be stated is that when charging an insurance company for speech therapy, they have different demands that have to do with “medical necessity”. So schools have an “educational necessity” while clinics may have to prove medical necessity. I would say it is not up to the personal discretion of the evaluating SLP. Medical necessity must be addressed and many time services then authorized for the therapy to begin or continue. I hope that is helpful.
Thank you for that valuable insight.
I have worked in the school setting for 20 years and we have to prove that the speech and/or language delay has a negative impact in the school setting. I may believe in early intervention and seeing a student with an articulation error but my professional judgement is trumped by our special education law. In the event I would have an IEP audit by the state I had better be able to show the negative impact. That is why many students with single sound errors who are making passing grades and are participating in class discussions, have friends at school, etc are not eligible for school based therapy. It is hard to get parents and teachers to understand not everyone qualifies. If they all did qualify I would have over 100 kids and we know that wouldn’t mean great services. I believe our special education law allows us to work with the children who are struggling the most in the school environment.
As a school-based SLP, I have had some occasions when I couldn’t provide services to a student because of the restrictions placed on my state’s eligibility requirements. When this happens, I feel that it is my ethical
obligation to direct the parents to an agency outside the school for them to consider.
I am a school based SLP and I too feel ethically like I should direct families to outside therapy if I can’t qualify them through school. HOWEVER, we are usually told NOT to do that or the school district can legally be made to pay for that outside therapy because we suggested it. So then we are stuck between professional ethics and educational legalities. Not a fun place to be.
Thank you so much for your article. As a parent who’s kind of new to the SPED world and who has experience with clinics but is looking forward to my first year this year working with our school SLPs, I have to say this article was very very useful. It was helpful to realize the basic difference between who is providing the limitations on service qualifications. I had no idea that clinic SLPs may have to prove medical need in addition to navigating the delightful *feel the sarcasm* world of insurance coverage.
I will say as a parent, at least in Tx, I can second the above comment. There is def. a strong (and false) thought that the clinics are “better” than school services. I also keep running into gossip that school SLPs are overworked to the point of jadedness/burn-out which contributes to the “bad” service and that they are only reactive to kids needs. The school SLPs sure get a bad rep down here. I’m also glad to know “Speech Teacher” has a negative connotation (SLP is hard for my kiddo to say so I always went with Speech).
Mind doing another article including a couple of more tips for helping support your SLPs especially with a clinic/school combo? I have had a hard time ensuring clinic/school/home are all on the same page with my elder’s autistic services and am anticipating similar issues with my SLPs. Clinics and schools seem to be set up SO differently concerning administration, communication channels, and even SLP/other therapy hierarchies. Id love to understand those differences too!
Going from clinic to school setting therapy can be shift but it can a smooth one too. To respond to some of your points… Speech Teacher is one of those things in the SLP world where you either hate it or could less what the kids call you. I always go with what the SLP introduces themselves as 🙂 You also brought up a great point how clinics and schools are set up very differently and administration can very so much that it impacts how they work together sometimes. I would recommend communicating with the clinic SLP and school SLP on the same email to make sure everyone is getting on the same page. I speak with many outside SLPs and it isn’t a hard thing to do.
This article was extremely helpful. I find myself having to have this conversation with teachers and parents and it is not an easy one to have. You put it in a way that is clear and understandable. I will refer to this article when explaining this to others in the future.
Hi. I find this article extremely helpful as a parent of a 5 year old little boy (in Texas) that receives speech therapy once a week at the public elementary school. His fluency disorders are mild. He will be in kindergarten next year.
A few positives of the school based therapy:
– Convenient as it’s in your neighborhood
– The therapist can keep an eye on your child once they are in school to possibly evaluate other areas of concern
– group session so my son knows he is not the only one with an issue
A few negatives of the school based therapy:
– one therapist with her own strengths and weaknesses unlike some of the private practices with multiple therapists where they can assign children to the appropriate therapist based on their individual needs.
– consistency of therapy is lacking. There are too many breaks (Christmas, Thanksgiving, random days off, spring break, the June/July/August break in the summer). It seems like children would benefit from year round care. My son missed three weeks of therapy this year due to the therapist calling in sick the week before Christmas and then the two weeks of Christmas break. How can this be beneficial to the student?
– you have no choice in the clinician assigned
– school district is lacking in communication and detail of reports
Overall I would give my local school district in a large urban city a C+ rating for therapy services. I think it’s a great program for low income students who otherwise wouldn’t receive services, but if you can pay for service I would go that route.
My son will be starting private sessions this month and I hope to see more improvements than I’ve seen in the past year with the school based therapy.
While there can be limitations within a school system, such as days off interrupting the flow sessions it great that you see the benefit of utilizing clinic resources too. School based SLPs and clinic SLPs frequently work together to develop plans for students they share so best possible plan can be created.
Recently, we noticed that our son has a slight lisp. I had a lisp for a while so I want to make sure that he goes to a speech-language pathology service to correct the lisp at an early age. I was wondering if we could enroll him through the school but it makes sense that his speech would have to be much worse to go through the school.
You can always ask the SLP to screen him but his qualification would depend on their parameters.
Hello! I’m an SLPA and working for a peds private clinic but I’m curious about working at a non-for-profit. What’s the main difference between private vs. NFP? Any advice on a newly licensed SLPA?
Hi Veronica 🙂 The main difference I can think between a clinic and NFP would be pay and possible benefits. As a new SLPA you may want to also consider which setting will give you the most exposure to different clients or help you hone your skills in a specific area.
I love this article and may link it to parents to read. Here where I am i feel like families think of “Private clinic” therapists as more skilled when we have had the same if not MORE training in schools due to the sheer VOLUME of students we come in contact with on a daily basis. My expertise in consulting with teachers and staff is also, I believe, an unrecognized value-remember the kids we have at school are in a language rich and educationally controlled environment for 7 hours out of their day! That’s a lot of language stimulation to be receiving-the idea that kids need MORE therapy and pulled from class more really bothers me (as if I don’t consider the kids’ needs).
Regardless, thank you for this article!