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. 🙂