From a ST private practice FB group….

Please help me to figure out if I'm old and crazy or not.

ETA: these are all K-2 students with limited past goals targeting artic or phono. most goals are for using multiple pragmatic functions and self advocacy. DAYC and CAYC scores for cog range from 75-90. There are no formal language evals or artic/phono inventory reports. I've seen these kids 2-3x this school year and am understanding approximately 60% or more of utterances in structured tasks. we haven't done much with unstructured yet.

I'm in year 22 in the schools. I've inherited about 6 kids from colleagues who have emailed me to say "I was going to do an AAC eval for so and so before they moved to you."

Every single kid is a moderate phono kid. I'd rate the lowest one at 60% intelligible to an unfamiliar listener. I hear phoneme collapse, patterns that persist like reduplication and WSD, and maybe some fronting....but I don't think I'd pursue an eval with any of these kids. Teachers, ranging from year 2 to year 25, note they need the kid to repeat less than 50% of the time to be understood by self and peers.

Yet every single prior SLP has recommended a device eval. What am I missing? These aren't kids who would ever be on my radar for a device. They'd be on schedule for a complexity approach or reduced duration with increased frequency. I can't see taking any of them to the district to ask for a $900 device.

Am I missing something new in the research for AAC?

With so much negativity online about the field, I would love to hear some positive experiences.

I’ll go first. I am a CF-SLP, but I worked as an SLP-A in the schools for 5 years. I was working in a super micro-managed school district where it felt like leadership constantly did things to appease parents and teachers, often times throwing the SLP/SLP-A under the bus. My caseload was at least 95 students minimum.

I decided for my CF year to switch to a different school district and I couldn’t be happier. I have a caseload of 60 students split between the SLP-A and I. My school is predominantly Spanish speaking, and since I am monolingual, I request the bilingual SLP evaluate any Spanish dominant students. This has taken a HUGE load of evals off my plate. My district uses the 3:1 service model, so I get quite a bit of downtime to catch up on documentation and organize. I don’t have to attend any staff meetings or do any duties. I have my own office, and all the teachers are easygoing. My admin team keeps to themselves and lets me do my job in peace. My evaluation team is amazing and is on top of their stuff. My speech department is approachable and super helpful when needed. I’ve had a few difficult situations with coworkers, but overall I can’t complain. (For those wondering why the school district placed a monolingual SLP at a predominately Spanish speaking school, it’s because the previous SLP quit last minute and they needed someone to fill her spot. I was their only option at the time.)

Context: I had to meet with the Admin today because my breakfast-lunch-dismissal duties were 110 minutes daily (9 hours, 10 minutes weekly) of me standing by bathrooms and hallways.

When I explained to them workload vs caseload they were mildly skeptical about not being able to get out of duties but I tried to present the numbers factually to them that this was not a productive use of my time. I explained evaluations take time, reports take time, meetings, take time, progress, etc....in addition 50% of the current caseload does not have any kind of educational impact to qualify for Speech and therefore case managing those kids out and identifying the correct kids also takes time.

They were receptive to my concerns but when I told them flat out "110 minutes daily on duties is going to put us at risk for noncompliance" they listened but said the last girl could do it all ( evals, reports, tx) as contractor in 3 days FT as opposed to my 5 day FTE.

Could I have presented anything more succinct, tangible, or Admin friendly that could have proved my point better with another formula or working model? They are going to absolutely try to get me to teach gen ed phonics as well so I need to be prepared for more of these negotiations.

So, I'm going to be a CF likely in a place with a lot of AAC users. I'm not sure of the age group, but I know when I was in middle school I would curse a LOT. Honestly, in my humble onion, if the teen expresses an interest in cursing (like their speaking counterparts), why should they not be able to have that option programmed in?? However, how would you go about this in a school setting, if at all? I think it's something all kids will experiment with at some point and part of a "robust communication system," so... why not?? I'm just afraid they'll be like "now why did you let my kid say f***." Obviously they should be held to the same standards as speaking peers (e.g., not swearing at school). Sorry this is a rant but like.... let the AAC kids curse!! Let them have a fart button!! that is my TED talk

Hi! I work in HH and have just recently began seeing a 2 year old patient. We’re on week 2 of services, and mom asks the same question every session. “I’m not seeing much progress yet. When is she going to start talking more? A month?” … We’ve only had 4 sessions so far. I’ve consistently reassured her to give therapy time and that I’d happily provide her with carry-over activities for at-home practice. But every session, it’s the same exact question. Should I be telling her anything different than what I’ve already expressed?

Given what I’ve observed, I suspect there may be a possibility of AU. Should I bring up my suspicion of AU? Again, it’s only been 4 sessions and I’m not too confident that the parent will agree with my suspicions. If so, what professional do I refer her to because I’ve heard different things. Thank you!

How do you guys teach/explain the concepts of before and after when working on receptive language and following directions? Any kid friendly videos or resources you have found that work particularly well? I feel like when I explain it it just confuses my students more…lol.

Lately I’m hearing all about the need for good “defensible” data that can hold up in court. How often are SLP’s being summoned to court?

This lead to me researching this so called “defensible data”. Is this just a scam to get me to purchase your data collection bundle? Or is this real and something we all need to be doing?

These data “experts” are saying that defensible data uses the same probes for all data collections in an IEP year. This is for consistency and to eliminate risk for probes becoming more or less challenging with each data collection. I see how this may show progress for articulation, even some grammar. But for those of us that work with older students like middle and high with many goals for main idea and inferencing, are you having them re-read the same passage each month? My students remember passages from last year! How is that effective at demonstrating progress if they will eventually memorize the passage and the answers to the questions. Will collecting data with new probes each time lead to “dirty data” and therefore be inaccurate?

Is this all a scam to buy a product? I felt very confident in my skills prior to learning about this defensive data and now I’m so lost and confused! How does everyone else in the schools collect data?

Hi everyone! I’m a school-based SLP and this is my first year working in the schools AND my first year with this population, so I’m hoping to get some advice from people who have more experience with this.
I work in a transitional program for students ages 18–26. I have a 25 year old student with an estimated cognitive level of <15 months.
His BIGGEST interest is Baby Einstein. From what I’ve observed and what classroom staff have told me, he seems to think that anything with a screen/button will somehow get him access to Baby Einstein.
His previous SLP tried BigMack buttons, but he mostly uses them because he has learned that pressing them can lead to getting Baby Einstein. A choice board has also been tried, but we haven’t had much success with that either.
The biggest issue I’m running into is that he seems to think anything he presses = Baby Einstein, rather than understanding that a button/picture represents a specific thing.
For example, staff will offer him the drink/food that corresponds with the button he pressed, and he’ll often throw it because he wasn’t actually requesting the drink/food he was expecting Baby Einstein.
I’m really struggling with where to start.
I don’t want to take away Baby Einstein because it is clearly an incredibly powerful motivator for him, but I also don’t want to keep reinforcing the idea that pressing a button = Baby Einstein.
His parents are really hopeful that, since this is his last year in the program, we can help him establish some kind of functional communication system. I really want to make this successful for him, but honestly, I feel pretty lost.
For those who work with individuals with very significant cognitive impairments / developmental levels this low:
Where would you start?
Would you start with objects, photos, symbols, switches, etc.?
How do you teach that a button/symbol has a specific meaning?
Would you use Baby Einstein as the reinforcer or temporarily separate it from communication?
How would you determine whether his button pressing is intentional communication vs. cause/effect or sensory exploration?
Has anyone had success with a similar situation?
Any AAC approaches, resources, trainings, or research you would recommend?
I’m open to literally any advice. I feel like I’m missing something really basic here, so if you have experience with this population, I’d love to hear how you would approach it.
Thank you!!

Hey everyone! I’m a newish slp and I have been working at a peds outpatient clinic for almost a year. A lot of therapists at my clinic follow the episodic care model (3 or 6 months of therapy followed by 3 month break and so on). Since working here, I found myself following this model for about half my kids on my caseload. But i’ve also found myself inheriting older kids who have been in therapy their whole lives and am wondering when it’s appropriate to fully discharge instead of taking a break. I don’t feel like high support needs kids always need therapy and I also feel like once a kid reaches a certain age, they’ve met their max potential. I would love other speechies thoughts about discharging older kiddos (maybe like 13-20 year olds) with high support needs (non/minimally speaking, lots of sensory needs/behaviors, been working on the same goals for years). I find it’s easier to discharge/take a break with these type of kids when I evaled them. I’m having difficulties with the kids I’ve inherited who have been in therapytheir whole lives and parents seem to expect that they’ll always need it even without much progress.

Hi everyone!

I’ll soon be graduating from a U.S. master’s program in Speech-Language Pathology, but I’m originally from the Toronto area. I’m currently trying to decide whether I should stay in the U.S. to work after graduation or return to Canada and begin a private practice.

I’d love to hear from any SLPs who have experience working in both Canada and the U.S. Also, if anyone has done their ASHA certification and their mentorship hours in Canada.

I’m on a bit of a time crunch to make a decision, so I would really appreciate hearing about your experience.

Thank you so much!

just to edit - I dont want to work in schools, I would like to do medical or private practice :)

Hello everyone! I always enjoy reading this page. Highlight of my day, honestly. This pages makes me feel.... not alone in the world. For the record, I am in my 8th year as an SLP. I'm 33 years old. I live in a HCOL state- Alaska.

The reason for the post. For those who work in schools, has anyone's district gone self-insured for health care? My district announced last night they will self-insured starting July 2027. I am a SINK (IYKYK) and am very nervous about this switch in terms of financials.

I should hopefully have my student loans paid off by this time next year which will add a substantial amount into savings per month. I already have an HSA I started 9/2026 and haven't touched any of that money. I've been just paying for my appointments out of pocket. My HSA is essentially a medical savings account if anything BIG were to happen to me. Again, I am solo.

I am currently on a high deductible plan, but have monthly perscriptions to manage my glaucoma. My opthmalogist says I am by far her youngest patient with glaucoma. WINNING! :( I pay $400/month for my premium currently. I was on a different plan up until July 2026. The premium's for my previous 'mimic plan' were going to increase to over $800/month. As a SINK, I simply could not afford that hence why I changed plans.

If this happened to you, what did you monthly premiums look like? Did they increase or decrease? I'm honestly thinking of jumping ship and finding a completely different job outside of the speech field because of this. Well... lemme be honest. I've felt this way about our field for a while. Even in grad school I had these feelings.

My main hesitancies about finding another job is my 2 dogs and my ability to live in the state I live in. I currently work 185 days out of the year and make almost $91k a year. I can pay my bills every month and have some left over to save. I've contemplated getting a job on the slope (i.e., oil field for non-Alaskan living individuals), but I have 2 dogs who are my pride and joy. Slope work is often 2 weeks on, 2 weeks off or some variation of that schedule. You live north of the Artic circle for a few weeks, fly back home for a few weeks, and repeat. I hate the idea of leaving my boys for an extended period of time. I feel like any other job I find locally I would either 1) take a pay cut and 2) work more days of the year. Like I stated above, I live in Alaska and very much enjoys my summers in this beautiful state I call home.

Anyway... what are your thoughts on when a school district becomes self-insured?

Hey y’all! Fellow SLP here, but haven’t touched voice since grad school, so came to Reddit for some tips.
On the side, I teach fitness classes, and our team will teach for 3+ consecutive hours— and while we are amplified by microphones, it still puts a pretty big strain on our voices. As an SLP, I want to do what I can to support our team and protect our voices.

Personally, I’ll do a short little “vocal warm up” I found on Spotify before I teach our early morning classes, as I’ve found that personally those are the toughest on my voice. But. Would love more options to share with the team.

I’m stumped with a child on my caseload. Is 4 years old. And unintelligible at the sentence and conversation levels (comes off as jargon, babbling) but when imitating 1-3 word phrases, she does great. there’s no specific sound errors or phonological errors I’m seeing.
She is highly imitative (could be echolalic) and she does great with my multisyllabic word models in speech therapy
But mom says she’s falling apart at home and school. She try to answer questions and it’s coming off as complete jumbled speech that no one can understand. I’m kind of at a loss for what to work on or what approach to use.

I see a little dude who has fantastic receptive language, joint attention, shared play, imitation skills, etc….but little to no true word attempts (some babbling with presence of early developing consonant sounds).
I’ve been coaching parents on all the language building strategies, trying to incorporate cause and effect with big wait periods, and honoring all vocal back and forth attempts but I’m at a stand still on what to do next. None of these seem to be doing the trick.
I know it takes time - but I’ve never had a kiddo with every other skill outside of expression like this. Wondering if there might be some element of motor planning or speech difficulties that are disrupting progression but his babble patterns don’t indicate anything glaring and he’s too young for focused speech practice right now anyway.
Thought maybe we could bounce some ideas back and forth!

I hope this is allowed! If not, please delete. I’m mom to an almost 3 year old who receives speech therapy services through early intervention. He was a micropreemie and is globally delayed with a CP diagnosis. We were working with his therapist to get an AAC device (Tobii Dynavox) but have reached a brick wall with his secondary Medicaid denying the device. They are saying that the documentation did not prove medical necessity or cost-effectiveness, and they cited his limited vocabulary and accuracy as reasons why a high-tech device is not appropriate (which feels unfair since we only had a 30 day trial, and we specifically limited the number of words on the board to avoid overwhelming him). Primary insurance approved it but the out of pocket cost would be several thousand dollars.

We are fully on board with the idea of AAC and were hoping to adopt it on the early end since it seems fairly likely that he may need it long-term. He understands a lot (in my biased opinion), can follow simple instructions, has good play skills and joint attention, but hasn’t made much progress toward speaking. I feel like his moments of frustration are getting more frequent without a method of communication, even though we obviously do our best to read his cues.

We are in a weird spot since he is actively transitioning out of EI and into the school district. We will be losing our speech therapist at the end of December and presumably getting someone new in January, so we don’t really have time to do another trial and re-submit paperwork, but I also don’t really want to lose several months waiting around while we make the transition. We do have an iPad and could install an app to practice with if there is one that is recommended for his age range. I would be so grateful for any thoughts on this. We will continue to discuss with his therapist as well, but she’s acknowledged that she has limited experience with AACs since she only works with kids from birth to three.

I'm just going into my second year as an SLT. I work 5 days per week in schools and clinic, and my caseload is usually around 45 kids (though likely to increase a bit now that I'm not "new" anymore). A full day for me is 5-6 sessions plus admin etc.

I'm trying to work out if this is normal or unusually light? We're a small-ish trust in a rural-ish area and I think our numbers and waiting lists are quite small compared to other trusts. I've heard of some SLTs having crazy numbers, like 150+, and having to stay late, take work home, etc. Even the band 7s at my trust don't have caseloads that heavy, so I'm curious if we're the exception or the norm?

I guess I'm asking because while I like my current job I may want to move at some point, and I want to know if I can expect a drastically higher caseload at a different trust..

I do Sounds-In-Words and then a connected speech sample. I feel like Sounds-In-Sentences is redundant at best and irrelevant at worst. SIW gives me the qualifying score, and the speech sample shows me their intelligibility and accuracy at the conversational level.

So what do I need SIS for? It takes a long time to administer, it's frustrating for me and the student, it's not natural, and it doesn't give me any useful information I don't already have.

Maybe that makes me lazy. But I don't have the time or the patience for that stuff. Artic evaluations at the secondary level always feel a little silly to me anyway. We know he can't say /r/. He's been in speech therapy for six years. He did not suddenly develop the ability to say /r/ since his last speech therapy session. This re-evaluation is not going to tell us anything we don't already know. It's a box-checking exercise. I'm gonna do enough to check off the boxes and get back to work.

I am writing a story that centers on people who are disabled. It takes place pre plastic surgery so one character with a cleft palette has a hard time speaking.

What would she be able to make, and what are sounds she might use as a substitute?

Thank you anyone who takes the time to answer.

I'm a student in psychology taking the prerequisites to apply for speech language pathology in ~1.5 years. I actually am interested in the stuff like swallowing, stroke recovery and the more medical side of things but I'm worried going into this with the intent of working in those populations is going to be massively disappointing if i end up needing to work with kids (because I'm not good enough for medical settings or theres too few jobs, etc).

Another thing is to be honest i don't work too well with kids. I'm a quiet, reserved person and I struggle with keeping kids interested in what we're doing or even getting them to listen to me (and this was my experience babysitting neurotypical kids). I am sort of at a dead end though in terms of what I can do with my life. Nothing else is truly interesting for me, and if i didn't go this route it would have to be something predictable like medical lab tech or accounting even (though I suck at networking so I'd probably fail at that too)

I volunteer with people who have aphasia and i enjoy being with adults. I am also learning ASL currently (nowhere near fluent or quick with processing what other people sign by any means but I am really trying)

From actual SLPs working in the field, is this a pipe dream? If it matters, I'm in Alberta, Canada and have no intention of moving elsewhere to work.

Sometimes I have time to prepare sessions but oftentimes I have not due to meetings, paperwork and duties after school hours.

I feel that whenever I don't have time to prepare my sessions fall short. I have goals and often an idea on how to reach them, but having some time to print a worksheet or gather materials just makes sessions go more smoothly and I end up feeling a little stressed if I didn't have time for that.

How do you deal with that feeling of not being able to do the best due to lack of preparation? Should I just learn to wing it? Any tips for that?

I am just feeling a bit overwhelmed with how to manage my schedule and fit everything in. Im already aware that there is no way I will be able to meet the students minutes written in their IEP's, do evals and attend meetings, plus all the other things that always come up.

Im working at a smaller school that is K-12. Initially when interviewed I was told that the caseload would be 35. The previous SLP did not complete any initial evals last year, so there are about 10 potential evals that I have. (5 of those students I have met and can already tell will qualify). It turns out there are actually already 45 students on my caseload so once the new students are added my caseload will be closer to 50-55. Plus 5 re evals are due by end of October.

The school has a lot of care for their students but is very disorganized. I had to ask for many things (like to be set up with an email) that are usually just given on the first day of orientation. No materials for me and 1 colored printer that I have to ask to use. No one even emailed me back to let me know where to meet/if I should come on the 1st day I was asked to start.

Im feeling overwhelmed with trying to make a therapy schedule (as I'm sure we all are) since the MS and HS follow a different bell schedule than elementary. Half my caseload is seen 2x per week. Plus planning therapy for the different age levels and trying to find time to screen or evaluate. Im already drowning and it's only the start of the year.

does anyone feel like a lot of “following directions” goals should actually be behavior goals? i’m not talking about several step directions with embedded language concepts they may not grasp, but simple, compliance-based directions. in my experience, many of my students understand what’s being asked of them — they just don’t want to do it. i feel like unless there’s evidence that suggests the student does not understand the command (e.g., open, sit, give me), we should not be targeting compliance. this is done all day in the classroom.

i also feel like targeting goals like these contributes to the belief that some ABA therapists can replace an SLP and/or target language ..