r/slp

I feel sick and fatigued every time I think about work. I’m currently in peds home health but have done EI and schools. I think it’s the mix of paperwork, therapy, and unstable pay. I see my husband, who is very smart and deserves all the good things, get paid 8 hours a day with good pto and benefits, when he probably works hard for like 4 hours. He also has a boss that is ok with boundaries, whereas every job I’ve had the higher ups say “we said you’d only have this many clients or this schedule, actually you need more!!” I’m setting boundaries at this new job, but it’s tough. I like EI but it’s not stable.

However I think of other job (minus my husbands wfh/good pay job, I tell him he’s lucky lol) and I feel like I’d like a more office type job, but maybe the grass isn’t greener on the other side. Maybe I just don’t want to work at all lol. No I’d be ok with part time, but what job allows you to work part time and make enough to live?? Also I see people who post “I do 40 visits a week” like dang, I only have 26 visits and it’s a lot for me. Maybe I’m just weak? Sorry I’m just venting now, just telling myself to get through this busy day. Thanks.

Any one have any other suggestions for a child with stubborn fronting. Spoon and cereal trick just aren’t working.

At my current school placement, we have a self-contained autism program with high needs students in addition to a pretty typical caseload of gen ed students. Currently, we have the caseload divided so that we each have an equal number of SDC students. Then we divided the gen ed caseload by grades. The other full time SLP is starting to talk about dividing caseload for next year (already?? 😅) and wants to keep all of her students, so we’d be changing what gen ed grades we’re servicing. I personally would prefer to keep my SDC students (they are more involved and I’ve built good relationships with the teachers and families). However, I’d love to keep my grades and just inherit/pass off students as they matriculate. My thought process is this would help with burnout, and make things easier on teachers (keeping their point of contact consistent).

With that long-winded context, I was curious how other people divide caseloads year after year? Do you grow with your students? Or keep your grade levels and pass students between SLPs?

I definitely see her side. I don’t think there’s a right or wrong way to do it. I’m just curious to see what others prefer!

Hi there. After some research I noticed this is a primarily female dominated field. I would like feedback from either females or males with schooling or on the job experience, sharing any barriers (if any) a male would have. From my perspective I don’t see any, but I would like raw insight from professionals with experience.

Side note* my background consists of healthcare management specifically in low-income community clinics serving all populations from basic pediatric appointments to elderly patients with chronic conditions. We serve all specialties you can think of as well. I assist physicians and staff with daily operations and solving patient issues (at times social issues).

My goal is to work more closely with patients (or even in schools with children) as a specialized licensed professional, rather than helping many patients daily from a broad overview.

Any feedback helps! Thank you!

Hi! I’m looking for a job that has benefits and also doesn’t have crazy productivity demands. I’ve learned over the years that my max is 4-5 therapy sessions OR 2 evals OR a combo of both per day.

I have ADHD and work in short bursts of energy with breaks in between. I have sensory sensitivities (fluorescent light, loud sounds, very drained by socialization) so working full time in person has never worked for me for more than a couple of months.

Ive done well with teletherapy, but so many companies expect 8+ sessions per day and it’s just not possible for me. I enjoy CF supervision, indirect non-client facing time, and consulting with team members. I’ve been looking out for non-clinical roles but I do really enjoy clinical if it’s less sessions per day. I need benefits and do not like fee-for-service. I’ve considered higher ed as well.

Overall, open to suggestions and/or company recommendations. I’m based in upstate NY, licensed in NY and MD. Thank you!

Hello,

I just wanted to brag on y'all. I had made a post about a behavior kid (admittedly when I was not in a good headspace), and there was a ton of motivation, good advice, and validation.

In another thread, u/nalgazz linked an article about imitation therapy. Y'all's suggestions plus that article, have really changed things the past few weeks.

Behaviors are still a concern, but they have ABA and pending OT eval.

But that imitation therapy? Had a kid that was scratching me senseless not too long ago laughing and attending to therapy.

Y'all are awesome. The job gets rough sometimes, and it's good to vent, but never forget that this is a place with loads of knowledge too!

Hello! I PRN (and am the only SLP) at an ltach and just got notification that a doctor is asking that I do a swallow evaluation on an a patient with an open trach. This patient was tolerating the PMV and on a PO diet a few months ago, but since then has stopped tolerating it and has been NPO for a bit.

Not sure I’ll have luck sending him out for an MBSS, as I tried with a previous patient who was on a vent and is expected to be for life, and the hospital that we requested it from refused d/t risk and liability. The same doctor had pushed for me to evaluate that patient because the patient “said he was eating regular food on the vent at his previous facility.” I’m pretty sure he was just talking that patient for his word because we didn’t have any documented proof of this at our facility at the time (although it later turned out he had done a FEES and the SLP there HAD cleared him for regular textures). He’s also questioned me wanting to get an MBSS before upgrading diets because it “takes too long”.

Not sure what to do/say to the doctor in this situation and it’s making me pretty anxious!

I am a former RBT turned SLP. Recently a post was generated in r/ ABA where the premise was why SLPs are critical towards RBTs . It led to some very productive responses (and a few trolly ones) but made me realize several miscommunications:

1) Misunderstanding of Education - A lot of discussion of the educational requirement differences where many commenters did not realize SLPs have master degrees and SLPAs have at least an Associate's degree.

2) EVERYONE WANTS REFORM - Many of the commenters agreed that the current pathway for RBTs is unsustainable, the entry requirements are too low for the qualifications needed to work with their respective clinical populations. Some ideas expressed were expanded education that allowed for clearer scopes to be defined and respected. (like RBTs having to receive AA degrees)

3) Philosophical Differences - While these particular posts can be filled with tension, I think more and more both camps are realizing were just different in every way imaginable. Measurable behavioral outputs vs. Linguistic/Cognitive Systems. It's like comparing Pokemon to Elder Scrolls: you can't compare them cleanly because they aren't the same game. Do they each have role playing elements? Yes, but they stand alone as two different video games.

4) THE SYSTEM - I think something all camps should consider is how much money and various overseeing systems pit our fields against each other, intentional or not. Insurance billing, productivity expectations, and services hours are all areas that the system refuses to adapt or reform because it's not about us (the providers) being financially stable. It's the system.

All in all, I do think this was one of the reddit posts where a lot of misunderstanding was addressed. Does it completely erase any online turf wars? It does not. But it's a positive step forward.

I am 4 years into my career and I've been in private practice ever since I got my license. I have no kids and therefore have a lot of time to give to work. I have about 50 scheduled sessions on my schedule each week and this past quarter I took two CFs for my boss. However, I am starting to get burnt out and feeling like I'm just there for money and nothing else. I just got married 2 weeks ago and my boss reached out to me on my wedding day telling my she forgot a PR that was due in 3 days and I needed to write it ASAP when she knew I was getting married...I know the grass always seems greener but I am considering a change. My husband works in the school system as an OT and always has great paid time off and meanwhile I work every holiday and most everyday of the year and he still made more money than me as a contractor. I currently do PRN for a school based company and I am considering going PT at the PP and more PT with the school company to see how the change is but as always it's scary and I've also built so many great bonds with my families some for 4 years. Any advice? I am starting to feel like I resent work and just dread going in the mornings.

I’m looking to get certified in FEES for my job, but I can’t afford to fly out to the East coast for in-person training. Is there any good online courses people have taken to start their training?

Hello! I would love to know if anyone knows the going rate for a 1099 contract through an agency vs with a school directly, for a school-based SLP, remote. Of course it will vary by location, but I would appreciate having an idea as I'm new to this space. Thank you

Hi all! I have a parent requesting resources for understanding neurodivergent vs neurotypical communication styles. I have articles but not a good book and would love to hear your recommendations. Thank you!

I won't personally be treating this patient, but the mother is incredibly sweet and willing to do whatever she can for her son. He's in speech therapy, but mom says they want to discharge him because he's not making progress and they've tried everything. He doesn't use any words, doesn't point, and hasn't been successful with things like PECs or an AAC device in the past. He is autistic. If anyone has an article or resource they find inspiring or helpful for this population, I'd love to share it with her. Thank you!

SOS: I’m a CF and I completed two CSE re-evals. I finished the reports but I somehow misplaced the record forms. I had put them in a folder and now it’s missing. I’ve destroyed my room trying to find them, retraced my steps, everything. I cannot find them and I’m freaking out. I genuinely do not know where it could be, I’ve looked everywhere. I know I need to let my supervisor know, but please be honest how much trouble will I be in? Is there anything I can do? I feel so so stupid and I’m beyond stressed out now.

Hi SLPs!

I’m currently working in OP and just evaluated a 70-year-old pt who had a stroke 13 years ago. I’d classify her as severe expressive, moderate-severe receptive. Also presenting with what appears to be AOS. Unable to use right arm.

Family stated they have tried multiple STs over the years with no success with any mode of communication.

She is alert and cooperative, but all utterances are stereotypies and even yes/no isn’t 100% reliable. She can follow directions though and imitate (facial expressions, not speech).

Where do I even begin with this case? I wanted to try high-tech AAC (humor me, I do think she’s capable) but wanted to ask others with more experience with this level of aphasia.

So I'm in the "cry in my car" phase of burn out, except I also cry outside my car, on the way to and from work, between clients at work, in the bathroom, on the weekends...basically I'm a mess. I'm nauseous all the time. I'm having mini panic attacks in sessions. I work mostly with little kids at a PP. It's not because of the kids, who are mostly well-behaved and adorable. My workplace has flexible hours (but no other benefits, fee for service). This field is just not a good fit for my personality. I can't keep being "on" all the time. I managed to do it for all of my career so far, but I've hit a wall and just can't anymore. I've cut back on the amount of kids I see, put in so little effort during sessions that I'm not convinced it's therapy anymore, I even took some substantial time off to recover from back to back colds and coughs and other bugs all winter, but nothing is helping. I can't realistically quit my job right now, nor do I want a new one in this field. Pivoting to a different field is no easy task either and I don't even know what else I'd want to do or if I'd be able to find a job doing it. I'm also TTC and not having any luck, which I think is at least partly making the burnout even worse. I know meds won't make our healthcare system better, improve my working conditions, or change my personality, but does anyone think they'd help in the short term? Anyone ever take anything to cope with work burnout or on meds now? Did/does it help?

Hi all,

I was just given a client I feel lost with (peds home health). The goals are to focus on tongue strength by doing exercises with a depressor. I have some experience with muscle strengthening from grad school, but they all were adults who had a stroke. I saw the client for the first time, and this kid seems… fine? I observed him eating, had him stick his tongue out and move it around, minimal speech errors (also he is 4). I will try the depressors but what if I don’t see anything “wrong”? Mom seems concerned and wants to continue speech. However mom was concerned about /l/, which he was able to do with prompting. Any advice? Thanks!

1st grade student - velars

I have a first grade student who really struggles with a lot of phono errors including fronting, stopping, gliding, and cluster reduction. I am using a cycles approach but velars are so challenging for this student. He didn’t regress during breaks, but Im debating on whether he should qualify for ESY due to the errors. His overall intelligibility isn’t too poor, but I feel like since some of his errors are way passed developmentally appropriate that maybe should qualify for ESY. What would you do in this case?