Since I have had the pleasure of working as both a school based therapist and private practice therapist I have found there are some similarities and many differences between the two settings. I have been asked countless times which is the best option and what exactly is the difference? Keep reading to find out more!
I would like to start this blog by sharing one very important fact: All SLP’s need to meet the same educational requirements to become licensed to practice. There are some differences from state to state, but in order to be nationally certified (Certificate of Clinical Competence) you will need to graduate from an accredited university, pass the Praxis exam, and complete a clinical fellowship year. It’s a pretty rigorous process that demonstrates exceptional academic and professional skills.
I would also like to note that there are many SLP’s who find a niche and specialize their skill set by attending professional development seminars and trainings. So while we all need to meet the same standards initially, from there you really do have control over what trainings you recieve. I know many therapists who specialize in AAC, autism, speech sound disorders, literacy, and the list could go on and on. Please keep this in mind as you read through the differences and always be sure to research and ask questions.
#1 – Group vs. Individual Instruction
When working in a school you have a set number of minutes when you are directly serving students with a very limited schedule. In order for an SLP to meet all of these minutes most kids are seen in groups. However, this isn’t the only ways a school based therapist can deliver services: they could push into the classroom and co-teach with the general education teacher, they could pull a small group to the hallway or the back of the class, they could see a small group in the speech therapy room, or they could see your child individually. There are many options and the right option should be the one that best meets your child’s needs.
But here something to be aware of: If your child has an IEP with speech minutes, those minutes are guaranteed to be met, but it does not always allow you to dictate the type of service delivery option. So, while you may feel that individual minutes would be great, you may not have the option to choose.
In private practice your sessions are all individual. This can be ideal for some kids who are working on speech sound productions, language based tasks, etc. where they are given 30 minutes of undivided attention and practice. Imagine the amount of growth that can be made in a shorter period of time when all of the attention and lessons are directly related to your child’s individual needs! This is one of the many reasons that parents will choose private practice. The activities are tailored specifically to each client’s goals and what we do is based on their data and performance from the previous session.
On the other hand, individual sessions for kids working on social skills can be tricky when when you don’t have a group dynamic. We can always try to recreate scenarios and be creative with the lesson but it is hard to replicate the dynamic of a group of same aged peers.
#2 Session Length and Frequency
At school, the amount of speech therapy a student receives may be restricted due to class schedule, SLP caseload, and school district policy. A school based SLP is not always in control of the amount of minutes they are able to provide. The amount of minutes recommended are typically determined by the degree of impairment which correlates to a certain number of minutes. For example, a mild impairment might get 10-20 minutes per week while a profound impairment would get a maximum of 120 minutes per week. These numbers are set by the district and dont allow for much wiggle room.
In a private setting, the frequency and length of speech therapy sessions are determined by the child’s parents and the SLP. For families who elect to use insurance to cover the cost of therapy, they will be given a certain number of sessions. We will save the discussion of insurance for a later blog! For those who choose to waive the involvement of a third party (insurance company) sessions can be determined by the family and provider. At this time I have opted to be an out of network provider with all insurance companies. This allows me and the families I serve to have complete control over the care provided to each client.
So what does a typical client schedule look like? They can vary, however consistency is a key component in making progress. I have some clients who will start with two 30-minutes sessions per week and as they gain skills we decrease to one 30-minute session until they are able to be dismissed. Some are scheduled three times per week to meet those goals as quickly as possible over the summer so they are prepped and ready to go for the school year. Others come one time per week for 30 minutes and are making exceptional progress! The schedule should be consistent and based on what works for you and your family.
#3 Scheduling Flexibility
Speech therapy sessions at school must be scheduled during school hours, meaning that the child will miss out on classroom activities. As a former school-based SLP, In my district we always tried not to schedule treatment during core math or reading instruction, but sometimes needed to take students from social studies, science, world language or music. It was not ideal, but they had to miss something to be available for speech services. This is a great scenario for many busy families. Your child is at school all day, so to have those services provided during those hours makes those few precious hours after school more flexible. I know many families have their kids enrolled in sports, piano lessons, karate,, and have to eat dinner, do homework, take baths and spend time together.
In a private clinic setting, parents and the SLP together determine frequency and duration of treatment sessions, but also a schedule outside of school hours. This tends to be a great option for families who would like to supplement the services at school, want to provide their child with a more individualized approach, or if their child didn’t qualify for services in the school setting (more on this one in a minute.)
One downfall of this set up is that those after school hours, 2:30 – 5:30, can be the busiest and most highly requested times. Since most parents would like those times, there is a higher chance that you will be on a wait list.
#4 Parent Involvement
In a school setting parent involvement is very challenging. Most SLP’s have very high caseloads (50-60+ kids to serve) and being in personal contact with each family is almost impossible. Many school based SLP’s will send out a detailed homework sheet with each child to keep families informed of what they are working on, some send home monthly newsletters to all families, others will send emails to certain parents. But building a relationship is challenging. Parents are not able to join sessions due to confidentiality, work schedule, interruptions and so on. This makes sending detailed information home after a session extremely important.
In a private speech therapy setting, parents are able to consult with the therapist before and after each session. In my practice, each parent has the option to stay for each session. This allows me to explain what I am doing, as i’m doing it and why. I find that educating parents in addition to the client provides the highest level of generalization since the parent is able to carryover the vocabulary I used, the way I said a sound, the cues I gave and how I indirectly correct an error.
I also can’t say enough about how important it is to build a relationship. I enjoy getting to know my clients and their families, to share in their celebrations, laugh about silly comments and connect with them in a more authentic and real way. When children feel comfortable they are more engaged. I want all of my families to feel comfortable when they walk into my clinic.
#5 Eligibility For Services
This is the biggest difference between school based and private speech services. And boy is it a duzy! You know how I mentioned district policies… well this is it and we are gonna have to get into some statistics first…
When a child takes a standardized assessment they earn a score. In most districts that score determines whether a student will qualify for services or not. A standardized assessment provides scores that are a national average of kids that same age – all of those scores create the bell shaped curve of average distribution. An average – smack dab in the middle standard score is 100 – this is called the ‘mean’. Most tests have a standard deviation of 15. This means that majority of typically developing students will fall one standard deviation above and below mean. If your child is performing in the average range they will score anywhere from 85-115 on the assessment. Many schools require a student to score 1.5 – 2 standard deviations below average in order to qualify for services. This means they would need to score below 74 to even be considered. Even if they get a 75 – they may not qualify.
Private speech therapy services are available for children of any age with any type or degree of communication impairment. We are able to treat children who may not meet eligibility criteria at school due to developmental norms or district policies. As long as there is an observed need, a child is able to get the help they need in a private practice.
Many of the students I see receive a combination of school and private services, while others didn’t qualify and with some short term intervention saw dramatic improvements in their communication and academic skills.
And there you have it! A few ways that school and private speech therapy are different. Like I said before, do your research, know your rights, and ask questions! What do you have to lose?!
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