What You Can Expect From Speech Therapy {A Guide for Parents} Part Six: Therapy Settings Explained

Welcome to the sixth installment of the What You Can Expect From Speech Therapy {A Guide for Parents} series.

Before we get started, you’ll want to read Part Two of this series where I covered How to Get a Speech Assessment, where I explain the basics of each setting. Today, I am going to tell you the pros and cons of each setting and give a little more information than I did in Part two.

Early Intervention Agencies

As I explain in Part Two, children from birth to three with disabilities can be serviced though what is usually refereed to as early intervention or early start programming. These services are provided from birth through a child’s third birthday. Though the exact programs vary state to state, children from birth to three are typically seen through some kind of early intervention (EI) program (IDEA part C: You can read about it HERE).

What Services Are Available:

Many many different types of services are available through EI, but those services vary by state to state and even county to county, so you need to locate your local early intervention agency to see what is specifically available. Services may include (for those who qualify):

• 1:1 speech therapy in your home
• speech therapy at a private practice clinic
• weekly group programs (like mini preschools)
• physical and occupational therapies
• behavioral therapies

Pros to Early Intervention Agencies

• Most EI is free or offered at a very low reduced rate. In my area, most services are free (when you qualify)
• Many EI speech therapy is offered in your home, which is a great PRO.
• Some EI services offer parent trainings and respite care again at little to no cost. Some of these services will continue even past your child’s third birthday if your child has a severe disability (again, this varies widely from state to state).

Cons to Early Intervention Agencies

• Because of major budget cuts, some EI services are only offered once a month  and the “speech therapy” isn’t always delivered by a speech-language pathologist! So you need to ask these questions as you go through the process. 
• Scheduling and choice of therapists: You may have little control over who your child sees and when.

Public Schools

As I explain in Part Two, children aged three and up (and even sometimes birth and up, it really depends on your area) who qualify can receive services though their local public school.

What Services Are Available:

Many many different types of services are available through the public schools as well and again those services vary by district to district! Services may include (for those who qualify):

• speech therapy in the school setting, either 1:1 (not as common) or group (most common)
• physical and occupational therapies
• behavioral therapies
• special day classes/special education classrooms
• 1:1 personal aides (for severely impaired children)
• counseling services
• resource services (individualized instruction in a pull-out model usually)

Pros to the Public School System

• These services are free for those children who qualify
• For children with multiple therapies, the school setting is a GREAT place because of the ability for all the professionals that work with your child to collaborate and work together to help your child succeed.
• If you stay living in the same area, your child may be able to stay with some of the same therapists over time

Cons to the Public School System

• Some states have high caseloads. Like one SLP is responsible for seeing over 80 children at a time! This can make it difficult for the school for SLPs to provide the type of services you may be wanting for your child.
• It is not year round. This is not an issue for many kids, but for some this can be an issue. There are many school breaks and holidays and services only need to be provided legally during the school year, and within the “extended school year” (i.e. summer) for children with significant impairments only.
• Your child misses school time for speech time. Again, this isn’t a huge issue for most kids, but it can be an issue for others.
• All the red tape. It is a process to get assessed (up to 60 days) and there are meetings and paperwork and rules. No one likes this. Especially not the SLPs! 

A note about the public schools: I worked in the public schools for many years, and I provided great if not excellent services to my students. NO ONE, and I mean NO ONE likes the red tape that can be a part of the public school special education system. Most of the time, the schools and the staff WANT to provide your child with the BEST and MORE but that is not how it always works because let’s face it: There are laws and money involved. The bottom line, is that if you want to see change in your child’s special education system…I strongly encourage you to start writing your congressmen and law makers because we need changes up HIGH to make BIG differences!

Private Practice

As I explain in Part Two, speech private practices are yet another option. I currently own my own tiny one-person private practice, but there are private practices of all shapes and sizes!

What Services Are Available:

This will totally vary from practice to practice. Some practices are JUST speech therapy, for others offer other therapies such as physical. occupational, behavioral and/or class programming. In addition, the specific types of speech therapy available will depend upon the individual training of the therapist(s) who work there. For example, I am a Hanen Certified SLP and offer Hanen parent trainings and methods, however I am NOT trained in say, PROMPT which is a specific therapy methodology for children with motor speech disorders. It is best to contact the practice to inquire about their specific services and the education/experience of the SLP(s).

In regards to location, some private practices may go into your home, some may have an office, and others may do both.

Pros to Private Practice

• Wider range of services: Private practices have less stringent guidelines for “qualifying” for therapy than the public school system, therefore your child may be able to get therapy privately that a school will not cover. 
• Individualized service: This can be a huge pro of private therapy. In the school system, the majority of services for speech are delivered in small groups (this is the educational model in the United States). In the private setting, your child will likely have therapy 1:1 and as a parent, you will likely have more consistent communication with your child’s SLP because you will be with him at/during the sessions.
• Specialized services: If your child has a significant issue in one area (like stuttering, motor speech disorders, voice disorders, hearing impairment) you may be able to find an SLP who has specialization in that specific area more so than other settings.

Cons to Private Practice

• Cost: Private therapy can get pricy. If you are lucky, your insurance may reimburse for part or all of the cost up to a certain amount, so be sure to contact your insurance before making your appt. Some practices take insurance directly while others can provide you with a statement to submit yourself (this is common). 
• Time: You have to fit *another* activity into your family’s schedule when you choose private services. In the school setting, the services happen during the school day which means you do not have to schedule and/or transport your child to speech.
• Consultation/collaboration with other professionals may be harder: One pro of the school setting is the fact that of all the professionals who work with your child are in the same building (well, at least some of the time). This can allow for easier collaboration and consultation between staff. Private SLPs absolutely can (and should) consult with other professionals that work with your child, but it may some at an additional cost (so ask what you are paying for).

Medical/Hospital

As I explain in Part Two, you can also receive services in the medical/hospital setting for speech therapy. You may need a referral from your child’s doctor for these services.

What Services Are Available:

Hospitals can have an array of services:

• Individual speech therapy in their building
• Occupational therapy
• Physical therapy
• Behavioral therapy (counselors, psychologists, psychiatrists)
• Doctors, specialists, surgeons, and other medical professionals

Pros to Medical/Hospital Services

• Specialists: If you have a child with a complicated medical diagnosis, the hospitals may have the best comprehensive services for you. Your SLP may have easier access to your child;s medical specialists if they work in the same building (like in school settings) which can make collaborations and consults easier.
• Specialization of services: Like in private practice, hospital SLPs will likely have more specialization in certain areas, specifically in specific syndromes and medical diagnoses than in other settings. They also may have more experience in feeding/swallowing than in most other settings.
• Access to medical equipment: Again, if your child has a serious medical diagnosis, SLPs in medical settings should have access to more medical equipment than in other settings.

Cons to Medical/Hospital Services

Medical/hospital services have the same cons as private practice (see above). The biggest con comes if you do not have insurance that covers speech therapy (many only cover a limited amount) as the cost could be even higher than with a private practice, so be sure to call ahead and get preauthorized through your insurance and/or check their rates for private pay clients if you plan to pay out of pocket.

University Speech Clinics

As I explain in Part Two, another option available to you, if you have one near by, is a university speech clinic. Universities that have programs in speech pathology/communication disorders usually have a clinic on campus offering discounted (and sometimes free) speech and language assessments and therapy. You can call around to universities in your area to find out if there is one in your area.

What Services Are Available:

Speech and hearing clinics on university campuses may offer the following services, conducted by graduate students who are under direct supervision by certified speech-language pathologists (often professors):

• Speech/language assessments
• Speech/language therapy
• Speech/language/hearing screenings
• Speech/language/hearing community events (like screenings, parent education, etc).

Pros to University Speech Clinics

• Discounted or free services
• Genrally 1:1 services
• Students are typically VERY motivated to make change in their clients
• The students generally are using the most up-to-date practices to treat, which is a huge pro

Cons to University Speech Clinics

•  Lack of consistency: Because the students are working with your children in a teaching environment, your child will likely have a new student SLP every semester. For some children who really depend on consistency, this can be a con. 
• Waiting lists: There may be a waiting list to be seen, especially if that is the only clinic in a wide area
• Lack of experience: Though the students are typically VERY motivated to make change, they are simply not as experienced. This can be a con, though they are being overseen and guided by a certified SLP.

So those are the main therapy settings explained in more detail! Have you had experience in different settings? What are your thoughts?

To read the other installments in this series, click HERE. 

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