Photograph via snooOG

A community of Speech-Language Pathologists (SLPs), Speech Therapists (STs), Speech-Language Therapists (SLTs), Clinical Fellowship Clinicians (SLP-CFs), Speech-Language Pathology Assistants (SLPAs), graduate clinicians and students. We discuss ideas, stories, information, and give general advice through our personal experience and research.

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A community of Speech-Language Pathologists (SLPs), Speech Therapists (STs), Speech-Language Therapists (SLTs), Clinical Fellowship Clinicians (SLP-CFs), Speech-Language Pathology Assistants (SLPAs), graduate students, graduate clinicians, and undergraduate students. We discuss therapy ideas, share stories, share informative links, and give general advice through our personal experience and research.

Speech-Language Pathologists, sometimes called speech therapists, assess, diagnose, treat, and help to prevent communication and swallowing disorders in patients. Speech, language, and swallowing disorders result from a variety of causes such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional problems.

Speech-language pathologists work with patients who have problems with speech, such as being unable to speak at all or speaking with difficulty, or with rhythm and fluency, such as stuttering. They may work with those who are unable to understand language or with people who have voice disorders, such as inappropriate pitch or a harsh voice. Find out more about SLPs here and here.

If you have a speech or language concern, please contact your local speech therapist. You can find a therapist in your area using ASHA's Professional Finder. Speech pathologists can talk about language, development, and the field in general, but they cannot diagnose or treat in this subreddit.

Feeling burn out or job stress? Consider talking to a mental health professional or researching strategies for anxiety, stress, and depression. Just as we cannot diagnose/treat speech and language disorders in this subereddit, we can only offer support, not true mental health counseling. * NIMH: National Institute of Mental Health * NAMI: National Alliance on Mental Illness

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caramelcashew is a Speech-Language Pathologist who has worked in 8 schools in 3 states over the last 3 years. Ask Her Anything.

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48,782 Subscribers


Is this a strange career path for a guy to go into?

I know it’s clearly a very female dominated profession but will people bat eyes about me pursuing this. Tbh I have many interests but this career path seemed to be the best paying (at least in my state), practical, in demand career path with some aligns to some of my general interests in linguistics, culture, and being in a supportive counseling type role for people.

22:25 UTC


Fellowship and loan deferment ?

I am seeing on the FSA website that those in a graduate fellowship position can apply to defer their loans, has anyone done this during their fellowship year? I’m kind of confused and when I called the loan servicer they were very helpful at all.

Actually I’d appreciate any loan repayment /deferment insight. Thanks!

22:10 UTC


Speech language pathologist meets Child with autism

22:03 UTC


What profession does your partner/spouse have?

We've all heard that firefighters and nurses always get together. Which profession is it for slps?

21:23 UTC


Help deciding between 2 jobs: SLP at multidisciplinary private practice vs. SLP at autism center

Hello everyone!

I am having a difficult time deciding between 2 job offers and hoped I could get some advice from more experienced professionals. So far, I have worked for 1.5 years at a private practice that also had other SLPs, OTs, and PTs. I enjoyed it but could definitely see some improvements in the next position. Also felt "in the way" at times when wanting a low sensory room or swing/gym activities. I am currently deciding between 2 jobs, and I just don't know what I don't know...

(Please no unhelpful comments/personal opinions about ABA therapy. The center I have an offer from is for children 1-6 years old, is very child-led, and the current SLP who goes there said "If I didn't own my private practice, I would take this job". She said the BCBA's are extremely collaborative and respect is mutually shown.)

Job 1: Similar to my experience so far. I'd be part of an SLP team at a clinic that also has OT and PT. I would still have my own treatment room, with closet space for personal materials. Separate feeding room. Access outside of treatment room to toy closets, art materials, swing room (lots of swings, not competing with OTs), and protocols. Would pick up clients and return them to parents in the lobby. Office manager to schedule and deal with cancellations and make-up appointments. Great feeling from owner, and staff seems happy.

Job 2: An autism center transitioning from contracting their SLP from a private practice to having an in-house SLP. Would have own treatment room with storage. Since I would be the first permanent SLP, I would get to choose what therapy materials and evaluations I want, and they would order them. Owner is on board to get a different EMR software if I don't like the one the BCBAs use. Clients would be brought to and picked up from my room. But no office manager for scheduling sessions or reminders for re-assessments/updated POCs. Great feeling from owner as well.

What are your experiences and thoughts?
Thanks y'all!!!

21:15 UTC


Any school SLPs worried about project 2025?

I mean, we likely won’t have jobs anymore…I’m assuming DOE licensure will go away. Along with IDEA?

20:37 UTC


Hey everyone I am about to take CETP exam in October. Any info on what the exam was like and advice on how to study/what to study?

19:32 UTC


Cleft Care in Developing Countries

I am completing final assignments in my graduate program and have the topic of "Cleft Lip and Palate Care in Developing Countries." I have looked a bit on the ASHA website, peer-reviewed articles via the college library resources, the International Cleft Lip and Palate Foundation, as well as Operation Smile. Does anyone in our supportive SLP community have any resources, companies, country/etc. specific issues or resources they would be comfortable sharing with me, and in turn my graduate class? I care about this topic and would love to do it justice.

19:01 UTC


SOAP Notes/Charting Help

Relatively "seasoned" SLP here however, until recently, I haven't had to write SOAP notes. Now I am required to write SOAP notes for some of my positions and I'm having some issues with where/how to state some things.

I have been working with a client with PPA and the client is very engaged in the therapy process. However, our last session, a family member attended the session and I spent a lot of time explaining what we were working on with the family member and the reason why. In speaking with this family member in the past, I don't think that they fully understand PPA and its progressive nature. They keep talking about "when my brother could do this and he could do that" and "the last speech therapist had my brother naming words". This client has had PPA for almost a decade and his communication skills have deteriorated significantly since the last time he had regular speech therapy. He is now typically only able to get out short sentences before he demonstrates word-finding difficulties (he'll say things like "I want to go to..." or "I like to ..." and then he gets stuck and isn't able to find the words to finish his sentence. A lot of what he says is vague because of his word-finding difficulties. My therapy plan includes working on semantic feature analysis, script training and working on supportive conversation techniques. I try to take a functional/meaningful approach with PPA, particularly in its later stages.

Anyway, the family member expressed during our session that they felt that their brother "needed to be practicing talking more so that they could talk like they could before". I've tried explaining my therapy approach as well as the progressive nature of PPA, and that we were working on his brother being able to communicate his basic wants and needs, whether it be verbally, or via other communication means. I've also been explaining the importance of communication partner training with PPA. The family all live in a different city from the client.

So long story short, my main question is - how do I chart in a SOAP note that I don't feel the family understands/gets it and that they don't seem to be in agreement with the therapy plan, even though the person with PPA/client is in agreement and does understand. Or do I not bother charting this? I did state in my notes things that the family member said, like "I want him to practice talking more". Is this enough and am I overthinking this?

Thanks in advance!!

18:44 UTC


CELF-5 Writing Supplement

Could anyone share one of the writing prompts for ages 11-12 on the CELF-5 Writing Supplement?

I have it at work, but not home with me this summer.

Thanks so much!!

17:56 UTC


Lululemon healthcare worker discount

I’m an SLP in a SNF, and just saw that lululemon offers 15% off to healthcare workers (specifically nurses, doctors, and first responders). I tried to upload verification but the verification site needed more proof of verification to verify that I’m a doctor, nurse, or first responder. I’m not any of those lol but I would really appreciate the discount, I provide healthcare services too! Have any SLPs been able to get the discount?

14:01 UTC


Free aac apps

Are there any free aac apps that can be used either on ipad or an android phone that offer both single word/phrase buttons and option for keyboard use? I work in Home Health and just picked up a Pt with ALS. She's been using her phonebto type messages, but I'm wondering if there's something better. I've used TD in the past but, I feel weird suggesting them now with the subscription service. Thanks for any help!

12:32 UTC


teletherapy speciality anyone?

have any of you ever offered private teletherapy services? (not pandemic related) Or - if you haven’t, what speciality area(s) do you think would be best for teletherapy?

Specifically for M-F “after school hours” but virtual. How creative and niche can we get!? let me hear from pediatrics world and adult world! what would you specialize in virtually??

1 Comment
04:49 UTC


Toddler is a runner

I’m treating a child in his home and they really don’t have a good closed in area to do therapy…and he’s a wiggle worm/runner. Any ideas? I’d hate to strap him into a high chair but we may need to!

03:11 UTC


It's an election year which means people are once again showing how they don't know what dementia is. 🙄

Don't get me wrong, I don't like Biden (though I will begrudgingly be voting for him,) but this stuff is really annoying.

03:09 UTC


Neurodiversity-Affirming (ND) Goals for Autistic Adult

Hi everyone!

Hoping for advice and specific goal suggestions for an autistic adult I recently evaluated. Some things you need to know...

This individual was accompanied by their mother, who initiated the evaluation and did much of the talking. I always spoke directly to the client but received pretty limited feedback from them throughout the evaluation. I could tell they were uncomfortable, and it was difficult to discern whether they actually wanted to be there, what their own personal goals are, and how I could best support them. The LAST thing I would ever want is to contribute to someone's discomfort or negative experience with therapy.

This individual primarily communicates with mouth words, but their mother mentioned that they are "sometimes non-verbal," which I explained is a shared experience among some autistic individuals- a loss of access to verbal speech. I suggested AAC, which was quickly shrugged off by their mother. I still want to offer AAC options throughout therapy.

Other areas of need I identified (a more appropriate word would be "presumed," unfortunately) include:

  • Professional/employment support, as they said themselves they are interested in getting a job
  • Self-advocacy
  • Strategies that can be used during conversation/social communication (IF THEY CHOOSE) and perspective-taking, as they said themselves they want to build relationships and successfully navigate social interactions
  • Executive functioning strategies (could really use some direction with this one)
  • Understanding autism and their communication preferences (thinking about talking about spoon theory, double empathy problem, comparing personal preferences/experiences to a neuro-typical experience (?), providing ND-affirming online resources and books)
  • PDA might also be at play, based on some of the things they shared?
  • Family education

THIS FEELS LIKE SO MUCH! HOW CAN I WRITE THESE GOALS? If you made it this far, I have been scouring the internet for resources and would be happy to include every ND-affirming organization, website, book, blog, individual, social media account, etc. that I've found. Maybe this post, or a separate one, could be a collection of ND-affirming resources.

02:35 UTC


Tips on not taking work home (CF)

Hi all! I’m currently a 2nd year graduate student who is about to graduate at the end of July. I’m currently finishing a full time internship at a private practice, and I’m currently expected to take work home everyday to finish documentation and provide lesson plans as there are no breaks built into my supervision schedule for any documentation or planning time. I start at a school in August with a caseload of 55 and for my sanity I can’t keep taking the same amount of work home that I currently do. Does anyone have any tips I can use during my CF in the schools to minimize the amount of work I take home, or even just tips for self advocacy?

00:42 UTC


New to the SNF and frustrated with productivity and unethical billing practices. Maybe this isn’t the setting for me?

I'm 2.5 years post grad but have mostly worked in the schools and private practice so far. I walked into my first few days of my new SNF job bright eyed and bushy tailed, and now not even three weeks later, I'm starting to consider looking again for other jobs.

I spent the first day and a half doing online trainings, and from there I was immediately given patients to treat and evaluations to complete. I am completely new to the SNF setting and I wanted to learn as much as I could so I could be able to function independently relatively quickly, so I spent a lot of time asking questions, exploring the EMR and documentation software and getting comfortable with it, figuring out where all materials and supplies were stored, learning the layout of the building and becoming acquainted with nurses, dietary staff, aides, other therapists, basically I introduced myself to everyone I saw because I know in a big facility it pays to have friends in all job positions you can feel comfortable asking questions and getting help from. For the patients I was given, I spent time chart reviewing, reviewing old therapy notes, etc. to really know their goals and be able to plan therapy for them.

I loved it at first. I enjoyed my patients and was getting on great with my coworkers. This is not a small feat for me as I can be pretty socially anxious and shy, and it's taken me a lot to learn to come out of my shell. The documentation system was confusing but nothing I couldn't handle, and I caught on fairly quickly even with minimal direct training or help, which was also a big thing for me, as in the past I haven't always adapted to new challenges as quickly as I would have liked. I had a vague idea of what productivity meant but I didn't concern myself with it too much at first, figuring I'd be given ample time to figure things out before I was held to the same standards as everyone else. I also floated to three other facilities in my first full week, so had to learn all facility specific things 4x over.

Well the beginning of my second full week, my DOR started addressing my productivity with me. I told her of course it would improve, it just took my a little while to learn everything and be as efficient as everyone else. I got it to 60%, and she informed me that the standard is 85-90%. Again, I said I was aware and I would get it up soon. She told me her boss wasn't going to allow her to give me too much more leeway. I was kind of taken aback to be honest but I just told her I'd figure it out.

I started writing down everything I did and how long it took me. Gradually I've been adopting practices I know aren't right, but that the other therapists are encouraging me to try, such as starting my "treatment time" as soon as I start walking to a patients room, doing large groups, chart reviewing in the room, including care plans in tx time, including documentation time in eval minutes, etc. My DOR wrote me a note on my productivity sheet today saying "are you sure there isn't anything else you could have billed for yesterday?" Today I went to see a patient and ended up assisting her to the bathroom for 10 minutes because no nurse was available, and I billed for that time. I even worked through my lunch today just because I was so paranoid about my productivity. If I see a patient I haven't seen before now I don't even spend a minute reviewing their goals or notes or planning any tx before I get into the room with them. I'm turning into a sub-par, unethical therapist and it's only been a few weeks. I hate this. I love what I do, but not like this.

Is this just how it is on med SLP side? I've been wanting to transition to a medical focused career, do I just need to adapt and figure it out? And how can I do that and still be ethical?

00:37 UTC


Working in a SNF makes me feel like nothing more than a billing machine. Feeling like a terrible SLP and not sure how much more of this I can take.

Does it get better? I came into this setting because I’m really interested in dysphagia, but the reality of what I do every day is becoming so depressing, and lately I’ve been asking myself, what is the point? I’ve worked in 5 different SNF’s and they’re all the same. Cognitive therapy is so dull. Dysphagia therapy is so limiting in this setting and the lack of motivation for it from patients is palpable. I can’t even blame them. A CNA asked me today if I’m going to be there to “watch the patient eat lunch” and I know she didn’t mean it negatively but it kinda stung. Like that’s what people think I’m doing when I’m working with someone during a meal. I have a few aphasia/apraxia patients and LOVE working with them because I feel like I am actually DOING SOMETHING and get positive feedback from other professionals about the patients visible (or audible I guess) progress. Everything else feels so monotonous. How am I supposed to do this for another 40 years?

23:34 UTC


Any signposting to resources, or experienced med SLP’s willing to give a newbie advice re: treating swallowing problems in those with total laryngectomy?

I have a new patient at my SNF who underwent total laryngectomy 15 years ago, recently had respiratory failure and had to be put on a vent. She’s now vent at night, trache collar during the day. She has a tracheoesophageal fistula. She communicates using an artificial larynx.

She has been NPO for about a month and was previously tolerating puréed diet before the respiratory failure hospitalization. Now that she can be trache collar during the day, I wanted to trial ice chips with her and then book an MBSS to see if I can restart her on an oral diet, but I’m scared and don’t know if there’s more I should do first?? I would really really appreciate any insight as a fresh out of school clinician!! Thank you SO much in advance to anyone who takes the time to reply to this!

21:53 UTC


SNF company cut my hours, should I leave?

Quick backstory, I accepted a 40 hour per week $45 per hour position at an SNF in January through a Rehab company(Ohio). My offer letter stated my hours could increase/decrease based on need, but I accepted because the facility desperately needed a full time ST.

Today, my DOR says to me “I’m not supposed to tell you, but since the company made administration cuts, they’re sending our location a ‘senior DOR’ on Monday whose disciplinary is ST. So she’s taking the majority of your caseload. You’ll be forced into part time and you’ll have to look for another facility.”

Is this common practice for our field? I’m truly shocked this happened after being at a private practice for 6 years. I know that no job is guaranteed but does this company sound like bad news? I’ve worked so hard building my caseload of clients, (some of which I’ve introduced to AAC for the first time in their lives) and I feel like my DOR isn’t advocating for me at this point, nor wants to keep me. Not to mention the job environment is extremely unethical, stressful, with a 90% productivity level.

I’ve built such strong rapports with all my clients and I’ll be so sad to leave. Some words of wisdom or advice would be much appreciated.

20:28 UTC


Strained-strangled voice? Harsh voice?

I’m currently in motor speech disorders, and I’m having the hardest time distinguishing between a strained-strangled voice and a harsh voice? What should these sound like? My professor attaches these characteristics to specific dysarthria diagnoses, but doesn’t really explain what they sound like.

20:26 UTC


How far do you travel for regional center clients?

20:22 UTC



I’m an slp in the outpatient clinic setting. I evaluated a child last year when they were 1;9 and although pls scores were all wnl (rec 88, exp 91, total 89) I recommended 1x/week for dysarthria. He wasn’t really moving his lips or tongue and mostly made vowels. I obviously didn’t give the gfta as he wasn’t old enough for it. I was not the one seeing him for therapy but he was back on my caseload as his last slp left the practice. By the time I started seeing him his re-evaluation was 2 months overdue but I wanted to see him a couple times before to get a more accurate representation of his communication skills.

He just turned 3. GFTA score was 104, Rec was 91, Exp was 85, and total was 87. Teachers said he has no difficulty in class and is showing the same skills as his peers. Mom’s concerns are K, R, J.

I understand parents need time to process this information and it should have been the last SLPs responsibility to start decreasing him if she knew she was going to discharge. At the time, I was not aware that she had planned to discharge him, and that is why I felt the 1x/month frequency was still appropriate despite his average scores - to provide a chance for consultation and monitoring for regression prior to discharge. Which is why I wrote in the report “1x/month unless regression increase frequency”. He did not have speech for two entire months, no regression was reported by teachers or parents, and I felt like he could’ve been discharged; however, given the process of how I typically discharge patients I didn’t think this was appropriate so I did consult with monitoring for regression in the back of my mind. 

I truly don’t feel that it is ethical to treat a child if he is demonstrating age-appropriate skills, having no communication breakdowns, with parent concerns of later developing speech sounds “K, R, J”, per mom. 

I am not comfortable meeting with this family when mom has shown she is not receptive to the extensive information and explanations I have provided. (I shared handouts of milestones and when sounds should be mastered). I am not comfortable adjusting this plan of care to increase the frequency just because the parent is upset. The parent being upset about the results does not justify medical necessity. I stand by my plan of care and now the pediatrician has signed off on them also.  

As my supervisor mentioned we are not a tutoring service and I don’t think it’s ethically correct to treat a child that is showing appropriate skills when we have a waitlist full of others who continue to have a hindrance in their communication skills. 

It bothers me to have a family so upset, but I think that some of that has to do with factors not directly related to my recommendations and outside of my control (many changes in providers, gap in service, overdue re-evaluation, etc). 

At first my supervisor had my back and now she’s flipped and saying that I need to do what the parents say and see him bi-weekly although the parents have agreed to get a second opinion.

Would it be ethical to see this child for more than 1 time a month?

20:05 UTC


AAC Schools

Looking for leads on schools anywhere in the US that specialize in CCN / where at least half of the caseload is AAC. None with ABA as the school’s “gold standard” of care, please. Insight is appreciated. Thanks!

19:28 UTC


Tips for a single SLP to retire in this kind of economy?

I tried to google it and they recommend by age 45, you should have 3.5-4 times your annual income in savings. That's just not realistic for me considering the kind of spotty work SLP has been even with 10 years of professional work.

Due to nearly all of us sufferring from underemployment in Fee for Service, flipped annual school contracts that leech money off our labor, positions that frequently dip in pay due to last minute cancellations, low pay hourly work in census based positions, how on EARTH are we supposed to retire comfortably?

I'm looking for tips on anything from smart banking, investments, etc. Financial literacy 101! Not everyone can land a nice public schools job with a pension in this field! Nor are we all married to an income earning spouse to purchase property with and split bills.

TIA for anything helpful to help us get ahead!

19:22 UTC


Cannot find a job; feeling baited into this field

For some background, SLP is my second career. My first is healthcare administration/IT/management with a heavy emphasis on quality, process engineering, and project management. I’ve worked for a number of years now at a large teaching hospital. Getting into management, I missed patient interaction and wanted to help patients in a more meaningful and rewarding way. While continuing to work at this hospital, I attended grad school and became an SLP. During grad school, I developed epilepsy, which complicated things but in no way impacted my performance and I am able to drive again at this time. I was told all throughout school how in demand SLPs are and how well-paying the jobs are. As I have found in my job search, this could not be further from the truth. I did my research before starting school, but it seems pay in this field has not kept up with the changes in economy.

Anyhow, I do not want to work in the schools, so my job search has been considering adult only settings for the most part. I graduated in December and still have not found a job that will pay me a reasonable amount - instead offering insultingly low pay because “I’m only a CF”. It seems my only option for completing my CF is to be paid $35/hr for a non guaranteed 30 hours in a subpar SNF. At this rate I would be taking a pay cut with fewer benefits and less flexibility. I don’t have this option as I am a mother and also going through a divorce so will have to pay all expenses on my own.

Our director at the hospital where I work keeps asking me to come manage one of our new locations - a position that would pay over $100k. I really loved working as an SLP in adult outpatient and inpatient rehab settings and found it incredibly rewarding, but it seems that continuing in this field/pursuing my CCC is only going to set me up for financial instability. Of note, the Cs are required for full licensure in my state. Moving out of state is not an option at this time. I only have 18 months from provisional licensure date (this past January) to obtain my full state licensure. Any advice? Do I just give up and call it a loss?

19:14 UTC


AAC process confusion

Does anyone have a guide, flow chart, list, anything that explains the process of AAC from the time you first get that very first basic speech/lang referral through to device acquisition? Think “basic 101” and then add mod-max support for explanation. I am ~10 months in private practice with outpatient pediatrics. I am at my wits end trying to comprehend the sequence. Some of my questions include:

  • When do you request an AAC eval? - before or after you have some treatment sessions?
  • When can/do you trial AAC devices? - before or after you request/get a referral for an AAC eval?

I can’t even start to think of all that’s part of at-home trails or coding or funding options or even the evaluation itself. My confusion is way at the beginning.

TLDR: I know clients need AAC support. I don’t know what to do AT ALL. Would appreciate as specific directions as possible and/or visuals.

I’ve looked through ASHA but I’m still so lost. There’s so many variables in this field. I can give more context if asked. I just needed to get this out there. TYSM in advance. <3

19:09 UTC


I have a massive lot of all my speech materials, where is a good place to sell it?

Hi y’all! After working my new job for the past year I’m finally ready to sell all my materials. The thing is I want to sell it as a massive lot, because I think breaking it up would be a lot more work.

Any suggestions on where to sell? I tried facebook marketplace but not having much luck selling as a lot (I have a lot of interest on individual things or smaller lots).

I’m in CT if that matters 😊

18:05 UTC


This is slimy and unethical right?

Is it me, or is this super unethical and slimy? I work for a decently paying but not so great home health agency. Care and concern for patients at the "corporate" level is nonexistent. They don't even pretend to care. The DOR has been after me about productivity which is largely out of my control since all they ever send me are patients who go to school full time and have ESY. The rehab department had apparently been on a mission to find me adult patients which was fine with me.

They finally send me an adult patient in my area, a guy with a hx esophageal cancer and a host of other complex medical issues. Again fine. When I call to schedule the eval the guy tells me that he had been working with the other SLP who works in my area for months, he wanted her back, and according to him she wanted to come back. My first thought was that maybe she told him him a white lie about coming back but asked to have the case reassigned for whatever reason (it happens, no biggie,) I contact the other SLP and she tells me that yes this was her patient, he was hospitalized for a few days, came home and when she tried to resume services the schedulers told her that he had been reassigned. Done deal. Couldn't have cared less about providing continuity for the patient. This for the sake of a couple of productivity points.

I'm going to say something about this to the schedulers and the DOR , I'm just not sure what yet. Any thoughts?

15:56 UTC

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