You're An SL- What?: Life as a SNF SLP

Hey hey, SLP friends! I'm excited to get back to the "You're an SL- What?" Series with one of my SLP best friends! Caroline was my neighbor and study buddy in grad school. I wouldn't have made it through without her! She's incredibly skilled at what she does and is always a great resource for me when I need a sounding board! Check out her experience!

Hi, my name is Caroline Baumunk. I graduated with my bachelors and masters from OU Health Sciences Center in Oklahoma. I have been working as a SLP for 4 years - one year in a pediatric private practice, and three years in SNF facilities. 

I first learned about speech pathology when I was a senior in high school. I would go to family functions and my cousin and cousin-in-law (who are both SLPs) would constantly talk about how much they loved their jobs and what they do. I was immediately interested because I was unsure of what I wanted to major in and they made it sound so great! I was interested in the health field and wanted a job where I could help people, but did not want to go the nurse or MD route. The more I looked into what a SLP actually “does” I was drawn to it even more. I loved the idea of how many various settings there were, thinking if I got tired of one I could try another. I also loved the amount of positive impact you could make on a person by doing speech therapy with them (in any setting), which is what I wanted most in a job. I shadowed both of my cousins multiple times and decided going into college to start on the path toward become a SLP. 

Graduation Day

I currently work at a CCRC, or Continuing Care Retirement Community. This type of community includes independent living, assisted living, skilled nursing (SNF,) long term care, and a locked memory care unit. I work primarily with patients in the skilled nursing who are there for rehab, long term care patients and memory care patients. I do have some outpatient appointments in Assisted Living Facilities (ALF) and Independent Living Facilities (ILF) though. This is different from other settings because we have such a wide range of patients to be seen. I have patients from 40 years old to over 100 years old on my caseload at any given time. Being this type of facility, a lot of the patients we get in the SNF come from our ILF and ALF, a lot of which come after having falls at home. Cognition is one of the primary things I address, especially memory, sequencing, safety, and finding ways to improve the patient’s safety and independence with completing their activities of daily living (ADLs) - think bathing, dressing, grooming, cooking, cleaning, leisure activities, etc. I also have a heavy dysphagia caseload. We have a significant amount of patients with dementia and Alzheimer’s diagnoses, which often require diet modifications due to the progression of the disease. Our facility has recently become “behavior health” certified because of the amount of Alzheimer’s and dementia patients we have. It has been challenging but fun learning how to work with this population, as I did not have a lot of experience prior to this. 

One of the greatest challenges I have had thus far is building up the speech department. The company I work for acquired this MASSIVE facility back in July (when I started) and the previous company had not done a great job with therapy. There were only 3 (!!!) people on the SLP caseload when I got there. This was quite a shock, as there are around 170 LTC beds and 50 memory care unit beds. To piggyback on the facility not previously having a strong therapy presence, I had the job of educating everyone (nurses, CNAs, dietary, etc) on what I actually DO and trying to implement new, more efficient ways of doing things. This initially was not well received because it wasn’t “how things have always been done”. I have made a lot of progress in educating people, doing multiple in-services at “all staff” meetings on the role of the SLP, diet modifications and prevention of aspiration/choking. Some days it still feels like an uphill battle, but it inspires me to look at much improvement we’ve made in the past 8 months, and think of where we will be in another 8 months. 

The greatest reward for me working in this facility is seeing progress not only with the patients but with the staff as well. When a I see staff members correctly following diet recommendations and following through with education I’ve provided, it makes me feel like i’m doing something right. Seeing a patient make progress and do things they didn’t think they could do anymore because they think they’re “too old”, seeing a patient be able to return back home independently, upgrading a diet for someone who has been eating puree and thickened liquids - those are the things that keep me coming back each day. My favorite experience being a SLP is just hearing patients and families say “thank you” and noticing how I was able to help them and their family members. I feel like speech therapy is often a thankless job, and I it feels nice when people notice how much you care, and the work you put in to help them. 

The one thing that I teach people almost every day about our field, is that we don’t JUST work on speech and talking. We also do thinking and swallowing :)

Celebrating passing our comps together!

Thank you SO much, Caroline, for taking the time to be a part of this series! I am so proud to call you a friend and to share this field with you! 

You're an SL- What?: Voice and Swallowing Specialist SLP

Hey hey, SLP friends! It has been a minute since my last post but I’m excited to jump back into the You’re and SL- What series! Next is a fellow Tulsan, Tiffany Turner. Before I moved home, I was a huge fan of all of her resources and her specialty I’ve had the honor of getting to know her and bump elbows at events since I’ve been home in Oklahoma! Tiffany fills a very large need and very specific niche in our area. I’ll let her tell you herself!

Last year I became Oklahoma’s 4th adult focused board certified specialist in swallowing and swallowing disorders. I own a regional swallowing and voice center in Tulsa, OK, Swallowing and Neurological Rehabilitation (SNR). I founded SNR in 2014 to fill a need I saw in our community for more specialized adult services. At SNR, my team and I perform fiberoptic endoscopic evaluation of swallowing (FEES) and videostroboscopy diagnostic procedures for patients throughout Oklahoma, both in our clinic and via mobile contracts with SNFs, small hospitals, etc. We also provide rehabilitation services for many types of acquired and progressive swallowing, voice, speech-language, and cognitive deficits. My team and I also host a dysphagia support workshop, a primary progressive aphasia support group, and a weekly voice maintenance group for patients with Parkinson’s disease. 

Another passion of mine is mentoring other speech-language pathologists. I’ve published several clinical resources for speech-language pathologists which have been downloaded by thousands of SLPs worldwide. They are available on my website at I also write guest articles for other national and local publications to raise awareness of my specialty niche along with giving guest lectures at local universities and other community events frequently. 

Tiffany and I at her event in Tulsa, March 2018

How did you learn about our field? Why did you become an SLP?

I was actually originally a secondary math education major, but after taking a substitute role early in college, I quickly learned that I liked helping people one on one rather than in the classroom setting. I’d also always had an interest in the medical field, so as I explored options, speech pathology seemed like a good mix of education and medical, my two main interests. Before looking into the profession as I was searching for a new major, I had never even heard of it. In general, I think our field is very misunderstood and underutilized, which is why I’m so passionate about raising awareness!

Give a description of the setting and population you work with.

I kind of mentioned this in my bio, but at Swallowing and Neurological Rehabilitation, we specialize in adult diagnostics and treatment for swallowing, voice, speech-language, and cognition. A couple specialty niches I have are fiberoptic endoscopic evaluation of swallowing (FEES) and videostroboscopy voice assessments. I complete endoscopies for several local ENTs who we work closely with, and my team and I also now provide mobile swallowing and voice diagnostics to help out our SLP colleagues in other settings with more limited access to instrumentals. Another unique specialty I have is working with progressive neurological conditions. I am on Tulsa’s Muscular Dystrophy Association (MDA) team where I serve at the monthly ALS clinic. My role there includes treating swallowing and assisting with voice recording early on since most of these patients will eventually lose their ability to speak.  I help them order and train on alternative communication devices as their disease progresses. 

What is the greatest challenge you face in your specific setting that may be different from other settings? 

Private practice with adults is very tough. Unlike a pediatric private practice (where you build a caseload and see those same kiddos for therapy for many years in many cases), with adults you only see them a handful of times, sometimes only once for diagnostics. I get patients who drive in from all over the state and region and have to serve a wide area and receive constant referrals each week to be able to maintain a caseload. Friends who own pediatric private practices on the other hand get much fewer new referrals coming in each week than I do but can grow much more quickly since their patients are mostly all long-term. 

What is the greatest reward for you in your job?

I love seeing results and seeing people get better! We have so many patients who come to our clinic on a feeding tube, and a few short weeks later, they are eating fully by mouth again and are able to get their feeding tube removed. Swallowing has always been my favorite area to treat because the results are so rewarding. I love to eat, so I love to help other people eat!

If you could teach the world one thing about our field that most people don’t know, what would it be?

Speech-language pathologists work with so much more than just speech. In fact, I rarely work with speech at all myself. Our field is very broad, and there are so many subspecialties within that. “Speech- language-swallowing-voice-cognitive pathologist” would be a much more fitting title, although it would be tough to fit on a nametag! If you’re looking for services for a particular area (e.g., swallowing, etc.), be sure to find someone who specializes in that area. 

Thank you so much, Tiffany!! If you would like to know more about her or her resources, make sure to check out her website! I can tell you first hand, they've been extremely helpful for me as a newbie and even still a few years in! Stay tuned for the next piece of this series coming August 19th!

You're an SL- What?: Life as an Acute Care SLP

Hey hey, friends!! Up next in the "You're an SL- What?" Series is another of my favorite SLPs! (And I want to be her when I grow up! #fangirl)

Carmin Bartow is a rockstar in the SLP world and I am lucky enough to know her personally! I adore her on all levels! If you want to know more about her work, obviously read below, but you can catch her on the Swallow Your Pride Podcast as well! (I'm slightly obsessed with SYP!) 

I received my undergraduate and graduate degrees from Eastern Illinois University.  I have been a practicing SLP for over 20 years (which is what I'm saying from now on...a slightly vague "over 20 years") and am a Board Certified Specialist in Swallowing and Swallowing Disorders. The majority of my career has been spent evaluating and treating adult patients in medical settings such as home health, skilled nursing facilities, long-term acute care hospitals and acute care hospitals.  I have been employed a Vanderbilt University Medical Center for the past 15 years and I love my job! My areas of specialty are dysphagia, head and neck cancer, and communication and swallowing disorders related to tracheostomy and ventilator dependence. In addition to my clinical responsibilities, I facilitate a head and neck cancer support group and enjoy presenting and teaching at Vanderbilt as well as at state and national conferences.  In 2015, I authored an ASHA publication entitled “Management of Communication and Swallowing Impairments Related to Artificial Airways”.  I have been an adjunct instructor for Tennessee State University teaching Dysphagia both on-site as well as through the distance education program.  I frequently supervise Vanderbilt graduate students and enjoy introducing them to the world of acute care.  I have been an Educational Consultant for Passy Muir, Inc. for many years.  That opportunity has allowed me to travel throughout the US teaching SLPs, nurses, physicians and respiratory therapists about tracheostomy tubes and speaking valves.  Overall, it has been a very good “over 20 years”!

How did you learn about our field? Why did you become an SLP?

I was majoring in Elementary Education in college.  I did a classroom observation at the end of my freshman year and was seriously horrified!  I sat in the back of that classroom thinking there is no way I could do this. Yikes!  It was definitely time to rethink my career choice!  Fortunately, my mom was a guidance counselor at a community college and she encouraged me take a career assessment test.  Speech pathologist was listed in the top 5 professions I should consider.  I did a little researching and luckily the school I attended had a communication disorders and sciences major – so I went for it.  After attending a few classes and learning more about the profession, I knew it was a great fit me.  
Give a description of the setting and population you work with. How is this different from other settings/populations?
I work in a large teaching hospital.  Vanderbilt University Medical Center (VUMC) has approximately 800 beds, 8 ICUs and is a Level 1 Trauma Center.  I work with both inpatients and outpatients conducting FEES, VFSS and providing a variety of speech and swallow assessments and treatments throughout the hospital. One aspect that is different with a teaching hospital is the daily interaction I have with medical students, interns and residents.  It is a great environment to teach our future MDs about the important role of the SLP in acute care. 

Do you collaborate with other disciplines? 

Yes, I frequently collaborate with dieticians, nurses, respiratory therapists, nurse practitioners, OTs, and PTs.  That collaboration is one of the aspects of my job that I really enjoy.  I have learned so much from these other disciplines and I know that using a team approach to care can result in the best patient outcomes.
Another example of collaboration is the Vanderbilt Multidisciplinary Tracheostomy Consult Service.  This service did not exist for years and there were many inconsistencies in tracheostomy care including referrals to speech pathology. I worked hard with several people from various disciplines (nursing, ENT surgeon, Trauma MD, respiratory therapy) to implement a trach team at VUMC.  After a multi-year endeavor, our efforts finally came to fruition.  The VUMC Trach Team exists!  I am part of this team along with a nurse practitioner, nurse proceduralist and MD.  Our team has significantly improved and standardized tracheostomy care in our facility. (Be on the look out for our first publication in SIG 13 Perspectives this year).

What are common diagnoses that you see?

Our SLP team evaluates and treats patients throughout the hospital with a variety of speech / language / cognitive and swallowing disorders.  

My particular areas of interest are:
  • Iatrogenic dysphagia (such as post-extubation dysphagia, radiation associated dysphagia and dysphagia associated with tracheostomy)
  • Dysphagia due to primary diagnosis  (such as stroke, TBI, and neurodegenerative disease)
  • Head and neck cancer
  • Communication impairments associated with tracheostomy and ventilator dependency
  • I spend the majority of my day working in the intensive care units. 

What is the greatest challenge you face in your specific setting that may be different from other settings?

Too many patients. Too little time.  Each acute care SLP starts the day with a full caseload of patients.  However, new referrals are entered all day, in all units throughout the hospital. Some days it is difficult to keep up!  Although it is often super busy and intense, I definitely enjoy the fast paced, think-on-your-feet environment of acute care.  

What is the greatest reward for you in your job?

I’ll give a 2 part response…
The most rewarding thing I do in my daily patient intervention is restoring communication to patients with tracheostomy and ventilator dependence.  There is quite a bit of research about ICU patients with tracheostomy experiencing delirium, depression, frustration, loss of dignity, and poor quality of life.  I know that a significant contributing factor is the inability to effectively communicate. When I can restore communication for these patients I know I’m making a difference.  There are many days that I’m holding back tears (sometimes unsuccessfully) as patients and families talk to each other, sometimes for the first time in quite a while.

Another very rewarding experience is facilitating a head and neck cancer support group at Gilda's Club Middle Tennessee.  We are a local chapter of SPOHNC (Support for People with Oral and Head and Neck Cancer) and have approximately 40 members.  I have learned so much from this awesome, inspiring, and supportive group of people!   

If you could teach the world one thing about our field that most people don’t know, what would it be?

Hmmm….that is a hard one!  I’m not sure about teaching the world, but I’ll share something I’m doing to teach other SLPs about medical speech pathology. We all learn the importance of evidence-based practice, but it is difficult to stay current and well versed in everything related to medical speech pathology. And, it is very difficult to find a good medical speech pathology course!  So, 3 years ago my SLP colleagues and I decided to host our very first “Medical Speech Pathology: Best Practices” course.  Our focus is to discuss best practices in the diagnosis and treatment of communication and swallowing disorders for adults with a variety of diagnoses. Our conference focuses on practical approaches to managing these patients and emphasizes the importance of implementing evidence-based practice in daily evaluation and treatment. We have presented on a variety of topics relevant to the medical SLP such as head and neck cancer, trach / vent, dysphagia evaluation and treatment, movement disorders, TBI, palliative care, delirium, and aphasia. In addition, our physician colleagues from various areas such as radiology, medical oncology, neurology, ENT, and trauma have presented at our conference to share their expertise and to highlight the importance of collaboration between the physician and the speech-language pathologist.  We have received great feedback from attendees and are enthusiastic about our next conference in February, 2019!

Anything else you’d like to include about yourself, your job/setting, or anything SLP related.

I was asked to give a lecture on the topic of “lifelong learning” recently. I’ll admit that I had some eye rolling moments when thinking about how to prepare for that talk. What do I know about lifelong learning? But as I started preparing for it, I realized that lifelong learning has really been key for me.  Continuing to learn, grow, take on challenges and seek new opportunities is what has kept me passionate about my career. I know my professional life would have been much less satisfying and probably a bit boring if I remained stagnate.  So, for any CFYs or young clinicians reading this, I would encourage you to find your niche and seek opportunities to grow, develop new skills, take on challenges and to keep learning.

Thank you so much, Carmin! You are such an incredible asset to our field, role model for all of us SLP babies, and a wonderful woman overall! I count myself blessed to know you!

You're an SL- What?: Life as an SLP Blogger

In the pediatric speech world, you have to live under a rock if you've never heard of my next guest. She's the OG blogger and SLP TPTer. She wears allll of the hats and does allll of the things! Basically, I adore her and am so thankful to know her! She is a true trail blazer and an asset to our field! Mrs. Jenna (Rayburn) Kirk!

My name is Jenna (Rayburn) Kirk, MA, CCC-SLP. I live in Dublin, Ohio with my husband and our two dogs! I’m in my 8th year as an SLP. I went to Ohio University and The Ohio State University and studied speech-language pathology all the way through my education. 
I currently work as a preschool SLP in a public school. I’ve had experience in the clinical setting as well.  I always describe myself as a person who not only has a passion for doing the therapy part of our job, but as someone with a  passion for educational resource design and professional development for SLPs too. I pretty much love everything about our job except for the paperwork. 
After my CF, I started a website ( where I share ideas and my journey as an SLP. I love the idea of peeking behind the curtains into someone else’s world. When I started sharing, not many people were really doing that yet. Now when you search for #speechtherapy, you get hundreds of ideas, but back then there were just a lonely few of us! 
I’ve presented on a variety of relevant topics to school-based speech-language pathologist including presentations at ASHA and ASHA Schools. Creating resources for other SLPs makes me feel like I really make an impact for not only my fellow SLPs but for the student they serve. I get to reach well past the 50 students on my own caseload and help children all across the country. That’s pretty amazing.  

How did you learn about our field? Why did you become an SLP?
I grew up next to a family with a child with autism spectrum disorder. I got to see what therapists did up close when they were in their home for therapy. It made it easy to see this was the perfect job for me! 

Give a description of the setting and population you work with. How is this different from other settings/populations?
I like to call myself an accidental entrepreneur. My dad tried to convince me to take some business classes in school in case I wanted to open my own clinic. I totally refused because the idea of owning my own business just never really sounded like something I wanted to do.   I started writing about speech therapy in 2011. From the beginning, my goal has been to connect with other professionals and to share what’s happening in my daily grind. Well, maybe not EVERYTHING. I try to share what works well! You can see my #SLPfails on Instagram though!
Shortly after I got started, Speech Room News turned from a hobby into a business. I realized I could take my passion for working with special needs children, my passion for problem solving, and my passion for crafting and make my own speech therapy materials. Like all passion projects, this one didn’t start as a business to make money. It started because I love to share, collaborate, and learn. Now that SRN is such a big part of my life, I’m happy to consider it not only my passion but a full-time job. Working as an educational  resource designer gives me the freedom to be really creative. Instead of sitting and wishing I had a resource when I’m working with a student, instead I sit and think about how I could create what I need. I usually create something really specific to a single student or my caseload. Then I think of ways to expand it to make it useful for more types of students. Then I dig deep to create something that’s also visually appealing and engaging for students. 

What is the greatest challenge you face in your specific setting that may be different from other settings?
When you’re creating something new, there is a risk there. For me, that can be the most difficult part.  You have the responsibility to know what is actually functional in therapy and the current research supporting that idea. Sometimes, I spends weeks making something and then decide it isn’t efficient enough for my liking and I start all over. Even if all goes well in the design, I might spend a month making a resource and then I have to wait and see if other SLPs think it’s something that will work for them too. I’m always waiting to hear what people think of a resource I’ve made. You’ll often catch me adding to resources once people in other settings use them because I want them to be as useful as possible.   I really pour my heart and soul into the things I create, and because I also work full-time as an SLP, that means I spend my nights and weekends creating. I wouldn’t do it if I didn’t love it. I also refuse to give up the social life I love, so that usually means less sleep. I’m my most creative from 9pm-midnight. 

What is the greatest reward for you in your job?
My greatest reward is getting an email from an SLP who has been struggling to do to much, who finds my resources, and realizes there’s a faster, easier, or better way to do something. If I help her love her job again, I’m over the moon. One sweet email like that from a fellow SLP, fuels my passion to create for a whole month. 

What has been one of your favorite experiences as an SLP?
Being part of an invited speaker panel at the 2016 ASHA convention was something I never thought would happen! What an honor to be brought on board my ASHA’s social media manager, Kelly. I loved sharing about social media with other SLPs who run clinics or university departments. 

I’m beyond honored that other SLPs utilize my resources to make their therapy more fun, efficient, or streamlined. It’s amazing how connected we are in our profession right now.  Technology and social media get a bad rap sometimes but I think it’s really bringing SLPs together in ways we never could’ve done before. The use of social media and blogs to share the ins and outs of our profession is growing to be an important part of the culture of speech language pathologists. I’m really proud to be apart of that. 

You're an SL- What?: Life of a High School SLP

Greetings!!  My name and professional title is Monica Judy, MS, CCC-SLP.  I am a pediatric speech language pathologist.  I received my master’s degree in 2004 from the University of Tulsa, OK.  I have worked in many environments since graduation including outpatient clinics, home health, teletherapy, and schools, providing speech therapy services to teenagers and young adults.  
I had an early knowledge of the speech therapy world as both my Mom and brother have received speech therapy as they were growing up.  I have always known I would work in the medical field and had a great passion for language.  Speech language pathology was the perfect fit for me.
I currently provide speech therapy services to teenage youth via teletherapy and in the traditional school setting.  I work with the individual student in my teletherapy sessions, which is essentially conducting a traditional therapy session via Skype.  I enjoy this model as it is a more relaxed setting.  The student is very comfortable in their home or classroom and I get to know the student on a personal level; where I develop the sessions specifically to them, their interests, and needs.  My students in the traditional school setting, I typically see in a much more collaborative role in a group setting in their classroom.  I work directly with the classroom teacher to provide them support in order to give them the tools and strategies to help the student be most successful in their communications in the academic setting.  I work with teens with varying diagnoses and needs.  I work with neurotypical teens who struggle to produce articulation sounds or have decreased vocabularies, students who have suffered traumatic brain injuries (TBI), and teens diagnosed with Down syndrome, Cerebral Palsy, Autism Spectrum Disorder or other cognitive/developmental delays.   
The greatest challenge for me is the time limitations or qualifications for students in the academic setting.  I feel the academic framework at times does not allow for the amount of time that the student may need for varying reasons including caseload numbers and qualification standards for therapy services. 
The greatest reward of my job is to provide my students with positivity and support so that they can reach their fullest potential.  I love helping my students find and utilize their voice no matter the mode of communication. 
My most favorite journey is when I have helped a child who was nonverbal and had no communication grow and flourish into a young lady who now is able to use her vocabulary of words and phrases to say I love you to her family.  
If I could teach the world one thing about our field…it would be the importance and value of words or communication.  That a manual sign, picture, or spoken word all hold significant value and deserve the chance to be heard.
I absolutely love my job!!  I find the greatest joy in helping my speech kids shine their light and helping their families and teachers in supporting that child be their best self!!
Monica Judy, MS, CCC-SLP

Thank you, Ms. Monica! The high school setting is one that I find so interesting and is definitely a special niche! Your students are so lucky to have you and I feel so lucky to know you! 

You're an SL- What?: Life as an Elementary School SLP

Surprise! It's a double feature to cover the elementary school setting! I have two of my sweetest SLPeeps who love their students with their whole hearts and give all they have each day! First up, my friend, Stephen. Then, you'll get to hear from my gal Amanda!
Stephen Lawrence
A little about myself… My name is Stephen Lawrence, and I am originally from Bound Brook, NJ. I moved to Tennessee in 2008 to continue my schooling at MTSU. While at MTSU, I read about a class called “Audiology” which, to me, sounded…fun. Long story short, this lead me to discover my love for the field of speech pathology.
While at MTSU, I was a member of our schools chapter of NSSLHA. During my three years of membership within NSSLHA, I served as our chapter’s treasurer and president. Our schools chapter also hosted an annual conference called “The Mid-Tenn Conference” where we raised money, hired presenters, and offered CEUs for attendees.
After MTSU I headed down the road to TSU to attend and complete graduate school. While working on my Masters degree, I was an active members of TSUs NSSLHA program and competed in the yearly quiz bowl/spirit competition. Currently I work full time in the public schools as a speech pathologist, and I work part time after school at a private clinic. Once a year, I work as an adjunct professor for Lipscomb University where I teach a graduate course in their BCBA (behavior therapy) department.

How did you learn about our field? Why did you become an SLP?
As I mentioned above, I didn’t find speech pathology, speech pathology found me and I am forever grateful. I truly “stumbled” upon this field, and felt like it was something I was meant to do. As I pursued speech pathology, my mother told me I saw a pathologist regularly in school and I suppose that drove me to work harder and serve students similar to myself. 

Give a description of the setting and population you work with. How is this different from other settings/populations?
I currently work in two settings, public schools and private practice. The majority of my time is spent in the public schools where I serve a very wide variety of students. My students range in age from pre-k (3yrs) to fourth grade (up to 12 yrs in some cases). My workload ranges from your basic /r/ artic student, to non-verbal students with Autism who use AAC/VOCD to communicate. The biggest difference between the two is the types of goals you can work on. In the school system, goals are based off of increasing academic and social emotional performance. In private practice, goals are centered on safety and independence. Although these categories may overlap in ways, you are typically allotted more “freedom” in private practice with what goals you target and how you target those goals.

What is your specific role with your patients? Do you collaborate with other disciplines? Is your facility a specialty facility in any area?
In the schools, therapists wear many hats. My primary role is to evaluate, diagnose, and treat any and all students who may be suspected of a speech/language disorder. I also work alongside our exceptional education team as a member of our behavior support team. We implement a variety of behavior modification techniques to foster a positive learning environment for our students. Other than the exceptional education teachers, I frequently have the pleasure of co-treating with an Occupational Therapist and Physical Therapist.

What are common diagnoses that you see?
In the schools, you truly see a little bit of everything. However, if there was one thing I saw the most of it would likely be articulation disorders. Errors specifically with the /r/ and frontalized/lateralized s/z.

What are some common goals that you address?
Aside from /r/, /s/, and /z/ goals, other common goals I target focus on building vocabulary. At my school, we have three Pre-k classrooms. As you can imagine I serve many students from each room, and many of them are non-verbal or basic emerging language. Often times I will frequently work on teaching them basic classroom curriculum (nouns/verbs). I look at this from a functional communication standpoint, but also a pragmatic participation standpoint.

What is the greatest challenge you face in your specific setting that may be different from other settings?
I find three major challenges that plague me daily in the schools. Workload size, qualification standards, and parent involvement. I currently have 82 students on my workload. Although I receive support from an outside SLP, that support is only twice a week for two and a half hours. The additional SLP is a huge asset, but there are still far too many students for one SLP to serve. 
When I’m not struggling to serve my tremendous workload, I am struggling to find ways to offer services to other struggling students. Not all student’s deficits are black and white. Some have very serious pragmatic, social deficits which don’t always reveal themselves on paper. It can be difficult to qualify students who don’t demonstrate typical speech/language deficits and meet that one and a half deviation point needed to qualify.
Lastly, many parents of the students I serve are not involved in their student’s education. They often decline their invitation to meetings, parent trainings, and don’t complete home packets. If parents do not get involved in their child’s therapy, it can be very difficult to generalize what is worked on at school to other areas of the student’s life.

What is the greatest reward for you in your job?
This question is easy, it’s the kids. I’ll be honest… the pay is sub-par, workload is impossible, and the extent of what you do is not appreciated. However, all of this is forgotten when your favorite student sprints down the hallway and jumps into your arms, or when your early morning Monday group talks about how much they missed you over the weekend, or when a student reminds you that you’re their best friend. These are the moments when I feel I am actually impacting and changing lives. It’s difficult to put a price tag on moments like these.

What has been one of your favorite experiences as an SLP?
I have had lots of favorite moments and experiences working in this field, so it’s very difficult for me to pick just one. I would have to go with the day an entire family came together to rejoice their sons/brothers first words. After working diligently with a student for several months, we had a break through and he began using 1-2 word vocal approximations to request wants and needs. When his family first heard him using words to request, we all just lost it. Everyone was so happy we jumped up and down, teared up a little, and just shook with excitement. It’s amazing to know you helped a family achieve something they never thought possible.

If you could teach the world one thing about our field that most people don’t know, what would it be?
I think I would just want to bring overall awareness to our profession. Far too often I believe speech pathologist are viewed as glorified teachers. Now I think teachers are AMAZING and we couldn’t have a functioning society without them, but we (SLPs) are not teachers. People often forget the wide variety of deficits we are trained and licensed to treat. People often forget that Speech Pathologist are the only profession in the school system that evaluates, diagnosis, and treats their students. It’s also overlooked that outside the schools we work on swallowing, voice, cognition, etc. When I look at our profession, I argue that we are one of the most valuable fields that cover such varying disorders.

Amanda Josserand

Hello everyone! My name is Amanda Josserand. I am a wife, a mother of two (11 year old son, 8 year old daughter) and a lover of golden retrievers (my two fur babies, Harvey and Charlie.) I have been a speech-language pathologist for 13 years, primarily in the education setting. I have dabbled in private practice and teaching at the college level as well. I attended the University of Tulsa for both my undergraduate and graduate degrees. After graduating I spent a year working in the public schools in Houston, Texas, before moving back to Tulsa. 

I learned about the field of speech-language pathology from a good family friend. She was attending TU and finishing her masters to be a speech-language pathologist when I was getting ready to graduate from high school. Because of a conversation with this friend, I enrolled in a few SLP courses my freshman year. I immediately fell in love with our profession! It was a great mix of medicine and teaching. Both careers I had considered exploring prior to finding our field.

I have spent 13 years working in the public schools.  I have worked with children ages 3-18, however most of my experience is with the elementary school population.  My role as an educational speech-language pathologist is to diagnose and treat children with speech/language impairments that are adversely affecting their education.  An educational speech-language pathologist differs from private practice SLPs.  Educational SLPs are tasked with considering a host of additional factors when it comes to providing appropriate speech therapy services for students during their academic day. We must consider how much time the child is missing class, do the benefits of therapy out weigh the potential harmful effects of being removed from the classroom, are the speech/language difficulties the child is experiencing adversely affecting their education, etc. Private practice SLPs, for the most part, can provide treatment at their discretion. In the educational setting, I can provide individual therapy, however most of the time I see children in small groups. We play games and participate in a wide array of activities while working on their individual goals. We have a great time! Another part of my job that I enjoy is getting to work with other professionals. On a daily basis I collaborate with classroom teachers, teacher assistants, special education teachers, counselors, English Language Learner teachers, Occupational Therapists, Physical Therapists, etc. 

The greatest challenge I face in the educational setting is educating parents and other professionals about the difference between SLPs in the private practice setting vs. those in the educational setting. As I previously mentioned, there are so many considerations that are involved in providing services to a student that are not a factor in the medical or private practice setting.

The greatest reward for me in my job is witnessing my students making progress. The first time a child produces a correct /r/ sound, after he/she has been working on it for a long time, is a sight to behold. 

One of my favorite experiences as an SLP has been teaching at the college level. I taught a senior level class on speech-language pathology methods and ethics. I loved getting to work with college level students. 

If I were going to teach the world something about our field it would be about our vast scope of practice. Most people think all we do is work with kids on the /r/ sound, and while that is a LARGE part of my current scope, SLPs do so much more! Articulation, language, fluency, social skills, assistive technology, swallowing, the list goes on and on! I love being an SLP!!!!

Thank you to both, Stephen and Amanda! I'm thankful for your contribution to this blog series and our field, but most importantly, your friendship! I adore you both!

You're an SL- What?: Life as an Early Intervention SLP

I hope you loved the first of this series with Megan in the NICU setting. I’ve always had such admiration of NICU SLPs because their role is so specialized and so vital for their sweet babies to not only survive but to thrive! Today, I have my “big” from grad school, my mentor, and one of my favorite humans. Truly, without Molly, I wouldn’t have made it through grad school and she continues to be an invaluable resource for me today. You’re going to love her!

My name is Molly Ooten, and I’ve been practicing for 5 years. I’m currently working at SoonerStart, our state’s early intervention program; my main focus is feeding and dysphagia(swallowing disorder.) I’ve been a speaker for the University of Central Oklahoma’s speech pathology and child development programs, and recently co-presented a feeding seminar at the Oklahoma Association of Neonatal and Pediatric Therapists (OANAPT) conference. 

How did you learn about our field? Why did you become an SLP?

I learned about the field when I was a teenager who babysat for a speech pathologist, and loved the idea that I could combine a love for education and a love for medicine in such a versatile career. I told everyone I wanted to be a baby doctor or a teacher for so long, that as soon as I learned what a speech pathologist does, I was hooked. I told everyone I would be a speech pathologist from the time I was 14 years old, and never looked back. 

Give a description of the setting and population you work with. How is this different from other settings/populations? What is your specific role with your patients? Do you collaborate with other disciplines? Is your facility a specialty facility in any area?

The early intervention setting is pretty unique. Our state adheres to a routines-based intervention program which basically means that every service we provide (loosely) must work within the child’s natural routines and be geared toward teaching the parent to implement. 
My frequency of service is typically lower than an outpatient clinic or a hospital; instead of seeing a child 1-2 times a week, I usually write IFSPs to see the child 1-4 times a month. I do see some kids weekly, but in general they are the exception. My specialty on our team is feeding and swallowing, so I do a lot of consults with other disciplines, and I do co-treat fairly regularly with motor providers. 
Our team also includes child development specialists, deaf educators, vision specialists, clinical psychologists, dietitians, and of course occupational and physical therapists. We try to stick with one provider per child, but I see a lot of medically complex kiddos and their needs are too great for just one person to meet. When I do have a child with motor delays, sensory processing problems, psychological issues, or other things not typically in our scope, I have a basic knowledge of some simple tips and techniques to help the family work with the child in that area. 
A good example would be an infant who I’m seeing for feeding, but also has motor delays because he was premature: I know how to talk about tummy time, support development of rolling and sitting, and learning to grasp toys or bring them to mouth. If it gets beyond my level of expertise, I can call in a team member to come on the case and help me out. The opposite is how I typically get new kids on my caseload—when a provider comes to me for a consult about feeding (or sometimes speech). 
I had 2 internship experiences in grad school that sparked a passion in me for pediatric dysphagia, but I wasn’t able to put that passion into practice until I came to SoonerStart. Since then I have completed over 40 hours in specialized continuing education in the area of pediatric feeding, and my caseload fluctuates between about 50-75% feeding kiddos at any given time. I also see kids with hearing loss, autism, genetic disorders, apraxia, and general language delay, but most of them have a feeding disorder that is co-morbid.

What is the greatest challenge you face in your specific setting that may be different from other settings?

The greatest challenge for me is packaging my therapy tricks in a way that is manageable for a parent to learn, and knowing when that parent is ready to hear and learn something about his or her child. I have to have a lot of delicate conversations with my families, especially regarding concerns for autism or genetic abnormalities, and gauging a parent’s readiness to accept can be difficult. Sometimes I’m the first person to voice a concern, and I get a wide spectrum of different reactions to my opinions.  Usually these conversations bring me closer to the family, and allow me more space to help them grow their child. Teaching the parent to essentially be the therapist takes a great deal of patience, but when you see that Mom rock a lateral spoon placement, it’s totally worth it.

What is the greatest reward for you in your job?

My favorite part of my job is the flexibility. I make my own schedule and usually see 4-5 kids per day. We only see children at home or at daycare, so I don’t hang out at the office much. If I need to reschedule an appointment I’m able to do it on my own time, and if a parent cancels I’m not obligated to make up the visit. Of course I also love working with the kids and getting to play with bubbles and play dough and baby food all day, but the flexibility is pretty unique to this program.

What has been one of your favorite experiences as an SLP?

One of my favorite experiences was in grad school, when I interned at a hospital. I had a young patient (30’s) with severe respiratory issues who had just gotten a tracheostomy tube. I was the first person to trial a Passy-Muir Valve (speaking valve) with him, and when he called his mom at work (she was a teacher) and said “I love you, Mom,” there wasn’t a dry eye in his hospital room—or her classroom.

If you could teach the world one thing about our field that most people don’t know, what would it be?

I’m sure everyone says this but we don’t just do speech!! I enjoy explaining what I do to other people, but it’s always nice when someone actually knows what feeding therapy is!

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