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!

You're an SL- What?: SLP Life in the NICU

I’m beyond excited to kick off the “You’re an SL- What?!” Series! This series will start with settings that involve our youngest patients and progress to settings that serve our older patients with a few non-traditional roles here and there. To start us off, Megan Kilpatrick from the NICU setting is going to share why exactly an infant could need an SLP!

Megan is a Speech-Language Pathologist in the Neonatal Intensive Care Unit at a hospital in Texas.

"I initially had wanted to go into teaching, but quickly learned after an internship that managing 25 kiddos all at once was not for me. I took the Intro to Communication Disorders class my freshman year of college and was hooked.  

I received my BS from TCU and my MS from Marquette University with a certificate in their BIES program (Bilingual-Bicultural English/Spanish). 

I am in my ninth year of practicing now. I started out working in two SNF’s, then moved into contract work and acute rehabs, and eventually started the job at a community acute hospital, where I am now. I have been there for four years. 

Just over a year ago, our hospital began to incorporate therapy into our NICU because they were trying to get state designation as a level III facility. We had essentially no therapy presence in the past in the NICU, so it has been a huge transition for both nurses and therapists. 

The NICU is considered an advanced area of practice, and it really takes a lot of supervision, mentorship, guidance, and continuing education to develop skills in there. Probably the most helpful resource I have found along my journey has been the Ignite program through NANT (a year-long mentoring program for NICU therapists). 

We receive speech orders on nearly all the babies admitted to the unit. We have an eleven bed unit, so it’s not usually very many at one time. Most of the babies I see are admitted to the unit for prematurity and/or RDS (respiratory distress syndrome). Most of my goals for them pertain to parents demonstrating competence with supportive feeding techniques and feeding positioning, development of pre-feeding skills, demonstrating stability during PO feeding, and ultimately reaching full oral feeds safely. 

When I evaluate a baby, I am looking at their overall development, how they show signs of stress, how they are calmed, and their oral motor function and status. If they are ready for PO (by mouth) feeding, I assess them with bottle-feeding and/or breastfeeding. Then as they grow, I continue to follow them to make sure they are developing their feeding skills appropriately, providing intervention as indicated, and educating parents. I work closely with Physical Therapy and Occupational Therapy as well. 

I think what sums up my job the best is when I tell parents my 3 goals for speech therapy: to make sure baby is eating safely, make sure he enjoys eating, and to make sure they enjoy feeding him. 

The hardest part of working in the NICU has been trying to start a culture change in our unit from volume-driven (amount of formula/milk intake) to cue-based/infant-driven feeding. There has been a lot of resistance from staff as it is not how they have always done things and change is just difficult. This challenge is just part of being in a NICU. Many units struggle with resistance on the topic. I pursue as much continuing education as I can find and keep up on research about best practices so that I can answer all the “why” questions. 

My favorite part of my job is when a parent is able to feed their baby on their own, safely and confidently. Feeding is a huge bonding experience, and it is rewarding to see parents enjoying it."

Megan is a rockstar! And I'm so thankful for her sharing a little SLP gospel about this specialized setting!! Next we will dive into the Early Intervention setting with my mentor and gal pal, Molly Ooten!

Featured Post

Baby Burnout

Healthcare workers and caregivers are among the highest at-risk populations to experience burnout. Working in a field in which we are pourin...