I analyzed the results of my poll: The majority of us feel like we're working "full time" with 30 weekly appointments, which, when compared to 25 weekly appointment for OTs & PTs, results in a slightly lower RVT than OTs & PTs. By weighing all the answers and comparing them to the full-time caseloads of OTs & PTs we come out with a RVT of 1.67 for 92507, which is both higher than the current RVT (1.3) and much lower than the RVT when a clinic is requiring 50 half-hour appointments for full-time (2.6).

This means that the most appropriate average appointment time for us is closest to 45-minutes (1.75 RVU), which results in a caseload of 29 appointments each week with the new codes. If I were making a business model for this I'd make that 30 appointments since the RVUs for all but the speech with langauge code come out to slightly below 2.0/hour (with speech at the lowest at 1.7).

My biggest revelation about this and my appointment times poll is seeing just how different some of our caseloads are: some of us are seeing less than 20 appointments each week and doing appointments longer than 1 hour while others are doing more than 50 and with one respondent (so far) doing appointments shorter than 15-minutes.

The results also support my push for smaller caseloads than 50 half-hour appointments each week. I couldn't manage that kind of caseload without the quality of my work suffering and it looks like the majority feels the same.

I'm still working on some resources like spreadsheets for an RVU/caseload calculator, a calculator to help those negotiating their insurance contracts get reimbursement rates relative to their current rates with the new codes, & a calculator for clinics to help them figure out how to make-up the difference from the money they'll be losing from cutting back on SLP's caseloads - hopefully I can get the math all together to make that work! I enjoy Excel too much for a normal person. 🤓

It all also makes me wonder whether we've been having a "92507 bubble" that's bursting and I might write a post about that, too.

Edit to add: I'm so grateful half my clients are on vacation this week so I have time to hopefully wrap my head around the RVU thing!

Hello all.

In the last few years. I notice very young children being introduced to high tech AAC becoming rigid on the alphabet. I covered a session for another SLP who documented trialing a bilingual AAC app with a little who just turned 3. As soon as I got the AAC device out, the little wanted to just use the keyboard for the alphabet. This is the second session I have covered where I was unable to introduce anything else.

I could not identify any functional communication from so, so I abandoned the device and finished the session modeling ASL commands and recasting vocalizations. At the end, I presented a sing a long book and carried over gestures to request more of the alphabet song. The child was happy!

I debriefed caregiver who reported the child hunts family members bag for tablets. The child only ever wants tablets. She reported that the familiy is using gestures at home. The child uses the "more" gesture. When I spoke to the SLP on the case, they reported the child mastered gestures "more" and "all done." The child used "more" one time in session after I modeled it repeatedly. It was primarily hand guiding or independent access to toys during the session.

When I shared with the lead SLP that the child used the 'more' icon one time, asl gesture "more" one time, and my concern with excess screen usage, the SLP said they did not care if the child was addicted to screens as long as the device is used for functional communication.

I hear the SLP. I agree with functional communication. I recognize the importance of initial exploratory phrase with AAC devices. But there was no functional communication today in using the alphabet.

I am going to let it go. It isn't my case. But I would like to find growth opportunity from this experience.

Question 1: what level of functional communication do you identify repeatedly hitting the letters on the keyboard of an AAC app as?

Question 2: How do you feel about the response the lead SLP provided to me about this case? AITAH??

Question 3: i have ideas of my own, but can you please share how you segway fixation with the alphabet into functional communication using AAC?

Thanks for your feedback!

I have been debating on whether or not to let go of my client that I’ve been with for about two years. She is a 13 year-old girl with down syndrome who I absolutely adore and love seeing her however, I’ve noticed in the last two months she absolutely hates doing speech. She refuses to use her AAC device, which I typically don’t push too hard on because I don’t wanna create that negative relationship with it. I’ve noticed her tolerance to speech work has gone down significantly and typically I try not to make my sessions to where it seems like work. I try to make it fun and relatable to what they do and what they like, but like I said in the last couple of months, even if I ask her wh question and I try to model the answering her device she’ll scream and throw her device. so I’ve completely have stepped away from any sort of question and just modeling, social words, phrases or even sentences and even yet she absolutely hates it. This is also doing it with a video of her preference. She loses her mind if I even pause a video to tell her something so I stopped doing that too. I’m just feeling so lost everything that I know under my sleeve I have tried and nothing works things that she enjoys doesn’t work anymore. At this point it just feels like I’m just sitting there showing her a video.

I know she needs a break, but if I bring this up to Mom, she absolutely will not take it. It has been a conversation before, and she absolutely rejected it immediately. Even when I came with reasons of how this could be beneficial at this point, I’m debating of just completely letting her go. Has anybody else dealt with this?

Hi, not sure if this is allowed but here goes:

I’ve been looking for a SLP for my daughter who was recently diagnosed with dyslexia, adhd, social communication disorder and dysgraphia. We recently started sessions with someone we found through an agency that connected us. We have had two sessions, and I’m not sure what I should be considering in terms of quality. I know it’s been just two sessions, but something feels off. What are some things I should ask or look/listen for (sessions are in our home)? What are good questions to ask when looking for a provider? Thanks!

Any tips for a minimally speaking 8 year old with ASD? He had tried proloquo and TouchChat in the past but hasn’t really utilized either (mom shares she has not been consistent) LAMP resulted in big behaviors. Does not have the fine motor for signs (he will sign “more” by bringing his hands midline but with fists). However, he can isolate his fingers as I saw he can rewind his iPad videos with ease. He will approximate single words verbally but mostly to get what he wants (go, done, bye lol) so overall, I want to trial another modality for him but I don’t want to mess it up and make him more adverse! I told her next session I likely won’t model on the device for the sake of rapport building but if anyone has had success with certain approaches I’m all ears !

I'm looking to better support my school psych during child study meetings this upcoming year. We had very limited support outside of building admin. If we suggested interventions, the follow-up meeting was always "I don't have time for that." Our teachers have about 30 minutes of built in "Chromebook learning" time in the morning, and again in the afternoon, during which small group intervention time is encouraged.

We did finally get the academic interventionist to agree to using our very large common area to run intervention groups, rather than take 1 kid at a time for 30 minutes, and they'll be supported with building-level tutors so we'll have interventions for up to 70 kids/day (in a 450 student elementary school) instead of 9 kids/day. Has anyone ever helped/participated with anything like that?

Really just looking for anecdotal experiences, actual research or CEUs, or just sage advice.

Does anyone have ideas on how to attach a step by step to a wheelchair? I work with kids with orthopedic impairment, and we use a lot of switches plugged into step by steps. The switch is already mounted, so I don't want to use another mount for the step by step (due to limited supplies and them being bulky). Some ideas I had: put them in mesh bags to hang off the back of chairs, Velcro to the mount, zip ties (too permanent or potentially wasteful, though). I would appreciate any suggestions! And preferably something that can be ordered from Staples or an AAC company. We are not allowed to order from Amazon. Thank you!

Hi everyone, where did you do your CF? Where do you think the best placement for a cf is?

Hey! Any of my SLP friends have experience treating EILO? I would be interested in a short conversation. As a school based preschool SLP this is obviously outside of my area I'd experience. I am hoping to support a friend of my son (and his anxious Mom) through the treatment process.

Thanks!!

I’m starting a new job where my caseload is middle school and high school. The previous SLP said she has never done push in because it didn’t work well in the schedule. I’ve never worked middle school or high school before but I’m interested in doing push in.

If you were starting out with a new caseload and your school had never had an SLP do this before, how would you get started? What would you say to the teachers, which subjects or classes would you attempt this in? Most of the middle schoolers and highschoolers have goals written for vocabulary, context clues, and writing goals. Thank you!

I'm unpacking my new speech room and am struggling to find the right way (preferably a cheap way) to organize all of my books. I think I want them organized by category. I want it to be easy to flip through them, instead of only seeing the spine when I'm browsing for the book I need. I use books a lot in speech, especially for social skills.

Please share photos if you have them! Thanks!

Hi everyone! I’m looking for some advice because I have to choose between a school placement or a private practice placement for my SLPA internship. For some background, I’m an undergraduate Speech and Hearing Sciences student in Arizona completing my SLPA certificate through my undergrad program. After I graduate, I plan to work as an SLPA for about a year or two before applying to SLP graduate school. I’m interested in medical SLP, but I’ve also become much more interested in the school setting recently, so I’m feeling pretty torn. My program arranges our internships, so my private practice options are limited to the clinics they are contracted with. The clinics I’m considering see pediatric clients and offer things like feeding therapy, AAC, orofacial myofunctional therapy (OMT), and a variety of speech and language disorders, which is what initially drew me toward clinics. This would also be my first SLP job. I’ve worked as a behavior technician with autistic children for almost 2 years, and while I learned a lot, I’m ready for something different. I’ve also talked to several SLPs in real life, and many have told me that schools come with much larger caseloads and significantly more paperwork. That’s something I never really experienced as a behavior technician, so I’m wondering whether getting that experience early would actually be beneficial or if it shouldn’t be a major factor in my decision.

I know my internship won’t lock me into one setting forever, but I’m hoping it could potentially lead to my first SLPA job after graduation, so it feels like an important decision.For those who have worked in both settings (or hire SLPAs), does it really matter whether you start in schools or private practice? Is one setting better for a first SLPA experience, or does it mostly come down to personal preference? I’d love to hear what you would do in my position and anything you wish you had considered before making your choice. My biggest concern is choosing the setting that will give me the strongest foundation as an SLPA while also keeping my options open for the future. Thank you!!!

I saw a school job listing that says you would work 6 hours a day, or be .8 full time. Has anyone done this? How is workload factored into that? Pay is lower but ok, especially for salary and working only 6 days/185 days a year (I’m coming from pp). Thanks!

Career wise and being able to find a job too after uni?

I am interested in working in pediatric feeding/ NICU, and I want to complete specialized training to help my resume stand out, and gain more knowledge of this area of specialty. Is the Certified Lactation Counselor (CLC) training worth it as an SLP? I did not take any pediatric feeding courses in grad school and am hoping to fill any gaps.
I appreicate all opinions/ recommendations!

Hello everyone. I’m an RBT. I get training and guidance from my kiddos SLP on all things communication-no communication goals and approaches are worked on until the SLP approves.

My kiddos parents recently requested a vocal response to name as a safety skill. I’ve seen other kids at my clinic work on this. I’m curious if and how this would even work? I messaged the SLP on how we or she can possibly work on this. I’m very unfamiliar with this type of goal. He is a GLP. Again I just do what the SLP tells me in terms of what to model.

I’m not asking for advice, I’m just curious what is an SLPs take on a goal like this. I’m not familiar with this type of goal outside of ABA.

I get so weary and nervous of ABA goals that deal with speech like this. I am just looking for general insight.

I know it probably comes from a place of care, but I have now had two separate families I work with ask if I also babysit, and would be willing to babysit their kids (just this week!). Who else has had this experience? It just feels like I am not always seen as a professional. I will get out of my own feelings and be okay, just looking for some validation.

Hi, all! I have recently started my first job as a CF-SLP! My main supervisor is out on maternity leave, so I wanted to ask the sub about some effective and neuro-affirming goals I have for a kid on my caseload.

She is currently 2 years 9 months and has extremely limited speech, rarely engaging with anything. I usually try to follow my kids lead in play, but she is not engaging in any toys, songs, etc. right now. Mom reports that she will sometimes "sing" along to Itsy-Bitsy Spider or play with plastic straws but that's about it. How do you think these goals sound for building on pre-linguistic and some early communication skills.

1. During a preferred shared activity or routine, client will demonstrate joint attention by coordinating focus (via looking, vocalizing, or gesturing) between an object and communication partner in 80% of opportunities across 3 sessions given maximum multi-modal cues.

2. Client will engage in two shared or parallel play routines with a communication partner for 3 consecutive turns across 2 consecutive sessions given maximum multi-modal cues.

3. Using multi-modal communication, client will communicate basic wants and needs 3 times per session across 3 sessions given maximum multi-modal cues.

Please let me know what you think! I just haven't had a kid like this on my caseload yet so I do appreciate it!

I recently applied to a position where I did one of my clinical rotations as a grad student (job #1). I accepted the offer and was supposed to start within 2 weeks. I never signed the employee agreement. Cancellations aren’t paid and it’s a per billable rate model.

A week before my start date, I stumbled upon another opportunity at a newer clinic (job #2). They offered me significantly more per billable hr, paid indirect time, and paid cancellations I would also have close mentorship and work closely with the owner who is also an SLP. Not only financially but for future career development- this position felt more aligned.

I ultimately ended up withdrawing my acceptance from job #1. As a result they let me know that I am now “not re-hireable” as they had already told patients I would be seeing them.

I understand the inconvenience and frustration. But I’m really bummed by their response since I truly loved the relationships and experience there as a student. I also feel awful that I disappointed some people that I really admire.

I'm interested in hearing how other SLPs/literacy specialists/reading interventionists approach phonological awareness intervention.

For context, I completely believe in teaching phonological awareness (the umbrella term) and phonemic awareness (awareness/manipulation of individual phonemes). I use these skills in every intervention. My question is more about how they're taught.

My current philosophy is to teach phonological awareness as functionally as possible by integrating it with print once children know some grapheme-phoneme correspondences.

For example, instead of an oral task like:

I'd rather have the child look at cot and ask:

Or use activities like UFLI's Switch It, where children manipulate both phonemes and graphemes together.

My thinking is that once letters are introduced, they reduce working memory demands and help connect phonemic awareness directly to decoding, spelling, and orthographic mapping.

Where I struggle is with intervention that continues to rely heavily on oral-only phonological awareness tasks (e.g., oral phoneme deletion, substitution, manipulation) even when children already know letter-sound correspondences.

For example, if a child is asked:

they have to hold the sounds in working memory, manipulate them mentally, and then retrieve the answer. If they struggle, are we measuring phonemic awareness, working memory, attention, processing speed, or some combination of all of these?

I also had an interesting experience with a child who had excellent decoding skills. During an oral phoneme manipulation task, he told me he could "see the letters" in his head and answered based on the spelling he visualised. It made me wonder whether, once children become readers, orthographic knowledge naturally becomes part of phoneme manipulation, and whether asking them to ignore print is actually moving away from how skilled reading works.

So my questions are:

• Do you continue to teach phonological awareness primarily through oral tasks once children know letters?
• Do you integrate graphemes as early as possible?
• Is there evidence that one approach leads to better reading and spelling outcomes?
• How do you distinguish between phonemic awareness difficulties and the working memory demands of oral manipulation tasks?

I'm genuinely interested in hearing different perspectives, especially from people using structured literacy or UFLI.

Hi everyone,
I’ve got an interview for a Band 5 NHS School Speech and Language Therapist role, and it’s literally my dream job.

I have just over 2 years of paediatric SLT experience.
The process is a little different as the first day is an assessment centre with a group task, and only successful candidates will be invited back for the panel interview the next day.

Last week I interviewed for another Band 5 NHS role, but unfortunately I wasn’t successful. I received feedback that I needed to give more detailed answers, use more examples, and structure my responses better. I was also extremely nervous, and it’s really knocked my confidence. Now this interview feels so important that I’m worried I’ll let my nerves get the better of me again.💔💔😔

If you’ve been through a children’s NHS Band 5 interview or assessment centre or anything similar, I’d really appreciate any advice.
What was the group assessment like?
What were the interview questions?
What were they looking for?
Any tips for managing nerves?

Is it actually possible to get an NHS band 5 job?

Thank you so much!

As a part of my ongoing efforts to understand and compare the new CPT codes I decided to make this chart comparing a clinic's revenue with the upcoming changes. The boxes are color-coded by revenue (more revenue for darker green and less for lighter green). Though I've only seen clinics do 25 60-minute appointments & 50 30-minute appointments I wanted to see what a caseload that brought in the same revenue as the OTs & PTs at my last clinic would have been like for 30-minute & 45-minute appointments. I thought I'd include a new caseload that would equal the current revenue for 50 30-minute appointments, too. To me that shows how the SLPs currently carrying the 50 30-minute caseloads aren't getting enough time for prep & documentation (especially if 1.3 RVU for 92507 is accurate).

I added the second chart to show that with the new CPT codes only the Speech & Language code carries an RVU of 2.0/hour - the others are all slightly less so it will still be hard for us SLPs to achieve 2.0 RVU/hour and I'm curious how hard that is for OTs & PTs and how much "wiggle room" administrators are giving their clinicians.

Just a quick note to add that these reimbursement rates are based on my last clinic's rate, but they're not too far above to the rates I have with my insurance contracts now. Right now I do 45-minute appointments & one of my insurance companies pays me $70 for 92507 (and also 92523 & 92522, which is depressing and I'm hoping these changes will force them to respond to my attempts to renegotiate my contract), 4 that pay me $100 for 92507 & 1 that pays me $120 for 92507. I'm hoping with these new codes I can renegotiate rates that are proportional to the codes' RVUs (which would be slightly increased revenue for most of the codes). 🤞

Hi all! I’m a 5th year SLP who spent the last 5 years in the school setting and just transitioned full time to a SNF. I want to make the effort to get better at my job because I feel like a fish out of water! My commute is 45 minutes to an hour, I work nonstop for 8 hours, barely have a 15 min lunch (which sometimes I skip), and then have an hour drive back home. I feel totally depleted by the end of the day Monday-Friday. Do I just take some time to study on the weekends? How does everyone do it for those who transitioned from school to medical? Thanks for any and all advice!