Choosing the Right Fit for Your Child
There are several questions to consider when thinking about speech and language therapy for your child. For example, would it be more beneficial to receive therapy at school or privately? Like with most educational decisions, there are pros and cons to each setting. And, what’s right for one child and family may not be the best fit for another.
Firstly, it is important to note a similarity across settings: school speech therapists and private clinicians are equally competent. They attend the same master’s programs and have identical graduate training. In New York, speech-language pathologists (SLPs) must have a state license and a Certificate of Clinical Competence awarded by the American Speech-Language-Hearing Association (ASHA) in order to practice. Private practitioners may choose to specialize based on their own interests and professional experience, while school SLPs are more generalists.
However, there are more differences between the settings than similarities:
Cost: One of the most obvious differences is cost. School services are offered free of charge, while private services are not. Despite this, private therapy does not have to be a financial burden on your family: speech therapy is often fully or partially covered by health insurance.
Criteria and constraints: School speech-language pathologists are required to function within the confines of school regulations. So, even though they may come across a child who could use extra support, they may not be able to provide services. Children need to score poorly on standardized measures of speech and language to be eligible for an Individualized Education Program (IEP) and receive therapy at school. Additionally, a negative academic impact needs to be proven. So, a child who struggles with pronouncing the “s” sound but has good grades and is thriving socially may not be eligible for services because their academics aren’t suffering. Private therapy is different because there are no entrance criteria. SLPs determine if a child needs services based on their own clinical judgement, which is informed by clinical observation, parent report, and informal assessments in addition to standardized tests.
Convenience: School therapy takes place during the course of the regular school day. So, while he or she will miss some time in class, there is no need to worry about making the time to drive your child to therapy, and there are no additional appointments to keep track of. This is not the case with private services, which are a recurring time commitment for families. And, while scheduling is always done at the family’s convenience, it may cut into homework time or conflict with after school activities.
Parent involvement and carryover: That being said, the trade-off for convenience is that you will have very little contact with your child’s school SLP. Some therapists will send home practice worksheets and intermittent progress notes, but not all. Unfortunately, due to high caseload volumes, many school speech-language pathologists are not able to keep in frequent contact with families. Further, they are only required to meet with parents during a student’s annual IEP meeting. A private setting is different because it facilitates collaboration between the clinician and the family to best meet the child’s needs. Parents can observe sessions and even participate in therapy when appropriate. Private speech therapists are able to provide specific feedback after each and every session, as well as implement home programs that follow the strategies used during the session. In this model, parents are given the tools they need to help with the acquisition of skills and assist their child in generalizing their communication goals across all environments.
Timing: Unfortunately, the IEP process can be a long one. By law, it can take up to 90 days between the time a parent requests an evaluation and the time that the IEP is developed. That’s a third of a school year! There is no such wait time in private practice: evaluations are generally scheduled within two weeks, and therapy can begin the following week. Plus, private therapy continues throughout the summer. School therapy is paused during the summer months, which often leads to regression.
Group vs. individual therapy: Children are usually seen in groups for school speech and language therapy. Often, group size depends on the size of the clinician’s caseload. Some children, such as those working on social communication, benefit from working in a group. For most children, however, working in a group can be distracting or embarrassing. Private clinicians only group children together when it is beneficial for the children and will lead to greater communicative gains, not due to scheduling constraints.
Personalization: School speech-language pathologists have a more difficult time personalizing their sessions because they have to take the skill levels and goals of all group members into account. So, in a group of three wherein one child is working on “r”, one is working on “l” and your child is working on “sh”, only a third of the session would be devoted to your child’s goal (in the time that is remaining after the SLP takes each child to and from their respective classrooms). Even in situations where all of the kids are working on the same sound, only a portion of the session would be devoted to targeting each child’s unique error pattern. In a private setting, where therapy is one-on-one, the speech-language pathologist can customize materials and lesson plans specific to that child. Additionally, this allows the child more opportunities each therapy session to practice the target skills. This is a much more intensive treatment model, which leads to quicker gains.
Privacy and confidentiality: The U.S. Department of Health and Human Services states that “most schools and school districts” are not required to follow the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This is concerning for some families. Although school practitioners themselves may adhere to the highest level of confidentiality, nothing is really private. Kids are pulled out of class to attend therapy, and everyone in the class knows where they are going. Once in the session, it is nearly impossible to be unaware of other group members. Kids know each other’s goals and how much progress everyone in the group is making. Private therapy, on the other hand, is just that: private. Private practitioners adhere to HIPAA; and, because therapy is one-on-one outside of school hours, peers don’t need to know anything about it. Private therapy does not require that any paperwork be placed in a child’s school records.
If you suspect that your child has a communication deficit, seek out services as soon as you can, regardless of the setting. According to research done by the National Institute on Deafness and Other Communication Disorders in 2016, 1 in 12 children ages 3–17 has a communication disorder. Overall, earlier intervention leads to better outcomes for kids.
For more information on private therapy, contact The Speech Studio at (914) 893–2223 or visit our website . A licensed and certified speech-language pathologist can recommend the best course of therapy for your child’s individual needs.