When deciding whether to pursue private speech-language therapy services for their child, parents may wonder about differences between school-based and outpatient/private therapy services. Let’s cover a few commonly asked questions about this topic.
What is the difference between a school-based speech-language pathologist (SLP) and an outpatient/private SLP?
Although some states require speech-language pathologists (SLPs) to hold a certificate that allows them to work in a school setting, in terms of the underlying training and qualifications required to earn a degree in speech-language pathology, there is no difference between school-based and outpatient/private SLPs. Both clinicians are required to obtain a graduate degree involving clinical therapy experience and extensive coursework pertaining to a wide variety of topics related to speech and language development, disorders, and treatment. Following graduation, both school-based and outpatient/private SLPs must pass the praxis exam and complete a Clinical Fellowship Year and are then eligible to hold the Certificate of Clinical Competence (CCC) awarded by our national governing body The American Speech-Language Hearing Association (ASHA). The CCCs indicate that the SLP is credentialed by ASHA and ensures that the SLP is obtaining required continuing education credits and abiding by the ASHA code of ethics.
I’m concerned about my child’s communication skills. Why is the school saying my child cannot receive speech at school?
School speech therapy services differ from outpatient/private services in several important ways that can impact whether a child can receive speech-language services at school. This can be confusing for parents.
An important difference between the two settings (school-based speech and outpatient or “private” speech) is “eligibility” or how the child qualifies for and accesses the services. In a private setting, an evaluation can be initiated when there is concern about any aspect of a child’s communication development. Following this evaluation, therapy services can be recommended if the results indicate a disorder or delay that is below age-level expectations and is impacting their daily life. However, qualifying for school services is a bit more complicated. All speech services provided by the school are available solely for the purpose of helping the student “access” the educational curriculum and function appropriately at school. These stipulations are in the federal law called The Individuals with Disabilities Education Act (IDEA). According to the law, in order to access speech services, the school is required to 1) demonstrate that the child has a disability (in one of the disability categories defined by the state), 2) formally document how the disability is negatively impacting the child’s performance at school, and 3) demonstrate that the child requires "specially designed instruction" to address these needs and help them access the school curriculum. The second component (proof of this negative impact on school performance) is called “adverse effect” and it is key to qualifying for school-based therapy services. If the school cannot demonstrate this adverse effect, it is illegal for them to remove the child from instruction in the general education setting and provide special education services (such as speech therapy).
It’s very important for parents to understand that a child can in fact, demonstrate deficits in communication (such as speech errors) but not be eligible for school-based speech services, because the impairment is not sufficiently impacting the child’s school performance (in other words, the adverse effect is either absent or not significant enough to warrant school services). This is not because the school SLP is trying to withhold services, but instead has to do with the strict eligibility criteria outlined by federal and state law. In fact, a student's communication skills often need to be significantly delayed or disordered to qualify for school-based services. Less severe communication deficits and disorders may not be significant enough to impact educational performance and qualify the child for school services, although the child may in fact benefit from or require speech-language services to address communication deficits.
One benefit of private speech-language services is that services can be recommended before the impairment has progressed to the more severe level that is often required to qualify for school services. Accessing private services earlier (instead of waiting until the concerns are significant as may be necessary at school) can reduce the social-emotional impact of communication difficulties and may reduce the overall time required to remediate the concerns.
My child receives speech at school. I asked if I should get outside speech services as well and I don’t feel like I got a clear answer. Why?
This is a tricky topic and a very important one. It is imperative that parents understand “how the system works” in this scenario. However, based on my experience, most parents don’t understand this aspect of the system nor are they aware of how it may impact the answer they receive in response to this important question.
The first element that is critical to understanding this issue is that the school is required by law to provide adequate speech services to help a child with an identified disability access the curriculum. (Remember that IDEA law we mentioned earlier? Same law here.) Because of this, if a school employee indicates that your child needs more speech, it could be legally interpreted as “the school is not providing ENOUGH speech,” and that could get the district in trouble with regulators, because if the child NEEDS more speech, the school could be required to provide it. This means, if a district employee suggests that school therapy is not enough, or a child needs more, the district could be on the hook to pay for more therapy.
The second very important element to understanding this issue, is that by law, the school is not required to provide intense services to maximize progress. The school is only legally required to provide enough support to help the child access the curriculum and demonstrate “adequate” progress. As one supreme court judge controversially put it: schools are not required to provide a Cadillac when a Chevy will suffice. This doesn’t mean that school therapy is watered-down, or not quality therapy. It just means it will likely not be the same level of intensity that a private setting is able to provide. Although we may disagree with this aspect of the educational system as professionals and parents, we nonetheless need to understand how this component of the system works so that we can make informed decisions.
I think it’s important to emphasize: the school SLP is not “the bad guy” in this scenario! It’s crucial to understand that school SLPs are often bound by district rubrics that govern how many service minutes can be provided based on the severity of a student’s speech needs. Further, when determining these minutes, school SLPs are only allowed to consider needs related to a child’s educational needs. This is an important distinction from the way a private SLP determines therapy needs. This is crucial for parents to understand because this does not mean that a child could not benefit from additional services outside of school. Again, I have to emphasize: this is not “school SLPs being stingy with services"; this is how the special education laws are structured. And while this legal standard may be a less-than-ideal educational benchmark, at the end of the day, it’s important for parents to understand the constraints school-based therapists face that impact therapy services (such as minutes guidelines, heavy caseloads, large group sizes, and schedule limitations) so that they can determine whether their child really would benefit from private services in addition to school services.
So how do you know if your child really would benefit from additional services? Listen carefully to how the school SLP answers your question. If the SLP points out that the school services your child is receiving are sufficient to support your child’s progress at school and are helping him/her access the curriculum, but stops short of saying no additional services are recommended, your ears should perk up. The SLP may say something like, “While I do think Johnny is getting what he needs at school, if you would like to seek out additional services, as his school SLP I would support that.” Or, “If Johnny, was my child, I might consider seeking out additional ways I could support him.” Or even, “If you are concerned about Johnny’s speech outside of school, you might want to mention it to his pediatrician or reach out to a private SLP.” Each of these answers might be a subtle way that the school SLP is indicating that although school services are helping your child’s progress at school, it might be worth investigating whether additional services could be beneficial to further support your child’s development.
Any person who has experienced special education - from either the parent or educator view - will tell you that the system can be difficult and confusing to navigate. The truth is, school therapists are not in a position to control how the special education system itself works. They are often bound by many factors beyond their control, including federal and state law, eligibility requirements, and district policy. This particular issue is an example of how both dedicated school therapists and well-meaning parents can be put in a tough position by the way the system is structured. Ultimately, if you are unsure whether your child would benefit from private services in addition to school-based services, seeking a second opinion from a private SLP can be helpful.
My child doesn’t qualify for a speech IEP but the school SLP says she/he can see my child “informally.” Is this enough?
Due to the strict eligibility criteria for accessing services, one way that schools have been able to provide help to more students is by utilizing an intervention framework called RtI or MTSS. These intervention programs are designed to give struggling students a boost of help to see if their skills can be improved by a short period of intense support without having to go through the full IEP process. In some districts (although not all), SLPs are allowed to use this informal framework to help kids who would ordinarily not qualify for services and give them just a little extra help.
Informal services can be a great way for students to receive a little extra support but there are some cautions parents should be aware of:
Informal services do not have the same standardized documentation requirements as IEPs. The paperwork involved in informal services will vary from district to district and sometimes from school to school. You may or may not receive updates about your child’s performance. In addition, if a new SLP takes over the following year, there may or may not be a paper trail to detail what your child has been working on and where they left off.
The therapist will likely use an informal screener of some kind to determine what your child needs. A full evaluation will not be performed because, without the “consent to evaluate” (an official step in the formal evaluation/IEP process), it would be illegal to test your child. Informal screeners are not “bad,” they can be very helpful, in fact. But they will not provide you with detailed, standardized scores and information about how your child is performing with regard to age-level expectations.
Informal services are not legally binding. Therefore, if the services are missed or cancelled, they may not be made up.
Informal services should only be used for a short period of time and should not be continuing year after year.
School SLPs are some of the warmest, most caring people I know. They want to help as many children as they can and informal services can be a great way for them to help more students. But school SLPs are also some of the busiest, most over-scheduled educators I know and their ability to provide consistent, effective informal services is often dependent on whether they can find time to squeeze the extra sessions into their already packed day.
If your child is receiving informal services, and after a few months progress is not being seen or services are not wrapping up, it may be advisable to seek a private consultation or evaluation to determine whether formal, more intensive private services might benefit your child.
So there you have it: some of the most commonly asked questions about school-based and private speech-language services. I hope this was helpful! The more you know, the better you can advocate for and support your child!
Jamela Robson, MA, CCC-SLP/L is a licensed and certified speech-language pathologist. She is the co-founder of Marigold Pediatric Therapies in Crystal Lake, Illinois. Jamela has experience working in both school and outpatient settings. She is passionate about helping kids communicate and believes that all healthy learning is rooted in connection and love.
*Disclaimer: This article represents the personal experiences, perspectives, and opinions of the author with regard to the topics discussed.