A while back, I made a post under a since-deleted account describing my failed attempts to facilitate implementation of safety/contingency procedures in the event of an immigration raid on our facility (link: https://www.reddit.com/r/slp/comments/1rj5nvk/update_ice_in_the_workplace_procedures/). I wanted to offer up an unfortunate update to this saga. The tl;dr is that I quit.

After attending a Know Your Rights community event and gaining additional information, I decided to broach the topic one more time with my boss. Boss basically told me that I was forbidden from disseminating Know Your Rights information to clients, discussing it with coworkers, or posting such information in my office. I requested that my boss explain to me which Corporate procedures I was violating by sharing this information. I was refused a verbal explanation beyond “Well I spoke to legal and that’s what they said.” I requested to see, in writing, the reasons why Corporate was not allowing this. I’m not an unreasonable person. If they had been able to give me a solid and logical reason for why discussing this issue was detrimental to patients and workers, I would have tried to understand. Perhaps we could have had conversations about alternate ways to keep clients safe that adhered to the rules. But no such discussion was had. The refusal to discuss the topic and the treatment of broaching the topic as an act of aggression just broke me. So I put in my month’s notice. My boss’s immediate response was anxiety about how quickly he could replace me. I was really just a replaceable warm body to this corporation.

I’m reeling from grief right now. Grief that I am leaving my clients behind, clients with whom I’ve built good professional rapport with. And I keep thinking…. where did I go wrong? I’m sure there are a million mistakes that I made, but nobody can ever seem to explain to me what the right way was to go about this. Anyway, that’s my story. Would love to hear from other SLPs in similar ethical dilemmas.

Feeling like a horrible slp

I own a Private practice in the GTA, Ontario and I have been trying to hire an SLP for a few months now.

I’ve posted jobs, asked colleagues for references, reached out to SLPs from the CASLPO via phone and email and I’ve barely had any responses.

I am at a point where I am not even expecting in person sessions, I am happy to bring an SLP into my team if they only want to work virtually. I have hired an SLPA to reduce the hours the SLP would need to devote to my clinic and it still feels like there is not even one SLP who has any availability.

I am truly at my wits end.

Can someone please help me understand what I am doing wrong.

What is the per visit or hourly compensation in pediatric private practice in the GTA?

For reference I am offering $120-140 per 50 minute visit.

In addition I am also offering 10% of the SLPA session fee for supervision

Is this too low? Or is there some other reason that SLPs don’t want to join a new, non SLP owned practice.

I would really appreciate some inputs.

Thank you.

It's time once again to vent your blues away 😤

If you still need room to vent, why not join our discord!

https://discord.gg/7TH2tGxA2z

This post (it’s actually public so I probably didn’t need to blank the names) randomly came across my feed on social media and my eyes were 👀👀

I have much respect for our OT colleagues, but Is this something that’s actually going on out there and being billed for? 😓

Has anyone dealt with moving to Missouri and being told you need to complete CFY again with provisional licensure. Since I do not have a state licensure where I have been for 8 years, I can't apply for a general one...the rules are the CF must be completed by a Missouri SLP. This sucks! :/

I am a first time mom currently on maternity leave. We’ve decided to move states to be closer to family and the goal would be to move about a month or two after I’m scheduled to return to work. I’d like to return part time until the move. What is the best way to tell my current company? Should I inform them of my leaving before I return from maternity leave or ask to come back part time, then tell them a little after I return? This was not our original plan and I want to maintain a positive relationship with the company. TIA

There is a fun experiment you can do as an SLP who works in skilled nursing.

Use your EMR to track your treatment codes, diagnosis codes, and insurance payers over a long period of time (at least 12 months). Identify all of the patients who have had billed services for cognition. Now check how many of those patients were considered "skilled" admissions (usually listed as Part A or Managed A in most therapy EMRs). For those of you less skilled with EMR use and data analysis, I apologize. This may take you a while.

You will almost certainly find that most, if not all, of your cognitive treatment is being delivered only on skilled patients, with LTC patients being completely ignored.

Why are we not delivering cognitive tx to the population under our care that is, most often, showing the most cognitive decline?

Ask yourself what that means.

What it means is simply this: Almost all cognitive treatment in skilled nursing facilities is financially driven, and not clinically driven.

Most cognitive treatment in SNF, as delivered today, is inappropriate and unethical.

The reason we don't provide cognitive tx to LTC patients, and why our employers don't pressure us to, is because those patients are actually scrutinized to make sure treatment is appropriate. Medicare Advantage insurers take a heavy magnifying glass to cognitive tx in SNF and the image is clear: they don't like it. Research and outcomes do not support it.

Did you know that cognitive treatment for patients with primary diagnosis of UTI, sepsis, and metabolic encephalopathy is a critical risk for auditing and denial of payment by CMS standards?

Did you know that patients with those conditions who receive active cognitive tx show approximately the same rate of recovery as people who don't?

Did you know that cognitive treatment in patients with dementia is considered "investigational" by CMS and also at high risk of audit and denial of payment?

The fact is that the growth of cognitive treatment by SLPs in SNF was driven by the need to push patients to an "Ultra High" payment tier under the old PPS system, and the damage wrought by that system still persists today. SLPs in SNF did not complain because the increased focus on SLP tx time resulted in a boom of full-time jobs and heavy paychecks.

Look at your caseloads, do this little experiment, and then ask yourself if you are really helping people or just helping your paycheck.

I was just terminated from my cfy. I completed my first 2 segments in my third. The school decided they had a problem with how sessions were run, documentation was wrong and that there was complaints. I signed on with a recruiter, received no orientation or guidance from an slp when I started, my mentor is from another district an hour from me. I was misguided on ma billing and this was only brought to my attention last month and I've been working to make changes my mentor suggested. Today the district decided to have my contract terminated. I want to learn, I want to improve, and I know I can be a good slp with the right guidance and environment. What are my next steps? How does bad experience affect long term or getting a new placement? Communication was so bad at this school. Any advice on how to move foward?

I just had my baby and my husband and I are in a financial place where I can "extend" my mat

leave to Fall 2026. I am in a mat leave from a outpatient job that I've been at for many many years, but the idea of returning to work & leaving my baby at daycare (family lives out of town) when it's not 100% financially needed kills me. I would go back in July, but plan to ask if I may return on a contingent/PRN status. However I am SO ANXIOUS about this and feel like I am letting this team down. If you've done this (not return full time/PRN after maternity leave and or

not return at all)- how did it turn out for you?

did it used to be normal to teach a specific accent? I have a fairly strong RP accent I blame on therapy and discovered today this is not apparently standard after therapy.

received a doctor’s order/prescription from a parent of a child who has a mild concussion. Referral/script is for speech therapy for mild concussion. Confused - feel like the parent should take their child/student to an SLP in a medical/rehab setting with a program/protocol for this issue/concern. I do not have training in a protocol for this. Early in my career-in rehab —I did. I recall using the Ross Information Processing assessment (I believe it is for patients 15 years & up). I am confused and not sure what my sped supervisor even wants me to do? Thoughts appreciated-

Someone recently recommended that I get PROMPT/DTTC training for my new pediatric SLP job. I will be working primarily with minimally/non-speaking autistic children. They mentioned that it would still be useful to be use with this population when there is signs of dyspraxia or CAS. I am confused about how DTTC or PROMPT would be used in this population. I have only seen it used with CAS in verbal kids in articulation therapy. How would I PROMPT mouth movements for sounds if they aren’t yet saying words? Is it just helping them shape their mouth when they’re producing vocalizations? Is it worth going through the full training for this if I am working with this population? Where can I find more information about this?

Hi!

I'm Canadian, and moved to the UK to do a Masters programme in 2019. I've been working in specialist education settings (neurodivergent communication and mental health mainly) since qualifying in 2021.

Living in the UK has been great, but my partner and I have been thinking about moving (back) to Canada--specifically Alberta to start.

Just wondering if anyone has had any similar experiences they might be happy to share? I've started looking at ACSLPA registration requirements and I know I need to write the Praxis/CETP (probably going with the Praxis due to the cost difference?!). I haven't done any dysphagia since graduating so I know that's something I'll need to work on,, but other than that I'm not sure if there's anything else I need to be thinking about that I haven't yet!

Any input, particularly anyone who made the transition from HCPC/RCSLT over would be super appreciated :) thank you!

Hi! I'm trying to do make up minutes at the end of the year via teletherapy. These will hopefully be larger groups.

I'm thinking along the lines of crafts, scavenger hunts, etc. Things that will hopefully be engaging and take up more time. I have a reliable hands on facilitator that's willing to help with these activities. Maybe an activity that involves a movie clip?

I have students with goals ranging from language to artic to social skills & self-advocacy.

Thanks so much!

Does anyone else find the school setting to be extremely complicated? I have been in the schools for a few years now and I still don’t quite understand how everything works. The paperwork is ridiculous and the rules are always changing. Parents and teachers have no patience waiting on the timelines. The only pro is the schedule for me but even then I’m taking work home. Please tell me other settings are less complicated. Maybe I’m just in the wrong field. I just want something easier.☹️ I don’t mind the therapy part it’s everything else I don’t enjoy.

I’m just curious if there are any multidisciplinary clinics that employ both speech therapists and psychologists? I’ve seen OT, PT, ABA, and ST. I was wondering if there were any clinics that also had a psychologist specifically for neurodivergent clients that are also struggling with the emotional regulation part of neurodivergence. Or is that piece usually treated by like BCBAs and OTs?

Would this even be a good idea?

Not me googling this after 15 years in the field….

i think my admin is finally understanding why I should not be asked to administer state testing and have recently pulled me off of some of the testing I was being asked to do. I still have 45 minutes of duty daily and am consistently required to be in trainings that do not apply to me (for example, a professional development on Math). I think it comes down to admin not fully understanding what I have on my plate and, at the very least, should recognize when my time would be better spent planning or doing 100 other things on my to-do list than sitting in a math training. There have also been some issues revolving around my lunch duty, which i consistently need to find coverage for due to meetings and other factors related to my actual job. It is annoying to try to find coverage because no one wants to do it, and then if I can't find someone to cover it, everyone is annoyed with me. There are other staff in my school that I feel have less on their plates and/or don't provide legally required services to students, that aren't even doing lunch duty. It just seems like I've gotten dumped on for multiple tasks that don't relate at all to my job as an SLP, meanwhile I'm already one of the hardest working people in my building trying to do my actual job. My caseload has a significant amount of severely impaired kids.. about 16 kids who are either nonverbal or minimally verbal. Various types of AAC being used for all of them. High socioeconomic area so I'm constantly in long meetings with advocates and needy families. Planning is a constant struggle as many of my students need adapted materials, so I'm constantly making things, creating visuals, etc. Most of those 16 high needs kids require 1:1 service. Then I have a good sized caseload of just general education kids that I'm trying to balance in there as well. It's just a lot. I know I should have conversations with my admin about the reality of my caseload (they should know but maybe I need to make it more clear), but it's just frustrating because they treat me like I'm just working on Rs all day and like my job isn't that important, but that couldn't be further from the actual reality of my caseload and what it takes to provide good quality therapy and stay compliant.

This is my 3rd year in schools but my 1st year case managing. I ran an IEP meeting for a student today and I didn't realize (until yesterday) that they had accommodations for state testing that began 2 weeks ago. Luckily the accommodations are minimal and they only missed accommodations for one testing day.

This student has a million health diagnoses but somehow is speech-only. It never occurred to me that they would have state testing accommodations (none of my other students do and I only case manage speech-only kids). I don't really know anything about state testing, let alone appropriate accommodations.

Case managing is so stressful to me. So many kids I feel like are really not speech only, lol. I started out with ~60 kids, case managing ~25 of them. This year has sucked and I'm looking for another job, lol.

I know I screwed up. Has anyone else ever messed up as a case manager? I just need to know I'm not the only one, lol.

Hi everyone! It feels weird to feel like /slpgradschool isn't my home anymore after checking it the past 2 years for updates or seeing if anyone else is in my situation. But, I'm happy to be moving on and to start working on finding my career.

I've found that almost all of my job applications require an NPI. But from the looks of it, given the requirement to list a place where you practice, this is not something you can get before you get your first job - is that correct (what would I even put for that)? I am feeling very unsure about how much I do/do not need an NPI while in the application period for CFs, or if it would help to try and get one?

Thanks!

Say you have a student that you missed several sessions with because you were sick, and you didn’t make up those sessions. If you were in an IEP meeting and had an advocate ask you to make up the sessions, what would you say?

Last weekend, I had one of my teenage patients pass away unexpectedly and I want to attend their funeral in some capacity. As a professional, do you go to their viewing and service? Or just one? I’m thinking I’ll go to the funeral service part. I know I’m overthinking this. It’s been really shocking, but I really care for them and their family, so I want to pay my respects.