How to choose a private slp who is the right fit

Hey parents...this post is for YOU!

Hi! I am a pediatric speech-language pathologist and a parent of a child with autism and apraxia. My son is now 15 years old and he has taught me so much about my profession! I get frequent emails from parents wondering how to choose a speech therapist for their child. So here is my two cents worth!

When you are tasked with finding a private speech-language pathologist (SLP) to work with your child, it is important to consider 1) professional qualifications, 2) specific therapy approaches that will be used, and 3) personality traits. This professional will be working with you and your child for a significant length of time (months or possibly even years!), so finding the right fit is essential.

FACT 1: The SLP is the expert on communication and swallowing disorders.
Fact 2: YOU are the expert on your child, your family, your routines, your culture, and your concerns. This makes YOU the best advocate for your child! And you play an important role in the therapy process, because the skills your child learns in speech therapy will need to be practiced at home too! My hope is that this post will empower you to find an SLP who will partner with you while helping your child maximize his or her developmental potential.

There are three areas that you need to consider during the interview process when looking for a private SLP. Interview process? Yep! I know that sounds very formal and kind of scary...but it doesn't have to be! Professionals should have no problem answering questions from parents about their qualifications and skills. So here we go...

QUESTIONS TO ASK REGARDING QUALIFICATIONS
1. What is your educational background? Be sure the SLP has a master's degree (either MA or MS) and is certified by the American Speech-Language-Hearing Association (ASHA). The initials after the name should include either MS, CCC-SLP or MA, CCC-SLP (the CCC stands for Certificate of Clinical Competence and it is awarded by ASHA). Some states use speech-language pathology assistants known as SLPAs. These are providers who have a bachelor's degree and must work under the supervision of an SLP.

2. How long have you been practicing? Ask how many years of total experience the SLP has, how many years specifically working with children, and in what settings he or she has worked (school, hospital, clinic, home health, early intervention). Remember, the number of years practicing in the field may tell you something about experience level, but it tells you nothing about therapy style, which can be more important to your child's overall success.

3. How much experience have you had working which children who have the same diagnosis as my child? This level of experience is more important than overall length of time in the field.

4. What additional trainings have you had related to ____________ ?  (Insert your child's diagnosis or primary struggle - autism, apraxia, Down syndrome, stuttering, or cleft palate, for example.) SLPs should be able to provide a list of professional development trainings they have attended. This is how therapists stay up to date on the most recent research available in our field. If an SLP is self-proclaiming expertise in a certain area, there should be proof of extensive professional development related to that diagnosis. 

5. How many children on your current or recent caseload have had the same struggles as my child? It is more difficult to keep therapy skills refined if the SLP only treats a specific disorder occasionally.

6. What resources can you recommend for me to learn more about my child's disorder/diagnosis? An SLP who specializes in a specific area should have resources readily available for parents. (This includes books, articles, and websites that have been vetted by the SLP.)

QUESTIONS TO ASK REGARDING THERAPY STYLE AND APPROACHES
1. What approach do you use when treating ________________ (insert your child's diagnosis or primary struggle). When treating childhood apraxia of speech, for example, the SLP should be using a MOTOR-BASED APPROACH THAT IS BASED ON PRINCIPLES OF MOTOR LEARNING. When treating a phonological disorder, the SLP might be using CONTRASTIVE APPROACHES such as MINIMAL PAIRS, MAXIMAL OPPOSITIONS, or MULTIPLE OPPOSITIONS. (As the parent, you don't need to know what these terms mean right now, but the point is that the SLP should be able to tell you what his or her approach is...without hesitation). Once in therapy, the SLP should be educating and empowering you on the chosen approach because YOU will need to help your child practice at home.

RED FLAG: If an SLP ever says, "We all have the same training so we can treat all disorders" - run the other direction as fast as you can. SLPs have the same degree, but we do not all have the same experience and post-graduate training. Some SLPs specialize in stuttering, some in apraxia, some in pediatric feeding disorders, and so on. Find a therapist who is passionate about, and specializes in your child's disorder. If one is not available in your area, try to find a specialist who can do virtual therapy (called teletherapy) or one who is willing to learn and enhance their skill set by taking professional development trainings specific to your child's diagnosis.

2. Why do you use this specific approach? There should be evidence/research that supports the use of the therapy approach.

3. What frequency of therapy do you recommend for a child with this diagnosis? There really should be no predetermined number. You want a therapist who talks about individualizing therapy frequency based on the child's needs. My goal as a therapist is to partner with parents so that specific strategies are embedded into daily routines at home, reducing the need for intensive one-on-one speech therapy sessions. Here is my mantra: therapy is for teaching the child new skills, life is for practicing them.

4. How long are your speech therapy sessions? Again, this should be individualized based on the child's needs. Some kiddos can handle 60 minute sessions, while others do better with 30 minute sessions.

5. How do you motivate children in speech therapy? Using playful and engaging activities based on your child's interests is the key.

6. Do you encourage parents to participate in therapy sessions? This is really important if you want to help your child make faster progress by practicing at home too.

7. Will you be coaching me on the specific strategies and cues that you use? You cannot help your child if you do not know how to implement the strategies and multi-sensory cues that are being used in therapy.

8. How do you make repetitive speech practice fun? Repetitive speech practice is key for improving speech skills. But pediatric SLPs should use playful and engaging activities to elicit repetitive speech practice without doing boring drill work. You want to find out what those activities are! (Note: Picture cards of speech targets are often used as visual cues to support speech production skills. This is not the same as doing drill work with flashcards in a rapid fire manner.)

9. How do you handle challenging behaviors during therapy? The therapist should identify what the child is trying to communicate by engaging in the challenging behavior. Is the child seeking attention, access to a desired item or activity, avoidance of an undesired activity, or reacting to sensory needs? Here are some strategies that I recommend to address challenging behaviors:

• Be flexible and adapt expectations based on the child's readiness for learning
• Find the child's optimum challenge point so that therapy activities are neither too easy nor too difficult
• Base therapeutic activities on the child's interests and preferences
• Add visual supports (such as a visual schedule, checklist, or a timer) so there are clearly defined expectations
• Provide sensory input as needed to help the child obtain and maintain a ready state for learning
• Pair talking tasks with play-based movement activities
• Temporarily reduce demands and instead focus on connecting with the child through playful interactions until the child is in a ready state for learning
• Select speech targets that are relevant, meaningful, and functional for the child (instead of working on random words from a commercial speech therapy program)
• Use behavioral momentum by starting therapy with an activity the child can do successfully and build off that success
• Avoid using time-out or other punitive responses (this is wasting valuable therapy time) and instead figure out how to prevent the behaviors from escalating in the first place
  

PERSONALITY TRAITS TO CONSIDER
When interviewing potential SLPs, these are some questions to ask yourself.

1. Is the SLP punctual and responsive? Did he/she respond to emails and phone calls in a timely manner.

2. Does the SLP act in a professional manner? Some providers are formal while others are more casual, but they should always be respectful and professional.

3. Is the SLP friendly? If nice isn't a word you would use to describe the SLP...move on to the next person on the list.

4. Is the SLP a kid person? If not...move on to the next person on the list. Personally, I LOVE working with the birth to 5 population and I happily tell every family that I work with about my passion for this age group.

Once your child has been in therapy for a while, here are some other questions to consider to be sure this is still a good fit.

1. Does my child enjoy going to therapy? Speech therapy should be a positive experience for your child.

2. Does my child eagerly tell others about things that happened in speech therapy? This is a good sign!

3. Does the SLP have a positive attitude? Why would anyone stay with an SLP who is a negative Nellie?

4. Am I comfortable asking questions? If the SLP is ever condescending or makes your feel dumb for asking a question, it is time to move on.

5. Does the SLP acknowledge when he/she does not know the answer to one of my questions and then seek out advice/help from other sources? No professional can know all the answers to everything. Hearing your SLP say, "I'm not sure, but let me find out and get back to you" is a sign of a confident but not arrogant SLP.

6. Does the SLP offer flexibility in scheduling to meet our current needs? Flexibility is the name of the game!

7. Is my child making functional progress? If the answer is anything but YES, then it is time for a conversation about what changes will be made to continue moving forward.

Whew! That was a lot of information. I hope this overview was helpful and I wish you all the best in locating the SLP that can help you help your child!