Every child is different, as are their individual needs- so, there is no blanket determination on how much speech therapy children should receive weekly. A question that comes up often is “My child gets speech in school - is private therapy really necessary?” Though the research on service intensity is all over the place (due to all of the variables that come with the large population who need speech therapy!) in the world of therapeutic services, the general rule of thumb is more and earlier is always better. This is based on over 40 years of research, which supports that early intervention is crucial during the early brain development period (before 3 years old) for short- and long-term progress.
School speech-language pathologists (SLPs) and private SLPs achieve the same degrees, pass the same qualifying exams, and are held to the same license maintenance requirements; the biggest difference is the environments in which they work. Three big factors that should be considered when determining your child's therapy plan are case load, service delivery/ individualization of instruction (is your child being instructed in the ways that allow them to learn best?) and parent involvement.
Full Disclosure: I am a private SLP. I will offer my thoughts and personal practices, where appropriate, in the "private SLP" sections below. I worked as a graduate student clinician in a public school for one semester many moons ago; so while I have had some exposure to the inner workings of the school SLP system, my personal experience is limited. The following information is pulled largely from available research in the field, which is linked below!
Case Load: School Speech Therapy
According to the The American Speech-Language Hearing Association (ASHA) 2018 School Survey, the median monthly caseload size of ASHA-certified, school-based SLPs working full time was 48 students, with a range from 3 students to 145 students. This means that in some school settings, one clinician can have up to 145 students to provide speech therapy to and complete all required documentation. This is B-A-N-A-N-A-S! (insert Mockingjay gesture to all my school SLPs out there!) and very impressive to me. SLPs are Super Heroes!
Case Load: Private Speech Therapy
A private SLP's caseload is decided by the SLP! Personally, I try to see no more than 4-5 children per day, in order to leave ample time to prepare materials, complete documentation, track data and confer with parents! (see below!)
Service Delivery/Individualized Instruction: School Speech Therapy
In school settings, SLPs may push into the classroom and co-teach with the general education teacher, pull a small group to a separate area within the classroom, pull out a small group into a speech therapy room, or they could see your child individually. Most often, children are seen in small groups within the school setting. If your child is working on social skills, or presents with a mild language or articulation disorder, small group instruction may be exactly what they need! However, ASHA reports that, “caseload size, rather than student characteristics, frequently influences recommendations about program intensity and/or model of service delivery. Larger caseloads may necessitate the use of service models that are not appropriate for some students and that may affect the SLP's ability to provide Free Appropriate Public Education (FAPE)” as is mandated by IDEA.
This means that in order to serve all of the children who need them, school SLPs are often forced to determine which kind of therapy your child receives and how often they will receive it based on time constraints, rather than what may be most beneficial to your child. If your child presents with a moderate-severe language disorder, attention deficit difficulties, sensory difficulties, or significant speech-sound disorder, exposure to small group therapy may be beneficial to promote social skills and take advantage of group learning activities; however, TheraCare poses that if your child is in a 30-minute group with 3 other children, they may end up receiving about 10 minutes of direct therapy specific to their targets per session. Individual therapy may be beneficial to add to ensure they are receiving intensive and individual attention to their language needs.
Service Delivery/Individualized Instruction: Private Speech Therapy
In private therapy your child receives individual therapy with their SLP. The flexibility of a private SLP's caseload allows for the sessions to be tailored to your child's individual needs and goals.
Parent Involvement: School Speech Therapy
Collaboration with parents and SLPs in the school remains difficult for many reasons, including a) parents are not present in school b) large caseloads of the SLP and c) privacy restrictions on electronic communication. School based SLP’s may send home homework sheets to be completed at home, fill out a communication log to review what was targeted in session, or send out monthly newsletters to review highlights from sessions. Data and progress review are typically reserved for quarterly progress reports and Individualized Education Plan (IEP) meetings, which usually happen annually.
Parent Involvement: Private Speech Therapy
At the end of each session, parents are updated on progress. SLPs have the opportunity to model strategies and activities and instruct parents in a 1-1 setting. Parents have the opportunity to ask questions face-to-face and can receive parent training as needed and requested! Increased collaboration opportunities with their child’s SLP often helps parents to feel more empowered and confident in their ability to help their children at home. Parent involvement has also been shown to enhance outcomes of speech therapy; therefore, this is a big area of focus after my sessions!
To wrap this post up, TheraCare said it best: “Giving your child the ability to receive therapy services in public schools and in a private setting maximizes their ability to make progress early. That means less services will be needed later on, when school coursework becomes more complex. Basically, the more therapy your child receives early on, the fewer services they will need later on! Public school services combined with private sessions makes for a one-two punch that tackles your child’s therapy needs early on.”
For a more visual explanation of differences between school and private therapy models, check out this blog by a former school SLP!
Jackie