Blurred Lines

I feel the strong need to preface this post, mainly because I suspect it will anger many people. However, before you get too angry, please read all the way to the end…and then if you want to comment – walk away for a few minutes before you hit send. I’d love a discussion, but don’t really want a debate, and I won’t argue. I’ve been considering this post for a while and I’ve resisted it for a couple of reasons. One, I’m not sure I’ve fully considered all aspects. Two, I’m not sure I have a solution (and I hate to be a part of a problem with out a solution). And three, the alternatives suck. If that hasn’t scared you off…  paperworkLike many SLPs, I receive emails from the American Speech Language Hearing Association (ASHA) announcing the need to support various lobbying efforts they are doing on our behalf. The latest one was regarding adding language in the Student Success Act (which would replace No Child Left Behind) to include using “specialized instructional support personnel (including audiologists and speech-language pathologists)” to have an expanded role in teaching reading curriculum in schools.

Lurking on the Facebook pages, I often see SLPs asking questions about social cognition, social thinking, executive function, literacy, reading, etc. Yet, many schools SLPs are no longer allowed to work on articulation errors. This made me think…are we, as a profession, over-reaching and diluting our effectiveness? Have we stepped up to the place and filled in gaps? Or have we stepped on toes and crowded other professionals?  If we look at the ASHA Scope of Practice for SLPs, we are able to address and serve (never service, that’s illegal in most states), the following areas:

  • Speech Sound Production (articulation, apraxia, dysarthria, ataxia, dyskinesis)
  • Resonance (hypernasality, hyponasality, cul-de-sac resonance, mixed resonance)
  • Voice (phonation quality, pitch, loudness, respiration)
  • Fluency (stuttering, cluttering)
  • Language (phonology, morphology, syntax, semantics, pragmatics*, literacy*, prelinguistic communication*, paralinguistic communication)
  • Cognition (attention, memory, sequencing, problem solving, executive functioning)
  • Feeding and Swallowing (oral, pharyngeal, laryngeal, esophogeal; orofacial myology including tongue thrust, oral-motor functions).

*The list further breaks down pragmatics to include language and social aspects of communication; literacy as reading, writing, and spelling; and prelinguistic communication as joint attention, intentionality, and communicative signaling. There is a whole list of potential etiologies of disorders that we may be involved with that includes everything from birth to death.

These are all important elements – and I’m in complete agreement that they are all vital. They are all things that we, as SLPs, are uniquely trained to support.

But the question has to be asked…Are we the best person to support them? Are we the only people who can support them?  

Let’s take reading. Now, please don’t get me wrong, I’m not saying we shouldn’t work on reading. I am saying, we need to look at if we are the best person to work on it.  Would a child be better served by an SLP or by someone who is trained specifically to work on READING strategies, skills, etc. I don’t know about all programs, but I can tell you my grad program did NOT prepare me to teach reading. Yes, I learned about the importance of phonological awareness and I learned different strategies for helping with reading comprehension. We even had a whole course in adolescent literacy…but not once did we learn about how to TEACH reading skills. I am many things, but I am not a reading specialist. I cannot teach a student WHY some words end in “ck” and some words end in “k” or why a “C” says /s/ sometimes and a /k/ other times. Could we  be harming those students if I insisted on taking them on without adequate training. Could I get training to be able to do that??? Sure… but in the meantime, wouldn’t it be better to let the reading specialists actually work with those kids?

Social skills…Again, yes…I acknowledge that social skills are definitely a form of communication and I work on them with every one of my kids (not just those that are diagnosed with a social skills disorder). Am I the only one in my school who can work on those? Absolutely not. SPED teachers are also trained in how to work with social skills training. Is it the same? No…and while some kids would be better served by me – some would be better served by the SPED teachers. If a student has an emotional disorder and is already seeing the SPED teacher for supports – why not let them continue with the social skills training as well? They are qualified.

Executive Functioning…is certainly not only the jurisdiction of the SLP. Imagine how many kids could be helped if *gasp* the classroom teacher helped with EF skills…or the SPED teacher. I have yet to see a single student (and many adults) who wouldn’t benefit from some EF skills support.

Response to Intervention…don’t get me started. Yes, I recognize that we are in a unique situation to help (and I do a lot with RTI)…but for many SLPs, students that are helped through RTI are not recognized as being on a caseload/workload and caseloads are not adjusted accordingly…so it’s entirely possible to have a caseload of 70 or more and still be expected to do RTI for another 10-30 students (can you say ludicrous? I knew you could).

I recognize that SLPs are a helping profession. We see a problem and we want, desperately, to help…and I am right there with you. I know that’s how I am. I tend to get protective of my kids and, I have a really hard time letting someone else help (because we all know we can do it better…except when we can’t). But…perhaps…it’s time to start saying no. To letting others pick up the slack and let those specialties shine. Maybe…just maybe…there’s someone who can do it just as good…and we can focus on someone else.

In so many ways, we are our own worst enemies. Not only do we not advocate for ourselves (hello janitor’s closet!), we don’t advocate for our students (how do you effectively work with 80 students?). Are we (and this is a true question, I’m not passing judgment), hurting ourselves (and our students) by over-reaching our scope of practice and not allowing others to help?

With the increased need for EBP, research practices, etc. we must be careful with how we allocate our time and services. Of course we want to help everyone, at least, I know I do. But, just like being on a falling plane and putting your air mask on first…we can’t help others if we don’t help ourselves first. If we continue to take on more roles, increase our scope of practice, without the proper support, we will burn out and be of no use to anyone.

A recent discussion with some university faculty shed light on some things for me. We have moved from being articulation and language specialists, to being a jack-of-all-trades. Our expected skill sets have moved beyond what can be reasonably taught in a master’s program. Yes, we have the basics…we know what it all is…but we only touch on a small part of the skills necessary for many of those expected roles.

Universities expect students to learn those skills during their externship or on their CFY…but in some areas CFYs are (largely) unsupervised. Some states don’t require SLPs to have their CCCs and therefore don’t offer a CFY necessarily.

Those elements that are in our scope of practice are critical. I know that. I know that in many schools, we are the only people who are willing (or able) to step up and support those skills. But, where does the line get drawn? If we are so busy working on reading, EF, social skills, and RTI that we can no longer support basic language development and articulation skills – have we really made anything better? Are we in danger of phasing out the Speech-Language pathologist and introducing the class tutor with a master’s degree? Are we violating our Code of Ethics when we take on a role, even if it’s in our scope of practice, for which we are inadequately trained?

In all honesty, I don’t know what the answer is. I’d love to hear your thoughts on this issue. Please, leave a comment.

Until then…Adventure on.


59 thoughts on “Blurred Lines

  1. I couldn’t agree more with this post! For me, it speaks to the need for more specialist recognition/training if this is the direction we’re continually headed in.

    • I would love to see more specialist training…BUT, there has to be someone who sees the whole picture. Have we specialized ourselves so much that there’s no more gestalt effect?

      If we look at it as doctors – we go to a general practitioner for our “every day” needs – because they see the patient as a whole. Specialists will state – check in with your family doctor so they know what’s going on… It’s because there has to be one person who sees that person not as a heart, or a pancreas, or a kidney…But as a person. There still needs to be those specialists – goodness knows if I have a heart attack I want to see a cardiologist…but there is still very much a need for that general practitioner as well.

      But who is the general practitioner in our field? Who are the specialists? Where are the ethical lines for treating a specialty disorder in a generalist manner?

      In an ideal world, we would have those skill sets to be able to see an individual as whole – and the time to treat that individual as whole. But we don’t live in an ideal world.

  2. I don’t see how this post could anger anyone, Mary! I am in full agreement and have fortunately worked in school districts where they would never expect the SLP to teach reading or even work with it at all, even though I know it falls under our umbrella. The special educators do that, as well as writing, because if they didn’t they’d only have math to do! (If there was a reading specialist, all the better, but I found those only in well-off districts.) We have so much on our plates already, I can’t imagine trying to do it all. I totally agree that we should stick to those areas that only we are distinctly qualified (and experienced) to address and leave the others to other people who can do them just as well (and sometimes better) as we can. Social pragmatics are usually easily incorporated into therapy sessions and often addressed by the school guidance counselor and/or psychologist as well. I would never take on an area I didn’t feel qualified to treat, even though I may have had training in school for it. We tend to gravitate toward our preferred areas and then gain knowledge and experience in just those areas. I am always upfront about not being comfortable addressing a certain issue and everyone has always been accepting of that. It’s important to educate people about this so that they don’t think you CAN do it all. On the flip side, I’ve found that people are usually surprised to hear about all the areas that we can be responsible for! I see specialization in the future as well, even though it’s happening on an informal basis now.

    • Thanks Pam. I’m usually surprised at which posts make people upset and which ones are accepted.

      Good point about how if SPED teachers didn’t work on reading they’d only have math (and how many students have math IEPs? Not many in my school!). 🙂

      We are amazing in what we do and how we help our students. I don’t want to see that amazingness diluted or stagnated.

  3. I COMPLETELY agree with you on all accounts! In my school system, we have Literacy Leaders who work with the students on reading. We view our role as working on the skills needed to attain the reading skills, but I am not a reading teacher, and do not have the certification to work with reading. And the social skills: My school system started “social groups” through a grant, but I didn’t participate since I already had students on my caseload who have social goals. At the ASHA convention, a coworker & I attended a presentation on that subject. We looked at each other and questioned whether that was something the counselor should be doing.
    I’m hitting “Post Comment” now…I don’t have to walk away and think about it! 🙂

    • I’m glad you didn’t have to walk away 😉

      What started my thinking about this was discussions with so many SLPs who seem to specialize in some great areas (and I was jealous) and then thinking wow…there’s no way to do that in the schools and not have a caseload of dang near every student enrolled.

      While I agree they are all skills we could treat – I’m not sure I’m the best person to do them all.

  4. Reading those advocacy e-mails from ASHA made me think the same thing. As I read it, I thought… “Wait…. why am I supporting this again?” Reading is such a huge area with lots of kids who need services… that is why we have reading teachers and SPED teachers. Let them do their jobs! We have more than enough on our plates. I think it is better to advocate for our profession by promoting the things we do well that others are not qualified to address.

    • as I read your comment Erin, I was struck with…perhaps administration would actually know what we do if we didn’t have our fingers in every pot in school.

      Like I said, I’m not sure what’s the right thing to do.

      • You make a really good point about how administrators have no idea what we actually do on a daily basis.

  5. Mary, this is excellent! Thank you!!! Please join us in the @Purposely Rebranding Speech-Language Pathology facebook group. This is one of the many problems we are trying to combat and we could use you there. Someone posted the link to your article there 🙂

  6. Additionally, this is starting to lead to feelings of inadequacy for me. I can’t be an expert in every single aspect of communication – especially when schools expect you to also learn how to be a “teacher.” They don’t leave you any time to gain expertise in our own field.

    • I definitely understand those feelings. I keep telling the staff at my school – I am NOT a teacher. I don’t know the first thing about grading, or teaching an entire curriculum. The only “teaching” course I ever took was my second semester of college I took a “how to teach secondary math” because I *thought* it would get me out of the math requirement for my bachelors degree. It didn’t. It didn’t prepare me to teach either.

      I have utmost respect for teachers – they work with the same kids all day every day and I’m not sure I could. They are generalists and when the kids don’t “get it” they need someone to turn to – a specialist.

  7. I just retired and struggled with this a long time. The way I handled it was to look at my school personnel. For a long time- no one did phonological awareness. Then I did it. But then the reg Ed teachers and special Ed teachers got trained. I stopped. Social skills were addressed in social worker and psychologists groups. I stopped those- except for the kids that needed the specialized skills I could offer. There were many. I still took artic and stuttering kids. The problem was what to address in each student because they needed so much. I think this is a problem we all have to figure out for ourselves.

  8. I agree with you completely!!!!!!! After 18 years in the field as the sole SLP in a small rural corporation, there are days that I feel soooo stressed due to being pulled in so many directions. Too many kids, too many disabilities, too many diverse areas of need—-ALL of which I am supposed to be the expert. While I love working in the school system and with the kids, my services are getting watered down because there’s too much for 1 SLP to know! Whenever I hear that ASHA has expanded our scope of practice, I must admit, that I just tend to think, “Sure, I’ll get right on that just as soon as I’ve provided quality therapy to my current caseload of 85 kids and can learn it in my free time.” (Hope my sarcastic tone can be inferred). I think it’s sad that many SLPs are not allowed to work on artic in the schools nor are some grad schools teaching how to do artic therapy in some places. If we don’t fix SPEECH anymore then why am I Speech-Language Pathologist? Seems like we need to increase our title to Speech, Receptive/expressive/pragmatic Language (oral and written), Voice, Fluency, Aural Rehab, Literacy, AAC, RTI, hearing Pathologist! I think I need a bigger badge. Sorry for the rant but your post hits a nerve with me and I totally agree with you!!!!

  9. I’m going to come in on the other side … While I agree the scope is getting so broad it feels vaguely ridiculous (will we need to go to grad school for two years general plus 1 year specialization?), I’m glad to have SLPs’ knowledge recognized for the help we can give in literacy. I don’t want to TEACH kids to read at school, but I would like to help with the knowledge. As many, many teachers have learned only whole language reading approaches, they are often stumped when a child struggles and they need phonological/phonics support. Even many special ed/reading specialists don’t learn about the sounds of language. We can help with that, and I do, whenever I’m asked. I had a teacher mention she couldn’t figure out why her student was putting a vowel on the end of the letters d, g, and b when he read. I was able to tell her those are voiced consonants and he was probably reading them as “buh”, and suggested she work on him saying just “b” without the vowel sound attached. How many teachers/aides do I hear saying letter sounds that way?!? Many. So, if we can be at the problem solving table when these literacy-related struggles are being discussed, we can shed light. But if we’re viewed as just the oral language people who sit in the broom closet, schools are missing out. Again, not as teachers of reading, but as experts in language who have something to contribute to the science of reading.

    • I agree. I’m not saying we shouldn’t be involved – I’m not even saying we shouldn’t teach reading. Really, the intent of this post wasn’t even about reading (although that’s the catalyst that prompted the post) the intent was to ask are we generalizing SO much that we are losing the effectiveness of our skill set. Have we generalized SO much that our caseloads have grown to the point where we can no longer do the work that we alone are trained to do?

      I agree completely that we should support reading and literacy. I also agree that we should offer support with EF, Behavior, social cognition, etc… But I don’t think we can be the only ones doing it…and sometimses, we have to acknowledge that others are more qualified to do it than we are.

  10. I have worked in the schools for 13 years and agree with much of what you say Mary. We can be a jack of all trades, but as the saying goes, we become a master of none. My school system SLPs do not teach or work directly on reading or writing instruction, but integrate and support both in therapy. You hit the nail on the head with your comment regarding SLPs not being the only resource. For our kids to succeed (especially kids with social language impairments), everyone they work with needs to be on the same page and supporting these skills as a team. It cannot just be the SLP. Thanks for sharing your thoughts!

  11. This is such a thought provoking issue. When I saw the post on ASHA, I cheered, because if we even mention the word reading in a motivation for health care benefits, the providers throw it out and tell us we are not there for teaching reading. However, I have so many kids on my caseload with phonological awareness issues who do not learn read because of it. So we cloak our motivation in the guises of phonological memory, phonological awareness and language terms in order to obtain benefits for these kids. I wish there were reading specialists int he schools to take the load off us, but ultimately the remedial teachers do not have an in depth enough knowledge of underlying phonological skills to facilitate reading in kids with difficulty. Perhaps it is because I have done a PG in remedial and have an understanding of the fuzzy lines that I feel that it is our role as SLPs to cover this issue, particularly when the difficulties are based on poor phonological skills.

    • Thanks Nikki. It’s always good to remind myself too, that not every school has reading specialists…and unfortunately, some reading specialists aren’t effective.

      For me, I’m not trained in it…there are people who are better trained in it. If I were the only person working on it, the kids would be at a disadvantage. Could I get trained in it? Absolutely if I wanted to pay for it myself (my district would not pay for it).

      You say the remedial teachers don’t have the necessary skills. Do all SLPs? Would more people be served if the remedial teachers were trained which would free up the SLPs for things that only SLPs can do?

      Like I said, I don’t know what the answer is. There are some situations where we are the best option…there are others where we’re not.

      All I know is that our scope in the schools continues to get wider with less training and the SLPs are paying the price with huge caseloads…ultimately the students are paying the price as well because they aren’t getting the specialized help they need.

    • I hear Nikki pointing out that she is filling in the gaps that the school system is not filling – reading specialists who are appropriately trained. I can appreciate that need.

      However, the solution to that need does not have to be “SLPs doing everything for everyone, again”. The problem is systemic – not all schools have the appropriate staff. The solution needs to also be systemic – FUND schools and TRAIN the reading specialists! Simply taking a piece of someone else’s workload and putting it on our overfull plates only enables the problem to continue. It does not solve it.

      Individual SLPs should continue to fill in gaps that may exist in their schools, but ASHA should be advocating for appropriate, systemic change. Not pushing policies that make the problem worse.

  12. Yes, yes, yes! This has been a concern of mine for years now! There are times that our scope has been diluted so much, that we can no longer serve the students who require help from the SLP, and the SLP only. When my district talked about no longer doing articulation therapy for students with one or two sound errors that were otherwise doing OK in the classroom (regardless of adverse attention they were drawing) in favor of us doing more RtI or working with reading/writing, I was very upset. The sped teacher or language arts specialist can help those students struggling with reading or writing, but the SLP is the only one who can work on articulation. And yes, that 4th grader who says “wabbit” but is in the Gifted and Talented program might be doing fine academically, but will probably be harshly judged by future employers when he is 21 and still can’t pronounce his /r/ while in interviews. If SLPs can focus on the areas that we are uniquely trained and specialized in, it will help to keep caseloads down and we will be able to provide our students greater and more intensive therapy, and making it more likely that they will progress faster. Every time I catch wind of increasing our scope of practice to include something else, especially something that another provider already works on, I see my caseload ticking up another few notches. Thank you for writing this article, and know that you definitely are not alone in your opinion.

    • I cringe (and cry just a bit) every time I hear of SLPs no longer being allowed to work on articulation. The argument is often “it’s not impacting academically” and “they can always get private practice.” Which to me feels like a huge cop-out. We need to advocate better for ourselves, our roles, and our clients.

  13. THIS.

    This is the post that has been bouncing in my head for YEARS. I say this exact thing all. the. time.

    In order to be specialists in some areas, SLPs need to NOT be “specialists” in all areas. Our field needs to have an edge, and we need to start trusting other, actual experts to do their jobs. Reading, executive functioning, social skills, pragmatics… The list of things we have stolen form other fields goes on and on.

    Basically, all the things you already said. 100%!!!

    ASHA’s position on this topic has been frustrating me since the day after I finished grad school. They are actually making this issue WORSE! Reading the position paper on SLP services in schools is a nightmare. It’s a perfect example of exactly the problem you address here.

  14. 100% agreement with you, Mary, and with Autumn, too. I am the only SLP in my district serving kids from age 3 through the 8th grade. I can’t do everything and if I am expected to by ASHA then I won’t do ANYTHING well. This leads to the inadequacy feeling.

  15. I completely agree! While there are many other professionals who can address other areas such as literacy, the SLP is the only one who can address articulation, phonology, fluency, and language issues. Of course, the SLP certainly could incorporate those areas while addressing communication. It is mind boggling that SLPs are being told not to work on articulation, but to focus on literacy, as if the two aren’t connected. The SLP is truly becoming the “Jack of all trades” but the master of none. Thank you for having the courage to speak out on this!

  16. Hi Mary, I completely agree with ALL of your points. Pragmatics is something that must be addressed 24/7, not 20 minutes 1-2x/week! Pediatric feeding and swallowing is very different than working with adults on the same skills and most of us were not trained for it. Removing articulation tx from our list of tasks will result in a major dis-service to students. I could go on and on. I’m a 31 year SLP and am very concerned about the future of our profession for the reasons given as well as the workload/shortage concerns. Thank you for writing this! Tracy W. Morlan, M.A. CCC-SLp GoldCountrySLP

  17. Hi Mary, I wanted to let you know that I am in full agreement with your blog post. I am new to the profession and have been working for two years, but I already, at times, feel overwhelmed with the scope of what we are expected to do. It is impossible to be an expert in everything and right now I feel that SLPs are spread so thin among various types of disorders (pragmatics, literacy, etc.) that we are not able to truly become an expert at anything. I also find that teachers can sometimes expect us to be a quick fix and not put in the time to also address the issues at hand. When I am willing to train a teacher to help the child I find that some are open and some are not, but even those who are open to it do not find the time to utilize what I have taught them about their students to help them throughout the day. I, personally, do not feel that literacy is our main area of expertise and was under the impression that the title of a reading specialist was just that. Unfortunately, my school district does not have anyone with that title. It is difficult to feel effective when you are trying to juggle so much without support from other school professionals taking a more active role in their students development and intervention, no matter what the disorder at hand.

    • Excellent point Tara that teachers sometimes expect us to be a quick fix. I find that often, they view us as a way to get out of working with certain children (particularly those who are challenging). Does your school have a Title I teacher? They are typically either reading or math specialists.

  18. I agree completely!! When I read that e-mail from ASHA my first thought was “MORE?! I can’t keep up with what I already do and now they want me to take on more!” I actually wanted to call my legislatures to tell them NOT to vote for this because we can’t provide any more services. I am happy to collaborate/consult with the SPED teachers and reg ed teachers to make modifications/accommodations for students but I can not take on any more direct responsibilities with students. I already feel like I’m not able to provide all of the best practice services/activities to support my students in the general curriculum that ASHA recommends, how can I possibly do more? This feels like a public relations move – “See all the things we can do. You can’t cut funding for our services. We can do anything.” But more and more I feel like the guy on the old Ed Sullivan show (see how old I am!) who would spin plates on the top of long poles. At first he could keep 4 or 5 plates from falling but after a while, they all fell because he couldn’t get to all of them often enough to keep them spinning. My students are starting to “fall” because I have too many plates spinning and I can’t give them all the attention they need and deserve. I understand that many districts, especially smaller or rural districts, do not have reading specialists but if we say that we can do that job, that lets those districts off the hook to hire someone trained in that field! They can use their SLP as a reading specialist and get two for the price of one. Except that they’re not. And we feel like failures because our services are stretched so thin that no one makes progress.
    Great piece, Mary! Thank you for posting it!

    • I had that same thought Karen! I actively oppose the position ASHA has taken on this issue, and am not pleased that they’re pushing it through. OBVIOUSLY they have not asked the school-based SLPs in the trenches what we think!

      • They never ask us what we think. As a school slp, my entire 16 year career, I feel ASHA has never been there for us. I really resent having to send them money every year.

        • They definitely rely on their volunteers and people doing things like peer-reviewing ethics, etc. Have you had the opportunity to do any volunteering for ASHA or your state association? It would be interesting to know how they figure out what should and shouldn’t be in our scope of practice…and for just one year, I’d love to see a focus on anything other than medicaid caps. I get so tired of reading those (I know they’re important, but they don’t apply to me so I’d love to see a shift…for just a little while).

  19. Oh goodness Yes!!! Amen and amen! I agree totally. Sometimes I feel like we, as a profession, have tried so hard to make sure we have a place and are needed that we have taken on too much. Glad I’m not the only one!

  20. Thank you very much for your post. I work in a district where the speech pathologist do not directly work on writing or reading. And in terms of social skills, I try to figure out who best can service the student. As you spoke of, sometimes that is the special ed teacher. Sometimes it is the counselor. I do not work in a district where our license specialist in school psychology work directly with the students at all.
    I was thinking the same thing when I read the information from ASAH. I am already stretched so thin, I couldn’t imagine taking on another area to address with students!

  21. I completely agree with this ! I have been asked to teach reading intervention. I went along with it for the first year but I realized I had no idea what I was doing and my 50+ kids with IEPs were losing good quality time to be served in speech and language goals. Thankfully I had a coordinator to advocate on my behalf. I think you are right, we love to help and quickly get taken advantage of at times. Another thing is teachers and administration in the school do not have a clear understanding of what our job actually is. Many of the things you said I have dealt with over the past few years!! Thanks for sharing !!

  22. I will start by saying that I am not an SLP. However I do teach special education and work very closely with my SLP. This is a great post and I completely agree. Every year when we transition students into our middle school from elementary, I switch their writing goals over from the SLPs responsibility to mine. After all, I went to school to learn to teach writing and I want to teach writing. It’s great that the SLP still incorporates writing into her groups, but I take on the instruction part. And every year there are several referrals from general Ed teachers for special education and before testing has even occurred, parents are told that the student could benefit from auditory processing services from the SLP. It’s become their way to shove a child into SPED because they don’t know how to teach them, and they don’t want to take time to make the needed accommodations. So on top of doing and teaching all those things you mentioned, the SLP also gets stuck with the kids that the teachers don’t know how to work with. And like someone mentioned in a comment, the administration has no idea what the SLP even does every day. It’s a lot to take on, especially when most of the SLPs in our district only work part time. Great post!

    • Thanks for the input. As an SLP I have no problem working on reading and writing supports – I want to reinforce what the specialist is teaching them. If it’s me teaching them – fine…if it’s a true reading specialist even better. Collaboration and cooperation is key to helping those students who need us.

  23. I agree with your thoughts! In my district, money and funding are the bottom line. The administration wants my caseload to be maxed as they receive money per child with an active speech IEP. No matter what the disability area, we have to stand our ground on not increasing our workload while maintaining a high caseload. We can barely provide adequate services now! I foresee lots of lobbying to adjust, or maintain, our current state and federal Regs as things begin to change.

  24. I 100% agree with you! Some SLPs I know have gotten themselves into things outside the usual scope of speech/language toward reading and writing, and I’ve always felt like maybe I’m lazy feeling like that’s too much. After reading this, I feel more like it’s me advocating for what is in our scope. Thanks for a lovely post!

  25. Totally agree! Our district was losing SLPs due to moves and retirements, and the positions weren’t being replaced because of budget-cuts. My caseload was approaching 70 (in addition to 12-15 being monitored through RtI. Something had to give, or I was seriously considering finding another job. On the advice of our SpEd director and approved by the SLP at the state level, I carefully combed through IEPs to look for overlaps in goals between SI and other SpEd classes. It was initially a difficult pill to swallow, admitting to myself (and others) that I’m not the ONLY professional trained to work on reading comprehension or grammar. After meeting with the IEP team, fellow teachers and parents determined that many of the students on my caseload could be dismissed from SI and get the intervention they needed in the SpEd and RegEd classrooms. We simply cannot do it all. Whittling down my caseload allowed me to provide more quality therapy to those who remain.

    • I think that’s the main issue. In the time when most SLPs are seriously overloaded in schools – we need to be prepared to … triage… if you will, those students who need our specialized help the most. If the reading specialist can see a student – which frees me up to work on artic with a student – all the better.

      The Scope of Practice is a wonderful thing – and it allows those practitioner that are in Private Practice, Clinics, etc. be able to do what they want to do – and specialize. I’ve heard from many SLPs who LOVE to teach reading and have specialized in it – which is great. But to expect the school-based SLP to do everything in that scope is a bit more challenging…and we really have to figure out if we’re the best person to do it. Sometimes we will be. Sometimes not. Like you said, sometimes it is a bitter pill to realize that we’re not the only one that can help…(or even the best one TO help).

  26. Hey Mary, I think you are right on with your thoughts about this issue. This issue comes up a lot with the Special Day Class population in my district. If a child is being placed in an SDC, then we are saying that the child needs the most restrictive environment to be successful. We are also indicating that those classrooms have trained professionals to embed language rich environments all day long. This is the same with our emotionally disturbed classrooms as well. The educators are provided emotional/behavioral support all day long. This does not mean the SLP needs to be an added service provider to meet that students needs. We can probably best used as a consultative model to help the teacher engineer their classroom. The problem that I find is convincing the IEP team (parents, educators) that sometimes the best approach doesn’t always include direct speech services. Serving students also looks differently depending on the least restrictive environment. One solution to help minimize this problem is to be given a manageable caseload and begin working with professionals to show them that the student may not be benefiting from pull out services….it takes a long time to transition students off services that could be best met in the classroom environment. So an added problem is finding time to go above and beyond to help support the teacher during that transition.

  27. Bravo! Scope has gotten completely out of hand. I wonder if it is due, in part, to the need for SLPs to feel themselves as “part of the team” rather than just ancillary support. At any rate, it’s important to clarify what we are able to do in the time we have available for each student. Again, thank you for your statement.

  28. As a practicing SLP in the schools, I am in favor of SLPs taking on more of a role in literacy instruction. We are the language experts and are the best discipline to teach in this regard. Language encompasses the areas of phonology, morphology, pragmatics, semantics, and syntax. In literacy instruction, phonemic awareness/phonics, fluency (speed,accuracy and expression), vocabulary (semantics) and morphology, and comprehension are the main areas identified by the international literacy association as the areas for comprehensive literacy instruction. In addition, oral language and literacy development have been found to be highly correlated with oral language at the core of literacy instruction and again, we are the experts in oral language development. In addition, our understanding of suprasegmentals also add to our ability to provide literacy instruction as we are trained in remediation of difficulties in this area and reading with expression is a significant part of reading instruction.
    As far as articulation therapy, I feel that articulation therapy is important to literacy development as well. It is often those children that experience articulation/phonological issues that will have have difficulty with decoding and with explicit articulation instruction by the SLP that difficulty can be eliminated or greatly reduced and as a result, decoding improves.
    I am not advocating for an increase in work load or caseload but I am advocating for SLPs to be more involved in literacy instruction. Learning to “teach” reading is comprised of teaching underlying skills that put together add up to reading with comprehension and meaning.
    I too have felt the “jack of all trades” feeling and typically that is related to diagnoses that I don’t treat on a regular basis including apraxia, voice disorders, and fluency (stuttering). With those diagnoses, I find myself researching for updated treatment ideas and assessment protocols. I feel that having to be an expert in all things speech and language is daunting but we have such an extensive background in a lot of areas that we are often expected to take the lead on a lot of disorders.
    I think that personal-professional interests plays a significant role in our feelings on where we want our expertise to be utilized within the schools. I totally enjoy the experience of teaching students the skills necessary for reading and writing and do not feel that I am not able to do so within my scope of practice. I do collaborate with my special education colleagues with both reading and writing goals and objectives but I find that they more often than not they come to me as the SLP to help them write the goals and objectives or help them interpret testing results for syntactic structure and grammatical concerns for both.
    After reading the posts, I consider myself lucky as my caseload is no where near 70-80. In my state, there is eligibility criteria as to who is eligible for Speech-language services. Under those guidelines, if articulation errors do not impact education, the student is not eligible for services. I have done many evaluations where this has turned out to be the case and I then place the students in an RTI intervention and provide services that way for a while.
    I too am not interested in a debate but I did want to offer a position from the other side of this issue. I was very pleased with ASHA’s role in this and with the passage of the legislation for us to be legitimately recognized for the skill set that we possess and can provide to students.

    • Thank you so much for your comment Traci. I agree, as language specialists, we are in a unique perspective to teach reading. I’m not saying we shouldn’t…The purpose of the post was to simply say, we need to be able to advocate for ourselves – and our students and consider that there may be someone MORE capable to take on certain aspects of some of our scope of practice. That just because it’s in OUR scope of practice, doesn’t mean that it isn’t in someone else’s scope of practice as well.

      It sounds as though you work in a great school. 🙂 I hope that you are recognized for your work with RTI. Many schools don’t consider students on RTI when considering caseload/workload issues so it simply adds to the already over-burdened SLP. Thankfully I’ve been able to consider the social aspect of education to recognize that articulation errors do have an impact. For those few students who are so mild they wouldn’t qualify, we have a speech intervention plan (similar to RTI, only the classroom teachers have no intervention to do – and it is included in my workload).

      I would love to be trained in the various aspects to teach reading and do something more than supplement what my reading specialist does…but at this point, in this school, it isn’t feasible for them to send me somewhere for training when their specialist is already trained.

      To me…it seems…that if we are going to be expected to walk into a school and teach reading – then we should have a basis to do so…and at this time we simply do not. There is nothing in my (or most so I’ve been informed) to prepare SLPs for teaching reading.

      Out of curiosity – what do you work on that you are uniquely trained to do that the SPED teacher isn’t? Maybe I can get some training if I approach it that way.

      • Hi Mary,
        I read your response and at first I was confused as to your response because I did not understand why as SLPs we would not want to be recognized for our abilities to teach literacy skills which, from my understanding, is what the legislation is meant to do. I will go back and read it again to be sure I am understanding it correctly. I don’t think it is saying that we have to teach literacy skills just that we are able by training to be involved with the teaching of literacy skills.
        As far as advocating for ourselves, I couldn’t agree more but I do feel that advocating in this regard should be done at the district level as all districts require and expect very different things for each of us. I am very interested in literacy and language and would be very excited to add those students to my caseload but my district does not feel the same way. This legislation may help me in changing their understanding of what services an SLP can provide. In addition, I understand that all SLPs do not feel the same way and have different views on what they feel they are able and interested in doing within their districts. That is why I feel that ASHA’s advocating for us at a national level is good but that we as professionals need to advocate for ourselves within our districts. The legislation does not say that we are the only ones able to teach literacy skills but that we are one of the ones who are able to teach literacy skills and should be recognized for that.
        With regards to my recognition in RTI, those students that I choose to add to my RTI caseload are not counted in my caseload numbers. I see them because I want to help them. Again, I think this is going to vary from district to district. My district does not recognize these numbers because they are not identified as special education students. I know that going in and choose to help them anyway. For those students that I do not see myself, I do talk to the parents about how they can help at home and provide instruction materials and monitor the student regularly. I am required by the state to determine eligibility and if I can’t, I feel this is the next best option.
        I think it would be helpful in our discussion to have an operational definition of “teaching reading”. The only people in my district who “teach reading” are the classroom teachers. There are reading specialists who provide support services to struggling readers and there are special education teachers who provide skill based instruction in small groups to support the classroom teacher with our special education students. Our literacy specialists are considered regular education and if a student needs more support than tier 3, special education is recommended. It is here that I feel that we as SLPs are able to offer instruction in literacy skills development. I feel that we could do more at an RTI level 2 also but that’s a different discussion I think.
        What sets the special education teacher apart from the SLP in my district is the type and amount of continuing education he/she has received. Our special education teachers are Wilson trained, LIPS trained, V/V trained (those are the ones I can think of off the top of my head) but those programs are certainly ones that an SLP could also be trained in if the district felt it beneficial.
        Overall, I am concerned that if we do not look at these issues nationally (the fact that we can teach literacy skills as well as a special education teacher) and instead consider them from a specific district perspective (caseload,workload) only, we are missing an opportunity for those who want to and feel capable to do so to be recognized for the skills that we have and can share with both students and colleagues. I don’t feel that this is about who is better able to do what but that we are are equally qualified to help our students acquire literacy skills. It seems that the districts, up until now, choose the special education teachers because they had no other information to the contrary. With this legislation, they do. They may feel the same way as always but it gives those of us who are interested in this area more leverage to ask them to reconsider.

        • This is exactly where I disagree, Traci. We may be equally *able to be trained* to provide literacy instruction, but based on our actual training in grad school, we are NOT given appropriate training to teach literacy skills. SpEd teachers ARE given that training – lots of it! – and we are not. We are not given classes in teaching pedagogy; we are not given classes in teaching decoding; we are not trained literacy specialists.

          We have lots of knowledge about what under-girds literacy, and we should definitely share that with our colleagues, but we’re still not literacy teachers. We are speech. language. pathologists.

          We have a literacy specialist in my school. She has an entire MA in teaching literacy. I have an MA in everything else. Which of us is qualified to teach reading, and which of us should stick with consulting?

          • Thank you for your comment. I agree, I am definitely NOT trained to teach reading and I could not do it as well as a SPED or Title teacher could. I will happily offer my services consulting, supporting, etc…but until I am trained – I will not teach reading. That would be like me saying I could go do brain surgery…I know a lot about the structure of the brain – could I do surgery…no. But I will help support the surgeon in whatever he needs – consult, rehab, etc…

            • It’s ok if we disagree. Discussions like these are very difficult to have in written form without the beauty of a verbal reciprocal dialog. Thanks for your thoughts.

        • I am not saying we shouldn’t do it – if we’re trained…and for some, like several private practice SLPs I know who are trained, it’s a fabulous way to benefit many children.

          I’m not saying reading should not be in our scope of practice. I’m saying that just because it IS in our scope of practice doesn’t mean we SHOULD be the ones doing it. For instance, in your school – you are not trained (yet) and you have others who are. Your efforts may be better spent elsewhere – helping those students that only you can help. Could you help them – absolutely – but you are not the only one who could, or at this time, even the best one who can.

          For a school that does not have a reading specialist or Title I teacher – perhaps you would be the best option (with the proper training).

          I, personally, am not a teacher. I have never taken a teaching class (other than that sad math class I took). Would I be interested in being trained in O-G, Wilson, V/V.. sure. But for the sake of being trained and supplementing/supporting what the true experts are doing. You said “…the fact that we can teach literacy skills as well as a special education teacher.” I can’t. They have TONS of training and practice. I have none.

          In my school, my SPED teachers see their students EVERY DAY. I have been told that to be consistent with O-G, Wilson, Barton, LiPS, etc. it needs to be EVERY DAY. If it’s not done every day, the program isn’t done with fidelity and progress is lost. There is ABSOLUTELY no way I would be able to do that without reducing the number of kids I see for other services.

          I completely agree that ASHA advocating for us is good…and I absolutely agree that we need to advocate for ourselves – you can look through old posts and see that. But, part of that advocacy is knowing when to say no, knowing when someone else is better qualified, and knowing when we need to step back and help the kids that we are truly the best ones to help. When we, as a field, have SLPs bailing out of the schools in droves because of too much paperwork, high-caseloads (many with caseloads of over 100), etc… having even MORE things to do is not the answer. We, as a profession, need to realize that we are not the only ones in a school that can help these kids. We need to let others do it when they are better trained. The only way we will avoid having even more of a shortage in schools is to reduce the numbers SLPs as seeing – and the way to do that is to delegate what can be delegate and work with those who truly need our specialized skill set (whatever those specialty skills may be).

  29. I am sure there are some gems in the comments. I just haven’t had a chance to read them yet.
    I am a jack of all trades and sooooo burned out. I work in acute care and outpatient setting. In a single day I may treat one of each of the major areas in our scope of practice.
    I don’t know what the answer is but I do know that I feel very under-equipped most days. I have done this job for 8 years and learned more than I could imagine.

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