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February 7, 2013 / the speech monster

Clinic and school-based work: the perfect balance?

We’re pretty blessed with an excellent social/welfare system in Australia that allows most working mums to have flexibility and choices with work arrangements. As SLPs are still quite in demand here, I have even more flexibility with the types of work I choose to take up to fill my work days. For the first 2-3 years of my SLP career, pre-baby era, I worked 4 days/week at a public school district and 2 days/week at a private clinic. Then, I tried doing my own private work (at a public school).

Currently, I work 2 days/week with a public school district, servicing a number of schools, and 1 day/week at the private clinic I worked at previously. And you know what, I LOVE this set up. If given the opportunity, and if community health positions/hospital positions come up more easily, I would fill up another day with that sort of work.

If you’re a soon-to-be SLP, new SLP, or someone who’s worked in school districts for a while and looking for a change, here’s my two cents regarding the pros and cons of clinic vs school-based setting (and why the best is to do both at a go, if possible!):

Note: Because school-based settings in Australia differ greatly from that in the States, and I’m based in Australia, some of the ‘issues’ may not apply to readers not in Australia (more specifically, Melbourne, Victoria).  


Image courtesy of Idea Go/

I have mentioned somewhere in some previous post before that I’m a traveling SLP. In Melbourne, Victoria, most mainstream school school districts, be it public or catholic, will hire about 2-3 SLPs for every 10-12 schools. This is an approximation/guess, but I’d be surprised if there was any school district around that have a smaller ratio of SLPs to schools. This means we travel to a few schools a week.

Some SLPs do fortnightly school visits, and the lucky or crazy ones like me do them weekly. Caseloads are, like everywhere else, massive, and most often, I find myself doing mostly assessments and then handballing kids off to external agencies for therapy, or giving teachers or teacher aides strategies/programs/ideas of how to help the child. At schools, I get a good overview of the child’s test-taking abilities, and can compare it with her functional abilities in the classroom and with peers. I am able to work closely with teachers on similar goals and cross-reference progress notes pretty easily. And because the teachers and I already have a working relationship, they often feel comfortable approaching me with questions or even ideas about what works (or doesn’t) with the child.

Because we are only able to provide such limited service with the number of staff hired, our service delivery has to be (unofficially) quite different from that of the traditional 1:1 therapy model. At present, there is no uniform service delivery which at times frustrates me because therapists can vary so differently in how deliver the service (e.g., how often they see a kid). However, this also challenges me to find more creative ways to be more efficient and effective. There are opportunities for us to run professional development courses or workshops with the schools to skill up teachers or even parents. I also really enjoy seeing how different schools work and learning about the variety of programs available.

Of course, working in this model, where I do mostly assessments and do more preventative work such as a whole-school intervention approach targeting teachers or parents, means that my 1:1 therapy time dwindles. Also, I’m often unable to follow through to do therapy with the kids that I’ve assessed. And that’s where clinic work comes in to strike that balance. Hurray!

At the clinic, which is extremely well resourced, I absolutely enjoy having games, worksheets, etc., within reach. Being a traveling SLP at my other job means I can only take along limited resources with me on the road and sometimes not even get a proper room to work from.

But at the clinic, I get a nice, brightly lit, clean room with appropriate desks and chairs, shelves where I can store (or find) resources, and a filing cabinet for my use. I also get to work with pre-school age clients some of whom may have more severe disabilities than and, yes, do therapy with most of the kiddos. Full-on, hands on, ongoing (as long as they will have me) therapy! I find clinic work quite a bit more challenging than school-based, public service work because the caseload I have is more varied and because parents seem to have higher expectations coming in the clinic as they are paying for the service.

Also, some of the kids at the clinic are such complex cases, I have to really be on my toes and come up with a variety of programs/activities to try to engage them. Sometimes, I also find the clinic environment a bit sterile and unrealistic. Shouldn’t we be offering therapy in the kids’ environment sometimes, especially when it comes to generalizing some of these goals? With the school-age clients, I find liaising with their teachers/school-based therapists quite difficult at times. Implementing goals in the classrooms or giving teachers strategies therefore becomes much harder.

My sole day at the clinic is also pretty full (by choice), and it leaves me with little room to breathe and unwind in between.

But, having said that, it is actually my most rewarding day.

My favorite moments are when I get to elicit even the slightest whimper or correct sound from a kid who was previously non-verbal or who has multiple phonological errors, or when I see a kid’s eyes light up when they get a sticker for using a correct sentence structure…

I could see myself working at the clinic all day, every day! But you know what, I do like having the balance, to get a more holistic view of the kid, and be able to set more realistic and functional expectations for her as well. By being out there with the teachers, parents, and kids’ peers, I also get to understand the kid’s environment a whole lot better. So my advice is, if you can, try to do both. Especially if you are in a similar work set-up to mine. I do think it’s a near-perfect balance in maintaining and continuing skills in almost all areas of our work.

It can be hard work, of course, switching from one environment to another, and it’s not for everyone.

Do you work in more than one setting? What do you think about that? If you’re only in one setting, would you ever consider expanding and working in more than one? 

One Comment

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  1. Moo's Pantry / Feb 20 2013 10:58 am

    I’m a teacher in a Speech and Language Provision for children with SLI. I work with a therapist who is with us for 1.5 days a week and a specialist teaching assistant. Working with the therapist has completely opened my eyes to new and fascinating teaching methods/resources. She has given me insights I would never have ‘seen’ just being a ‘mainstream’ teacher. Sadly, it has made me realise what a ‘one size fits all’ curriculum we have in the UK for children accessing mainstream…. I wish there was more we could do to fight the system!!! Keep going – educating the teachers is the best way forward – you sound like you’re doing an amazing job. THEN try to work on a policy-making level… 🙂

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