What Is the Difference Between Public School Speech-Language Therapy and Private Therapy Anyway?
Want to hear a secret? In addition to seeing clients through Compass, I work as a Speech-Language Pathologist in a local elementary school. When people find out that I work in both private and school-based settings, they often lean in and whisper, “But which is better? Your private therapy, right?”
Given that it’s such a common question, it might be frustrating to realize that there is no single answer, but it is good to understand the difference so that you can make the decision that is right for your family. It's important to remember that no matter what setting you choose, ALL SLPs have the same credential, educational background, and desire to help your children succeed!
Pros and Cons of Speech Therapy in Schools
Qualifying for therapy in the schools: The ultimate goal of school speech therapy is to help the child access and benefit from their education.
In order to qualify a child for Speech and Language services under an Individualized Education Plan, the SLP must be able to document and ‘prove’ that the child’s speech/language impairment is significantly and negatively impacting their learning in school. So if a student is struggling with a sound or two like their /r/ but gets good grades, is social and not afraid to speak up in class, and says it doesn’t really bother them, they would not qualify for school-based services even though their articulation might be clearly delayed (in some districts, this student might qualify for a short intervention but that varies from school to school).
Schools are held to entrance and exit criteria set up by their district or state. This means that a school in one district may not ‘qualify’ a student for speech services until they are two standard deviations below average (e.g. they scored in the second percentile on a standardized measure, meaning they underperformed 98% of their same-age peers) while other schools may say one standard deviation (meaning they are in the 16th percentile and underperforming 84% of their peers). So, while there may be two school districts only five miles apart from each other, they may have different criteria and the same student might qualify under one set of guidelines but not another. Weird, right? SLPs have some of the biggest hearts around. We want to help everyone and have a hard time telling someone ‘no’ to services because, depending on the setting, we have to follow certain rules. It doesn’t mean we don’t want to help. It just means our hands are tied. Trust me, it is our least favorite part of the job.
Children who are eligible for school-based SLP services get them for free under the Individuals with Disabilities Education Act (IDEA). This is amazing and speaks to the importance of ensuring that all children can access and benefit from public education.
I love that as a school-based SLP, I can collaborate with teachers frequently and work with my students on the areas that they are struggling with most in the classroom, at recess, or at lunch. It is so valuable to have this real-life component to therapy.
In regard to “Cons”, therapists in the schools often carry heavy caseloads, which results in group therapy sessions. Groups can be wonderful ways for children to build confidence in a social setting with peers that mimics a real-world environment. BUT, it can also mean that the poor SLP is trying to treat multiple kids at once and playing whack-a-mole with the attention and behavioral problems that can pop up and distract everyone else in the group. In the best case, each kid in the group therapy gets less direct attention from the SLP but is benefiting from listening and learning from their peers because their goals are similar and they work well together. In the worst case, this means that therapy is diluted and the 30-minute session gets divided up so the skills your child needs are only targeted directly for a portion of the session. We know that students with communication disorders benefit from intensive practices of skills and may need a “dose” of 30-100 times to practice a skill to make the most effective progress. In groups, this is just not always feasible.
Again, this is not to fault school SLPs who do an amazing job balancing out their schedules and thinking of each child’s needs. But think about a gym class versus personal training. Which one is likely to get faster results? In addition, every time the school SLP meets with your child, they are missing classroom instruction. Missing class like this regularly can have both academic and social consequences, so it’s a huge trade-off.
Pros and Cons of Private Practice
Private Practice SLP providers like Compass are different. A private therapist may treat any person who demonstrates some type or degree of communication impairment, regardless of the severity or whether they would 'qualify' in the school setting for services. If the need for supports is demonstrated through evaluation, observation and parent/caregiver/child feedback, a private SLP can provide that therapy.
Pros and Cons of Private Speech Therapy
The goal of private speech/ language therapy is to help the child master communication goals as quickly as possible. It is understood that the child’s challenges may not be severely impacting their schoolwork so they may not qualify for services (many often can “get by” in school), but that doesn’t mean that those challenges aren’t real and worthy of being addressed. As a parent, you know that your child’s communication differences can have a negative impact on their self-confidence, performance in school, peer relationships, and future vocations/career opportunities and success. Private SLP services allow you to start working on these areas as soon as possible before your child falls significantly behind.
The “Pros” are that your child receives individualized attention and care, and a therapy plan as unique as they are. The SLP can concentrate all of their effort, energy, and attention on your child. Their patient’s treatment plan includes highly targeted goals that are individualized and tailored to their strengths, challenges, and needs. Treatment includes the latest and most comprehensive evidence-based intervention programs, strategies and techniques. As a result, you’ll see skills emerging faster and more reliably, and your child will likely meet their treatment goals faster than if they were in a traditional school-based program.
We also place importance on incorporating immediate caregivers and family in individual therapy as well as collaborating with other healthcare and educational providers. In regard to family, there is an opportunity for the parent or caregiver to sit in with the patient, either for part or all of the session, and learn what they do and how they learn. We foster this important parent-therapist partnership. We will give you homework as well as activities and strategies to use in your daily routines to help your loved one grow. This will facilitate carryover of skills into your home and community. It improves the quality and speed of outcomes when parents and therapists work in partnership, as a team, to teach and generalize skills.
The “Con” of private therapy is the cost. Plain and simple.
What if my student qualified under the school system? Do I need to seek private speech therapy in addition to school speech?
This question is a problem for school-based SLPs. If they say, “yes, your child needs additional speech therapy” or “you need to take him to an ENT”, the school district may be liable to pay for these services. Because of this, many therapists will just say “no” to avoid any conflict. It puts them in a difficult position. You will likely hear a school therapist respond, “I would ask your pediatrician about it”, or “it might be a good idea to do it”. When a parent is unaware of this problem, they may not follow up and get additional private therapy, even when it would be very helpful for their child.
Our answer to this question: If you are asking this question and able to afford private speech therapy, yes, we would absolutely suggest you do both! When children are receiving services in both settings, it is important for both clinicians to be in communication. The ultimate goal is for your child to get past this speech, language and communication problem and put it behind them.