Speech and language goal writing is a joke, But I don’t know what the solution even after almost 40 years

Posted by Teresa Sadowski MA CCC-SLP on Jun 2, 2024 in slider | 0 comments

June 2 2024, #7 reflection series

I am so sorry I have not been able to finish this up in May as I expected. I forgot that blog writing is work. My website is also not as up to date as it needs to me and I’m working on that. The articles are written but editing takes time.

Over my 35-year, career as a Speech Language Pathologist I can’t even begin to count how many workshops, conferences, directives, computer programs, formulas, templates I’ve either had to or been specifically told to use to write the perfect speech and language goals and objectives.  Very few of these have actually been suggested by SLPs.  

Starting with the biggie, making a goal/objective measurable.  It’s time the truth come out. Measuring speech and language skills is almost impossible to do in small increments.  We really have no standardized leveled materials which in itself makes measuring objectives almost impossible. I have always looked at speech and language skills based on development.  That’s how I was trained and that’s what makes sense to me.  Looking at a child with a true disability I still approach a student with developmental type objectives, looking for skills they might be able to obtain, trying to fill in the gaps.  What developmental piece is missing not just what they didn’t do on the test.  I also look more at what skill is going to help in life rather than just in the classroom.  As far as I know standardized speech and language goals/objectives based on development have not been created.  We address way too many areas and skills to even make this feasible.  Not to mention all the variables the student may have especially around neurological development and cognitive deficits.  We can’t see how a student thinks or processing information.  

I feel very strongly that basing a child’s (especially a young child) goals and objectives on curriculum is just wrong in so many ways.  Which right now, basing goals and objectives on curriculum, seems to be the flavor of the month in many schools I work in.  I want the kids to be successful in life, play and ability to work down the road.  Focusing on curriculum speech and language goals will often (if not usually) create gaps in underlying speech and language development.

We were always supposed to be write  goals that could be picked up and moved to another school, state or therapist.  Well I’m here to tell you that doesn’t work well either mainly because we don’t have leveled materials or a “speech curriculum”.  The 10 idioms I work on may be much more difficult to understand than the previous SLP.  Now don’t get me wrong I am not advocating for  a speech and language curriculum because our students are very unique in their needs.  I have picked up some of the most absurd goals/objectives over the years, written by previous therapists, that are far from measurable and far from being obtainable.  That alone points out the fact that speech and language goals and objectives are unique, very individualized and frankly extremely subjective.

In the early 90ies, when the use of computers was new, it was computer programs that suggested generic goals where all we had to do is pick them out and manually change the he’s and she’s and the percentages.  This didn’t last long because as we kept more and more challenging students in schools the goals and especially the objectives didn’t fit.  

Then came certain language we had to use as a template.  Again this sometimes fit my students but most of the times it did not.

I went to one workshop where the genius administration engaged a speaker from another state.  Well that state had a whole different way of wording their goals.  It was amazing that the other special educators couldn’t even respectfully see how her principles could be applied and the nasty questions flew.  The special educators had leveled materials and were not able to think with flexibility.  One point this speaker did make was that we don’t have to write a goal/multiple objectives for every need.  Yes we can work on multiple areas but pick one or two areas you want to report on.  That was life changing for me and made my life simpler as I paired down my goals/objectives.

Then we had to start writing pragmatic goals.  Such a subjective area yet we were supposed to pin this down to be an exact.  One speech therapist Marcia Garcia Winner created a program called Social Thinking and must have made millions.  This became the gold standard because she included ways to “measure” social pragmatic skills and abilities.  Administrators and counsellors loved it but just for the reason that it made social pragmatic skills measurable.  Problem was the program really wasn’t “standardized”.  Nobody cared about that though.  That didn’t seem to matter.  I also observed that most people didn’t use the program in total but pick a few areas or tasks within the program.  There are a lot of good suggestions and activities within the Social Thinking program and you could write some decent goals with percentages to make administration happy.  The other problem I had with the program is that it worked well for the lower functioning kids but didn’t had much benefit for the higher functioning kids.

I’ve never understood how a goal could have a percentage then the objectives also have a percentage.  That might work if the percentages were all the same.  It was often easier to make the percentages the same than to discuss it with administration.  My husband a business man and mathematician tried to explain it to me but it just doesn’t seem logical to me.

Then the time came when we had to start showing the data to go along with the percentage.  However, it’s been my experience that no one has ever asked for this data.  Not to mention the underlying logistics of collecting this data makes it truly impossible.  Imagine having a group of 4-6 and you have to collect even the simplest data on 3-4 objectives on each student.  It is impossible. (As a side note, when I have worked with behavioral specialists, who are big on data collection, focusing on just one student, they are not usually actively working with a student when collecting data. If they were working directly with a student they usually had a colleague collecting the data or had teachers/aides collecting data….let that sink in.  It’s interesting that behavorial specialists get support for data collection but we don’t.  We do not advocate for data collection assistance nor does our professional groups advocate for data collection assistance).  Every SLP that I know of has fudged or guesstimated data at some point.

When possible I like to write goals with the student will do XYZ, rather than a student will do XYZ 80% of the time.  Again this just makes more sense to me, especially with the students with developmental challenges.  I don’t want them using a sound only 80% of the time, the goal should be to carryover the sound 100% of the time.  I don’t want them turn taking 80% of the time, using past tense 80% of the time, or greeting people 4/5 opportunities, I want them doing skills like this all of the time.  

The only standardized options we have as SLPs is formal testing.  Basically we have no specific entrance and exit criteria other than formal testing.  We use to be able to consider other factors and use our clinical judgement.  These days we have to look at data and test scores.  Has the student plateaued, is the student benefiting from therapy, can speech and language skills be better learned in classroom (exmp. older kids with a skilled English language teacher or strong curriculum) and do they want to be there (again older students wanting to be typical or are embarrassed to come to therapy), not much of that matters these days.  A student may begin receiving services in preschool and still receive services in 12^th grade.  Now this is appropriate for some but not for as many that stay on caseload.  The way it is now students stay on caseload until they test out.  Well the problem with that is children who do poorly on our testing are rarely ever going to be able to pass our testing with flying colors.  Not to mention we only test them formally every 3 years in the public schools

I do believe the way we have been instructed to write goals/objectives ends up keeping a lot of kids on services forever.  Speech and language skills are so different so abstract or subjective in so many ways. Abilities differ so much.  How effective are the goals/objectives we write?  Given the format and theories around goal writing has changed so much during my career basically tells me we are not doing it correctly.  I realize there has to be something for accountability and to measure progress but what is it.  Speech and language skills are not a one size fits all.  There is so much inconsistency around goal writing.  Goals/objectives go into the IEP which is a legal document so we still have to be very careful how we do this. I really don’t have an answer.

My advice

You don’t have to write an objective for every deficit area.  Make life easy for yourself, pick 2, 3, objectives at most that you want to work on.  (This wasn’t my idea but I picked it up in one of my many workshops.) You can always address other areas without having to formally document it or collect data.

Further Questions

What do you think about goal writing?

Do you have any words of wisdom to make goal writing easier?

How is it expected in your state of district?

Do you have exit criteria?  If so are you sure your exit criteria is legal? Is your exit criteria based on achieving goals or doing well on standardized testing?

How do you write goals or how are you expected to write goals?  Share people.

We and ASHA have not done a good job defining our role in schools

Posted by Teresa Sadowski MA CCC-SLP on May 18, 2024 in Administrators Page, pictures, slider | 0 comments

May 18, 2024 #6 reflection series

What exactly is our role in schools?  If you asked 100 different Speech Language Pathologists you’d get 100 different answers.  Part of the problem is that so much falls under our scope of practice.  Let’s think about that.  The school SLP works with students who present with any of the following.

• Identified receptive and expressive language disabilities
• Delayed language development
• Language disabilities specific to syndromes or physical impairments
• Developmental disabilities
• Cognitive disabilities
• Specific learning disabilities 
• Autism or autism spectrum disorder
• Impaired development of higher order language skills 
• Difficulty in the pragmatic or social skill realm
• Oral motor difficulties (affecting articulation or feeding issues)
• Hearing impairments and cochlear implants
• Dysfluent speech
• Developmental articulation needs
• Central Auditory Processing Disorder
• Non-verbal due to physical impairment
• Voice disorders

That is one heck of a checklist and I probably could add many more.  Now many SLP’s are also dabbling in literacy in schools with good reason.  So you can understand why administrators and teachers may be unclear about all the areas we are trained to address.  However, when defining our roles in schools administrators rarely ask SLPs and SLP’s rarely speak up.  Part of the issue is with usually only one SLP in building or district you have no power to do anything.  SLP’s in a district could band together to effect change and define roles, I’ve actually seen this happen.  But usually SLPs in districts are too busy to even get together.  In smaller districts there usually are not enough of us to effect change.

Our title change in the 80ies to Speech Language Pathologist muddied the waters even more.  At that time we were entering with masters degrees and our role really getting ready to expand.  Administration probably didn’t like they had to pay us more.  At that time not as many administrators had a masters so I’m sure on some level that was an issue.  ASHA didn’t do a lot of administrator education or public education on our expanded training and new skill set.  Back then we didn’t have the internet so providing the information on the Speech Language Pathologists expanding role would have been difficult.  With that said ASHA has had a lot of years to get it right and they haven’t.  Yes, there is a lot of very good information on the ASHA web site but there are few administrators who would have access to it and even fewer who would take the time to research the role of the SLP.  I’ve always wondered why ASHA had never, to my knowledge, offer continuing ed to administrators.  And why administrators never ask the best way to use our skill set to benefit students and programs.  

So I guess I see most of the fault with school administration.  However, school administration doesn’t know what they don’t know because ASHA hasn’t told them and school SLP’s for various reasons don’t speak up.  I will also add that school principals and special ed team chairs/directors do have a lot on their plate to begin with.  I believe they feel we know our job and as long as the paper work is filled out correctly and parents are happy all is right with the world.  We do have more autonomy than teachers these days.

Back in 2015 I wrote a little book called, The School Speech Language Pathologist An Administrator’s Guide to understanding the role of the SLP in schools along with strategies to aid staffing, workload management and student success.  I will admit, writing this book was a therapeutic assignment to deal with my own frustrations.  The few administrators that I gave a copy to did not receive it well.  Passed one on to ASHA and even that wasn’t received well. (Apparently I gave it to someone whose husband was a school administrator).  I presented a poster session at ASHA which was well received by attendees but again never heard a peep from ASHA (not that I really expected to).

What school administrators and ASHA do not seem to understand is that in any given year our workload can vary greatly.  If you have a caseload heavy with students with more severe disabilities, that is going to create a much heavier workload than say a caseload heavy with articulation needs and developmental needs.  In a classroom, teachers may have more challenging years than others given the make-up of their classes.  However, teachers usually know that they will never have more than 20-25 kids in a classroom, per their contract and the union will advocate for assistance.  That is a luxury I’ve never had.  There is no way an SLP can be effective with caseloads of 30-80, you know you’re providing band aid services.  I’ve had a few years where I knew this was going to happen and guess what …..I left. 

You can also somewhat understand the misunderstanding of our role because underlying language skill development and especially pragmatic skill development is very abstract and subjective.  Try explaining all you do to someone.

My Thoughts

• ASHA need to do better with education of administrators, principals and teachers regarding the role of the SLP in schools.
• SLP’s need to speak up about their role and when workloads/caseloads are too high.
• Lack of understanding of the role of the SLP contributes to high workloads/caseloads.
• Any therapist with extremely high caseloads is fooling themselves if they think they are servicing the students appropriately.  It is not a badge of honor to have a high workload or caseload.
• If I read one more article written in an ASHA publication on caseload management I may scream.  Given my years of experience I am expert at caseload management and scheduling. The articles seem to miss the point that numbers and workload need to be lessened to provide appropriate services.

Schools still don’t know what we do

Posted by Teresa Sadowski MA CCC-SLP on May 13, 2024 in Administrators Page, slider, SLP Chat | 0 comments

May 13, 2024 #5 reflection series

I still find it amazing that so many teachers, administrators and some team members have no idea the extent of our knowledge.  They sit in meetings with us, listening to us explain in depth evaluations, progress and service plans and seem to pick up nothing.  

Why don’t people know what we do beyond working with articulation skills or getting words out?  We are somewhat responsible for this, however ASHA is the bigger problem.  Changing our title to Speech Language Pathologist back in the early 80ies didn’t help with clarification.  ASHA has never put in specific guidelines about our roles in schools, areas we address, skills we may have or even caseload limits.  As a school speech language pathologist, I have always felt abandoned by ASHA and any suggestions/questions/ concerns I’ve presented over the years have fallen on deaf ears.

In the recent past I’ve attended 2 ASHA conventions.  I have felt the School SLP was pretty much ignored as a focus, even though I would bet most of the SLPs who attend are school based.  Two things have lead me to this conclusion.  First, at the last ASHA convention I attended in Boston, I went to the opening welcome session.  During that session they went on and on about the good things ASHA was doing mostly medical based, political or international.  I was paying attention, the contributions/needs of the school-based therapist were mention only once and that was in passing.  I also noticed that any session that I was interested in as a school-based therapist was being held in a space that was too small.  Just about every session I attended, I was put in overflow sometimes sitting on the floor.  I don’t know too many other professions that put up with sitting on the floor during a professional conference.

We may have to take a little responsibility for not being understood.  A big part of the issue is there is usually only one SLP in a building.  I’ve only worked in one school system where there was a solidarity among the SLPs, where we could really point out and ask for things.  I’ve never been recognized as different from a teacher in a union.  Maybe we just haven’t done enough to point out the very real differences in our job compared to teachers.  Teachers usually get an hour a day for planning but we often need that hour and more for testing/paperwork.  Even if you have an administrator that understands, their hands are tied.  

 I’ve tried to do some education about our field, presenting a workshop for teaching assistants, writing articles for parents in school newsletters and presenting topics at Ed Camp.  I even wrote a book for administrators.  You would think hearing us present our reports would clue them in a little.  Listening and learning from others is how I learned a lot about motor skills and vestibular skills, perceptual skills and the list goes on.

Some School Psychologists might “get” what we do but it really doesn’t impact them so much. They present their report and we’re left to follow up.  The rest of the team….few read our stuff, less than few take notes during meetings or even ask relevant questions.  Schools just know they have to have us on staff.  They don’t like the fact that we overlap with medical (which is a much bigger deal in schools than most even know).  I do believe that’s where we run into problems, we know so much tied into medical. It is amazing they sometimes don’t even see that there might be a connection with learning.

Side Story….

I’ve approached so called reading specialists pointing out that students are missing key underlying skills (never in a meeting but off to the side).  It was like talking to a wall.  They seem to have little understanding how underlying listening, memory, auditory perceptual skills and other skills affect reading. They put students in whatever reading program is the flavor of the day.   A couple of years pass, the reading specialists try a few other programs by then the student is in 4^th grade and barely reading because the underlying skills were not addressed.  Now if you are a therapist that has dual certification or just a vast knowledge in reading be careful because, if they do finally see the light they will have you doing the work of two.  (My thoughts on our role in literacy will be discussed in a later reflection article)

Side story…..

At one ASHA convention I went to the Sig meeting for school therapists.  They stood up there and went on and on about school therapists getting more involved in the Sig.  They felt sure our districts would give us time off to be involved.  The therapists were too polite to laugh out loud.  However, are our jaws hanging open.  No school therapist is going to have time to sit on a committee and few if any schools would allow even unpaid time off for such a venture (I’m not sure ASHA knows we are mandated to see students as scheduled).  The ASHA reps were so far off base in regards to the school SLP.  The SLP’s attending the meeting couldn’t wait to get out of there since there was nothing of substance discussed. 

So after the meeting I go up to talk to the ASHA reps and to give them a copy of my book.  It was not a warm reception.  I ended up talking to the one rep whose husband was a school administrator.  You would think I just insulted the man.  It was just so clear to me that ASHA was also either clueless, had little to no respect for the lowly school SLP and frankly didn’t want to change.  Plus they clearly did not want to make connections even with someone advocating for the school SLP.

Side Story…..

These days I don’t run into too many syndromes, medical issues or disabilities that I have never heard of before. In the recent past I was seeing a student with Tubular Sclerosis. That was a new one on me. Now before sitting down with the team I did some simple research on the disorder. Discussing things with the team I was surprised to hear that no one at the table really knew what disease entailed. I had just showed up on the scene and they had worked with the student for 3 years. Not that it really made a difference in how this student was serviced. I was just taken aback that know one was curious enough to research the disease. Research is so easy these days why wouldn’t you. My brief research explained so much to the team.

My Advice:  We have a very large scope of practice.  Do your best to try and explain your role in schools as situations arise. That is really all you can do.  Don’t wait till you’re old and brave to speak up for yourself.  Don’t take on extra roles, even if you have the expertise.  Don’t work on reading and writing as formal goals/objectives.  School SLPs are not given the time in their day/week to address reading and writing efficiently. 

Love working with the kids but the paperwork…….

Posted by Teresa Sadowski MA CCC-SLP on May 11, 2024 in slider | 0 comments

May 11, 2024 #4

I don’t think anyone will argue that the best thing about being a Speech Language Pathologist in schools is working with the kids.  I even love working as a team when that would actually happen.  I like to think I’ve made a difference in the lives of at least a few of the students I worked with over the years.

But…..

Paperwork requirements alone have just gone over the top and really sour the overall situation.  You would have thought that the computer would have streamlined paperwork but in fact it just made it easier to create more paperwork.  I know some if not most days or weeks I spend more hours on paperwork and going to meetings than on servicing the students.  If I see a group of 4-5 students for an hour a week, that is about 30-35 hours of service a school year give or take the school schedule, cancellations for school events, meetings and absences.  At a minimum we have to write an ed plan with goals/accommodations, perhaps daily/weekly notes to help remember what the student did, data collection, perhaps fill out medicaid billing and write the dreaded progress report 3-4 times a year, for every student.  Depending on the needs of some students will take a lot longer to write up than others.  That’s easily 5-10 hours (if not more and it is always more) of basic paperwork/meetings per student.  You do the math.  Not to mention the hours it takes to write up a good technical report that can hold up to scrutiny.  

When working as an employee I was never given any extra time to complete the legally binding paperwork as caseloads grew.  I completed the paperwork either after school, which was not unreasonable at a minimum but it was never a minimum.  I worked many nights for hours after putting my kids to bed.  Or in 10–15-minute increments when I had a hole in my schedule.  We all know that our planning time in schools was/is very inadequate for the amount of planning we have to do but we have to follow what the teachers are given through the union even though our job is very different and requires a lot more legally binding documents (more on that later).  After about 30 years in the field I finally saw the light, entered private practice and now bill for those services.  

I always thought it my inability to complete tasks quickly and efficiently, that’s why I put in the hours.  I was wrong it was a slowly growing workload.

One thing I have noticed or realized over the years is that very little of what we write up is ever read by anyone.  Especially those awful progress reports (I’ve always considered those a creative writing exercise).  Few people read our extensive evaluations.  Few people on the team look over the IEP’s or read goals written by others. Worse yet our accommodations/modifications in IEPs are usually only glanced at by other team members.  In my experience it’s when the accommodations/modification are not followed that school systems end up in a tussle with parents.

In our world today I guess paperwork is here to stay.  Until that powers that be at levels way above the schools power/influence see the light we are doomed to have more and more paperwork.  The thing that gets me is that it isn’t SLP’s creating the paperwork it’s always someone who thinks they have the best idea since sliced bread adding to our paperwork load.

My thoughts:  Wouldn’t it be nice to spend more time with the students than doing paperwork.  Wouldn’t it be nice to have paperwork that is specialized to the Speech/Language Therapy process.  Wouldn’t it be nice for schools to give us enough time, maybe a smaller caseload to have time to write up paperwork, that will hold up to litigation.  

The field of speech language pathology has changed significantly over the course of my career and has become more technical.

Posted by Teresa Sadowski MA CCC-SLP on May 8, 2024 in Administrators Page, pictures, slider | 0 comments

May 8, 2024 #3

When I first started working most of my caseload was made up primarily of students with developmental articulation and grammatical issues.  Students were rarely serviced beyond early grade school.  This was before the big integration push and students with more challenging needs were often sent to other specialized schools.  Many schools did not have specialized programs within their districts.  

If students required testing beyond the basic battery back then they went to hospitals to have testing done.  Now we pretty much do the testing I use to see in these extensive evaluations.  My evaluations back in the day were a few hand written pages, typed out by a secretary.  Yes, for the first few years of my career I had a secretary to do my typing because computers were just coming in to common usage.  We’d get these extensive hospital evaluations with way over the top recommendations.  Interestingly, these evaluations and their recommendations carried a lot more weight than our recommendations.   Hospital SLP back then were considered way more knowledgeable than the lowly school SLP.  When we tried to explain that we had the same qualifications and totally understood the needs and recommendations it fell on deaf ears.  Unfortunately, that is still the case.

The push for integration changed everything.  Within a few years our caseloads doubled, tripled and quadrupled.  We were doing testing well beyond our basic battery.  Yet we still were not allowed to diagnosis and still cannot today.  Nor, were we given any more hours in the week to do this.  Students with significant needs were often dropped into classrooms with teachers who had no idea how students learned differently. Administrations often saw this as a one size fits all and a way to save big money.  The idea was that putting disabled students with regular education students was somehow going to make them less disabled and improve their social life.  It rarely did and many student did not get the education they needed.

This would have all taken place only a few years after the requirements changed requiring us to have a masters degree.  ASHA did very little if anything to help define our role in schools with the changes going on in education.  With only one SLP in a school or district at the time and things moving so fast, we were rarely able to help define our role or advocate for change in staffing.  Needless to say we were never consulted by school administration.

With our testing becoming more encompassing we were writing longer reports and providing more analysis. Yet we were never given more time to actually do the testing or write up.  With caseloads increasing we were never given more time to service kids.  School schedules were rarely conducive to scheduling students. Thus we ended up seeing kids in bigger and bigger groups meaning each student received less and less time.

Now please don’t get me started on push in services (I will do a post on that).  Except for the rare student transitioning out of direct therapy, push in services do not provide adequate support.  Now if a school was supportive of a true co-teaching model that might be another story but I never saw that happen.

My Thoughts:  As our role became more technical in schools, I wish ASHA would have taken a more active role in providing schools guidance on the role of the SLP in schools.  I was never asked about my skill set or the best way to provide service. Caseloads/workloads grew based on who showed up that year not what was appropriate or best for the kids.  Workload not just caseload grew to the point for many that we just provide band aid services with groups that were too large and perhaps not so carefully crafted paperwork (many don’t understand our paperwork are often legal documents that have to be able to hold up in court).   I like the fact that I have been able to develop my skill set and quite frankly the situation made me become more knowledgeable.  I also believe integration has been a wonderful thing for many students but not all. If ASHA writes one more article on how to manage a caseload I may scream.

Would I do it Again?

Posted by Teresa Sadowski MA CCC-SLP on May 7, 2024 in Administrators Page, pictures, slider, SLP Chat | 0 comments

May 7, 2024 #2

I have frequently asked myself if I had to do things over again would I become a Speech Language Pathologist.  The answer is I really don’t know.  

First you have to understand that when I graduated from high school in 1979 women in general still didn’t have (or knew about) as many options as they do today.  At my all girls high school we were put basically on 3 tracks, medical/science (which meant nursing, although one of my besties from HS became a doctor), educational or secretarial.  I knew I did not want to be a nurse and had no idea how important secretarial skills would become so that left education.  Growing up in the neighborhood I did we really didn’t know about the larger universe or the intricacies of certain fields.  In my neighborhood the Dads were building cars not designing them.  I had no idea there was even a field called engineering.  The only engineer I knew drove a train.  I only knew about speech therapy because I had a younger brother who had severe dyspraxia, so my mom (a nurse) knew a little about that field.  

When I applied to college the major was still called “speech therapy” and Eastern Michigan University offered one of the first 5-year masters degree programs in the country.  While I was in college the title changed to “Speech Language Pathologist” and masters was required.  By this time I was excited about the new things I was learning.  However, looking back I probably would have been excited about learning things in any field.  I remember one class that did interest me more than others and that was Acoustics of Sound.  I thought briefly about becoming a sound engineer but did not feel I had the math abilities to do it.  Perhaps if I had known more about the field of sound engineering I maybe would have considered it a little more seriously.  

One other piece about college that kept me from veering off the SLP tract was time and money.  If you took another class of interest that meant that it would cost more and you could feasibly have to be in school another semester.  I don’t know how it is now but back then courses/student teaching and internships were so packed/planned you really couldn’t go off track.  With the high cost of education I imagine that the pressure to stay on track is even more today.  Speech Language Pathology course credits don’t really carryover to too many other fields.

So was I stuck?  Yes, I was but at least there were a lot of different things you could do in the field.  The hours were not bad.  You could get a job anywhere.  

What really made me rethink things was after being in a few years I realized that I really wasn’t valued in the school setting.  We are still seen as a requirement not an asset.  I also realized that if I worked hard it was only going to give me intrinsic gratification.  I do love helping others so that was wonderful.  Then I realized I wasn’t ever going to make enough money to really support myself unless I worked a million hours.  Keep in mind this was long before most people were thinking outside the box and being creative.  I would never in my career get a bonus.  Advancement without going back to school was never going to happen no matter how hard I worked.  Not to mention in schools there’s nowhere for an SLP to go.  It would mean a job change to advance in schools.

My own work ethic made me put in too many hours, spend too much of my money on materials/supplies and never saying no (I will have a post on this one) and caused some significant stress when dealing with administration or contentious IEP situations (mostly caused by schools not servicing kids properly).

My Advice:  I think I would do this again probably because I wouldn’t have known any better at the time.  I love working with kids and families.  I love being at the top of my field and very knowledgeable.  I wouldn’t recommend going into the field of education at this time for various reasons.  The hours did work out well for me, especially when I was raising my kids.  I was lucky I had a husband with a great income and access to much better benefits.  However, if I understood the economy better back then the low pay and so little chance for advancement, would have made me think twice.  If you are already an SLP, open that private practice sooner or find some other way to supplement your income using your vast knowledge.  

What have I learned as a Speech Language Pathologist the past 40 years?  A Reflection

Posted by Teresa Sadowski MA CCC-SLP on May 5, 2024 in Administrators Page, pictures, slider, SLP Chat | 0 comments

44 years ago I embarked on my career as a Speech Language Pathologist.  When I started college the course of study was still called the Speech Therapy program in the school’s catalog.  By the time I finished the program changed to the Speech Language Pathology program and a Masters was then required in order to work.  Eastern Michigan University was proactive with the change and I was fortunate enough to enter one of the first 5 year master degree programs in the country.  Most of the “Speech Therapists” at the time knew they were going to be grandfathered in but it was still an issue for many.  Basically we were also rebranded and at that time the distinction was Speech Therapists didn’t have a masters and Speech Language Pathologists did.  With that said even back then people were saying that the term Speech Language Pathologist was an odd moniker.  I couldn’t imagine that 40 years later our role in schools would still be loosely defined with most administrators not understanding our skill set.  I’m often called the “speech therapist” or “speech teacher” and you know what it doesn’t bother me too much.  I will however introduce myself as a speech language pathologist in meetings.  

So I graduated Eastern with a masters degree and added the letters SLP after my name.  I was on my way.

So now it’s May 2024 and a lifetime since I started working as a Speech Language Pathologist, 39 years to be exact.  While I started my career in early intervention, most of my work has been in the public schools with some private practice on the side.  In 2016, I stopped working for schools as an employee (I had had about all I could take) and went exclusively into private practice, contracting to schools instead.  

While I’ve loved working with kids in schools, I’ve tried to vary my career just to do a little something different and to expand my skill set.  I have been blogging on and off since 2007.  My first blog was Your Middle Schooler: A Unique Age and my second blog is this blog The School Speech Therapist.  I also wrote a book for school administrators called The School Speech Language Pathologist  an Administrator’s Guide to understanding the role of the SLP in schools along with strategies to aid staffing, workload management and student success, it wasn’t received well.  Blogging was and is a lot of fun, saying I wrote a book sound cool but the actual writing was a lot of work for very little return.  Plus I’m beginning to realize that blogging alone is perhaps a bit outdated these days. 

As I’m pondering retirement I’ve decided to close out my blog sometime in the near future.  However, always the person who wants to share their knowledge and expertise, I’ve decided to write a series of articles reflecting issues I’ve faced as a school SLP and the joys I’ve experienced as a school SLP.  I want to be able to impart my wisdom to the masses.  No really, my objectives would be to share what I’ve learned from experiences, provide guidance to help any school SLP avoid pitfalls, provide practical information, point out my concerns and share some of the good times.  I will admit that like my book this is probably going to be a bit of a therapeutic assignment for me.  I hope it will also help me remember that I did sometimes make a difference in the life of at least a few kids.    

During the month of May, which as we know is Better Speech and Hearing month, I plan to post an article a day (yes I am a few days behind already).  Now I know Better Speech and Hearing month is supposed to be for us to provide information to the community but this May I want to provide information to my SLP community.

I have a variety of topics planned.  However, if you have any specific topics, situations you want to ask about, any questions, concerns you’ve faced or just a fun story to share, I would love to hear from you.  Email me at teresa@tbsspeechtherapy.com

Please indulge this aging SLP and follow along through the month of May 2024

By the way, my domain name may be going up for sale at some point if anyone is interested.

Thinking about COVID 19, Schools and Speech Language Pathologists

Posted by Teresa Sadowski MA CCC-SLP on Jun 28, 2020 in Administrators Page, Parent Information, slider, SLP Chat | 1 comment

To all you Speech Language Pathologists working with unreasonable caseloads now is the time to advocate for yourselves and your students.  Think a lot about this as the guidelines for the “new normal” start coming out in every state.

This week in Massachusetts the guidelines for what school is going to look like were released.  It pretty much encompasses what I expected it would.  Earlier guidelines came out for summer opening only a couple of weeks ago.  Both these documents provide very generic guidelines and both read as if the people who wrote them have never spent a day working in a public schools or even remember going to school.  Again it is one more document that clearly shows that they do not know the role of the SLP in schools and how we work with kids.

According to what I read, here are some take-aways from the guidelines:

• Physical distancing-Students should be kept 3-6 feet away from each other and all face the same way.  I don’t know about you but I have never been put in a space where social distancing was possible with a small group of 3-4 students.
• Limiting travel within a school-We have to pick up and return kids, we travel around the building constantly.  I wonder if we are even going to be able to see kids in small groups.
• Based on what I read it appears that we would have to use a mask and a shield because face it we work closely with kids and spit flies
• We need to prepare for remote learning just in case.  Well I did get a little experience with that during this last shut down. The three factors that seemed to be the biggest problems were my lack of training, not enough time to see everyone (since on line sessions have to have time cushions on each side and small groups are really not feasible) and lack of materials.  I was able to convert many of my materials to on line but that took a lot of time. Will teachers and therapists be given the time to basically develop a whole new curriculum or find/buy/create new on line material? Will schools pony up for the cost? (As a side note, which has bothered me since shut down. Where, are the common core people on this?  If common core is so great and so important why don’t we have an on line version with materials ready to go.  Schools have incurred considerable costs trying to piece something together to get through the year.  Why doesn’t the department of education have an on line platform ready to go? Not that I want this since I am not a fan of common core but really why does every school district in the country have to reinvent the wheel during a crisis?)

I think that those 4 points alone will make it impossible to service extremely large caseloads.  Now is the time to approach your administrators and talk about your concerns not in the fall because they will be totally overwhelmed.

Beyond the 4 points mentioned above I have some personal concerns you might also want to point out

• How am I going to clean my materials and my room?  Does the room need to be sanitized after each student or group?  Where is the time to do this if your schedule is back to back?  Will someone be hired to help with this?  Will you be given adequate cleaning supplies that actually kill germs and absorb?  Where is the nearest water supply to wash hands and help with cleaning?  Say you regularly see 8-10 groups a day and you work in the office in between when is this cleaning suppose to take place?
• How effective can Speech Language Pathologists be with everyone in masks?  I think that is a valid question.   How do you work on articulation and pragmatics when you are wearing masks?  Is it possible to just wear shields during therapy?  
• Masks add a layer of distraction and your perception can be a little off both to the sides and down.  This will affect all learning and coordination for some.
• Scheduling will be next to impossible, yet we will be on the hook if the IEP isn’t followed. Specifically ask you administrator what is expected and ask them to make a schedule for you.  This is something I recommend all the time and it is the only way school admin will ever know the obstacles we face.  Be very candid about the time you will need for assessments, IEPs. progress notes and added cleaning.  Assessments will be up this year because many were skipped during the shut down.
• If kids don’t come to school every day, what will services look like?  Can IEPs be followed if the student is not in school everyday?  Will IEPs need to be rewritten?
• On line therapy seems to be the best thing since sliced bread.  It is a good alternative but it has its limitations.  There is no way I was as effective especially without experience, training and resources.  On line therapy has been around for years, it’s a specialty area. It really hasn’t taken off like you would have expect to and there is a reason for that.  So much of what we do needs to be hands on.  One point that was sorely overlooked during the covid shutdown is that when you do on line therapy there needs to be another adult either with the student to facilitate/monitor or another team member in the session with you.  Every in-service I have listened to has pointed this out as a safety measure.

No, I would not want to be the one who have to put any state guidelines together and I do understand why it has to be done.  The guidelines from Massachusetts looks impressive, citing almost 4 pages of research but I always question the validity of the research.  Is the research they used to come up with the guidelines reliable? I hope so but that doesn’t always happen with research especially now when there is so much question with the covid data and numbers overall.  Could the guidelines be picked apart? Easily. Do the guidelines often contradict each other? At times. I think it will be interesting to see how guidelines vary from state to state.  

Speech Language Pathologists will not be able to function in the same way given the “new normal”.  We as a profession should be deciding how we do our job along with what makes a reasonable caseload (within the guidelines being presented) and not let school administration tell us what our jobs will be. I believe the guidelines are somewhat generic so schools have some leeway on how things are implemented.  Just note if you were handling a caseload say even above 30 before covid, you will have a challenging time meeting the needs and the IEPs of these same 30 kids.  You may be doing both in school and on line therapy. Department of Education will get around to looking at what was provided and what wasn’t.  When that day comes it will not be pretty.  Just make sure you keep in touch with your administration on what you are able to provide within the limitations of a school day (whatever that looks like at your school) and documented it.  Say NO if you can’t take on more or can’t manage with the new restrictions.  When possible provide administration with solutions that might work.  Work as a team with other speech language pathologists in the district.  I rarely see this happen but when it does it is a very good thing.  

We will get through this, no choice we have to.  However, how you get through this is up to you.  I feel being proactive will make the situation a little bit better in the long run and your position in schools stronger.  Working with other SLPs in your district will frankly give you more autonomy and a bigger voice.  It is up to you to advocate for yourself and the students you service.

Schools have to get back to normal in the fall….not the “new normal”

Posted by Teresa Sadowski MA CCC-SLP on Jun 17, 2020 in slider, SLP Chat | 0 comments

***I actually wrote this article about two weeks ago and did not get a chance to post it. Since then the powers that be are hinting at how Covid will effect summer services and school next fall but nothing seems definite yet.

Just about every news outlet is starting to do stories on what school is going to look like in the fall. The buzz word “new normal” seems to be the current catch all phrase starting to surpass   “we’re all in this together but apart” (another phrase which is being use to calm people fears, face it we are alone in this and most of us are looking out for number one.  But that is an article for another day).  All kinds of crazy things are mentioned in news trailers and in on line articles.  I just hope the powers that be use some common sense when deciding on what procedures will be used in schools.  After over 30 years working in the schools and what I’ve heard about and observed the past 3 months I can tell you this….students need to get back to normal not a so called new normal.  It’s the schools, administration and adults around them that will have to make changes.  

During this time of shut down there is no doubt that student’s have suffered.  Most schools and teachers have done their very best but few had the immediate means and the skills needed to truly implement on line learning.  Add in a layer where some many parents do not have the skills, desire, time or programming to help their child. Add in another layer where students may not have the technology needed for successful on line learning and on line learning clearly can’t work for many.  Those are just surface concerns.  Some student’s and parents need the structure of school to be successful.  For many years to come scholars will be debating whether on line learning vs. paper packets vs. no school at all made a difference.  They will be looking at gaps in development, studying skill levels of parent and skill level of teachers to teach remotely.  I see many theses and many dissertations coming out of this.

So how do we get students back to a normal school experience?  Keep in mind my suggestions are based on a situation where there is no active spread of covid 19.  But let’s face it kids have picked up various bugs (and literally bugs) from other kids for years and they will continue to do so.  It’s not bad to catch a few germs and some will argue it is actually a good thing.  We can’t keep kids clean and tidy all day if we don’t want them to grow up with a complex and a poor immune system. Most kids like to play and get dirty and some will tell us that dirt and germs are a good thing.  

How clean are schools?

In most schools I’ve worked in schools get a deep clean over the summer and maybe during longer breaks but other than that it is a daily surface clean or a spot clean.  When only a couple of people are hired to clean a whole school in a 4-hour window, just how good is the school cleaned?  I’ve also questioned the types of products most schools use.  I think in the past schools usually have purchased the cheapest products and water down the product.  If there isn’t a head custodian overseeing cleaning in the district, principals need to take ownership of cleaning schools and frankly they miss so much.  I worked in one school where the doormats did not get cleaned for 2 years and that was just one of many things that were not properly cleaned. 

School Bathrooms

School bathrooms usually only get the once over at night, toilets and sinks.  Boy’s rooms often smell like urine, stall walls and locks are hardly ever touched with a rag.  Basically, school bathrooms need to be cleaned thoroughly several times during the day.  Think of how many people (little ones without the best habits) are using a single bathroom on a daily basis.  Deep cleaning at night with a strong bleach or other equivalent product is a must.  Students may need some instruction on good bathroom habits and expected behavior in a public bathroom.  Just about any time a little one uses a public bathroom outside of school they are accompanied by an adult.  We assume they know what do but many don’t.  Perhaps buying some paper towels that actually absorb might help too.

The Nurses Office

Usually a pretty clean place but again it does depend on the nurse.  There should be standards and should be disinfected/cleaned at some point during the day.  Sometimes some really sick kids spend hours in there.  The biggest problem isn’t with the nurse’s office per say it is with parents sending their kids to school knowing they are sick.  That happens a lot more than you think.  While I don’t think you would be able to punish/fine the parent, they should be expected to show up ASAP.  I have noted that with the rigors of common core, parents and students are often afraid to miss school because they will fall behind.  Not sure what the solution is there but it should be easier to catch up if you are out sick.  Schools need to try and create a separate place for sick student’s to be observed until their parents show up.  Nurses have a really tough job determining which students are really sick and which students want or need attention.  Nurses need to get parents and counselors involved if they suspect students are coming to them often for attention.

The Cafeteria

Frankly I’d be more concern about the lousy food with poor nutritional value served in most school cafeterias than catching something.  However school cafeterias are pretty gross.  Not so much the food prep area (I say food prep area because few schools actually cook food anymore) but I am sure the food prep area could use a better cleaning at night.  The cafeterias themselves are pretty gross, often dirty and loud.  Kids usually have 10-15 minutes to shove in their food and move on.  Spot cleaned at best during lunchtime, surfaced cleaned after lunchtime.  I usually see rags in a bucket used to clean seats and tables between grades.  Children often have to bring their coats with them and guess where they end up…on the dirty floor.  With that said, lunch boxes often spend a lot of time on the floor during the day.  So many kids come to school with lunch boxes that are filthy inside and out.  School cafeterias have functioned like this for my entire life but there has to be room for improvement.

The Gym

Students spend a lot of time in gym class and sitting on the gym floor for various assemblies.  At best, they gym floor is dry dusted once in a great while.  In most places, kids are wearing their street shoes into gym class.  I remember having to change into our sneakers before gym class. My gym teacher probably did that for two reasons, that way we always had sneakers and it also kept the gym a little cleaner.  Public schools can’t expect kids to keep shoes at school anymore and a lot of students couldn’t change shoes efficiently these days.  Gyms need to be cleaned more often and better ventilated.  I’m going into brand new schools or new gyms where they are basically sweat boxes with a single door for ventilation.  While challenging, wood floors have to be sanitized at some point and dirt needs to be cleaned up.

The Classroom

Anyone who thinks you can social distance in a classroom is living in a dream world.  However, this is an opportunity to advocate for decreased classroom size.  If you ask students to wear a mask all day, you’ll probably create a bigger germ problem than you have in the classrooms now.  All I envision is cloth masks that never get washed, touched constantly, decreased attention and in the end the masks will up on the floor half the time. If you put up desk separators they will fall down all the time, kids will miss a lot of instruction, naughty behaviors will emerge from behind the curtain and quiet kids will be missed.

Water bottles are right up there with lunchboxes in terms of how gross they are.  Some kids chomp on them all day, some are rarely washed and most end up on the floor at some point.  Water bottles came into favor after the H1N1 flu closed down the remaining working fountains in schools.  Parents were worried that their child was somehow going to dehydrate severely at school and schools went along with it.  Water bottles wouldn’t be so bad if they were used with some polite expectations and kept in a clean place.  Water filling stations are the new drinking fountains.  Sounds like a good idea, until you actually watch the students use the filling station.  Most put the lip of their bottle up to where the water comes out, touching the spigot. Again this is where some education is in order or schools will have to monitor usage.

Kids who come to school a little on the dirty side might need a bit of help.  These kids are usually ignored in school either because adults don’t want to put them down or adults just don’t want to get involved. Reality is these kids need some discrete help by either talking to them, taking them to the nurse or counselor for help or by helping them get cleaned up.  Keep in mind there are kids who are very clean when they leave in the morning and show up to school dirty and kids who are living in not so great surroundings. Schools need to learn to tell the differences and have a consistent plan to help these students.  Certain kids are also going to show up clean when they get to school and look really grubby when they leave school.  It is just their nature.

There are sinks in some schools and hand washing is better than sanitizing.  However, the sinks are usually filthy and like bathrooms need to be cleaned several times per day.  Again kids need to be taught how to use soap and wash hands properly.

Desks and tabletops should be cleaned at the end of the day.  Dirty chairs should not sit on top of desks.  Classrooms should be decluttered so make cleaning at night easier. Doorknobs should be wiped down. However, using an ineffective cleaner and those brown paper towels will do nothing.  Things like books and keyboards will be germy, that is a fact of life.  Unless you want to put kids in a bubble and end up with weakened immune systems they have to take some risks.

Heating systems and ventilation systems need to be repaired and updated.  Here in the northeast the first few days in September and the last days in June (well not this year) are usually hot as blazes.  Basically, turning schools into hot stinky messes. In the winter I’ve walked into classrooms where rooms were so hot the windows were open.  Those classes were like being in a petri dish.  Then the classroom next door was so cold the kids noses were red.

My biggest fear

My biggest fear is that those that work closely with kids in schools will not be able to touch kids at all. I mean things like holding a little ones hand, comforting a child with a hug, giving high fives for good work, giving a pat on a back, guiding a child down the hall, buddy hugs or even a well deserved/needed hug.  I can’t tell you how many times I’ve received an unexpected hug from a child and if I can’t hug back or have to stop a hug, I will be heart broken.  

Here is what I expect will happen

Schools all over the country will put unrealistic and absurd guidelines in place.  These guidelines will be severe and a knee jerk reaction to the current situation.  Most will be based on the personal fears of the administration, pandering to parents or what other schools are doing.  Not on evidence based science or even common sense.

I think these guidelines will fade quickly over a short period of time, even the guidelines that do make sense.  Schools will be cleaned properly for a few months and then they will fall back to their old ways.  Principals will tout how clean their schools are citing the bathrooms or cafeterias but the rest of the building will be neglected.  Schools will buy the effective more expensive cleaners and other supplies but will be taken away the next budget cycle.  They will pay for extra custodians for a year or so then the budget will cut them out too.

So I sound cynical but I am basing this on recent history.  Every time there is a school shooting incident administrations, teachers and parents jump on the bandwagon about school safety.  There is always a lot of training and lot of plans.  Basically, these become band-aid measures and procedures put into place, most not permanent.  Within a few months, we find doors left propped open or unlocked, strangers not being questioned as they walk through the building, broken camera systems, communication systems not being updated as promised and people being buzzed in when they really don’t know who they are.   

There is going to be a lot of fall out when the shut down is over.  Parents who are not happy will address school boards; school boards will blame administrators who will in turn point fingers at principals.  Principals will then throw teachers under the bus. Right now every realizes that the shutdown is nothing that could have been planned for and that everyone is doing the best they can with limited knowledge working in technology and having to recreate their content and materials to fit on line learning.  6 months from now people will forget the challenges and ask why schools couldn’t do a better job.  I predict there will be a lot of changes with administrative staff because of the finger pointing.  However, the administration and principals will be looking for smaller schools and districts to work for.

Basically schools need to improve the cleanliness of buildings, help/encourage basic hygiene for student and parents, budget for increase custodial staff/cleaning supplies and fix heating/ventilation systems. This may not solve all the issues but it is something to think about.

How are school SLPs handling their caseload during the Covid 19 crisis?

Posted by Teresa Sadowski MA CCC-SLP on Apr 11, 2020 in Administrators Page, slider, SLP Chat | 2 comments

We’ve been out of school now for 4 weeks here in the northeast because of Covid 19.  While I only have a small private practice that I put on hold, I have been wondering how school speech language pathologists across the country are managing their caseloads, especially those therapists who are put in positions where they have 30-50-80+ students on their caseload. Even when working in schools some very creative scheduling, often with help from an SLPA, has to take place to manage a large caseload.  

If you’re an SLP with a large caseload you’re often seeing kids in groups of 3-5 (basically each student is getting 6-10 minutes per session to work on their specific skills, less if you’re a big data collector).  I think of these as Band-Aid services, doing just enough for the students to say they’ve been to speech therapy.  Now I am not criticizing because I’ve been in that position and I know why/how SLPs end up in that position.  That’s a conversation for another time.  However, after this is over I hope SLP’s use this experience to help advocate for lower caseload numbers.  

Teletherapy sounds like the perfect solution on paper.  I imagine school administrators might think this is easy peasy.  I participated in a day long in-service on teletherapy and it seemed to be working well for those presenting.  However, it was clear that the presenters honed their skills over time and were basically experts in teletherapy, the same way many of us are experts in articulation/oral motor, working within a specific population or literacy.  This was not a step by step conference on how to set up teletherapy but more about how it can be used and aspect that need to be taken into consideration.  

I actually thought some of the advanced things the presenters were doing within the teletherapy format were very cool and innovative.  However, a few things were pointed out (either during the conference or in conversations among other SLPs) that were significant that I can bet school administrators haven’t even taken into consideration when they tell their SLPs to just do teletherapy.  

• Rural and lower economic students may not have the internet access or updated equipment to participate in teletherapy.
• Parents need to have significant buy in and need to be present during teletherapy sessions. First because they have to be able to help their kids connect to teletherapy, second they may have to be facilitators for their child to access therapy and third is a safety issue, you don’t want to be alone on line with a student of any age.
• Seeing kids in groups during teletherapy is tricky.  Even with the so-called relaxed rules around HIPPA because of Covid 19, permission is needed to see kids in groups on line.  With the parent factor, you really never know if parents have history with each other.  Plus do you really want parents to find out that you see their kids with so many others?
• Because there are only so many hours in a day it will be almost impossible to follow any IEP to the letter of the law much less with students who receive extensive services. When all this is done it looks like parents will be allowed and entitled to request compensatory services.  I can’t even imagine what that will look like for some, even if only a few parents take advantage of this.
• Bottom line is, it is impossible to see large numbers of students through telepractice 
• There will be technical glitches on both ends.  Right now I’m reading about a lot of glitches.  I assume this is primarily because of volume and many people who are new to the platform that don’t know how to troubleshoot.  Is your school IT team prepared to trouble shoot these glitches, calling parents if needed?
• If a glitch happens, do administrators realize you’ve lost a session and how much time went into troubleshooting.  Is there a plan B if the teletherapy platform chosen won’t connect?  (This week my personal PT had to use a different platform, connecting through her phone, using her personal number).
• When using teletherapy it is unlikely that you will be able to schedule students back to back.   If a half hour session ends at 9:59 you are physically unable to make the connections and be ready to go for your next client/group at 10:00 on the dot.  If you do get behind, you have no secretary to call and let the groups know. (Again not criticizing because it has happened to me, during traditional therapy it often happens that once you’ve dropped off and rounded up the next group of students you might be 5-10 into the next session).  Scheduling half hour sessions 45 minutes apart seems to be the norm to avoid getting behind.
• Until you get very good at teletherapy and build up appropriate materials, teletherapy prep is going to take some time.  I would imagine in some cases a pre-email is sent with materials to print out.  While that is time well spent, unless pointed out to administrators they will not even think about it.  

Do phone calls and emails work any better?  Perhaps in some cases, who knows? These are very unusual times.  I think most people are grasping at straws and trying very hard to make remote learning work.  My thoughts are that teletherapy has a better chance of working well in a private practice or clinic setting.  If a school wants you to try teletherapy and sets up/pays for the platform, offers at least minimal training and want all district SLPs use the same teletherapy guidelines, try it out and consider it a learning experience.  Keep track of the pros and cons so you can report on it later. Also keep track of all contacts with parents and students phone, email or teletherapy.  

If your school administration is leaving it up to you alone to set up and use teletherapy, I would say no. That type of situation just leaves you hanging, especially if you don’t carry your own personal liability insurance.  I checked with Trust Risk Management, my liability insurance provider and my policy covers teletherapy.  Without school investment, there is no IT support when you need it.  If something goes wrong you will be blamed.  I’ve worked in schools long enough to know that when this is all over the blame game will be massive, so be prepared.  

I would love to know how school SLPs, especially those with large caseloads are managing.  Please comment on glitches and successes.  Is teletherapy even the term schools are using? Did your school jump into on line learning too soon without the proper research/training? One other thought …it’s too bad CEU’s are not available for those of us who are working on developing our skills in the use of teletherapy.  So many SLPs and educators in general are putting a lot of hours in to developing a totally new skill set.  I will bet that in the next few years teletherapy becomes a graduate course.