Hi, everyone, and welcome to the Missing Link for SLPs podcast. I’m Mattie and you are listening to an episode in our podcast series, “Oh, the Places You Will Go: an SLP Spotlight” where I get to interview speech pathologists who have interesting positions in our field; from the very basic to the most interesting spots, places people they work with and all of that in-between.
I get to have the fun of just chatting with these SLPs finding out what they do, how they got their jobs, and any words of advice they have for other SLPs! So listen as we explore all the wonderful things an SLP can do.
MM: Welcome to this episode of the Missing Link for SLPs and I am here with Sarah Schaefer. Today, we are zooming so I can see her big beautiful smile and you will definitely hear it in her voice! Sarah and I work together as faculty at St. Cloud State University and she is like my go-to resource for anything school system related. So I’ve asked her on here today to tell us what it’s like as a school speech pathologist. So welcome, Sarah.
SS: Well, thank you, Mattie! You’re so sweet.
MM: Well, we have fun! That we do and that makes a really big difference. A really big difference! It’s enjoyable. So you tell us about your experiences as a school speech pathologist…
SS: Well, I’ve actually had kind of a really fun time as a school speech pathologist because there’s been a lot to lead up to that point. And so I’ve worked in a variety of areas and with a variety of ages Just so I’ve kind of done a little bit of everything. It’s been really fun!
MM: That sounds excellent. So you’ve worked with just in the school system? Have you ever worked preschool, older school, high school? You’ve worked the whole range?
SS: The whole range. Actually, prior to becoming an SLP, I was a sign language interpreter. I worked as a sign language interpreter mostly in the educational setting. And that was from elementary to high school again and then I decided to come back and become a speech-language pathologist. I initially worked in an outpatient setting where we also did contract work to local school districts. And so because of that, I was working a part-time position the school district was having a hard time filling or maternity leaves and so I worked from birth to high school with a variety of students in that setting.
MM: Why did you choose to work in the schools versus the medical setting? Why did you choose schools?
SS: Oh, that is such a hard question. I think a lot of it really came from that when I was an interpreter, I worked in the schools and just loved it. I really loved being in the school setting. I’m a little bit of a nerd and when the school supplies come out in the fall and I’m the first to run out and grab a shopping cart full of pencils and notebooks and folders. It’s just a fun time.
But I really wanted to kind of get a perspective of what medical looked like and what educational looks like and both have pros and cons. But it just depends on what is a good fit for you at that time.
MM: Were you able to get experience in both settings?
SS: I was! I worked in an outpatient rehab at a pediatric clinic for almost three years. So we typically would work a 40-hour workweek, but usually in outpatient pediatrics, it’s Monday through Thursday, and you work 10 hour days. You work with a variety of kids and you get a lot of very unique cases. And then I kind of had my foot in the door a little bit with the educational setting just because we did those contracts. A couple of days a week we would go on contract settings in local school districts, so I kind of got the best of both worlds.
I even got an experience to work at a private school, which was really unique because we were doing outpatient pediatric medical facility billing while working in a private school. So that was a really unique experience too. But yeah, I think both settings are really great.
I would say medical is probably a little more fast-paced. And I think that medical, you get a lot more variety of disabilities and disorders that you wouldn’t necessarily see in the educational setting. And I think that on the flip side of that, you also get exposed to more clients and their families. You get a lot more of a rapport built between families –not that you don’t in the educational setting, it’s just that the opportunity is a lot greater because you see them dropping off their little one for sessions and then picking them up afterward. While in the school, you only see them really at an IEP meeting or at conferences. So that’s kind of a plus on the medical side.
But I really do love working in the schools. I like the atmosphere. I like the students I get to work with. You can build a report. But yeah, I just enjoy the educational setting.
MM: It sounds like you! I know in the medical setting, I’ve worked with children and we see them for a shorter period of time because we’re focused on and insurance only covers so much. And then there are deductibles sometimes and things like that. So I think one of the benefits of working in a school setting may be that you do get to see this child go from point A to point B, which may be as long as needed. So that would be neat to see the continuum.
SS: Yeah, yeah. It’s kind of fun. I think both settings have their challenges. In an educational setting, you’re working really hard to get them to receive services just because the criteria is a lot more difficult. In the state of Minnesota, for receiving services in schools, they have to be two standard deviations below the mean, when compared to their same-age peers, and depending on the disorder that you’re evaluating for, it might even be on two assessments, whereas in the medical facility, it’s just one standard deviation on one assessment, and that’s it, and then they qualify. So in the schools, you’re working hard to get the services and then in the medical setting, you’re working hard to keep their services to show that they’re making gains to show that what you’re doing is working. So both have their challenges.
MM: What would you say is one of the biggest challenges of working with a school setting?
SS; The biggest challenge in working in the school setting is I feel like, in the school setting, you have a lot that you’re working through as far as kind of that bureaucracy piece. You have an administration who’s overseeing you. And then you have a lot of documentation that sometimes it feels like you aren’t able to capture what you want to capture on the student. But in order to be compliant with due process, you are putting information in that wouldn’t necessarily pertain to speech but more towards school and academics. And so you have to kind of do a little bit of tap dancing to make sure that what you are doing is academically appropriate.
I think it can sometimes be challenging as to what schools recognize as a disorder or a disability. Sometimes, schools are a little bit behind on that. For example, auditory processing disorder: in the medical world, we recognize it, we see it, we understand it, we treat it. In the educational setting, they’re a little bit behind on that so you have to kind of figure out a way to word it so that you are still getting them the services that they need and the support that they need, but still being compliant to the regulations. That’s a little bit of tap dancing, but that’s what makes us good at what we do, right?
MM: Yes, yes, yes. Yes. So if you are talking to students who are trying to decide which way to go, and you were in some challenging times right now with COVID and the riots going on, what recommendations would you give to the undergraduate or graduate student who’s really trying to prepare herself to step into the school setting? What kind of opportunities should they be looking for? Courses to take? People to meet?
MM: I think that internships are really a great experience to kind of see what that educational setting looks like. So when you’re talking to your clinical supervisors, if you want to, just make it known that you’re interested in that area, and you want more experience in that area so that you can see what it would look like. And then also, if you are wanting to work in the educational setting, I think it’s a good idea to get experience with the software that the schools are using, just so that you can kind of be familiar with it. And so just letting your supervisor know that “Hey, I would love to have more experience with the software that you’re using to report due process or paperwork for students.” Sometimes knowing that information, even though it’s a little bit different for each district can help you just because learning different ways to report stuff is really helpful. Everybody does it just a tiny bit differently, and kind of learning some fast ways to do things or efficient ways to report different disorders and disabilities is really helpful in your career.
MM: Excellent, excellent. So take us through a typical day in your school, how does it roll out? Who do you work with? Who are members on your team?
SS: Well, I’m really lucky, I get to work with a lot of different people on my team. I work obviously with administration, so that would be the principal and assistant principal. And then I also work with another speech pathologist at my school. And so we tend to team a lot and something that I think students should know is that everybody has their niche. Some people are really good at one thing and maybe not so good as another, but they might be working with a person who is the opposite.
Just knowing that you don’t have to be 100% accurate all the time in every single area. But if you find an area that you’re really good at, that you let your team know that, “Hey, this is the area that I really am good at. “And people will validate it and use that and if you don’t know an area, that’s an opportunity to reach out to your team and ask them their opinion and their advice because more than likely someone on your team has had more experience and can offer some really great advice to what you can do to be more supportive to your students.
But getting back to your question of who I would work with: I work with special ed teachers. I work with reading and math interventionists. I work with OT and (our occupational therapists) and physical therapists, psychologists, counselors, social workers. There’s a lot of people with vision and hearing loss Deaf and Hard of Hearing teachers so I’m lucky I get to work with them a lot.
More specifically within my day, I typically work with special ed teachers and regular ed classroom teachers. And then I also work with what’s called a D&CD teacher. So that’s developmentally and cognitively delayed students. I get to work with that classroom. And the teacher of that classroom and I work hand in hand and we tend to team-teach together. So if he (the teacher) has a topic that he wants to work on for that week, then I find speech-related activities that work within that topic, so that we’re working together to just kind of cover more ground.
There’s that academic piece again, to make sure that my speech is functional. What I’m providing for speech therapy is functional towards the academics and then they also work with an EBD teacher so that’s an emotional behavioral disorder. And within that classroom setting, I tend to go into the classroom – where they call that a push in. And then I and the social worker for the school will team teach. And that’s where I provide my speech therapy. And she provides her social-emotional support and we work together on different concepts. So I bring the communication side of it, and how to work through some of the nonverbal pieces within communication or figurative language, and then she works with how to regulate those behaviors and how to be socially appropriate in a variety of settings. So we work together on a lot of concepts because it just seems to work well for our students and, and it’s great to be able to team-teach. The more the merrier.
MM: You really into big teams at that school!
SS: At school, we do!
You do not realize all that depth in the outpatient setting. Where we work with peds, we work with physical therapists, occupational therapists, some other therapists maybe, but normally, it’s just primarily PT and OT. Very, very, very different.
And you know, when I worked in outpatient, it was the same. It was PT, OT, and ST. And that was really fun too because I feel like occupational therapy and physical therapy, in the medical side of things, is not the same as the educational side. I feel like there’s a lot more that they can tackle on the medical side, then educational, they tend to have more of a consultative role, where OT and PT and medical they get to kind of be hands on a little bit more.
MM: A lot more in-depth because we will get a child for like, a big amount of time. But you know, you made an interesting observation earlier where you said, people can really niche down. And I think when graduate students come into whatever setting they’re going into, they think they have to be experts in everything. And, they’re not. When you take the Praxes, you have to know like everything. And when you start practicing, you do really get to say, “I really want to learn more about autism or AC,” or you know, whatever. So, I think maybe this is common for the students, but as you begin to think of where you go, really think about what you want to do. What are your passions? What do you want to work with? What disorders do you really see yourself getting excited about? And then find the setting that matches your interest.
SS: Yeah, yeah. And you know, people once you start working with them, they will recognize those passions and interests and they will come to you for advice in those areas, and vice versa. You’ll recognize it and people that you work with. If you are not necessarily comfortable working with autism, you may work with a special ed teacher or with an occupational therapist that really loves working with clients with autism and has some great resources and support for you so that you can be more effective as a therapist. So just because you don’t know, the ins and outs of every single disorder does not mean that you will not learn it from other people that you work with.
MM: Right. Right. And we know that we’re always, always, always learning, always learning. Oh, yes.
SS: I think that’s what’s really great about our field is that we, we tend to be a bunch of nerds and we were not afraid to say that and we just really enjoy learning all the different pieces.
Learning new information on how to provide better therapy and how to be more supportive of our clients!
MM: Right! So can you walk us through a typical day? What day do you what time do you walk in the school door? How does it roll out? When you take your lunch? Do you get lunch? How long is it?
SS; Well, for me because I work in the EBD classrooms, they call them setting classrooms because I work in the EBD and the DCD classroom, I typically do that for about half of my day, bopping between the two classrooms. So from the time I walk in the door at about 7:15 by 7:30, I’m usually meeting with my team members, whether it be the other speech path that I work with just kind of reviewing any information that we had talked about previously, maybe new activities or new programming that we’re going to try with our clients or with our students that day. And then at eight o’clock, students start rolling in, and in the school district that I work in, we typically do 15 minutes, sessions two times a week.
Now that’s not necessarily typical in all school districts in the area. Most of them will do 20-minute sessions for two days a week. And I found that I think both are very effective. But within the 15 minutes sessions, we tend to be able to kind of manage those higher caseloads that we’re seeing more in the educational setting, but still, get rates to work as soon as the students walk in the door. So they come in, I usually have a folder for each student, where they take out their folder and they take out their datasheet. They hand it to me. Look at what they worked on the previous day. And then I usually have some sort of game that I used with all of my students for that day. And then I just cater to it, depending on what their needs are. So if I’m playing, let’s say Candyland, that’s a speech path, go-to. If I’m playing Candyland with my students, and their articulation, well, then I’ll have I’ll have various apps or different articulation flashcards available that we’re going through between each child so that we’re getting all those reps in.
And if it’s a language student, a lot of times I’ll have picture cards available where they are describing a picture scene using their targets for that day. Or if it’s figurative language- that I’ve got figurative language cards that will use in between each turn. So then it’s just a little bit different depending on what student I work with, but usually, my students come in, and usually they’re in groups of one to three. I don’t have many where I have three students. And that’s kind of the plus of having 15-minute sessions versus 20 is that I can keep the number of students in my session a little bit smaller so that it’s more one on one.
And, then we do our tasks. We get our drill in, if you will. And then they usually have a sticker chart. And if their behavior was on tasks for that day, they get a sticker. And when their chart is filled up, and it’s then they get a game day. And usually, it’s like 12 or 15 sessions before they can get a game date. So they have to work for it for a while. And then I have at least 15 minutes of prep each day, or at least I’m supposed to, but sometimes, depending on if there’s other a small emergency or if there’s a meltdown with a student who has communication difficulties, I might jump into that moment and help out by just guiding and redirecting teachers to use like that first-then language, cuz sometimes when you’re in the heat of the moment, it’s hard to remember those things. And so I’ll jump into those moments and help out.
And then usually, I did a 30-minute lunch, most of the time, but I’m having my lunch, independently. Sometimes I do a couple of days a week where me and the other speech pathologists will have lunch together. But you might find that you enjoy having your lunch by yourself, just because you’ve been talking with people all day long, and you just want the quiet.
MM: I go home at night and my husband’s like, he says, “You just don’t talk at all.” and I say, “I talk all day long!”
SS; And usually, at that point in my day, I’m in my classroom and I’m so lucky in the building that I’m at; I have a full-sized classroom. I keep the lights low, and then I use alternative lighting in my room instead of that overhead lighting. So it’s very calm in there. We usually have some sort of music playing in the background during like my prep or lunchtime, but then, of course, it’s quiet during sessions. But yeah, it’s kind of a fun day.
I have two different areas in my room. One area is a table with chairs and that’s typically where I have like my drill sessions where we’re drilling through articulation, or language skills. And then I also have an alternative part of my classroom, where it’s a cardboard box. And literally, it’s just a dishwasher box that I’ve used in my classroom that I have Christmas lights inside of it. And then I have coloring cramps for the kids and like a beanbag inside there so they can go in there. So if a student’s especially like kids on the spectrum tend to just need to decompress, and sometimes their classrooms are a little overwhelming for an entire day. So a lot of times I’ll do my therapy inside this little cardboard box and I’ll have a book there that I’m reading to the student and they’re answering WH questions, but they’re coloring on the wall too at the same time. So it’s a nice little sensory mix in case I have students that are just have had too much for the day and need a little bit of a break. So I’ve got two little zones in my room.
Depending on what their needs are for the day, we might do therapy in our I call it the “relaxation station” in the cardboard box or we might do it at the table, depending on what their needs are and then at the end of my day when students are wrapping up and getting their backpacks on and heading out the door, I’m typically meeting with team members and just reviewing how the day went for the students that I’m working with and any concerns that I could help out with for the next day.
I typically try to leave at about 3:15. Usually. Now, when we have conferences, typically we’re supposed to report on all of our students and write progress notes for each student that we send out with their grades to their family members. So those days I might stay a little bit later just to get some more due process done, or if I have multiple evaluations going on, sometimes I’ll say a little bit later.
Our building has taken on the practice of using the three-to-one model that ASHA recommends educational settings to use. And that’s three weeks of direct service and one week of indirect. So that’s me going into classrooms for a week for all my students and touching base with family members or classroom teachers to see how they’re doing and using their speech skills within other environments. And then also working on that due process piece so that might be third party billing, so MA billing or progress, note reporting or evaluation writing. We’ve utilized that a lot more and that’s helped with not having to stay after hours as often. And so that’s been really great.
MM: Do you ever pick up hours over the summer or do you just work a nine-month school year?
SS: I do. It’s completely voluntary. You don’t have to pick up hours over the summer. You can work just that nine months and be done and have your summers wide open for you. This summer, I did choose to work for the summer. There are two other speech paths that also work over the summer. I let them take on the bulk of the caseload because they enjoy having that extra income. And then I just kind take the overflow if they have too many students, then I take the overflow. So it’s nice. I usually work just two days a week from like eight to noon. And, it’s only four weeks out of the summer. So it’s two weeks in June, two weeks in July. It’s short and easy and it’s just to help maintain skills. It’s a very different environment very relaxed. More just fun and summer activities you get to be a little more creative and have a little bit more of an artistic license. But it’s not for progressing their skills. It’s derived to just maintain the skills that they have that they don’t lose any before the next school year. So that’s kind of nice.
MM: Nice! So everybody loves a good story, I asked you to think of a story where something went really wrong. And then our last question will tell us a story or last topic will tell us a story where something went really well.
SS: There are many instances where you will have something go completely wrong. And one of my favorite stories is when I was working with a student who happened to be afraid of being kidnapped. They were very, very much afraid. It was an original fear. I hadn’t worked with any students or clients who have had that fear previously so it was kind of new and a unique experience for me. And within that experience, the student also had difficulty seeing and so I was walking with them down the hallway, and they saw an adult coming that they did not recognize and they fled. They ran and literally yelled, “Stranger Danger!” So they took off running down the hallways, and again, this child could not see the greatest so we were concerned on many levels about if they were to trip and fall or run into something hidden. So it was myself and a couple other teachers and professionals that were trying to track this student down and figure out where they had run off to and of course that day I had worn heels. So running was a little bit of a tricky option for me.
So that was a day where there were things went completely wrong and it happens to be that the same student also was afraid that you hated them, and was convinced that you hated them. And so they would ask when things got tricky or they got hard, they would ask, “You hate me, don’t you?” And then, of course, our natural response because that’s who we are a speech paths – we are giving compassionate people, our natural response is, you know, “I don’t hate you. Why would you think that? Of course not!” And then, unfortunately, that reaction, that response just made it worse for this particular student. And so they would go throughout their day meeting with classroom teachers, meeting with special ed teachers, meeting with friends, meeting with Speech. And they would ask this question and of course, people would respond that way and then it was meltdown city. And then it was hard to get that student back the rest of the day.
MM: How did you respond?
SS: Well, after several months of us working with the student and not having much previous history about the student, finally, one day after getting to know them and realizing that they had a really great sense of humor, one day, I took a risk and (I don’t recommend taking risks very often), but this time it did pay off and I said, in a very deadpan voice, very flat effect face, “Yes, I am furious at you, grrr!”. And they started laughing. They thought that was the funniest thing ever. No meltdowns, we spread the word told all the other teachers, all the support staff, and then it was not an issue anymore.
So it was a risk. It could have gone really badly. In hindsight looking back at it because that would have been an interesting story to tell parents that, “Yes, I did tell your students that I was furious with them,” but I know it worked out really well and the student had a much different attitude towards people and we didn’t after that point, everybody used that kind of humor to work with them. And we didn’t have issues with that anymore.
MM: Excellent. Yeah, it’s kind of a good story. Story went wrong that turned out well.
SS: Yes. You just never know. I mean, some of what you’re you’re working with, you really have to trust your gut. You have to trust your instincts. And you have to be willing to be observant of what your client needs because every client is different. Every client comes with an experience and a story and a home life that might be affecting what’s happening in that moment. And you have to understand that and be respectful of that and just take that into consideration when you’re working with them, that they might need something a little different from you than what you were initially expecting – more than just flashcards because that’s this job is much more than just flashcards.
MM: Right! Do you have a story you can share with us where you thought, “This is why I do what I do!”
SS: Oh, yes. Oh, my goodness. I’m gonna cry with this one, I think.
I have to hold myself together here. There was a client that I worked with and they were very young and they had Down Syndrome and they were nonverbal. And family was very concerned. They were really concerned that their child would be nonverbal forever. And as we know, with Down Syndrome, yes, there’s a lot of similarities. These no two people with Down Syndrome who are the same. There’s a lot of variety within that disorder and so when they’re young, you just really don’t know what they’re capable of yet until they have a few years worth of therapy to kind of see how they’re progressing. And so, I worked with this particular family and again, this client was nonverbal, and we worked using baby sign as a form of communication and we worked with this family, I would say it was a good four months into, working with them. We also did some apraxia therapy with this particular kiddo too. With language and with baby sign we kind of just threw up everything at him that we could. And one day as we were, (again, trying not to cry).
One day, as we were heading back from the lobby to the session this client turned and looked at their mom and said, “Bye, Mom”. Mom just cried and cried because that was one of the first times that she had ever communicated to her mom and we had practice doing it every session going from every lobby session to our backroom. Every time we would turn and say bye to mom and usually we would get a wave. But one day she said, “Bye, Mom”. And that was…that was the best.
MM: Thanks for sharing that. I think there are many of us speech pathologists who tear up easily when we talk about our success stories and why we do what we do. We believe that communication is so powerful and so necessary. And something as simple as a child reaching to a parent or those have been some of my first my best stories when I’ve worked in the pediatric clinic outpatient clinics where a child has said something to a parent. And that is like, a parent will wait and wait to wait for years for that child to be able to do that.
SS: And you know, it’s something as simple as, “Bye”, that we take for granted without meaning to. And so when, when a parent is able to hear that from their child for the first time, it’s just so powerful. And then it just reminds you why you got into this field. Why you’re doing what you’re doing and it makes all those moments that are kind of a struggle, it makes it all worth it.
SS: It just makes you work harder moving forward and it also helps to validate that yes, what I’m doing is exactly what needs to be done. This is working. So that’s just a lot of really great stuff.
MM: Right, right. Excellent! Any final words of wisdom for the newer speech pathologists?
SS: Final words of wisdom? I would just say be open to new experiences and be open to working in a setting that you never thought you would work in and with a population you never thought you would work with. because you might just find that you absolutely love, a place that you never knew existed.
MM: Well, thank you! Thank you! Thank you for bringing your passion, your joy, your love for what we do. So I can see it in your face and that’s why I do what I do with these podcasts because this is exactly the message I want to get out for people to hear. So thank you. Thank you for your time.
Absolutely. And thank you, Mattie for inviting me. This has been wonderful!
I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge.
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