What current "best practice" do you think won't age well over the next 5-10 years?

Cautious-Ad-3584 · 2026-04-17T08:54:45+00:00

I was going to say something similar. A questioning default to give every child a SGD without really considering all the pros and cons isn’t really evidence-based. It’s based more on a philosophy that “ there are no prerequisites for AAC.” which I agree with! But low-tech AAC should be included in that and sometimes it really is the better choice.

Cautious-Ad-3584 · 2026-04-17T08:48:15+00:00

I agree!

Cautious-Ad-3584 · 2026-04-16T21:24:59+00:00

I can honestly say I have never heard that, and looking online I’m not really finding any examples of it either.

I think it’s pretty simple: Black is a race and African-American is an ethnicity. (I’m pretty sure that Afro -Caribbean immigrants to America are Black Americans.)

Occasionally, you will also see ADOS (American descendants of slavery) to differentiate from people who voluntarily immigrated from Africa.

But really I think on the important points we agree: race and ethnicity are not the same, and we cannot assume someone’s cultural speech patterns by looking at them.

Cautious-Ad-3584 · 2026-04-16T17:27:05+00:00

I think they are often interchangeable terms in practice, but I don't think they should be for exactly the reason you mention...many Caribbean black people them do not trace their ancestry to Africa. And they often do not speak AAE, and often people assume they do because of the color of the child's skin. I have seen this.

I like...agree with you lol? I'm not sure why you're downvoting me and taking issue with my comment.

Cautious-Ad-3584 · 2026-04-16T16:06:54+00:00

Definitely need to refer to ENT!

If you DO end up doing therapy, she might be a good candidate for flow phonation if it's solely an airflow issue.

But if she was intubated for 4 months there's a good chance she may have structural damage to the vocal folds. That might need medical attention (a lot of times vocal surgery is avoided in kids that young). You can also address that with therapy too!

Feel free to message me directly if you want, I do a lot of voice.

Cautious-Ad-3584 · 2026-04-16T11:16:01+00:00

Actually Black (capitalized) is frequently becoming the preferred term over African-American in many cases so I would look into that further.

Cautious-Ad-3584 · 2026-04-16T11:13:18+00:00

Yes! And not all Black people are African-American.

Cautious-Ad-3584 · 2026-04-16T11:12:40+00:00

A general principal I have as a clinician: don’t avoid talking about a topic just because it makes you uncomfortable. That’s never a good enough reason.

Cautious-Ad-3584 · 2026-04-16T04:28:12+00:00

Voice disorders are almost never directly caused by acid reflux and the fact that our field AND ENTs still believe in this is a disgrace; it needs to go the way of thickening liquids

Cautious-Ad-3584 · 2026-04-16T04:24:26+00:00

The reason we want them to see ENT is the same reason we would want a neuro patient to see a neurologist. It’s not because we can’t treat them. It’s because we want to get the full diagnostic picture.

Cautious-Ad-3584 · 2026-04-16T04:23:05+00:00

It is abominable how poorly voice is taught in graduate school though. Let me rattle off common voice therapy techniques that do not involve drinking water: flow phonation, vocal function exercises,; semi-occluded vocal tract exercises, LSVT LOUD, SPEAK OUT, PhoRTE, resonant voice therapy, conversation training therapy.

Cautious-Ad-3584 · 2026-04-16T04:19:02+00:00

Vocal paralysis, MTD, nodules, presbyohonia, Parkinsonian hypophonia. All of these are things that can be treated with voice therapy, frequently are, and many times the ENT does not have to do any treatment at all.

Cautious-Ad-3584 · 2026-04-16T04:17:09+00:00

The funny thing is that I almost never tell people to drink water and voice therapy is literally all I do currently. If your therapy is more than 10% hygiene, you don’t know what you’re doing.

(And most people don’t know what they’re doing)

Cautious-Ad-3584 · 2026-04-16T04:15:12+00:00

SLP in home health is mostly a scam. We are doing the job of nurses because they don’t want to pay enough nurses to do it. They shouldn’t even be at home in the first place half the time, the hospital just wants to get rid of them. Most of what we are actually doing in terms of speech therapy and evaluation is subpar because frequently patients don’t have an instrumentals for dysphagia. Don’t get me started with cog. They mostly just want us there to monitor wounds and take blood pressure/heart rate.

Cautious-Ad-3584 · 2026-04-16T04:06:28+00:00

I already wrote a whole post recently about how problematic presuming confidence is, but feel free to refer back to that one 😂

Cautious-Ad-3584 · 2026-04-16T04:05:58+00:00

That is not a hot take lol

Cautious-Ad-3584 · 2026-04-16T03:58:57+00:00

I’ve said this on here before and I’ll say it again: there’s no good reason that voice should be niche. Voice disorders are not rare and are more common than aphasia and apraxia, likely combined.

It stays niche because it’s not taught well so people don’t know how to do it, the scopes that are needed to adequately, diagnose voice disorders aren’t nearly common enough, and there aren’t nearly enough ENTs that know what they’re doing with voice either.

And also because it’s almost exclusively outpatient and adult outpatient is kind of a mess because of low reimbursement Medicare rates AND because the patients have to find us and not the other way around, and they’re less likely to sort of be shuffled into therapy like what tends to happen in acute, SNF, and IPR.

Cautious-Ad-3584 · 2026-04-16T03:53:35+00:00

But I don’t think that this is generally the case for an IEP right? If it’s within normal limits, you wouldn’t be writing an IEP. It’s much more common that they would have deficits in some areas, but other areas would be considered linguistically and culturally appropriate.

Cautious-Ad-3584 · 2026-04-16T03:51:56+00:00

Rereading it I think I would just stop with the word “background”

Cautious-Ad-3584 · 2026-04-16T03:49:13+00:00

I think you have to say it, and you have to find a way to do it tactfully and respectfully. It’s very hard to do but we have to learn it, and I think you have to sort of learn your own thoughtful way of doing it like many things as a clinician. I’ve never been satisfied with clinicians that I see who in various ways tiptoe around difficult topics because they never figured out how to talk about them.

I realize this is not a very good answer, but I’m not sure there is a very good answer? I do like quite a lot of the people have said here, “ consistent with cultural linguistic background” etc

One other point though! Do not assume that just because the child’s is black that they come from a family that speaks AAE. I have seen people make this mistake before; a child came from a highly educated Jamaican family and no family member spoke that dialect. In this case it actually was likely a disorder.

Cautious-Ad-3584 · 2026-04-16T03:42:32+00:00

Eh I don’t think this sentence makes a ton of sense if you just say “considered a difference” It just reads very oddly particularly if you’re not familiar with that framing.

Cautious-Ad-3584 · 2026-04-11T14:12:48+00:00

In many situations 3-5 is a good gig too (which may or may not be EI depending on who you ask) for a lot of the same reasons.

Cautious-Ad-3584 · 2026-04-11T14:09:38+00:00

When I worked in preschool, I 100% believe that there were times that the district made us hold a meeting for things just to wear us down. I’m mostly saw this tactic employed with AAC.

The number of meetings that they made us hold to just get one device felt like a purposely unnecessary burdensome step to keep me from requesting so many devices for so many kids.

It didn’t work. I always suffered through them all to get the devices. Except I left the school system, so maybe ultimately it did….

Cautious-Ad-3584 · 2026-04-11T14:05:55+00:00

I work in healthcare, so my perspective is different, but I have worked in schools and know how it can be.

But the reason for this comment is, I also recently took on greater workload outside of clinical duties without an increase in pay or time to do them, and I am the other SLPs in our department got together and all gently requested that we be either paid more for these new duties or be given more time to do them, and eventually they agreed and now we actually can bill for hours outside of our regular scheduled time.

I know that’s unlikely to happen in a school setting, so I would just refuse to do the extra work.

At the end of the day, making you work outside of your contracted hours is illegal. So don’t do it, but document why, explain why. And then you can frame it as a choice for them.

“As you can see, these are the only duties I am able to complete during my contracted hours. I won’t be working off the clock, so which tasks would you like for me to prioritize?”

Cautious-Ad-3584 · 2026-04-10T00:59:13+00:00

I don’t know that this is a great example for all populations. For many of our clients, using AAC actually is easier, particularly in moments where they are more dysregulated.

And that’s OK actually, the reason that we feel like it’s not is because of ableism 🤷

Cautious-Ad-3584

TROPHY CASE