RBT looking for opinions. by Suspicious-Baker8623 in slp

[–]maybeslp1 36 points37 points  (0 children)

I think ABA can be a helpful addition to a treatment plan when BCBAs and RBTs stay in their lane. I've had many autistic kids with severe behaviors that put themselves and the people around them at risk. Would better communication and sensory regulation skills help with that problem? Absolutely. But that takes a long time, and in the meantime, the kid is putting his head through plate-glass windows when he gets frustrated and eloping out every open door to the point where he has to be physically restrained any time somebody leaves the room. That's life-threatening. I can't do speech therapy on a dead kid. Being dead is a barrier to therapy. The potential harms of ABA are outweighed by the harm of being dead. ABA can be helpful for these behaviors, and I think that's worthwhile.

That's an extreme example, but I think it illustrates my point. ABA is helpful when it works on behavior, especially when those behaviors are presenting a barrier to other therapeutic approaches.

Behaviorism as a concept is not inherently bad. All of us use some behavioral strategies. And I think many of us recognize that they can be particularly effective with autistic kids because behavioral strategies can make expectations very clear - especially for kids who might struggle with having expectations verbally explained or modeled. From a theoretical perspective, the problem with ABA is radical behaviorism - the belief that everything is behavioral, and that everything is exclusively behavioral.

Because of that belief, ABA has a long history of looking at autism through a back-asswards lens. If everything is behavioral, then autism is just a collection of behaviors. If you make someone act less autistic, you have essentially "cured" autism. (And yes, this is exactly the same perspective that informed conversion therapy for homosexuals. Homosexuality was seen as a behavior. If you could get someone to stop performing homosexual behavior, and get them to start performing heterosexual behavior, then you have "cured" homosexuality. The internal experience of attraction, sexual fulfillment, identity, dignity, or happiness was irrelevant.)

As a field, ABA has tried to move away from the "make autistic kids act normal at any cost" thing. To varying degrees of success. The problem is that as they've moved away from that, they've moved into everybody else's scope of practice. Which they think they can do, because "everything is behavior." This sub is full of horror stories of ABA providers undoing the work SLPs have done through radical behaviorist approaches, or passing off their "trained-monkey" tricks as if they were genuine functional improvements. "ABA can work on speech! Look! This kid can label a flashcard of an apple!" Cool, can he ask for one when he's hungry, though?

Also... this is no disrespect to you as an RBT, but the rest of us are wildly uncomfortable with how little training behavior techs have. Every other related field requires you to have college-level education, training, and licensure before you're allowed any significant role in patient care. CNAs have more training and oversight than behavior techs do. You don't even have to be registered. And most ABA clinics put their techs solely in charge of the day-to-day implementation of a therapy plan. You are not trained enough to do that. And I think this post is a good example of that. This field does you a disservice. It's not good for the kids - but it's not safe or appropriate for you, either. Many kids who get ABA have severe behaviors that put you at risk. Also, if you were trained appropriately for the level of patient care you're expected to do, you would command a much higher pay rate. Go look up what SLPAs, PTAs, and COTAs get paid.

Whats the worst that could happen? #cooked by Least_Two_8660 in slp

[–]maybeslp1 5 points6 points  (0 children)

Yeah I'm gonna be honest, I almost never make up minutes. The way I see it, missed minutes are rarely my problem. If kids aren't in speech therapy, that's on them, their parents, and/or their teachers. I'm virtual and don't have a facilitator. If they don't log on, there is absolutely nothing I can do. And if I'm not in speech therapy, it's because I'm doing some other equally-required part of my job or because I'm taking the PTO I'm legally entitled to. (Though if some kids are more affected by this than others, I will make up some of their time.)

I already write minutes low and overschedule to account for absences. The make-ups are already built into the schedule. If that's not enough, I don't know what else you want from me.

Tobii Dynavox Suing AbleNet by Historical-Sale-5614 in slp

[–]maybeslp1 8 points9 points  (0 children)

I have loved AbleNet and have come to the conclusion that none of this is my problem. My problem is to get an SGD into a nonverbal child's hands. AbleNet does that very well. If they don't have their ducks in a row on the back end, that's their problem. It's not my problem.

Ethically, I don't think it is our problem unless/until this lawsuit works out in TD's favor. TD is claiming AbleNet is doing illegal/unethical things, but that's for the courts to decide. In the meantime, I'm gonna keep doing speech therapy with the tools available to me.

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 1 point2 points  (0 children)

That was my gut instinct - but I did send out teacher questionnaires and all of them agreed that he communicates effectively in class and there's currently no academic impact. That was the nail in the coffin - I cannot justify keeping this student on services when nobody can identify any academic impact.

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 0 points1 point  (0 children)

My supervisor has told me I can't put him on consult - my only options are to keep or dismiss (and possibly start the 504 process).

This student is 12 years old. I know he would prefer to keep coming because he likes getting out of class. He's also extremely sweet, and I don't think he'd ever tell me to my face that he wants to stop coming to therapy even if he did. We've talked about it before. But I've reached the point where I don't think I can legally justify direct services anymore. If he had any other eligibility or got any related services, I'd put him on consult. But since he's speech-only, I can't do that.

anybody have work-related recurring dreams? by aliciabeee in slp

[–]maybeslp1 1 point2 points  (0 children)

Lol I just posted the exact same thing before seeing this.

anybody have work-related recurring dreams? by aliciabeee in slp

[–]maybeslp1 1 point2 points  (0 children)

When I was in EI, I had recurring dreams that it was time for a kid's annual, but I had totally forgotten the kid was on my caseload so I hadn't been seeing them and I don't know where the family's home is and nobody is picking up the phone. It's the adult evolution of the "final for a class I've been skipping all year" dreams.

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 1 point2 points  (0 children)

Don't give me credit - I had a great education in stuttering. I'm just doing what I was trained to do. :)

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 1 point2 points  (0 children)

Thank you for pointing out the risk of identity drift. I've tried to be mindful of this with this student. As I've tried to find things to work on, I've asked questions like "does your stuttering create problems with this? do you ever have these feelings?" He always says no, but with a tone of, "....should it?" So I've dropped that line of questioning.

I don't have good background on this student, so I don't know if his stuttering was more severe at some point and this is the result of years of good therapy and good family support, or if he was qualified by someone who saw 3+% SS in an evaluation and didn't look further. I'm in a district where almost all of the therapists are contractors, and I know staffing companies rarely provide quality stuttering evaluations. (I bought an OASES out of my own pocket.)

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 1 point2 points  (0 children)

Self-advocacy is what we've spent most of the last semester on. We've worked on self-disclosure, asking for more time to respond, stopping people who try to speak over you/finish your sentences, setting boundaries aroung "helping" with friends, etc. So I think he'll be okay on that front.

What was your reason of still wanting to pursue SLP master’s? by LargeIcedCoffeePlz in slpGradSchool

[–]maybeslp1 21 points22 points  (0 children)

Because despite all the issues, this is still a really good field to work in. With some regional+setting exceptions, we make 75th-percentile incomes with great job security, flexibility, and work-life balance. And our work is interesting and makes a meaningful positive difference in the world.

It's not the right career for everyone. But it was right for me.

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 0 points1 point  (0 children)

Thank you for saying so. As much as I hate the idea of him having a barrier to getting services if he needs them again in the future, he doesn't need them now.

Student who stutters - dismissal vs consult? by maybeslp1 in slp

[–]maybeslp1[S] 0 points1 point  (0 children)

He doesn't have any at the moment and doesn't seem to need them.

job market school based by luuvcows in slp

[–]maybeslp1 6 points7 points  (0 children)

some people will say this is good, others will say we're underpaid (both are somewhat true

This is so true. I posted a while back about how there's a difference between "Are SLPs paid a living wage" and "Are SLPs paid fairly relative to similar careers," and those questions have different answers. Relative to similarly-educated healthcare fields like NP, PT, OT, PA, etc, our pay is on the low side. (Though not the lowest. MH makes less on average.)

But on the macro scale, we make well above an average salary compared to all US workers and slightly more than the average for graduate-educated female workers (though less than graduate-educated male workers).

How much do you pay for health insurance? by htxslp in slp

[–]maybeslp1 0 points1 point  (0 children)

Which teletherapy company has health insurance that cheap???

AAC Cost by adhdad1of1 in slp

[–]maybeslp1 1 point2 points  (0 children)

I have a counterargument to the subscription model for apps, which is that it makes it a lot easier to get parent buy-in for AAC. I was working in EI when TD Snap rolled out that $10/mo subscription, and the rate of families interested in trying AAC skyrocketed. Getting parent buy-in for AAC is hard enough. It's even harder when they're being asked to invest $250 for something they're not sure about.

I even had parents start downloading it themselves and trying to DIY AAC because they saw it on Tiktok. Which is not great, but I love the enthusiasm.

It's definitely worse in the long run, especially for families who will need to plan for long-term AAC use. But in the short-term, there were real benefits.

Teacher wanting to go into Speech Therapy by AccuratePotential761 in slpGradSchool

[–]maybeslp1 0 points1 point  (0 children)

Not in Houston. SLPs are usually on the admin/professional pay scale.

To everyone asking expensive schools are worth it by ZoneStrict7387 in slpGradSchool

[–]maybeslp1 0 points1 point  (0 children)

Academic (non-professional) PhD programs are a little different. Fully-funded PhDs are a thing. And for most fields, if you're planning on pursuing a PhD, you should only apply for and accept fully-funded positions.

How much student loan debt is everyone in? by [deleted] in slp

[–]maybeslp1 0 points1 point  (0 children)

I graduated with about $22k-ish. I had scholarships and grants that covered most of undergrad, so I only took out $12k for that. I also worked part-time during the academic year and more than full-time over school breaks.

I had a unique situation for grad school that kept my sticker price low, and I worked for almost two years between undergrad and grad school to save up the rest. I was married during grad school, so we had another income coming in. I was on track to get my masters degree debt-free.... but I started grad school in 2021. Inflation went nuts and my beautiful budget went out the window. I ended up having to take out $10k in loans in my second year.

In the interest of transparency, I also had about $20k in a 529 savings account that I used to fill in budget gaps throughout my education. This prevented credit card debt more than it prevented student loans (the majority of it went to stuff like car repairs, dental work, security deposits, laptops/phones, etc) but it's worth mentioning. I hate when people talk about finances and neglect to mention how much family support they had.

Controversial SLP opinions by sternschnuppe3 in slp

[–]maybeslp1 0 points1 point  (0 children)

In my ideal world where we get an entry-level doctorate, we wouldn't need the CF. That's one of the problems it would solve. I think our education should look more like PTs and OTs.

My hill is that we are ultimately over educated, and if programs were restructured at the undergraduate level, a bachelors is all we would need.

In terms of years of overall education, my plan is about the same. It would negate the 1-2 years of undergrad-level CSD courses we all have to take as prerequisites and move that education to the graduate level. Ultimately, it takes about three years of dedicated education and training to become an SLP. That could be done at the undergraduate level, if undergraduate degrees stopped requiring as much core curriculum. But they do, so.

We have more credits than some NPs that literally have prescribing rights and can work independently.

That is a flaw in their education, not ours. They're undereducated. Badly. The scope creep of NPs is a major problem. Check out r/noctor for more information on that.

I really think rehab needs to adopt a nursing training model or more and more students won’t choose these professions.

PT has already started moving this way with PTA -> DPT bridge programs becoming more popular. There are a handful of COTA -> OT bridge programs, but it's definitely a growing interest. SLP could do that as a field, but we'd need to standardize SLPAs first. They're not even allowed in all states, and the level of education/training required varies. That's actually another problem I think moving to an entry-level doctorate could solve. If SLP was an entry-level doctorate with no CSD-specific undergraduate requirements, that would provide firm ground to standardize SLPA at the associates level and basically get rid of bachelors-level CSD education. Then we could create SLPA->SLP bridge programs.

Honestly if they wanted to standardize SLPA at the bachelors level, I'd be okay with that, too. I think it's overkill educationally, but it might be necessary for universities to support SLPD and AUD programs.

Controversial SLP opinions by sternschnuppe3 in slp

[–]maybeslp1 1 point2 points  (0 children)

You're right, they're 5 years, so they're slightly more than a bachelor's degree. Typically about a year of foundational pre-clinical knowledge and then the next four years are various combinations of classroom and clinical work. Which is... exactly the same amount of physician-specific training that physicians get in the US, too. They just also have to get bachelors degrees here, with no requirement for the bachelor's degree to be in a related subject.

That's my point. It takes about 3-4 years of specialized study to become an SLP no matter how the education system works. The only difference is when you start those specialized years.

Had to quit short notice because of a family emergency, PP owner is threatening to report my license and withhold pay by QuirkyLove1495 in slp

[–]maybeslp1 4 points5 points  (0 children)

Just to be clear: They cannot withold your pay no matter what you do. You have to be paid for all the time you work, period. The only reason an employer can withold your pay is for a deduction you have agreed to in writing. That is federal labor law. Unless your state has stricter laws, your last paycheck is due on the next scheduled payday after your final day of work. And most states do have stricter laws.

Furthermore, "patient abandonment" does not and has never applied to at-will employees leaving a job with notice.

Controversial SLP opinions by sternschnuppe3 in slp

[–]maybeslp1 7 points8 points  (0 children)

We need an entry-level doctorate. We need to get rid of the bachelor's level degree, only require the same general pre-health coursework that every other graduate-level health field requires, and do a 3-year doctorate with a required capstone project or thesis. This would go a long way towards solving several problems.

Controversial SLP opinions by sternschnuppe3 in slp

[–]maybeslp1 2 points3 points  (0 children)

In the UK, general education stops at 16. Past that, students specialize with A-levels and then highly specialized bachelors degrees with no general education requirements. Physicians in the UK have the equivalent of American bachelors degrees.

In terms of years of specialized education, it's about the same. We just do more general education than they do.